COVID-19 Vaccination Among Lactating Women: A Comparative Cross-Sectional Study

 The pregnancy and lactation periods are special times when individuals are more susceptible to morbidity and mortality from COVID-19. Breastfeeding individuals like pregnant women are at a higher risk of experiencing symptoms and requiring hospitalization, including intensive care. Therefore, vaccination is considered the most effective approach to help pregnant and lactating women cope with COVID-19. Despite recommendations for COVID-19 vaccination, the coverage among lactating mothers has been insufficient.

 This cross-sectional comparative study aimed to determine the chance of COVID-19 vaccination among lactating women with associated variables such as COVID-19 fear, breastfeeding self-efficacy, and some demographic characteristics.

 A total of 450 breastfeeding women were included in the study, divided into two groups: those who received the COVID-19 vaccine (n = 225) and those who did not (n = 225). Individuals were 18-49 years old, had an infant aged under 6 months based on the birth card, a single pregnancy, a healthy newborn, and no contraindications to breastfeeding based on electronic health records. After receiving approval from the Ethics Committee of Iran University of Medical Sciences, the participants from health centers in Tehran, Iran, were selected using a multi-stage sampling method. Data were collected using demographic forms including mothers’, babies’, and husbands’ ages, mothers’ and husbands’ educational level and occupation, child number, household economic level, childbirth type, type of baby feeding, history of COVID-19 infection, COVID-19 questionnaires, and Dennis’ Breastfeeding Self-efficacy Scale. The data were analyzed using SPSS16 software, employing statistical methods such as independent t-tests, chi-squared tests, and logistic regression.

 Two groups of breastfeeding women (225 vaccinated) and (225 unvaccinated) were compared regarding demographic characteristics, fear of COVID-19, and self-efficacy in breastfeeding. There were no differences in mothers’ ages, educational levels, baby’s age, childbirth type, husbands’ occupation, household economic level, history of COVID-19 infection, and husband’s age between the two groups. The variables that had a significance level lower than 0.2 were entered into the logistic regression model. The findings from 450 breastfeeding women showed that husbands’ education level (crude odds ratio [OR] = 95% confidence interval (CI)]: 0.44 [0.19-0.76], P = 0.04), having more than 4 children (OR = 0.56, CI: 0.31-0.89, P = 0.04), and lower fear level of the COVID-19 (OR = 0.90, CI: 0.87-0.94, P<0.001) had higher odds of receiving vaccine than others. So, the type of baby feeding, women’s education level, women’s and their husbands’ occupation, and breastfeeding self-efficacy did not predict receiving vaccination.

 This study highlights that unvaccinated breastfeeding women have a higher fear of COVID-19 infection, have husbands with lower levels of education, and have fewer children. Vaccination has emerged as a critical topic impacting the health and well-being of communities worldwide. When it comes to unvaccinated breastfeeding women, it is necessary to consider various factors with a holistic perspective. Understanding the importance, safety, and efficacy of vaccines is crucial. So, the decision to vaccinate is personal and should be based on a comprehensive understanding of available information. Unvaccinated breastfeeding women should engage in prevention programs even before that. Both pregnant women and their husbands should be educated in preparation classes for childbirth. Of course, other factors could affect refusal to receive vaccines. These data could help health providers and policymakers in future crises.