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Relational autonomy proposes that persons are socially embedded, with decisions being made within social relationships. Through this theoretical lens, this article explores how the healthcare professional–patient relationship can affect pregnant women’s decisions to accept pertussis and influenza vaccines.

Hackney was chosen as the study site as it has very low vaccine uptake rates. In-depth interviews were conducted with 40 pregnant and recently pregnant women, as well as 10 healthcare professionals. Interviews explored experiences of the UK's National Health Service (NHS) health care and views towards vaccination in pregnancy. An observation of a consultation between a pregnant patient and her General Practitioners (GPs) was also conducted in order to understand how the vaccination discussion takes place.

The findings of this study indicate that advice from friends and family can greatly influence a pregnant woman’s vaccination decisions. The patient’s social context, including influences on her decisions, must be understood by healthcare professionals, so that discussions about concerns can take place. If close relationships with patients are formed, healthcare professional advice is more likely to be trusted. With support from healthcare professionals, patients feel competent, empowered to make the right decision for them, and are more likely to vaccinate.

This research will help to inform contextualised policies aimed at increasing vaccination acceptance and reducing inequality in access to vaccination during pregnancy in Hackney.

To the author’s knowledge, this chapter is the first to apply the theory of relational autonomy to views towards maternal vaccination and decision making. It provides valuable insights into how healthcare professionals’ interactions with their pregnant patients can influence vaccination acceptance. The chapter contains advice on how both healthcare professionals and policy-makers can include mothers in vaccine decision-making processes in more personalised ways, by adopting a dialogue that appreciates and understands the social processes around vaccination concerns.

Much of the discussion surrounding the antivaccine movement focuses on the decision of parents to not vaccinate their children and the resulting danger posed to others. However, the primary risk is borne by the child left unvaccinated. Although living in a developed country with high vaccination rates provides a certain amount of protection through population immunity, the unvaccinated child is still exposed to a considerably greater risk of preventable diseases than one who is vaccinated. I explore the tension between parental choice and the child’s right to be free of preventable diseases. The chapter’s goal is twofold: to advocate for moving from a dyadic framework – considering the interests of the parents against those of the state – to a triadic one, in which the interests of the child are given as much weight as those of the parent and the state; and to discuss which protections are available, and how they can be improved. Specific legal tools available to protect that child are examined, including tort liability of the parents to the child, whether and to what degree criminal law has a role, under what circumstances parental choice should be overridden, and the role of school immunization requirements in protecting the individual child.

Child immunization is widely recognized as a cost-effective preventive medicine. Unfortunately, in India about 50% of the eligible children aged 12–23 months miss some essential vaccination. Though a positive association between maternal education and markers of child health like immunization has been long established, the literature has struggled to find a causal relationship, mainly because education is inextricably correlated with other socioeconomic variables like income. In this chapter, I propose a new instrument for women’s education in India using the following facts. First, due to lack of sanitary facilities in schools, particularly rural schools, large number of girls drop out of school once they reach puberty. Second, age at menarche is largely determined by biological factors and not social factors. Together, age at menarche can explain variations in schooling, yet be independent of outcome variables like child immunization. I find that additional years of maternal schooling (conditional on strictly positive years of schooling) do increase the probability of complete immunization of children.

Evaluating primary care for children has not before been undertaken on a national level, and only infrequently on an international level, an adult-focused perspective is the norm. The Models of Child Health Appraised (MOCHA) project explored the evaluation of quality of primary care for children in a nationally comparable way, which recognises the influence of all components of child well-being and well-becoming. Using adult-focused metrics fails to account for children’s physical and psycho-social development at different ages, differences in health and non-health determinants, patterns of disease and risk factors and the stages of the life course. To do this, we attempted to identify comparable measures of child health in the European Union and European Economic Area countries, we aimed to perform a structural equation modelling technique to identify causal effects of certain policies or procedures in children’s primary care and we aimed to identify and interrogate large datasets for key tracer conditions. We found that the creation of comparative data for children and child health services remains a low priority in Europe, and the largely unmet need for indicators covering all the healthcare dimensions hampers development of evidence-based policy. In terms of the MOCHA project objective of appraising models of child primary health care, the results of this specific work show that the means of appraisal of system and service quality are not yet agreed or mature, as well as having inadequate data to fuel them.

Public health programs facilitate access to resources that not only provide individuals’ options but also often foreclose individual preference through prescriptive requirements. This chapter takes two disparate cases from public health – vaccines and family planning –that reveal patterns of inequality in who has access to individual choice and who requires state support to exercise choice. Looking specifically at dynamics of funding and compulsion, this chapter elucidates how reliance on the rhetoric of individual choice as an expression of freedom rewards those with the greatest access to resources and fails to make sure that all members of the community have the resources to shape their own outcomes or to make sure collective health is protected.