Results of the Survey on Vaccination during Pregnancy 2021
- Pertussis vaccine coverage during pregnancy has increased from 44% in 2019 to 65% in 2021, while influenza vaccine coverage increased from 45% in 2019 to 53% in 2021.
- Lack of awareness that the pertussis vaccine is recommended during pregnancy is the main reason for non-vaccination against pertussis during pregnancy (46%) while the most common reason for not getting the influenza vaccine during pregnancy was “not wanting to be vaccinated during pregnancy” (51%).
- The proportion of women vaccinated against pertussis and influenza during pregnancy was substantially higher among women who received a recommendation to be vaccinated (86% pertussis; 70% influenza), compared to those who did not receive a recommendation to be vaccinated (9% pertussis; 14% influenza).
- More women with a bachelor's degree or above received the pertussis and influenza vaccines (71% and 64%, respectively) compared to those with a high school education or less and more women with a household income of more than $160,000 per year received the pertussis and influenza vaccines (74% and 68%, respectively) compared to women in lower income brackets.
- There are gaps for Indigenous women; influenza vaccine coverage was significantly lower in 2021 among Indigenous women (28%), compared to non-Indigenous women (54%).
On this page
- Pertussis and influenza vaccination for pregnant women in Canada
- Vaccine uptake
- Healthcare provider recommendations
- Reasons for not vaccinating
- Impact of COVID-19 pandemic on vaccination during pregnancy
- Technical notes & limitations
- Future research
Pertussis and influenza vaccination for pregnant women in Canada
Since 2007, the National Advisory Committee On Immunization (NACI)Footnote i has recommended that all pregnant women be vaccinated against influenza at any stage of their pregnancy during each pregnancyFootnote i. All provinces and territories (PT's) currently offer the influenza vaccine free of charge to pregnant womenFootnote ii.
As of March 2018, NACI has also recommended that all pregnant women be vaccinated against pertussis (whooping cough) to prevent neonatal and infant pertussis infectionFootnote iii. The vaccine should ideally be provided between 27 and 32 weeks of pregnancy. Regardless of immunization history, vaccination against pertussis using the tetanus, diphtheria, and pertussis (Tdap) vaccine should be offered in every pregnancy. PT's began offering the pertussis vaccine free of charge to pregnant women in April 2018 and program roll-out continued until complete implementation in all jurisdictions in April 2022Footnote iv.
The Survey on Vaccination during Pregnancy (SVP) was first conducted in 2019 and again in 2021. The SVP collects information from women about their pertussis and influenza vaccination received during pregnancy and their knowledge, attitudes, and beliefs around these vaccines. The 2021 SVP included 3,347 biological mothers of children born between September 1st, 2020 and March 1st 2021.
A number of questions were added to the survey in 2021. These questions aimed to determine the impact of COVID-19 public health restrictions on pertussis and influenza vaccination among pregnant women (e.g. obstacles, delays). At the time when mothers in the 2021 SVP were pregnant, the COVID-19 vaccine was not yet recommended to them in Canada. Therefore, vaccination status against COVID-19 could not be assessed for pregnant women within this survey cycle.
NOTE: All differences noted are significant at the 95% confidence level
Increase in pertussis vaccination among pregnant women since program implementation in 2018
Approximately 65% of mothers who knew that they had been vaccinated reported receiving the pertussis vaccine in 2021, which is a significant increase since 2019 (44%) (Table 1). An increase in pertussis coverage was anticipated as vaccination programs for pregnant women continued to be implemented across jurisdictions from 2018 onwards.
Pertussis uptake by province and territory varied from a high of 80% (Prince Edward Island, Nova Scotia and New Brunswick) to 52% (British Columbia), although in the majority of jurisdictions, pertussis vaccine coverage has increased significantly since 2019. One of the reasons for differences between provinces and territories is that not all jurisdictions began offering the vaccine and promoting it to health care professionals and pregnant women at the same timeFootnote 1.
Increase in influenza vaccination among pregnant women since previous survey cycle
Approximately 53% of women who knew that they had been vaccinated reported receiving the influenza vaccine in 2021, which is a significant increase since 2019 (45%) (Table 2). Influenza vaccine uptake by province and territory varied from a high of 83% (Nova Scotia) to 44% (Quebec). Variations could be due to different start dates for seasonal influenza programs by province and territory.
Variations in pertussis and influenza coverage by mothers' characteristics
There were significant differences in pertussis and influenza vaccine uptake by demographic characteristics of the mother (See Table 3).
Pertussis vaccine uptake during pregnancy was highest among mothers aged 35-39 years (69%) and lowest among those 40 years and above (53%Footnote 2). Women 30-34 years of age had the highest rates of influenza coverage (59%), while those 15-24 years of age had the lowest (36%Footnote 2).
The proportion of pregnant women vaccinated against pertussis and influenza increased with higher levels of education and annual household income.
- A larger proportion of pregnant women who obtained their bachelor's degree or above were vaccinated compared to those with a high school education or less (71% vs. 55% for pertussis and 64% vs. 36% for influenza).
- A larger proportion of pregnant women who reported an annual household income of more than $160,000 per year were vaccinated compared to women who earned less than $40,000 per year (74% vs. 56% for pertussis and 68% vs. 42% for influenza).
Influenza vaccine coverage estimates were significantly lower among women living in rural areas (37%) compared to those living in urban areas (55%). No differences were reported for pertussis vaccine coverage between women who lived in urban and rural locations.
In 2021, pertussis vaccine coverage among Indigenous women was 57% compared to 65% among non-Indigenous women, though this difference is not statistically significant. For comparison, in 2019 there was no gap in pertussis vaccine coverage (45% for Indigenous women vs. 44% for non-Indigenous women). Approximately 52%Footnote 2 of First Nations women received the pertussis vaccine during pregnancy. Due to small sample sizes, separate estimates for Métis and Inuit could not be published.
In 2021, 28%Footnote 2 of Indigenous women were vaccinated against influenza, compared to 54% of non-Indigenous women. This gap of 26% in vaccine coverage between Indigenous and non-Indigenous women has increased from 11% in 2019 (35% Indigenous vs. 46% non-Indigenous). Due to small sample sizes, separate estimates for First Nations, Métis and Inuit could not be published for influenza.
A new question was added in the 2021 SVP to collect information about different population groups, which allows for comparison between women of various racial/ethnic backgrounds. Pertussis vaccine uptake was highest among Chinese women 72%Footnote 2, followed by white Canadian women (66%), South Asian (65%), Filipino (57%Footnote 2) and Black women (55%Footnote 2). For influenza vaccination, fewer estimates were reportable by population group due to small sample sizes. Based on reportable groups, no major differences were seen between white Canadian women and South Asian women (53%Footnote 2 and 54%, respectively).
Women born outside of Canada were as likely to be vaccinated against pertussis and influenza during pregnancy as women born in Canada (62% vs. 66% for pertussis and 53% vs. 53% for influenza).
Healthcare provider recommendations
Healthcare provider recommendations have increased since 2019
Overall, women who had received a recommendation to vaccinate from their maternal health care provider, were more likely to receive vaccination against pertussis and influenza during pregnancy compared to those who did not receive a recommendation from their maternal health care provider. The proportion of women vaccinated against pertussis and influenza during pregnancy was substantially higher among women who received a recommendation to be vaccinated (86% pertussis; 70% influenza), compared to those who did not receive a recommendation to be vaccinated (9% pertussis; 14% influenza).
The proportion of women who received prenatal care and reported that they were advised by their primary health care provider during pregnancy to get vaccinated against pertussis and/or influenza, has increased significantly from the previous survey cycle. Over two-thirds of women (69% for both vaccines) were advised to receive pertussis and/or influenza vaccination during their pregnancy in 2021, compared to 49% for pertussis vaccine and 61% for influenza vaccine, in 2019. This may have contributed to more women being vaccinated during pregnancy in 2021.
The proportion of women who received a recommendation to vaccinate against pertussis was similar by type of primary maternity care provider (69% obstetrician-gynecologist, 70% general practitioner, 68% midwife), while the proportion of women who received a recommendation to vaccinate against pertussis was lower among those under the care of nurses (57%Footnote 2). For influenza, the proportion of women who received a recommendation to vaccinate with the influenza vaccine during pregnancy was the same across all healthcare provider types (69% obstetrician-gynecologist, 69% general practitioner, 69%Footnote 2 midwife). The estimate for nurses was not reportable due to the small sample size.
The proportion of women who received a recommendation to vaccinate against pertussis and/or influenza was higher among women with a bachelor's degree or above, compared to women with a high school education or less (72% vs. 63% for pertussis and 74% vs. 64% for influenza). The same pattern was observed for pertussis recommendations by income; a larger proportion of women who earned more than $160,000 household income per year received a recommendation to receive the pertussis vaccine (77%), compared to those in lower income groups ($40,000 or less per year; 62% pertussis).
A gap was observed for Indigenous women, who were less likely to receive a recommendation to vaccinate against pertussis during pregnancy (55%Footnote 2), compared to non-Indigenous women (69%).
Reasons for not vaccinating
Among women who did not receive the pertussis vaccine during pregnancy, the main reasons reported were:
- “I was not aware that the pertussis vaccine was recommended during pregnancy to protect my baby” (46% in 2021 compared to 60% in 2019)
- “I did not want to be vaccinated against pertussis during my pregnancy” (23% in 2021)
In 2021, approximately 26% of women reported “other” reasons for not being vaccinated against pertussis during pregnancy. The majority of women with “other” reasons, reported that they had already been vaccinated against pertussis in a previous pregnancy or in their lifetime.
Lack of awareness that the pertussis vaccine is recommended during pregnancy is still the main reason reported for non-vaccination, however, there are improvements with fewer women indicating this as the main reason in 2021, compared to 2019. Among women who did not receive the influenza vaccine during pregnancy, the main reasons reported were:
- “I did not want to be vaccinated against influenza during my pregnancy” (51%)
- “I did not know that this vaccine was recommended during pregnancy” (22%)
Not wanting to vaccinate against influenza during pregnancy remains the leading reason for non-vaccination; 46% of women reported this reason in 2019. Further analyses of survey data are underway on knowledge, attitudes and beliefs regarding vaccination and will be published at a later date. These additional analyses may provide further information on reasons for non-vaccination during pregnancy.
|Province or Territory||Percentage of mothers vaccinated against pertussis during pregnancy, % (95%CI)Table 1 Footnote *|
|2019Table 1 Footnote 1||2021Table 1 Footnote 2|
|Canada||43.5 (41.4-45.6)||64.8 (62.1-67.4)Table 1 Footnote **|
|Newfoundland and Labrador||15.9 (12.5-20.0)||79.0 (73.3-83.8)Table 1 Footnote **|
|Prince Edward Island||76.2 (70.9-80.7)||80.4 (73.9-85.6)|
|Nova Scotia||62.2 (56.9-67.9)||80.4 (74.8-85.1)Table 1 Footnote **|
|New Brunswick||71.0 (66.3-75.3)||↑79.5 (74.1-84.1)Table 1 Footnote **|
|Quebec||48.8 (44.4-53.1)||75.2 (70.1-79.7)Table 1 Footnote **|
|Ontario||40.3 (35.9-44.9)||60.0 (54.2-65.6)Table 1 Footnote **|
|Manitoba||57.0 (51.5-62.4)||69.6 (64.1-74.7)Table 1 Footnote **|
|Saskatchewan||74.0 (69.2-78.3)||78.0 (73.0-84.2)|
|Alberta||37.9 (33.6-42.4)||60.1 (53.9-65.9)Table 1 Footnote **|
|British Columbia||25.6 (21.6-29.9)||52.4 (46.8-57.9)Table 1 Footnote **|
|Yukon||↑56.5 (44.8-67.6)||77.2 (66.8-85.1)Table 1 Footnote **|
|Northwest Territories||80.1 (54.6-93.1)||59.3 (45.3-71.9)|
|Nunavut||N/ATable 1 Footnote F||N/ATable 1 Footnote F|
↑ Rounds up to whole number.
↓ Rounds down to whole number.
Note: One of the reasons for differences between provinces and territories is that not all jurisdictions began offering the pertussis vaccine and promoting it to health care professionals and pregnant women at the same time. Implementation of a publicly funded vaccination program against pertussis began in jurisdictions starting in April 2018 with complete implementation as of April 2022. The pertussis vaccine was not yet publicly funded for pregnant women in ON at the time of data collection for the 2021 SVP.
|Province or Territory||Percentage of mothers vaccinated against influenza during pregnancy, % (95%CI)Table 2 Footnote *|
|2019Table 2 Footnote 1||2021Table 2 Footnote 2|
|Canada||45.0 (42.1-47.9)||52.7 (48.8-56.6)Table 2 Footnote **|
|Newfoundland and Labrador||41.4 (34.7-48.4)||63.6 (55.2-71.2)Table 2 Footnote **|
|Prince Edward Island||75.2 (67.6-81.6)||77.3 (68.0-84.5)|
|Nova Scotia||↓71.5 (63.9-78.0)||↑82.5 (75.0-88.1)Table 2 Footnote **|
|New Brunswick||58.4 (49.9-66.3)||59.1 (50.2-67.4)|
|Quebec||32.9 (27.6-38.7)||44.2 (36.4-52.3)Table 2 Footnote **|
|Ontario||43.3 (37.2-49.6)||48.9 (41.2-56.7)|
|Manitoba||48.8 (41.2-56.4)||59.2 (50.1-67.6)|
|Saskatchewan||64.9 (57.0-72.1)||64.8 (57.1-71.7)|
|Alberta||49.4 (43.5-55.3)||58.3 (50.3-65.9)|
|British Columbia||49.8 (43.4-56.2)||61.0 (52.1-69.1)Table 2 Footnote **|
|Yukon||66.0 (51.7-77.8)Table 2 Footnote E||66.8 (51.3-79.3)Table 2 Footnote E|
|Northwest Territories||84.8 (53.7-96.4)Table 2 Footnote E||71.7 (55.7-83.6)Table 2 Footnote E|
|Nunavut||N/ATable 2 Footnote F||N/ATable 2 Footnote F|
↑ Rounds up to whole number.
↓ Rounds down to whole number.
Note: Influenza vaccination programs were implemented at different times during the 2020-2021 influenza season. The earliest program was implemented in PEI and NB in early October and the latest implementation date was Nov 1, 2020 in Quebec.
|Demographic factors||Vaccine coverage against pertussis, 2021Table 3 Footnote 1
% (95%CI)Table 3 Footnote *
|Vaccine coverage against influenza, 2021Table 3 Footnote 2
% (95%CI)Table 3 Footnote *
|Mothers age group at time of child's birth|
|15-24 yrs||60.7 (49.2-71.0)||36.2 (23.7-51.0)Table 3 Footnote E|
|25-29 yrs||63.2 (57.9-68.1)||44.4 (36.9-52.1)|
|30-34 yrs||66.4 (62.1-70.5)||58.7 (52.3-84.8)|
|35-39yrs||69.2 (63.5-74.4)||58.2 (49.8-66.3)|
|40yrs+||53.4 (40.7-65.7)Table 3 Footnote E||N/ATable 3 Footnote F|
|High School or less||54.7 (48.0-61.2)||35.6 (26.5-45.8)|
|Above High School, below Bachelor's||62.1 (57.2-66.8)||46.6 (40.3-53.0)|
|Bachelor's and above||71.0 (67.4-74.4)||63.8 (58.1-69.1)|
|2020 Household Income|
|Less than $40,000||56.4 (46.5-65.9)||41.7 (28.4-56.2)Table 3 Footnote E|
|$40,000 - $79,999||58.9 (53.2-64.5)||46.4 (38.7-54.2)|
|$80,000 - $99,999||64.0 (57.1-70.3)||47.0 (37.7-56.4)|
|$100,000 - $119,999||↑68.5 (61.1-75.1)||44.7 (35.0-54.9)|
|$120,000 - $139,999||64.1 (56.5-71.0)||60.0 (48.2-70.7)|
|$140,000 - $159,999||71.1 (62.3-78.6)||61.9 (48.1-74.0)Table 3 Footnote E|
|More than $160,000||74.3 (68.9-79.1)||68.4 (60.3-75.6)|
|Urban or rural living location|
|Urban||64.9 (61.9-67.9)||55.4 (51.1-59.6)|
|Rural||63.1 (56.7-69.1)||37.4 (28.7-46.9)|
|Location where mother born|
|Born inside Canada||66.3 (63.1-69.3)||52.7 (47.9-57.4)|
|Born outside of Canada||62.0 (56.9-66.8)||52.8 (45.7-59.9)|
|Yes||56.6 (43.1-69.2)||28.0 (16.5-43.3)Table 3 Footnote E|
|No||65.2 (62.4-67.8)||53.6 (49.6-57.6)|
|White Canadian||66.2 (62.9-69.3)||52.7 (47.6-57.6)|
|Indigenous||56.6 (43.1-69.2)||28.0 (26.5-43.4)Table 3 Footnote E|
|South Asian||64.6 (55.3-72.9)||53.7 (40.4-66.5)Table 3 Footnote E|
|Chinese||72.4 (60.5-81.8)Table 3 Footnote E||N/ATable 3 Footnote F|
|Black||54.7 (43.3-65.6)Table 3 Footnote E||N/ATable 3 Footnote F|
|Filipino||57.4 (44.5-69.4)Table 3 Footnote E||N/ATable 3 Footnote F|
|Other Racialized groups||65.2 (56.0-73.5)||↓56.5 (43.5-68.6) Table 3 Footnote E|
↑ Rounds up to whole number.
↓ Rounds down to whole number.
Impact of COVID-19 pandemic on vaccination during pregnancy
In the 2021 SVP, pregnant women were asked a series of questions to determine the impact of the COVID-19 pandemic on their decision to receive vaccines against influenza and pertussis during pregnancy. The majority of women (77%) responded that the pandemic had no influence on their decision to vaccinate, while 6% reported they were less inclined and 17% reported that the pandemic made them more inclined to vaccinate against pertussis and influenza during pregnancy. This pattern remains consistent across population groups (Black, Filipino, etc.), where the majority of women did not report a change in their decision to vaccinate due to the COVID-19 pandemic.
Women were also asked if they had encountered any obstacles and/or delayed receiving vaccinations during pregnancy by more than 30 days for a reason that could be attributed to the COVID-19 pandemic.
While the majority of women did not face obstacles, 11% of women reported that they had encountered an obstacle or delayed vaccination during the COVID-19 pandemic.
Among those who reported experiencing an obstacle the three main ones indicated were:
- Limited appointment availability, 73%
- Concern about being exposed to COVID-19, 40%
- Lack of walk-in options, 25%
The main reasons for delay are as follows:
- Limited appointment availability, 65%Footnote 2
- My doctor or local public health authority recommended delaying vaccination, 12%Footnote 2
- Concern about being exposed to COVID-19, 8%Footnote 2
Technical notes & limitations
The Survey on Vaccination during Pregnancy (SVP) was first conducted in 2019 and again in 2021, as a component of the childhood National Immunization Coverage Survey (cNICS). The Public Health Agency of Canada and Statistics Canada have been collaborating to conduct the cNICS every two years since 2011.
The Survey on Vaccination during Pregnancy was administered using an electronic questionnaire or a telephone interview. Data collection occurred between January 10th 2022 and April 14th 2022. The target population for this second component of the survey was women who gave birth between September 1st, 2020 and March 1st, 2021, living in the 10 provinces and 3 territories, and not residing on First Nations reserves and not institutionalized.
Women who participated in the 2021 SVP self-reported their vaccinations, which may have led to recall bias and under or over estimation of vaccine coverage.
The 2021 SVP includes a sufficient number of respondents (n=3,347) to report estimates at the national and provincial/territorial level. However, the number of participants from Nunavut was insufficient to allow specific reporting of reliable estimates for this jurisdiction and these participants are included in the calculation of national vaccine coverage estimates.
Although respondents were asked about vaccination against pertussis only, this vaccine is given as part of a Tdap vaccine in combination with diphtheria and tetanus.
For vaccination against influenza (flu), the analysis only looked at the time period when the influenza vaccine was offered – December 1st, 2020 to March 1st, 2021.
Indigenous people included in this study are those who self-identified as First Nations people, Inuit or Métis. More information can be found at Statistics Canada.
Further analysis of other data collected in the 2021 SVP is still underway. Results will be posted on canada.ca as they become available.
For more information
- Footnote 1
Influenza vaccination programs were implemented at different times during the 2020-2021 influenza season. The earliest program was implemented in PEI and NB in early October and the latest implementation date was Nov 1, 2020 in Quebec.
- Footnote 2
Estimates and confidence intervals are of marginal quality due to high sampling variability and should be used with caution.
- Footnote i
Statement on Influenza Vaccination for the 2007-2008 Season, Canada Communicable Disease Report. Volume 33. ACS-7, 1 July 2007. An Advisory Committee Statement (ACS). National Advisory Committee on Immunization (NACI): (https://www.canada.ca/en/public-health/services/reports-publications/canada-communicable-disease-report-ccdr/monthly-issue/2007-33/statement-on-influenza-vaccination-2007-2008-season.html)
- Footnote ii
Public Funding for Influenza Vaccination by Province/Territory (as of August 2020): (https://www.canada.ca/en/public-health/services/provincial-territorial-immunization-information/public-funding-influenza-vaccination-province-territory.html)
- Footnote iii
Update on immunization in pregnancy with tetanus toxoid, reduced diphtheria toxoid and reduced acellular pertussis (Tdap) vaccine: An Advisory Committee Statement (ACS)
National Advisory Committee on Immunization (NACI) February 2018: (https://www.canada.ca/en/public-health/services/publications/healthy-living/update-immunization-pregnancy-tdap-vaccine.html#a5)
- Footnote iv
Provincial and Territorial Routine Vaccination Programs for Healthy, Previously Immunized Adults - Canada.ca: (https://www.canada.ca/en/public-health/services/provincial-territorial-immunization-information/routine-vaccination-healthy-previously-immunized-adult.html)
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