Pregnancy

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Some Pregnant People Are Still Being Denied The COVID-19 Vaccine. Why Is This So Hard?

Being turned away at local COVID-19 vaccination sites across the country is just one of the many obstacles pregnant people face when it comes to accessing the vaccine.

Jessica, a woman from Essex County, New Jersey who is pregnant with her second child, took every step possible to ensure that she could get the COVID-19 vaccine as soon as it was available to pregnant women.

First, she followed the recommendation of the New Jersey Department of Health and consulted with her OB-GYN about the vaccine. After an enthusiastic green light from her care provider, she decided to delay her Tdap vaccine — a combination immunization that protects both the pregnant woman and baby against tetanus, diphtheria, and pertussis — because she read that there might be issues with getting the Tdap and COVID-19 vaccines within two weeks of each other. (In fact, the standing order for the Pfizer COVID-19 vaccine is that it shouldn’t be administered within two weeks of any other vaccine.) All logistical hoops seemingly jumped through, Jessica, whose name has been changed for privacy, opted to sign up for the immunization via her local health department, assuming that the wait would be shorter than through private providers, drug stores, or the state.

But much to her surprise, she was denied the COVID-19 vaccine because she is pregnant.

Despite recommendations from the American College of Obstetricians and Gynecologists (ACOG) and the Centers for Disease Control and Prevention (CDC), among others, that the COVID-19 vaccine should not be withheld from those who are pregnant or lactating, people like Jessica are being turned away at local COVID-19 vaccination sites across the country, making protecting oneself during pregnancy from dangerous complications of the virus all the more difficult. But being turned away on-site is just one of the many obstacles pregnant people are facing when it comes to accessing the COVID-19 vaccine.

Barriers To The Vaccine For Pregnant People

For instance, when Jessica went to her county health department's website to register, the site wouldn't let her. "It said that they were not registering pregnant people at the time, even though the state had said we were in the next group,” she explains. “The county website basically said, ‘If you select that you are pregnant, you have to get the vaccine through your primary care physician.’ But my primary care physician didn’t have the capacity to keep the vaccine [because of temperature]. I kind of resigned myself to the fact that I wasn't going to get it for a while and got my Tdap instead.”

“Being turned away at vaccination sites can make pregnant patients feel like they've made the wrong decision,” says Dr. Sindhu K. Srinivas, M.D., director of obstetrical services at the Hospital of the University of Pennsylvania and a member of the Society for Maternal-Fetal Medicine COVID-19 task force. “[A pregnant person] who really toiled with this decision and decided that the vaccine is the right choice for them, who then has somebody question that decision and turn them away, makes it feel like, ‘Well, is this something harmful that I'm doing that I shouldn't be doing?’ which then perpetuates this continued issue of misinformation about the vaccine.”

And while, for the most part, pregnant women being turned away simply boils down to a lack of clear policy guidelines, ever-shifting recommendations and poor communication, the results could be dire. COVID-19 increases the risk of serious illness for pregnant women who contract the virus, including a higher likelihood of developing respiratory complications requiring intensive care — including intubation — than women who aren't pregnant. But as is the case with most new vaccines, pregnant and lactating women were not included in the initial COVID-19 vaccine trials, meaning that there is limited data on how the vaccine might impact both pregnant people and fetuses. And while more than 10,000 pregnant women have now gotten shots — and according to Dr. Anthony Fauci have raised no “red flags” — the lack of concrete information has made the decision to get the COVID-19 vaccine when eligible a deeply personal and emotional one for many pregnant people, weighing risk factors for contracting coronavirus (potential exposure, additional comorbidities, and increased risk of serious illness) against the risk of the unknown. And that’s even before you reach the bureaucratic red tape.

“Anyone who's turning [pregnant] patients away who have made the decision to get the vaccine is not following the current guidance from the American College of OB-GYN, the Society for Maternal Fetal Medicine and the CDC, who've all said that pregnant patients [who are also part of a recommended group, i.e. an essential worker or someone with underlying conditions] should be given access to the vaccine,” says Srinivas.

Lactating parents are also at risk of being denied the COVID-19 vaccine. In January, Kate Raess, a clinical therapist who is breastfeeding her newborn son, was denied the vaccine during an appointment at a Kane County, Illinois Health Department location. “I was so shocked,” Raess told The Chicago Tribune. “To sit down in that metal chair and be told no, it’s like someone took a pin to a little kid’s balloon … that a county board felt that I couldn’t make this decision, and they would make it for me.” (In response to the Tribune story, Kane County changed its policy and is now vaccinating both pregnant and lactating individuals.)

Reports of pregnant people being denied the COVID-19 vaccine by government agencies and private businesses are now so rampant that several national medical organizations, including the American Medical Association, ACOG, and the CDC, issued a joint statement on February 3, 2021 rebuking any person or group that turns pregnant and lactating people away, pointing out that doing so “violates their bodily autonomy.”

“Pregnant individuals who otherwise meet the criteria for COVID-19 vaccines should not be denied the opportunity to be vaccinated,” the group wrote. “Excluding this critical population at increased risk of severe illness and death related to COVID-19 is unethical.”

Of course, being denied the shot outright is the most blatant, but not the only, vaccine hurdle that pregnant people face.

A Symptom Of A Larger (Systemic) Problem

The bureaucratic drudgery and barriers to access for health care in America today are nothing new. For many pregnant people — particularly those from low-income or rural communities — difficulty accessing the COVID-19 vaccine is simply a heightened version of an entire medical-industrial complex that makes receiving appropriate care during pregnancy a draining experience on every level: financially, psychologically, emotionally, and, of course, physically.

In the United States, 2.2 million women of childbearing age live in maternity care deserts — areas of the country that have no hospital offering obstetric care — while another 4.8 million live in counties with limited access to maternity care, according to the March of Dimes. And for Black women, who are three times more likely to die from complications in childbirth than white women in the U.S., relying on a medical system that has consistently failed them is cause for hesitancy and skepticism about the COVID-19 vaccine.

Availability of the vaccine does not equal accessibility, especially when considerations are practically non-existent for people with extenuating circumstances.

“I'm an African-American woman. The majority of my clients are African-American. The decision to take the vaccine is one that's been highly controversial because it is so personal, and a lot of people have reservations,” says Monica Miller, a birth and postpartum doula from Homewood, Illinois. “Black women are more likely to die in childbirth than any other race, even when you control for factors of health and economic status. There's a lot of distrust, but at the same time, this vaccine is so important.”

Since December, the COVID-19 vaccine rollout has revealed itself to be a high-stakes puzzle: figuring out when and where the shots can be accessed then hurrying to get in line has become the de facto, haphazard means of distribution. For many pregnant people — including those without reliable internet to secure an online appointment, essential workers with inflexible hours, or those who are caretakers — this means an additional set of roadblocks to being vaccinated. And even though these pregnant people might be at greater risk for contracting COVID-19 due to their jobs or living situation, the barriers (too few time slots, limited locations, not enough shots) are simply too great. Availability of the vaccine does not equal accessibility, especially when considerations are practically non-existent for people with extenuating circumstances.

“Part of getting access to the vaccine is just persistence, because you literally have to be on the [government] website — at least in New Jersey — every day, checking multiple times a day, trying to get these appointments,” says Jessica. “I've heard in other places that there are lines you have to wait in and all kinds of other things that are equally difficult. Unfortunately, it's people who are really persistent and who can keep checking and checking who are getting the appointments.”

When Eligibility Comes Too Little, Too Late

Pregnant women in many states are also worried that the COVID-19 vaccine won’t even be available to them until after they give birth, and the eligibility timeline for many women could leave a vulnerable population exposed and unprotected during the particularly risky third trimester.

“My [doctor] highly recommends getting vaccinated … [and says] that the full vaccination by third trimester is crucial because there is so much pressure on a pregnant woman’s lungs already,” says Kate Medley, a Durham, North Carolina-based photojournalist who is in her second trimester. “I qualify as frontline, but in a secondary category. They speculate that would put me at first dose in late May, second dose in mid-June, baby is due in early July — so not great options. Hopefully, the timelines and availability will shift.”

In Kentucky, Jennifer Vernia is running into similar issues around accessing the vaccine and the ticking clock of her due date. “Depending on when they start vaccinating [for my group], there may be some issues getting both shots before I give birth in June. I would suggest some federal policy changes to ensure that pregnant [people] are able to get the vaccine earlier in all states. Having each state with a different rollout plan makes it unequal for all pregnant women to be able to receive the vaccine when they may need it.”

Another systemic barrier cropping up across the country is particularly daunting: Before they’ll give the vaccine, some vaccination sites are requiring that pregnant women have a note from their doctor. This not only creates yet another logistical nightmare for people who are already overwhelmed, it’s also wildly infantilizing.

Pregnant people have been largely left on their own when it comes to grappling with COVID-19 vaccine access.

“This week, someone said to me that they had heard places were requiring a letter from their doctor,” says Srinivas. “And while pregnant individuals are encouraged to discuss the vaccination with their clinical care team when feasible, the documentation of such a discussion is not required prior to receiving a COVID-19 vaccine. A patient who is coming of their own accord, who's pregnant, wanting to be vaccinated, should 100% not be turned away.”

And while the official systems of distribution for the COVID-19 vaccine continue to reveal themselves as a source of frustration for pregnant people, both Jessica and Monica point to word of mouth as the most reliable, easy-to-navigate means of finding out the latest happenings with vaccines. Whether that means combing through local mom Facebook groups or being part of a telephone-style information relay with news about where vaccines might be available to pregnant women for a limited window, one thing is abundantly clear: pregnant people have been largely left on their own when it comes to grappling with COVID-19 vaccine access.

For Jessica, even a second try at being vaccinated by the county was thwarted after other parents-to-be passed on tales of being turned away on-site. She eventually received her COVID-19 vaccine via a massive state-operated location, free from doctor’s note requirements and endless impediments. (In Essex County, the health department has now reversed their position and will vaccinate people who are pregnant.)

The confusion for pregnant women lingers, though, as the country’s piecemeal COVID-19 vaccine rollout reflects yet another way that individuals carry the bulk of the burden for unlocking access to healthcare in America today.