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A vaccine represents the most promising strategy for combatting the COVID-19 pandemic through primary prevention. No study has been reported on the acceptability of the COVID-19 vaccine in South Africa (SA) and in the region. The objective of this study was to determine the acceptance of a COVID-19 vaccine among pregnant women. A cross-sectional, descriptive study was conducted at the Kwadabeka Community Health Center (KCHC), Durban. Logistic regression analysis was performed to determine the factors for vaccine acceptability among pregnant women. About two-thirds of pregnant women (63.3%) may accept COVID-19 vaccination once it becomes available in SA. Participants who were <22 years of age were 72% less likely (OR=0.28, CI: 0.13 -0.62) to accept the vaccine, compared to those who were >39 years old. Women with 0-1 parity were 4.3 times more likely (OR=4.3, CI: 1.98-9.48) to accept the vaccine than those with four or more parity. Single pregnant women were less likely (OR=0.23, CI: 0.10- 0.51) to accept the vaccine than those living with their partners. Employed pregnant women had four times more chances of accepting the vaccine (OR= 4.2, CI: 2.28-7.75) than unemployed pregnant women. It was also found that having a positive attitude towards vaccination increased the chance of accepting the vaccine by four times (OR=4.05, CI: 1.89-8.69). Our study found a 63.3% acceptance of a COVID-19 vaccine, but there were noticeable demographic, knowledge, attitude and practice disparities observed in vaccine acceptance among pregnant women. Before a COVID-19 vaccine is introduced to SA, public health officials and policymakers must prioritize effective COVID-19 vaccine-acceptance messages and mass education for all South Africans, especially for the most vulnerable.

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