vivid emotional mental scenes may be meaningfully linked to whether women get vaccinated
In the quiet calculus of a pregnant woman's mind, the images that arise unbidden—a sick infant, antibodies crossing a placenta—may carry more weight than any printed fact sheet. Researchers from the University of Western Australia and the University of Plymouth have found that the vividness and emotional tone of mental imagery directly shapes whether and when pregnant women choose to vaccinate, independent of their broader attitudes toward vaccines. The study, drawing on records from over 400 women at a Perth hospital, suggests that the inner theater of imagination is not mere background noise in health decisions, but a meaningful force in its own right—one that public health campaigns have largely left unaddressed.
- Vaccine hesitancy during pregnancy carries real consequences for infant health, and researchers have now identified an overlooked psychological lever driving it: the spontaneous mental images women form when contemplating vaccination.
- Women who pictured harm—side effects, danger, injury—showed measurably greater reluctance toward whooping cough and flu vaccines, a pattern that persisted even after controlling for their general views on vaccination.
- Positive imagery proved to be the stronger force: women who visualized protective antibodies crossing the placenta were not only more likely to vaccinate but did so earlier in their pregnancies.
- By the end of pregnancy, over 82% of participants had received the whooping cough vaccine, yet flu uptake lagged at 60% and COVID-19 vaccination reached only 7.2%, hinting at how differently each vaccine is imagined.
- The research team is now working to translate these findings into deliberate visual health messaging—asking what 'seeds' campaigns plant in the minds of expectant mothers and whether those seeds grow toward protection or fear.
In a waiting room at King Edward Memorial Hospital in Perth, a pregnant woman contemplates vaccination. The image that surfaces in her mind—a sick newborn, or perhaps antibodies flowing through an umbilical cord—may quietly determine her choice. This is the premise at the heart of new research from the University of Western Australia and the University of Plymouth, which set out to discover whether spontaneous mental imagery meaningfully shapes maternal vaccine decisions.
More than 400 pregnant women were recruited at the hospital and asked to describe what they visualized when thinking about vaccination risks and benefits. Researchers then cross-referenced their responses with official immunization records to see who actually got vaccinated and when.
The findings were clear. Women who reported negative mental imagery—scenes of harm or side effects—showed greater hesitancy toward whooping cough and influenza vaccines. Crucially, this held even after accounting for their general attitudes toward pregnancy vaccination, suggesting that mental imagery captures something psychologically distinct, not merely a reflection of pre-existing beliefs.
Positive imagery proved to be the stronger predictor of action. Women who visualized protective mechanisms, such as antibodies crossing the placenta, were significantly more likely to receive the whooping cough vaccine and to receive it earlier. By the end of pregnancy, 82.1% had received that vaccine, while flu uptake stood at 60.1% and COVID-19 vaccination at just 7.2%.
Dr. Julie Ji noted that pregnancy is an emotionally heightened period in which vivid mental scenes are far from incidental—they appear meaningfully linked to whether and when women vaccinate. Professor Katie Attwell drew a direct line to public health practice, arguing that understanding imagery's role opens new possibilities for intervention: health campaigns, she suggested, should become far more conscious of the visual impressions they leave in expectant mothers' minds. The study, published in Social Science & Medicine, proposes that the pictures forming in a pregnant woman's imagination may ultimately matter as much as any clinical fact.
A pregnant woman sits in a waiting room at King Edward Memorial Hospital in Perth, thinking about whether to get vaccinated against whooping cough. In her mind's eye, she sees something—maybe a sick infant in a hospital bed, or maybe antibodies flowing through an umbilical cord to protect her unborn child. That image, vivid and unbidden, may well determine what she decides to do.
Researchers from the University of Western Australia and the University of Plymouth wanted to understand whether these mental pictures—the ones that flash through a pregnant woman's mind when she contemplates vaccination—actually shape her choices. They recruited more than 400 pregnant women waiting for appointments at King Edward Memorial Hospital and asked them to describe what they visualized when thinking about vaccination risks and benefits. Did they imagine their babies getting sick from disease? Did they picture vaccine side effects? Did they see protection being passed along to their child? The women also reported their feelings about whooping cough, influenza, and COVID-19 vaccines. Then the researchers checked official immunization records to see which vaccines each woman actually received and when.
What they found was striking: the mental images mattered. Women who reported negative imagery—scenarios of harm, side effects, danger—showed greater hesitancy toward whooping cough and influenza vaccines, particularly if they hadn't yet been vaccinated. This pattern held even after accounting for their general attitudes about government-recommended vaccines during pregnancy, suggesting that these vivid mental scenes capture something distinct about how women psychologically experience vaccine decisions, not merely reflecting what they already believed.
But the real predictor of actual vaccination behavior was positive imagery. Women who visualized protective mechanisms—antibodies crossing the placenta, their babies shielded from disease—were significantly more likely to receive the whooping cough vaccine and to get it earlier in their pregnancies. By the end of pregnancy, 82.1 percent of participants had received the whooping cough vaccine, 60.1 percent had received the influenza vaccine, and only 7.2 percent had received the COVID-19 vaccine.
Dr. Julie Ji, an adjunct research fellow at UWA's School of Psychological Science, emphasized that pregnancy is a uniquely sensitive period for health decisions, weighted with emotional and psychological significance. "Our results suggest that vivid emotional mental scenes that pop to mind when someone is thinking about vaccination are not just incidental," she said. "They may be meaningfully linked to how people feel about vaccines, and in some cases, whether and when they get vaccinated."
Professor Katie Attwell, who leads VaxPolLab at UWA's School of Social Sciences, saw immediate practical implications. At a time when vaccine hesitancy threatens public health, understanding the role of mental imagery opens a new avenue for intervention. "Now that we understand the importance of these mental images, we can support health professionals and government campaigns to be more conscious of what visual seeds they might be sowing," she said. The research team, which included experts in psychology, midwifery, social sciences, pediatrics, and infectious diseases across Australian and British institutions, is now investigating how mental imagery can be deliberately harnessed to support informed decision-making during pregnancy. The findings, published in Social Science & Medicine and funded by the Telethon Channel 7 Western Australia Child Research Fund, suggest that the pictures in a pregnant woman's mind may be as important as the facts on a pamphlet.
Citas Notables
Vivid emotional mental scenes that pop to mind when someone is thinking about vaccination are not just incidental—they may be meaningfully linked to how people feel about vaccines, and in some cases, whether and when they get vaccinated.— Dr. Julie Ji, UWA School of Psychological Science
Now that we understand the importance of these mental images, we can support health professionals and government campaigns to be more conscious of what visual seeds they might be sowing.— Professor Katie Attwell, VaxPolLab, UWA School of Social Sciences
La Conversación del Hearth Otra perspectiva de la historia
Why does it matter what a pregnant woman imagines? Isn't the science of vaccines what should drive her decision?
The science matters enormously. But this research shows that how people *feel* about the science—the mental pictures they construct—actually predicts what they'll do. A woman can know vaccines are safe and still hesitate if she vividly imagines harm.
So negative imagery is the problem. We just need to flood campaigns with positive images?
It's more subtle than that. The study found that positive imagery about protection—imagining antibodies crossing the placenta, for instance—genuinely linked to higher vaccination rates. But you can't manufacture vivid mental imagery through a poster. It has to resonate with how a woman actually thinks about her body and her baby.
What about the women who didn't get vaccinated at all? What were they imagining?
The study doesn't tell us their specific images, only that women with negative imagery showed more hesitancy. Some may have been imagining side effects. Others may have had no clear image at all—just a vague sense of unease. That's part of what makes this finding important: it suggests mental imagery is a lever we haven't been consciously using.
The COVID-19 numbers are striking—only 7.2 percent. Were those women imagining something different?
The study doesn't break down imagery by vaccine type, but the timing matters. This data was collected during a period of significant public debate about COVID vaccines in pregnancy. The low uptake likely reflects broader hesitancy in the community, not just individual mental images.
So what do health professionals do with this information?
They start listening differently. Instead of just presenting facts, they might ask pregnant women what they're picturing when they think about vaccination. They might help women construct more protective mental images—not through manipulation, but through conversation that helps them imagine how vaccines actually work in their bodies.