# Factors associated with COVID-19 vaccine uptake and hesitancy among women of reproductive age in Mozambique

## TL;DR

This study explores factors influencing COVID-19 vaccine uptake and hesitancy among women of reproductive age in Mozambique, finding high vaccination rates but notable disparities.

## Contribution

The study introduces mobile phone surveys as a method for collecting data on vaccination and related factors in Mozambique.

## Key findings

- The adjusted vaccination rate among women aged 15–49 was 77.2%.
- Needle dislike and vaccine safety concerns were the main reasons for hesitancy.
- Vaccine acceptance was associated with age, education, and use of maternal health services.

## Abstract

Vaccine hesitancy has become one of the biggest challenges in combating the COVID-19 pandemic globally. This paper aims to determine the factors associated with COVID-19 vaccination and hesitancy among women of reproductive age in Mozambique.

A cross-sectional mobile phone survey was conducted among women ages 15–49 to test the use of mobile phone interviews to collect data on household deaths and other topics related to pregnancy, delivery care, women’s empowerment, and COVID-19 vaccination. We calculated COVID-19 vaccination coverage rates, defined as women who received at least one dose of the COVID-19 vaccine, and described reasons for not taking the vaccine. Multivariate logistic regression was used to assess factors associated with COVID-19 vaccine uptake in the study population. All estimates were adjusted using post-adjustment weighting based on the raking approach to redress the sample to be nationally representative.

The mobile phone survey response rate was estimated at 39.1% (n = 13,235). The adjusted COVID-19 vaccination rate was estimated at 77.2% [95%CI: 74.9–79.5] among women aged 15–49. Among the unvaccinated women, about 11.9% were hesitant to take the COVID-19 vaccine if offered. The primary reasons reported for not taking the vaccine were the dislike of needles (17.1%), COVID-19 vaccine safety concerns (12.0%), COVID-19 vaccine effectiveness concerns (10.2%), and medical reasons (5.6%). We found a positive and significant association between COVID-19 vaccine acceptance and age group, education, marital status, province and place of residence, and women who used maternal health facility services. However, women empowerment factors were not significantly associated with increased COVID-19 vaccine acceptance.

Our findings showed high rates of COVID-19 vaccination among women aged 15–49 with social, economic, and residential inequalities. To increase COVID-19 vaccine coverage among women in Mozambique, more effort should be put into vaccinating younger women, uneducated women, and those delivering outside a health facility. More attention should also be given to factors related to vaccine acceptance and hesitancy in Mozambique.