Health
Why pregnant women should complete five doses of tetanus vaccine — Gynaecologists
Seasoned maternal health experts have urged pregnant women to take and complete the five-dose tetanus toxoid vaccination schedule, even after childbirth, to ensure they get lifelong immunity against a disease that is better prevented than managed.
They noted that the TT vaccination is an essential part of antenatal care that protects both mother and baby against the bacteria that cause tetanus.
In interviews with PUNCH Healthwise, the gynaecologists said although maternal and neonatal tetanus cases have declined over the years due to improved immunisation coverage, the disease remains deadly and preventable.
The gynaecologists stated that pregnant women are more vulnerable to tetanus during childbirth, especially those who deliver in unclean environments or where unsterilised instruments are used.
They also dismissed common misconceptions surrounding the vaccine, saying there is no evidence that tetanus toxoid causes miscarriage, infertility, big babies or increases the likelihood of caesarean delivery.
According to the World Health Organisation, tetanus is caused by infection of a cut or wound with the spores of the bacterium Clostridium tetani, with most cases occurring within 14 days of infection.
The disease is not transmitted from person to person and can be prevented through vaccination with tetanus-toxoid-containing vaccines.
The global health body noted that most reported tetanus cases occur among newborns and mothers who have not been adequately vaccinated, adding that more than 7,700 newborns died from neonatal tetanus in 2021, representing an 84 per cent reduction since 2000, largely due to expanded immunisation.
In 2025, about 85 per cent of infants worldwide received three doses of the diphtheria-tetanus-pertussis vaccine.
In 2024, the National Primary Health Care Development Agency said that tetanus and diphtheria are threatening pregnant women in the country, stressing that immunisation was recommended for the safety of pregnant women and their babies.
PUNCH Healthwise earlier reported that hesitancy in receiving the tetanus vaccine among pregnant women have caused a resurgence of tetanus infections in Nigeria.
The report also showed that the preference of some pregnant mothers to visit Traditional Birth Attendants made women see mandatory tetanus immunisation as an option and not a requirement.
Commenting on the matter, a Consultant Obstetrician and Gynaecologist at the Federal Medical Centre, Abeokuta, Ogun State, Dr Olanrewaju Jimoh, said tetanus toxoid vaccination was one of the most important interventions available to pregnant women because it offered protection to both mother and child simultaneously.
He said, “Tetanus toxoid vaccination is very important in pregnancy and to pregnant women because it offers protection or immunity against tetanus for both the mother and baby. The woman receives the tetanus toxoid, and it provides protection from the organism causing tetanus for the woman not to have tetanus. It also protects the baby from having neonatal tetanus when the baby is born.”
Jimoh said the impact of increased vaccination coverage was already visible in the data, noting that Nigeria had recorded a downward trend in the prevalence of both maternal and neonatal tetanus as immunisation rates improved.
He, however, warned that the risk of tetanus during delivery remained real, especially for women who did not deliver in a standardised healthcare environment.
He said, “A woman is at risk of having tetanus during delivery, especially those who did not deliver in a standardised environment or level of care. Such a woman is prone to having tetanus during delivery, especially if it is done in an unkempt environment with unsterilised instruments used, and with several cuts.”
On the severity of the disease, Jimoh said tetanus was a condition that was far easier to prevent than to treat, and that prevention was the only truly reliable defence.
He said, “One thing about tetanus is that it is better prevented than managed because the mortality resulting from tetanus once it has happened is so massive that prevention is very important.”
The gynaecologist explained the five-dose schedule in detail, saying the first dose was to be collected at the first antenatal contact, the second dose four weeks after the first, the third dose six months after the second, the fourth dose one year after the third, and the fifth dose one year after the fourth.
He said a common and dangerous pattern was for women to abandon the schedule after delivering their babies, wrongly believing that the vaccine was no longer necessary once they were no longer pregnant.
He said, “It is important to know that the first dose actually confers no immunity at all. It is by the time you are talking about the second dose that it confers immunity for some months. By the time you are getting to the fifth dose, you are talking about immunity for life. That’s why it is important to get to the fifth dose.”
Jimoh advised women who had missed doses not to restart the schedule from scratch but to continue from where they left off, regardless of whether they were currently pregnant.
The maternal health expert said, “If you are missing a dose, as soon as you remember, you can start and continue whether you are pregnant or not. There is always no need to start all over again. Getting to the fifth dose is the ultimate because it provides the immunity to that person for life.”
Jimoh acknowledged that isolated cases of maternal and neonatal tetanus were still being recorded in Nigeria, even as overall incidence declined.
He also stressed that the mother’s responsibility did not end with her own vaccination, urging women to ensure their newborns received the full national childhood immunisation schedule for additional protection against tetanus.
The doctor said, “It is not only about the mother taking the vaccination for the sake of the baby. When the baby is delivered, there are some national immunisation schedules that are protecting the baby from having tetanus and the mother needs to ensure that the baby is fully immunised.”
Addressing widespread misconceptions about the tetanus toxoid vaccine, Jimoh said the false belief that the vaccine caused miscarriage arose because the first doses were typically administered in the early stages of pregnancy, when miscarriages were naturally most common, leading some women and their families to draw a false connection between the vaccine and pregnancy loss.
He said, “Miscarriages are very common during the first trimester naturally. Because of this misconception, most hospitals don’t give the tetanus toxoid until after 20 weeks. While this doesn’t make it right, they are just trying to protect themselves and avoid being mislabelled.”
The gynaecologist dismissed all the other prevailing myths about the vaccine, including beliefs that it caused infertility, produced abnormally large babies, or made caesarean section inevitable, describing each of them as medically false.
He said, “Some people believe that it causes infertility, but that’s not true. Other misconceptions are that it causes the baby to be big and would have to be born through caesarean section. That is not true either. Some people believe the tetanus toxoid is only for those who want to deliver at home and not needed for those who would have their deliveries in the hospital. TT is safe in pregnancy and does not make babies big or cause miscarriage.”
Jimoh advised pregnant women to take the tetanus toxoid vaccine seriously, consult their doctors or healthcare workers for clarification, complete their vaccination schedule after delivery, and ensure their babies are fully immunised.
In an earlier interview with PUNCH Healthwise, a consultant Obstetrician and Gynaecologist, Dr Babatunde Rosiji, noted that tetanus is deadly and fatal, stating, “Once a neonate, a newborn within 28 days of birth, contracts tetanus, the mortality rate is as high as approaching 100 per cent. They rarely survive.
“The essence of the vaccination is to protect the neonates from contracting tetanus. But we have observed that some women only take a dose of the vaccine which does not protect them against tetanus throughout the pregnancy.
“At least two shots will protect the mother and child, but we aim to administer five doses to cover the baby for life.”
Rosiji emphasised the need for more awareness of the anti-tetanus toxin, stating that it does not only protect the mother, but also gives protection to the neonates.
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