Parental and clinician influences on HPV vaccination uptake in urban India: a qualitative study

Abstract Despite the availability of effective vaccines, HPV vaccination uptake among adolescent girls in India remains low. Most existing studies focus primarily on parental awareness or hesitancy, with limited attention to the interaction between parental decision-making and clinician recommendations. This qualitative study explored factors influencing parents’ decision-making about HPV vaccination for their adolescent daughters and clinicians’ attitudes and practices regarding vaccine recommendations in an urban Indian setting. In-depth interviews were conducted with 43 parents of adolescent girls (aged 10–19 years) and 19 clinicians across public and private healthcare settings in Pune. Interviews were conducted in English, Hindi, or Marathi, and were analysed thematically. Findings revealed that parental decision-making was shaped by gaps in knowledge, stigma surrounding sexual health, and structural barriers such as high vaccine cost and lack of availability in public health facilities. Parents frequently relied on informal or unreliable information sources and reported limited opportunities for meaningful discussion with clinicians. Cultural norms related to sexuality and concerns about future marital prospects contributed to delayed or refused vaccination. Clinicians, while generally aware of HPV and cervical cancer, often rely on risk-based rather than universal recommendations due to time constraints, perceived parental resistance, affordability concerns, and uncertainty around guidelines. This selective recommendation approach unintentionally reinforced stigma by linking vaccination with sexual activity. The study highlights how individual beliefs, clinician practices, and systemic constraints collectively limit HPV vaccine uptake. Addressing these challenges requires multilevel interventions, including culturally sensitive communication, clinician training aligned with universal vaccination guidelines, and integration of HPV vaccination into public programs to ensure equitable access.