Abstract Background: Vaccine-preventable diseases are major contributors to the disease burden in Sub-Saharan Africa, accounting for many childhood illnesses, disabilities, and mortality. There is dearth of knowledge on the drivers of vaccine hesitancy in Nigeria and the extent of its impact on coverage. Pregnant women are a particularly important vulnerable and at-risk group and, additionally, very relevant for childhood vaccination decisions. However, this group is understudied in Nigeria. This study’s aims are to adapt Confidence, Complacency, Constraints, Calculation, and Collective Responsibility, also known as the 5C psychological antecedence scale for the Nigerian context and to measure vaccine hesitancy to predict the intention to vaccinate among pregnant women (prenatal) and subsequent vaccination behavior (postnatal). Method: It is a longitudinal study that used multi-stage sampling procedure. One healthcare facility was selected from each district in five regional clusters, from which 255 pregnant women were randomly drawn. A standardized questionnaire was used to collect data on demographic characteristics, sources of vaccination information, and the 5C psychological antecedents of vaccination. Additional variables tested included the importance of religion, masculinity, and rumor/conspiracy theory. The scale’s reliability was explored, and a backward elimination regression analysis was performed to identify the major determinants of childhood vaccination intention among pregnant women (T1) and their postnatal behavior (T2). Results: The prenatal (T1) findings revealed low reliability of the 5C subscales in Nigeria’s setting. Pregnant women’s intention to vaccinate unborn children was lower if they were Muslims, had lower confidence in public authorities or the health system, if husband approval was important for vaccination, and if they believed in rumor. Postnatal (T2) findings revealed that vaccination was more likely to follow mothers’ religious beliefs, when confidence in vaccine effectiveness was high and when mothers felt responsible for the collective. However, higher levels of everyday stress (constraints) were related to less vaccination behavior, and intention did not predict actual vaccination behavior. Conclusion: The 5C scale is incompletely adaptable in Nigeria but is a better tool for measuring vaccination behavior than intention. Overall, the vaccination intention did not predict behavior among pregnant women. The additional variables are good instruments that need further exploration.
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