Case Report: Parental Refusal of Immunization in a 12-Month-Old Infant as a Midwifery Case Report on Knowledge Factors

Abstract

Introduction: Routine childhood immunization is an essential public-health intervention for preventing vaccine-preventable diseases. Despite high reported immunization coverage in Magetan Regency in 2025, delayed or incomplete vaccination can still occur when parents have limited knowledge, safety concerns, or conflicting family information. Objective: To describe midwifery care for a 12-month-old infant whose routine immunization was incomplete because of parental knowledge-related hesitancy. Methods: A descriptive case report was conducted at a private midwifery practice in Magetan, East Java, from 2 to 21 February 2026. The case was managed using the SOAP framework. Data were collected through maternal interviews, review of the child’s immunization record, physical examination, growth and developmental assessment, observation of parental responses, and four follow-up visits. Counseling used therapeutic communication and a leaflet covering immunization benefits, vaccine-preventable diseases, routine schedules, and common adverse events following immunization (AEFI). Results: The 12-month-old male infant had received only a birth dose of hepatitis B vaccine, with no subsequent routine immunizations documented. At the first visit, the mother reported limited knowledge and fear of adverse effects and was influenced by information from neighbors and social media. The infant had mild cough and coryza but was otherwise clinically well, with normal growth and development. Across four visits, maternal understanding improved after structured counseling and leaflet-based education. By the final visit, the mother could explain the benefits of immunization and expressed willingness to vaccinate her child, but implementation had not yet occurred because the decision still required discussion with her husband. Conclusion: Individualized counseling, empathetic communication, and accessible written information improved maternal knowledge and vaccine acceptance in this case. Family involvement and continued follow-up are important when parental decision-making is shared.