London School of Hygiene & Tropical Medicine

Relational autonomy proposes that persons are socially embedded, with decisions being made within social relationships. Through this theoretical lens, this paper analyses how the healthcare worker-patient relationship can affect pregnant women’s’ decisions to accept pertussis and influenza vaccines. Hackney was chosen as the site for this study as it had very low vaccine uptake rates during pregnancy. In-depth interviews were conducted with 40 pregnant and recently pregnant women, as well as ten healthcare professionals. Interviews explored experiences of NHS healthcare and views towards vaccination in pregnancy.

An observation of a consultation between a pregnant patient and her GP was also conducted in order to understand how the vaccination discussion takes place. The findings of this study indicate that advice from friends and family can greatly influence a pregnant woman’s vaccination decisions. The patient’s social context, including influences on her decisions must be understood by healthcare workers so that discussions about concerns can take place. If a close relationship with patients is formed, patients tend to trust their healthcare worker’s advice. With support from the healthcare workers, patients feel competent and empowered to make the right decision for them and are more likely to vaccinate.