Neoliberal Mothering and Vaccine Refusal

by Jennifer A. Reich

“Thanks, Anti-Vaxxers. You Just Brought Back Measles in NYC. Measles was considered eliminated at the turn of the millennium. Now it’s back, thanks to the loons who refuse to vaccinate their children.”

This was the lead of a story this spring on the Daily Beast. Although this impassioned post communicates fear and frustration that accompany threats of vaccine-preventable infectious disease, it doesn’t accurately characterize the parents who choose not to vaccinate their children. In this study, published in October in Gender & Society, I interview mothers who reject recommended vaccines for their children, either by opting out completely, consenting to only a few, or reworking the schedule to meet their own preferences to understand how they make sense of the choice. These mothers care about their own children and aim to make the best decisions for them, which they believe requires questioning medical information, educating themselves from sources they see as more reliable (and independent from medical or public health sources), and actively managing their children’s lives.

Research shows that parents who intentionally reject vaccines (versus under-vaccinated children who lack access to care) look different. Children who are intentionally unvaccinated are more likely to be white, have a college-educated mother, and a higher family income (as Table 1 shows). Taking these patterns seriously, my research explores how vaccine resistance is a form of privilege that allows mothers to reject professional recommendations and opt out of state law without fear of repercussion. How do mothers’ explanations reflect their access to privilege and what might be the costs of other families?

Table 1:

Reich_image_October 2014

Mothers in my study describe their efforts to protect their children’s health in ways they see as making vaccines unnecessary. They focus on organic foods, breastfeeding, health-promoting practices at home, and control of their children’s social exposure as ways they see themselves as mitigating disease risk. As experts on their own children, women saw their efforts as superior to the generic recommendations made by medical professionals who did not know their children. Although many of these practices are not shown to affect vulnerability to infectious disease, mothers worked hard in time and resource-intensive ways to protect their children without vaccines.

Public health law which requires vaccines for school attendance aims to create community-level immunity by vaccinating a critical portion of the population. In the chart below, if you imagine that all the green people are vaccinated and the red people are infected with vaccine-preventable diseases, the blue unvaccinated people are protected from infection because all the green people who are vaccinated create community immunity (or herd immunity) which serves to protect those in the community who would be vulnerable. This includes those who cannot be vaccinated for medical reasons, those for whom vaccines didn’t work to generate immunity, the elderly, the immune-compromised, or those who lack access to care. It also includes those mentioned above, who are undervacccinated because they lack access to healthcare providers and vaccines. Those who simply choose not to participate in vaccines are known in public health literatures as free-riders since they gain protection from the community without actually contributing to public health.

Reich_image2_October 2014

My research shows that although mothers were often familiar with claims that their children were free-riders, they found the argument that they should participate in public health to be unconvincing. Rather, as mothers, they see themselves as uniquely responsible to their own children and do not perceive responsibility for other children who they hope have mothers making good decisions for them. However, they rarely consider that other children’s mothers may not be equally able to invest these same resources of time, education, or money in optimizing their children’s health, or that vigilance cannot necessarily control infectious disease.

Mothers who reject vaccines are not “loons” as popular media would suggest. They spend considerable time and resources deciding what their children need and how to protect them. Yet they do so from a perspective that treats vaccines as a technology for individual consumption that mothers should assess and decide independently whether to use. This ethos—reflecting neoliberal goals that individuals behave as informed consumers responsible for their own health—lies in sharp contrast to the tenets of public health that expect individuals to accept minimal risk to protect those among them who are most vulnerable.

Jennifer A. Reich is Associate Professor of Sociology at the University of Colorado, Denver. Her article, “Neoliberal Mothering and Vaccine Refusal: Imagined Gated Communities and the Privilege of Choice,” is forthcoming in Gender & Society and currently available via OnlineFirst here. For the article press release, click here.

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35 thoughts on “Neoliberal Mothering and Vaccine Refusal

  1. What is fascinating to me is the emotional backlash, albeit out of fear & frustration, by those who vaccinate to safeguard their children, seem to miss the one glaring point I see amongst the crisis hysteria (surrounding whether to or not vaccinate their children), that IF in fact, the vaccines work to protect and immunize those who get vaccinated or get their children vaccinated, then why the continuation of fear? Your child & you are thus safe and secure.

    Why then are they so frightened still? Did they NOT choose to vaccinate out of researching the pros & cons themselves? OR did they vaccinate because they were frightened NOT to?

    It seems to me, that if they had actually “chosen” to vaccinate, they would have done so, with the belief that they have secured their children from the dreaded childhood diseases that MY generation survived and overwhelmingly so: Measles, Rubella, Mumps & Chickenpox.

    To pass on these immunities by Nature has turned out to be the most successful way to survive, INCLUDING that fact, as you point to in your article, that some people, even through the all-seeing/all-knowing gods of science, have NOT been immunized at all and may or may not die from said childhood diseases after all.

    IF these gods, cannot improve on Nature, and you take your chances both ways, why the histrionics over the issue? Because, MOST people who vaccinate their children do NOT choose to out of knowledge or research, but because they are AFRAID NOT TO.

    1. You seem to assume that a person ONLY cares about their own child… Have you never been concerned for the welfare of another person or child? If your neighbours were beating their child, would you not care because it wasn’t your child being beaten?

    2. I think I know what you’re driving at, and you’re wrong. People have died in car crashes because they wore their seatbelts – they got jammed and prevented them leaving before the leaking fuel tank caught fire or the car sank in the river and whatnot. Obviously, “you take your chances both ways” when you decide to put your seatbelt on. It doesn’t make both choices equally sensible, nor does it mean the “gods of science”, the ones who invented nylon and gravity ratchets, have somehow failed to improve on seatbelt-less Nature in terms of making auto accidents more survivable

    3. Hoo boy. The basic answer is that a vaccine isn’t 100% successful or effective. It’s just a lot better than not. Hence, reducing the number of possible disease vectors is still a priority.

      “If you have good locks, why should you want police (society) to spend resources catching burglars? After all, are you not protected?”

    4. Your comment completely overlooks the people the concern is primarily about, the most vulnerable people – the risk posed to babies who have not yet had all their vaccinations, and those small number who have medical conditions that prevent them from being vaccinated (certain allergies being an example). These are the ones most at risk from the negligence of the anti-vaxxers. It is also the case that vaccination isn’t a 100% guarantee, and a significant level of exposure from contact with a contagious person such as an unvaccinated individual, let’s say in the early stages of whooping cough when it just looks like an ordinary cold, could easily pass the illness to a vaccinated person as well. In this way, a vaccinated child could pick up ones of these diseases also, say from a day care centre, and they may have a younger sibling who is only a baby, or contact with a friend’s younger sibling who is a baby, and pass it to them also, with potentially devastating consequences. These are the reasons why vaccinated people are concerned about the anti-vaxxers.

      1. Exactly. Vaccination can’t be given at birth: infants are vulnerable until they’re big enough and strong enough to handle the vaccine. Likewise, some people have conditions that make vaccination impossible. I know a couple whose son has cystic fibrosis: he can’t be vaccinated, and for him, the common cold could put him in the hospital, let alone measles. The purpose of vaccination is to protect ourselves AND those who can’t be vaccinated.

    5. I don’t understand your argument. Are you willing to allow natural selection to take its course and take a chance that someone in your family falls dangerously (or even mildly) ill from a preventable disease? If I have a choice to prevent my child from even getting a cold, then I will. The two days and nights of constant saline drops and nasal suctioning while she struggles to breathe are enough for me to be “frightened” about her falling sick. And that’s nothing to the dangers of measles, polio, whooping cough.

      Do you have numbers for the population that survived those diseases in YOUR generation? That’s what all the graphics are for – more people in YOUR generation DIED because they succumbed to diseases that their “Natural” immunity did not save them from. Stop fear-shaming and accept your responsibility to keep these diseases from spreading. It is still a war of survival that we wage against disease-causing organisms. One we are not likely to outright win anytime soon – let alone lose by betting against ourselves.

    6. Drop the ‘gods of science’ nonsense. Unlike religion, science has testable, repeatable results.

      Also, I vaccinate because I studied biology back in the day, and have at least some understanding of how the immune system actually works.

    7. Hello,

      Before commenting as if you know how vaccines work, you should read up on them. Vaccines are not 100% protection against disease and some require boosters. Vaccinated children risk of contracting disease is significantly lower then unvaccinated kids if all kids are vaccinated. The risk of a vaccinated child getting a disease increases when an unvaccinated child is with them. The risk increases even more if their is a confirmed disease in the population to vaccinated kids.

      So yes, their is genuine outrage from those who vaccinate their kids against those who do not vaccinate their kids.

    8. Put this one in the loony bin. Simple and short answer to the basis for your tirade: Bacteria and viruses can mutate when infecting or replicating. The more unvaccinated people there are, the more chances the measles of today have of becoming the black plague of tomorrow.

      There’s also the minor point of protecting those who can’t get vaccinated if they wanted to.

    9. I don’t have kids and this issue hasn’t hit close to home, so I just read about it online, but this comment seems typical. The problems like babies under the age of vaccination dying because other people don’t immunize are all over the debates … but anti-vax advocates are still regularly chiming in that we should take a huge risk and ignore the experts without getting even the most-basic, read-it-on-facebook level of knowledge of why we need vaccinations or how well they’ve been tested. I’m all for getting deeply educated and becoming an expert and arguing with the establishment when you know what you’re talking about, but the anti-vax discussion that I’ve been witnessing hasn’t been that. Arguments out of ignorance and putting lives at risk sloppily.

  2. Because my 8 month old son can’t have the measles immunization yet. And so-and-so’s child with cancer had their immunity wiped out by chemo. And some other person’s child got the shot, but their body produced no antibodies against the vaccine. The reason we’re so pissed off is that vaccination isn’t an individual issue: it’s a societal issue.

    Vaccination only works for the vulnerable among us (like my 8mo. old son, and the child undergoing chemo) when the percentage of vaccinated individuals is above a threshold that can be determined *mathematically* based on the infectiousness of the disease.

    You can’t “pass on” immunity to measles. And a male *definitely* can’t pass on resistance to mumps, since it renders many of them infertile. And while survival of Measles is a nice goal, the side effects (like Meningitis, Death, deafness, etc) kind of suck, so immunity would be better.

    If we eliminate a disease by scaring parents into vaccinating, then I’m all for it. That’s why polio doesn’t exist in the US anymore: parents were too scared to *not* vaccinate; the vaccine worked; and now we don’t have to worry about our children spending their lives in a ventilator or iron lung.

  3. Basically and fundamentally, they only care about their own children. They don’t give a shit about anyone else, they’d rather every other child that might be in competition with their precious git be eliminated. It is narcissistic, selfish, and stupid. College education does not necessarily mean any kind of smarts or analytic reasoning, unfortunately.

    I am old. I was born right on the edge of vaccination for things like polio being introduced. I GOT rubella and mumps, which worried the hell out of my mom. I was vaccinated with the MMR and polio, but my mom still worried about public places in the summer, when polio was likely to spread.

    I would like to give every single one of these stupid people a copy of Roald Dahl’s essay about his dear daughter. They should have to read it, and demonstrate they are willing to have their children die that very same way. Or be maimed by polio (the gift that keeps on giving, like chicken pox survivors get shingles, polio survivors often get it again later in life).

  4. Yes, I agree Mr. White, and many of us also studied genetics, genetic modification of neonatal brains by RNA, molecular biology, effects of mercury, aluminum, and albumin on the tissues of the body, and chose, quite prudently, NOT to vaccinate our infants. They can make choices for themselves when they are adults.

  5. As a veterinary technician I have been trained to understand basic immunology and disease transmission. My three children are all up to date on their recommended vaccines, but my two youngest are only 6 months old, so they are not yet fully vaccinated against measles (or a multitude of other diseases). If their older sister comes in contact with one of these diseases, and doesn’t wash her hands before playing with the babies, they can become infected even though my older child is safe from the disease because she is fully vaccinated. THAT is why I am concerned about other people’s decision not to vaccinate their children despite choosing to have my children vaccinated. It isn’t a fear that the vaccine will fail it is because my infants can’t be fully vaccinated at their age. I’m sure that many other parents of vaccinated children are in the same situation as I am of understanding the benefits and the limitations of vaccination.

  6. I think the FDA bears a huge responsibility in letting this level of distrust gain such a foothold. They are unable to keep up with the safety of our FOOD supply and give us transparent information about pesticides and GMOs. They are swayed by lobbyists from big pharma and big agra to make decisions that are NOT in the best interest of the people they are supposed to protect. By the time something is found to be a hazard, too many of us have already put it into our bodies, and must live with the consequences. As a country, we’ve lost faith in an agency that is supposed to keep us safe enough to take care of our most basic human need for food and water, and it is not a far stretch from there to see vaccines as an optional medication, and blog information as viable. Vote for people who want to FIX the FDA. We’ve underestimated their importance, and looked the other way at its corruption for far too long, and it is hurting us as a country in so many ways. Vaccinate your kids, and eat organic. You CAN do both! ;-).

  7. Oh dear, more propaganda to further ‘for profit’ corporations agenda to have 100% control over disease profits (certainly not health CARE). the list of side effects for the MMR alone is lengthy but includes high fever, seizures, diabetes, deafness, paralysis of the eye muscles, lack of muscle coordination, pneumonia, etc. And “Page 11 of the insert for the Tripedia vaccine we had as kids lists autism as an adverse reaction. Brain encephalopathy, encephalitis, and neurological damage are listed as possible adverse reactions on every single vaccine package insert (I hope you haven’t left reading the package inserts up to the “professionals” too.)” And on and on and on. These corporations talk out of both sides of their mouths ‘take it, it is good for you’, but you can’t sue us because we list all the side effect, but if you don’t take it, we will target you, harass you.

    And we will never know the prevalence of side effects because one has to have an army of attorneys for yourself and for your supporting doctors and scientists who will risk their careers to support you. It is a sorry situation that needs to be remedied.

  8. A few questions I have for the author:
    What made you choose to approach this as a change that needs to come from privileged white mothers’ choices and not from public health approaches? Why, for example, do you focus on these women changing their family’s choices on behalf of kids who don’t have access, rather than addressing this as a problem inherent in a system where many lack access? Why did you choose to analyze privileged mothers’ refusal motivations rather than access barriers for marginalized communities?
    Why did you only investigate the philosophy and motivations of privileged mothers’ healthcare choices, but not those of poor mothers of color and others who lack access? Did you ask these under-resourced communities if they would prefer to have their healthcare choices enforced by the government under a “public health” ethos? Without asking them, how do you know that these communities might not also opt for personal autonomy in healthcare choices, might not also have skepticism of mainstream medical recommendations. and even refuse vaccine recommendations? Why do those you say are the most vulnerable not have a voice in the solutions you present? Why do you believe that the public health profession is more trustworthy to make decisions for us than we are? Do you think this has born out, historically? If not,what has changed?
    As someone who has grown up as a mother in marginalized communities, I am very skeptical of your conclusions and your approach here.
    Justice is when people have control of their own decisions regarding their bodies and families. Informed refusal is a very sacred component of that, and of adequate healthcare. It also means we (the “vulnerable”) create our own solutions to healthcare problems, not sociologists, MDs, MPHs, or the State.

  9. Food for thought:
    Is illness wholly bad?
    Here’s an analogy: Terrorism is an increasing threat globally, 911, Boston, France etc. We could greatly reduce the chance of a plot being carried out if we were to give up our right to privacy and have our phones, tapped, letters opened, emails read and cameras installed in our homes – it would be for the greater good and we’d all be less likely to suffer from any terrorist act. Should we? Substitute terrorism for illness and surveillance for vaccines and we have a similar debate.

  10. This comparison is just a tactic to stimulate class and race warfare. It gives the poor and lower middle class, & also single parents, who believe in vaccines, a reason to be resentful of 2 parent and higher earning or higher social status families- which many poor people hold this resentment already. it uses manipulative phrasing like ” community-level immunity” – and infers that if you do not participate, you don’t care about your community, it also puts the responsibility of vaccine induced immunity on the ‘privileged’ as though because someone can afford it – it is therefore their civil duty to protect those without medical access.

    Its very false in totally ignoring and hiding the fact that mothers who choose not to vaccinate are NOT doing so because they feel that vaccines are unnecessary- because of our overall health practices and food choices- another reason for the poor to hate the rich – when the truth is that we choose not to because of awareness of toxins and adverse affects. it doesn’t address all the people who vaccinated one or some of their kids and stopped after a child had an adverse reaction. I personally know many people who do not vaccinate and do not fall into the high-earning category described above. “research shows” is not substantial enough, it would be nice if the article actually sited Any research at all.

    No mention is made of ‘outbreaks’ of infections diseases in populations where 98% have been vaccinated. The idea of herd-immunity should not be a taken as a given truth but a comforting hypothesis at best.

    “This ethos—reflecting neoliberal goals that individuals behave as informed consumers responsible for their own health—lies in sharp contrast to the tenets of public health that expect individuals to accept minimal risk to protect those among them who are most vulnerable.”

    ^ the author takes a communistic stance by placing the responsibility of public health on higher educated and higher earning parents. While I don’t argue that the overall income level of people who chose not to vaccinate (myself not included) is higher than under-vaccinated people, who are not avoiding vaccines because of informed decision but financial inability, I think the income gap’s correlation with vaccine decent, has more to do with free-time. People who earn less have to work longer to make ends meet and can’t devote that time to research – they put trust in the nightly news and doctors and people who seem to know – because they don’t have time or cannot afford access to study and make an informed choice – and as stated in the article they are aware they are uneducated and trust in those who ‘are.’

    The idea that individuals should be responsible for themselves is in sharp contrast to the beliefs of those who think public health expects individuals to accept minimal risk to protect others… OK that is a statement – but it doesn’t examine whether this expectation is ethical and fair.

    This article paints a white, educated person who chooses not to take the personal risk of many adverse affects, including death, as a selfish person who does not care about their community and public health. It is unfair to expect anyone to take the risk of dying or losing the life of their child, to protect everyone else.

    People who are immuno compromised already, or too young or infirm to get vaccines are given a medical pass? But, if it is all for public health, then even these people should get their vaccines and take the risk for everyone else if they can, right? Since the fear for them is that the vaccine could injure or kill them, and that is the same reason we all choose not to vaccinate.

    Nice try pretending to be diplomatic and credit those who choose not to with being health conscious while still calling them inconsiderate and not giving them credit for countless hours of research or heartbreaking personal loss. Way to avoid the fact that large groups of medical professionals are against mandatory vaccination.

    If you want to create class warfare why not talk about the conflicts of interest involved with the CDC, FDA and all the pharmaceutical companies that make and profit from vaccine use? Those are the rich, deep pockets – those are the inconsiderate. What is one vaccine-injured child to them?
    A statistic. What is it so a mother? Her entire world!

    Crafty, and socially manipulative, this article is very incomplete.

  11. Terrific analysis by Ms. Reich. I’ve never seen this group of educated, wealthy vaccine-refusers called “neoliberal” before. I think it totally fits.

  12. I’d like to see the actual research proving that those who don’t vaccinate are upper middle class and college educated. I hear this same claim about mothers who homeschool. But my own experience (as someone who did homeschool, did vaccinate, but had homeschooling friends who didn’t – and who now teaches college in the humanities while being vehemently against neoliberalism ) has been that a lot of working-class families homeschooled and didn’t vaccinate. The more affluent can afford to put their kids in expensive private schools if they’re struggling in school. And they’re not that likely to distrust mainstream experts, the government, or the corporations. Working-class people don’t earn much, so if they’re with a partner and have more than one child, it often costs more to put them in childcare than it would to forego the lousy paying job and stay home with them. Likewise, as Pierre Bourdieu, Paulo Freire, and plenty of others have noted, poor and working class kids tend to not fare so well in schools that perpetuate the classism and deep inequalities in this society. So they may pull their kids out if they see them suffering. This isn’t exactly neoliberalism, unless any effort to care for the particular – our own selves and those we know and love – all becomes neoliberalism.

    As for vaccination, I can only say that I’ve seen some profound changes during my own lifetime. When I was a kid in the 1970s, I never encountered kids with what we now call “autistic spectrum disorder.” I did know one child who was diagnosed as autistic, but his behavior was quite different than the behavior we’re now calling “autistic.” And it’s become so common. It’s not just that we’ve found a label for it. There’s something different going on. Denying that doesn’t really do any good because enough of us can tell, and we have no particular agenda or reason to want to see it. Those of us with kids diagnosed “on the spectrum” (and I’m one) started off vaccinating. I still went ahead and vaccinated my younger child later, but by then they’d at least taken the mercury preservative out of baby vaccines. I wasn’t sure what to do, but tried to make the best guess.

    It’s a ridiculous accusation to say that those who don’t vaccinate don’t care about any children than their own. Many of these folks volunteer in the community and give so much of their time to help others in various ways. If people want to debate the actual vaccination safety issue, that’s fine, but this effort to move past that and malign people’s motives or claim that it’s because they’re all in the upper classes (something I’ve not seen proven) is sloppy and wrong.

    I’ll end by noting that I live in an area with a lot of Somali immigrants. Some Somali folks here have been quoted in articles saying that they’re becoming afraid to vaccinate because they’ve seen their kids react right after vaccines and then not return to being how they were before. Are you really going to insist that they too are just enacting neoliberalism if some decide not to take their kids in for vaccines out of fear? It’s absurd to equate parents who care about their kids and are trying to figure out how to keep them safe with our government and its corporate bedfellows who continue to inflict austerity onto us all with low wages, precarious jobs, and a lack of a real safety net. Please… And if we’re supposed to just trust that that unholy alliance has our best interest at heart, maybe you can explain how this happened… http://www.theguardian.com/us-news/2015/apr/02/johns-hopkins-lawsuit-deliberate-std-infections-guatemala

    1. I don’t see a way to edit that so let me amend one thing to be more accurate…. Of those I knew who homeschooled (in multiple groups and in more than one state – secular and generally progressive), many were working-class, sometimes working part time as servers or in retail. (Lest I be used to prove otherwise – I went back to school much later in life and finally managed to finish, then get a master’s. Our family income always qualified us for earned income credit…) But if we proved that many working-class and/or immigrant folks are holding off on vaccination, then I guess the framing could just shift to slamming the “ignorant” working-class or “superstitious” immigrants. How about in-depth, intelligent, respectful responses to the concerns about vaccines instead?

      1. One last thing: I really appreciate your site. I just want to interrogate the assumptions made in this particular post.

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