Improving Women’s Vaccination Rates – How the OB-GYN Can Help.
May 21, 2010

By Christine Vara
Mother’s Day may have come and gone, but a mother’s work is never done.  In today’s society, it’s no secret that mothers bear the majority of the responsibility in caring for the children.  As most mothers will admit, this role often takes priority over their own health care.  There are countless times when a mother will suffer with her own illness, while continuing to make the meals, fold the laundry, help with homework and shuttle the kids to soccer practice.  Personally, I don’t feel like I have time to get sick and even when I’m not feeling up to par, I don’t typically make the time to go to the doctor.    
In fact, my most frequently visited doctors are my dentist and my OB-GYN.  Of course, after giving birth to five children, it makes sense that I have a closer relationship with my gynecologist than my family practitioner.  So when I recently read about a new health initiative to improve immunization rates among women by incorporating vaccinations into OB-GYN visits, it seemed to make perfect sense. 
The article, which appeared in the Dallas Morning News,  discussed a study being conducted by Duke University.  Preliminary research results were obtained from three different pilot programs set up at OB-GYN offices in North Carolina.  What they discovered was that vaccination rates for the Tdap shot among postpartum patients soared from 16.7 percent to 85.7 percent when these immunizations were administered at the OB-GYN office. 
What is interesting to note is that mothers are often the primary source of infection amongst infants.  In fact, the CDC statistics show that 32% of infant pertussis cases were a result of an infected mother.  With such an increase in the adult vaccination rate – as reflected in this study – one can only speculate the positive impact these immunizations might have on the health of our children.   While this study shows promise, questions remain as to whether the obstetricians and gynecologists will be receptive to administering these, and possibly other vaccinations, during routine OB-GYN visits.  
In discussing the subject with obstetrician gynecologist Dr. Amy Tuteur of SkepticalOB, she comments, “It certainly sounds like a good idea. It’s basically a recognition that many women of reproductive age get all their medical care from an OB-GYN. There’s bound to be higher uptake at a postpartum visit when a mother learns that if she doesn’t get vaccinated she could make her newborn very sick.” 
As with all good ideas, the challenge will be to find a way for the results of this study to be incorporated into general practice.  In researching current obstetrician gynecological practice, Dr. Amy directed me to an article published in the American Journal of Preventative Medicine that concluded, “Immunization is an important part of women’s health care and has been, at least partially, incorporated into obstetrician-gynecologist practice.”  However, it also recognized that in regards to OB-GYNs, “Financial burdens and knowledge regarding vaccine recommendations remain barriers to vaccine administration.” 
For instance, while 91% of OB-GYNs indicated that they stock the human papillomavirus (HPV) vaccine and 66.8% stock the influenza vaccine, less than 30% of practices stock any other vaccine.  Since the Duke study showed promise in offering the Tdap shot, which will provide immunization against pertussis, it is particularly disappointing that this report indicates that Tdap vaccine is not typically stocked or administered by OB-GYNs. 
Additionally, the article cited that a majority of OB-GYNs agreed that financial factors, such as inadequate reimbursement, were barriers to vaccine administration.  Others believed their immunization training was less than adequate and felt their practice would benefit from continuing medical education courses.  In conclusion, while the obstetricians and gynecologists see the obvious benefit of vaccinations, there are a myriad of challenges presented in making vaccination administration a part of routine practice.   
In moving forward with health care reform in this country, I believe it is important that we address these issues.  Vaccines are arguably an important preventive measure that could be administered by a variety of doctors. However, if insurance plans will not reimburse all doctors for vaccines, than obstetricians and gynecologists won’t offer them, no matter what positive results are reported as part of the Duke study.
In the meantime, our educational efforts will need to focus on empowering the patients. Women should be made aware of the benefits of adult vaccinations for themselves and their children.  It is my hope that our voices, as mothers caring for our children, will become a vital part of encouraging a shift in policy, and that women will begin to request vaccination from all their doctors and in turn help protect the health of their children.

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