Media broadcasts and discussion programs have brought about social anxiety and hesitation about the safety of the 2009 H1N1 vaccine in Turkey and many other countries 
. This situation has affected the vaccination rate of pregnant women, as well as all of society 
. The 2009 H1N1 vaccine is a new vaccination and the entire world is curious about its effectiveness and reliability 
. Since the vaccine can show adverse effects on a fetus, many pregnant women are unwilling to adopt the recommendations of public health authorities 
Many around the world hold different opinions about the vaccine. It was found that 2% of pregnant women 
in a 2000 Canadian study and 12.8% of pregnant women 
in an American study had received the seasonal influenza vaccine. In our study, 8.9% of pregnant women (28 women) received the vaccination. By January 1, 2010, the vaccination rate among pregnant women in the United States was 38% 
. In another study performed in France that was smilar to the study performed in the United States the acceptability of 2009 H1N1 vaccine was 37.9% among pregnant women 
There are many factors affecting the decisions of pregnant women in Turkey to receive the 2009 H1N1 vaccination. In our study, 37.9% of the women stated that they decided on their own whether or not to vaccinate, 10.5% said that the decision was made by their spouses, and 51.5% stated that they made the decision with their spouses. In addition, 68.5% of pregnant women stated that they were comfortable with their decisions concerning the vaccine, 7.3% said that they were not comfortable, and 24.2% stated that they were hesitant. The decisions of having vaccination were affected by television, health personnel, and suggestions from relatives. The decisions of not vaccinating were affected by television, explanations from the Ministry of Health, and explanations from politicians. Intensive discussions about the vaccine have taken place in Turkey, and an overall level of anxiety has developed throughout society about this subject. In the beginning, the Ministry of Health persistently suggested that everyone should be vaccinated and also stated that the Prime Minister and President would be vaccinated. However, the Prime Minister strongly implied that the Minister of Health should not speak for him in front of the media. Moreover, the Prime Minister stated that he and his family would definitely not be vaccinated [
]. This situation increased the Turkish society's hesitations about the vaccine. Almost daily, television programs discussed 2009 H1N1 and its vaccine, and featured scientists and politicians defending and contradicting its effectiveness and dangers 
. These types of discussions and debates could have fortified society's hesitation over the vaccination. Moreover, they could cause vaccination rates to remain low. In our study, participants expressed that their decisions whether or not to get the vaccine were mostly affected by television. Our results show that the media plays the biggest role in informing the public about a pandemic. In a study performed by Jones et al., participants cited the internet as the most common source of information concerning 2009 H1N1. Furthermore, the study found that radio, television, health personnel, and friends were the most common information sources after the internet 
In a study made by Lau et al., one-fourth of the study group felt that the vaccine was unsafe, one-third believed it to be effective against influenza, and two-thirds stated that the vaccine had been approved through clinical experiments 
. As seen in Table S1
, two-thirds of the pregnant women in the research group stated that the 2009 H1N1 vaccine had not been approved and would only be given (as a trial) to the public in Turkey. Three-fourths of the pregnant women said that there are some other countries manipulating the receipt of the vaccine, believed that the vaccine was harmful in the long term, and stated that vaccine companies were responsible for creating 2009 H1N1. Our results show how fear is developed in society, and how media broadcasts about scientific subjects are primarily accredited for conspiracy theories. Nearly three-fourths of the pregnant women in our study stated that the vaccine could cause miscarriage, deformation in the child, and infertility. In a 2006 study by Yudin et al. on pregnant women, 80% of the participants stated that they believed the influenza vaccine could lead to defects in their children 
. These results were similar to what we found in our study.
Possible side effects of the 2009 H1N1 vaccine are: ruddiness, sensitivity or swelling at the site of vaccination, headache, muscle and joint aches, fever, nausea, perspiration, chilling, and tremors. Rare adverse effects include: serious allergic reaction, anaphylaxis, neuritis, nephritis, vasculitis, thrombocytopenia, convulsion, encephalomyelitis, and Guillain-Barre Syndrome 
. With respect to such side effects, one-third of the pregnant women in our study thought that the vaccine could cause ruddiness, swelling, hardness, cyanosis and pain in the region of vaccination, lassitude and fatigue. One-fourth of the participants stated that the vaccine could cause headache, apoplexy and neuropathies, perspiration and tremors, joint and muscle aches, extensive skin reaction, and reduction in tension. Other side effects that our participants less commonly attributed to the vaccine include: shock, pain throughout the nervous system, and bleeding from reduced clotting. Although the media had intensively discussed the adverse effects of the vaccine, the rate of related knowledge in the study group remained low. This could be because the media hype caused public confusion about the truths and falsities related to the vaccine. In a study by Lau et al., half of the research group stated that the adverse effects of the 2009 H1N1 vaccine were very few or none, while 16% claimed the effects to be many or severe, and 29% said that they did not know about possible adverse effects 
. In our study, 20% of the pregnant women stated that 2009 H1N1 spreads faster than seasonal flu and that its fatality rate was lower than that of seasonal flu. In a similar study, 36% of the study group stated that the fatality speed of pandemic flu was higher than that of seasonal flu and 42% stated that it spread faster 
. Due to the panicked atmosphere formed throughout society, our study group could have thought that the fatality of pandemic flu was higher than that of seasonal flu.
As is evident in the logistic regression model in , among the independent variables, the effect of HVSERP points (p
0.04) and occupation (p
0.01) was statistically significant on vaccination decision (p<0.05); but the effect of educational status (p
0.60) and having a child (p
0.22) were not statistically significant on vaccination decision (p>0.05). The probability of receiving the 2009 H1N1 vaccine was 3.46 times higher among working women than housewives, 1.85 times higher among women who have a child than those who do not, and 1.29 times higher among women with a high-school education or higher than those with only a secondary-school education and below. Every one point increase in the HVSERP score increased the probability of receiving the 2009 H1N1 vaccine by 1.34 times. These data show that knowing the vaccine's side effects about pregnancy significantly increased the vaccination rate among pregnant women. This finding shows that during a pandemic, it is critical to inform at-risk groups about their special condition.
In conclusion, the H1N1 vaccination rate among pregnant women in our study was too low (8.9%). Half of the study group stated that they made their decisions with their spouses whether or not to be vaccinated, and one-third of the group stated that they felt comfortable with their decisions about vaccination. Every one point increase in the HVSERP score increased the probability of receiving the 2009 H1N1 vaccine by 1.34 times. During a pandemic, it is important that the media work in coordination with the Ministry of Health and avoid spreading news that disconcerts society. Also, informing at-risk groups about their risks is important during a pandemic. Our study's limitations are that we performed it in a short time during a single influenza season and in a single healthcare center. Another limitation is that 2009 H1N1 vaccines started to be distributed among pregnant women only after the 2009 H1N1 epidemic obviously had started, so the low uptake rate might have resulted from the delay in vaccinations. As Schwarzinger et al. said, having influenza-like symptoms during that time could be associated with the vaccine's reduced acceptability in our study 
. Further studies that substantiate our results should be performed with more pregnants in other hospitals and in other influenza seasons for to our results be generalized.