A PLACE FOR SHARING

Competency 3: Ethics

Valerie Raziano, DrPH Candidate at the Dornsife School of Public Health at Drexel University

Valerie graduated with her MPH in Epidemiology from Emory University and her BS in Microbiology from Rutgers University. She is currently pursuing her DrPH at the Dornsife School of Public Health at Drexel University. Her doctoral research applies both qualitative and quantitative methods to understand and improve maternal and child immunization uptake in Pennsylvania. Valerie is an MCH Trainee at Dornsife and served as a Student Fellow for the Maternal and Child Health Section of the American Public Health Association from 2019-2020. She hopes to pursue a career in vaccinations and maternal and child health.

My first introduction to midwifery was through the popular BBC show, “Call the Midwife” which is a cheeky drama about a troupe of British midwives and a couple of fun nuns crusading for women’s health. In contrast, my first introduction to vaccinations was through a visceral, but forgettable, visit to the pediatrician at about six months of age. While I have developed a strong professional interest in vaccinations, I have recently become curious about the role of midwives in promoting vaccinations to protect maternal and child health. As only half of pregnant women receive recommended vaccines during pregnancy, and midwifery-led care is increasing in the US, this research area may offer key lessons in ethics and communication strategies in vaccine delivery.

Vaccines are critical tools for disease prevention which have interesting ethical implications as they protect individuals and the general public. Individuals directly benefit from being immunized with their consent, and their actions contribute an indirect benefit to their community through herd immunity. In healthcare, the ethical principle of respect for individual autonomy generally underpins decision making. However in public health, the larger community or population is most important. Therefore utilitarianism-based policies and decisions that promote the greatest good for the greatest number of people often define public health priorities. In sum, vaccines are safe and effective tools for preventing infectious diseases at both individual and population levels. Health care practitioners who administer vaccines play critical roles in ensuring the population benefit is ethically realized. 

So, what do these ethical issues have to do with researching midwives who deliver vaccines during prenatal care? One large issue in vaccines today is how to enable health care practitioners to effectively communicate with patients who have concerns, are hesitant toward, or refuse readily available vaccines. Effective communication of risks and benefits to inform patients is increasingly challenging given widespread misinformation, and most US research in this area reflects the experiences of physicians and the populations that they serve. This bias means that communication tools, practices, and decisions that rely on this body of research lack the experiences of those seeking care from midwives in midwife-led settings. Therefore, I have developed a research study that will explore the process of vaccination delivery during prenatal care in midwife-led settings.  I hope that this project will help to balance available information, and yield communication insights to expand our understanding of diverse approaches to prenatal vaccine delivery in different health care settings.