Protecting New Mothers and Babies through Postpartum Immunization

The postpartum period represents a critical window to protect both mothers and newborns from vaccine-preventable diseases. In low- and middle-income countries, where 92% of the world’s 260,000 annual maternal deaths occur, postpartum immunization offers dual protection, safeguarding mothers while providing passive protection to breastfeeding infants through antibodies transferred via breast milk.

Based on WHO recommendations, key vaccines for postpartum administration include Tdap for mothers who missed vaccination during pregnancy, influenza vaccine during flu seasons, COVID-19 vaccines for unvaccinated mothers, and live vaccines like MMR and varicella for non-immune mothers. 

What Are the Benefits of Immunizing Postpartum Women?

• Provides Critical Protection for Mothers Who Missed Vaccination During Pregnancy: Many women in LMICs have limited antenatal care access, making postpartum vaccination a vital safety net.
• Protects Infants Through Passive Immunity Via Breast Milk: Maternal antibodies transferred through breastfeeding provide crucial early protection to newborns before they begin their own vaccination schedule at 6-8 weeks of age.
• Prevents Transmission of Deadly Diseases to Newborns: Immediate postpartum Tdap vaccination significantly reduces the risk of mothers transmitting pertussis to their infants.
• Establishes Immunity for Future Pregnancies: Postpartum vaccination, particularly with live vaccines like MMR and varicella that cannot be given during pregnancy, builds protective immunity that will safeguard both mother and baby in subsequent pregnancies.
• Leverages Existing Healthcare Contact Points: The postpartum period provides crucial opportunities to reach women who may have had limited healthcare access during delivery and postnatal care.

How to Implement

What’s the Evidence?

• WHO data shows that since 2000, neonatal tetanus has been eliminated in 36 of 59 countries where it was previously a public health problem, primarily through maternal tetanus vaccination programs. In Sub-Saharan Africa, systematic postpartum vaccination strategies contributed to reducing neonatal tetanus deaths from an estimated 94% baseline, demonstrating the life-saving potential of well-implemented maternal immunization programs.
• Studies from LMIC settings show that maternal Tdap vaccination provides 90-95% protection against severe pertussis in infants during their most vulnerable first months of life. In countries where postpartum Tdap vaccination was systematically implemented as a catch-up strategy, infant pertussis hospitalization rates decreased by 60-80% compared to baseline levels.
• A systematic review of 44 studies across LMICs demonstrated that integrating maternal immunization with routine postnatal care services increased vaccination coverage by 40-60% while maintaining service quality, with the highest success rates observed in programs that included postpartum vaccination as a standard component.

Key Indicators

• Postpartum Vaccination Coverage Rate: Percentage of postpartum women who receive recommended vaccines within 6 weeks of delivery.
• Missed Opportunity Rate: Percentage of postpartum women who had healthcare contact but did not receive indicated vaccines during routine postnatal care visits.
• Healthcare Worker Competency Rate: Percentage of postpartum care providers trained and demonstrating competency in vaccination protocols and counseling for breastfeeding mothers.
• Supply Chain Reliability: Percentage of time vaccines are available when needed at postpartum care sites.