The South African Paediatric Association (SAPA) remains committed to promoting the wellbeing of all children and their mothers.


It has been brought to the attention of SAPA that some pregnant and breastfeeding women are being advised by public and private sector healthcare workers, including general practitioners, obstetricians and paediatricians to decline or delay COVID-19 vaccination.

The National Department of Health has issued a circular recommending all pregnant and breastfeeding women be offered the vaccination1 and SAPA supports these recommendations.


  • COVID-19 during pregnancy increases the risk of preterm birth and other adverse obstetric outcomes.
  • Pregnant women and those in the early postnatal period are at substantially higher risk for severe COVID-19, including dying.
  • The available evidence supports the safety, immunogenicity, and efficacy of all currently available COVID-19 vaccines in both pregnant and breastfeeding women.
  • The vaccine has up to 96% effectiveness against documented infection in pregnant women2
  • Additional benefits of vaccination include the transfer of SARS-CoV-2 antibodies to the infant transplacentally and in breast milk this is likely to provide significant benefit to the infant.
  • Other vaccines, including tetanus, influenza and pertussis vaccines, are already part of recommended routine ante- and post-natal care as they have been shown to be safe and effective for both mother and infant.3
  • As yet, it is considered unlikely, that unidentified rare adverse effects of COVID-19 vaccination in pregnant and breastfeeding women will develop. However, ongoing safety monitoring will ensure these can be detected.


COVID-19 vaccination should be offered to all eligible women during any stage of pregnancy, and during lactation.

This position paper represents the view of the South African Paediatric Association, a professional society representing paediatricians in the public and private sector in South Africa. The position is supported by the Paediatric Management Group, the South African Academy of Family Physicians and the South African Society of Obstetricians and Gynaecologists.


  1. Updated Circular: Vaccination of Pregnant and Breastfeeding Women, NDoH, 29 August 2021 breastfeeding-women/
  2. Dagan, N., Barda, N., Biron-Shental, T. et al. Effectiveness of the BNT162b2 mRNA COVID-19 vaccine in pregnancy. Nat Med 27, 1693-1695 (2021).
  3. Zamparini, J, Murray, L, Saggers, R T, Wise, A J, & Lombaard, H. (2021). Considerations for COVID-19 vaccination in pregnancy. South African Medical Journal 2021;111(6):544-549.

SAPA Scientific committee

Despina Demopoulos
Ziyaad Dangor
Mignon McCulloch
Haroon Saloojee
Gary Reubenson
Neil McKerrow