By Courtney Thornton and Jennifer A. Reich
“Black & Brown parents actually do get penalized for not being able to afford vaccines or take time off to vaccinate children on time. CPS (child protective services) gets involved for medical neglect & child endangerment But ytpipo (white people) deliberately choose not to vaccinate their children with no consequences.”
This observation was offered by a Black mother in an online forum for other Black mothers who had concerns about childhood vaccines. As the COVID-19 pandemic has illustrated, the success of public health campaigns, including those related to vaccines, depend on trust. Yet as this mother and others like her note, state efforts to support public health do not necessarily respond to minoritized communities as to white families who question the need to vaccinate.
Mothers who reject or delay vaccines for their children are most likely to be white, college educated (or have at least some college), married, and have higher household incomes. These mothers describe their decisions to reject vaccines in terms of their desire to feel like good mothers who are active decision-makers on behalf of their children. These mothers perceive vaccines as a personal consumption choice meant to optimize their children’s health. They view themselves as experts on their own children, free to accept or reject medical advice as they see fit. This practice is labor and resource intensive and comes with judgments from other mothers and society at large. Yet, white mothers seldom fear state sanctions for doing this in ways that mothers of color do.
Our findings in our recent Gender & Society article provide insight into how Black mothers who opt out of vaccines by choice view the stakes of their decision, including fears that they may be more likely to experience state surveillance and sanctions because of it. Much of the research on Black children who are not fully vaccinated has focused on structural barriers that limit access to vaccines. These children, labeled “under-vaccinated”, are more likely to be children of color, have families with lower incomes, and a mother who is not college educated and is likely to be single. Although structural barriers do limit access to healthcare, the focus on lack of access may ignore Black mothers’ agency and the ways their decisions reflect negative experiences with health systems. To understand this issue, we analyzed online discussions geared towards and used by Black mothers. We show that although Black mothers raise many of the same concerns about vaccines as do white mothers, they view their decisions as riskier since they lack the same privilege that protects white women from state policing and punishment.
Medical racism, in its many forms, is indisputably gendered. Black women face discrimination, heightened scrutiny in interactions with healthcare providers, and inadequate care that leads to disproportionate illness and premature death. Black women also encounter gendered racism in other social institutions that are interconnected with healthcare, including schools and welfare systems. These experiences contribute to Black women’s low levels of trust in public health systems. This often extends to their children and informs their daily parenting strategies.
The women in our study shared oft-cited concerns about vaccine safety and efficacy. But unlike white mothers, they saw vaccines as a white technology created without, and sometimes in contradiction to, the interests of Black people. Citing unfounded claims that Black boys experience high rates of autism after vaccination, one mother insisted,
“its wasn’t created by us for us, hence why so many of our black boys have autism, because we react differently… We have left holistic natural way to take for face value western eurocentric ways.”
Once Black mothers decide to avoid or delay vaccines for their children, they find themselves at odds with the state and its actors. Women who posted in these forums discussed how more privileged parents could avoid state surveillance and punitive action in ways they could not. These concerns often revolved around state laws that require evidence of vaccination as a condition of enrollment in schools or childcare settings. Many mothers recognized that some states are more permissive and allow non-medical exemptions from vaccine requirements for school attendance, but saw those states as often places that could be hostile to families of color. Illustrating this, one mother weighed the challenges of living in primarily white areas against the promise of being able to opt out of vaccines without losing access to schools for their children:
“I hear terrible things about Texas and being a black woman though. Unfortunately a lot of the more scary conservative, racist, sexist politicians are in the states/cities with the [more] choice friendly options for vaccine.”
Lower income Black mothers felt especially vulnerable due to the increased level of scrutiny and loss of privacy they experienced when enrolled in public assistance programs. Because the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) focuses on the health of children, many states require up-to-date vaccine records and regular well-child visits to access the benefits. Women who posted worried that WIC caseworkers would report them to CPS and worried about allegations of medical neglect. They often strategized what information they would share with pediatricians who often collaborate with WIC caseworkers. As one mother cautioned, “Advice do not use govt services. Not to use WIC or welfare because they will force you.” Another mother confirmed these concerns:
“I’m in the WIC program well kind of. I stop going because my WIC worker keeps talking about my kids check up appointments and vaccines. I told her several times I do not vaccinate.”
Pervasive stereotypes of Black women impact all Black mothers, irrespective of class, forcing them to manage their interactions with arms of the state, including healthcare, education, and welfare systems, to protect themselves and their children. Unlike white mothers who are more likely to view physicians as service providers or consultants, the mothers in our study discussed pediatricians as potential threats who could report their families to state agencies, an apt fear since evidence shows physicians are more likely to report Black families to CPS. Mothers referenced this fear as a reason they felt distrustful and alienated from healthcare systems. As one mother explained,
“I try to avoid CPS in all so I do a yearly checkup, lie about vaccination status etc… As soon as they would start to get suspicious of me saying delayed vaccinations, I would find another doctor.”
As Black mothers online identified the freedoms white mothers have, they pointed to the ways inequality powerfully shapes and constrains their options, their ability to exercise choice. This study shows how race, class, and gender are inextricably linked to views of vaccines specifically and of the state more generally. We do not suggest that vaccines are unimportant. Rather, the efficacy of public health campaigns depends on trust in leaders, scientists, and medical professionals, as the COVID-19 pandemic has shown. Structural gendered racism in healthcare and in interactions with long arms of the state fuels Black mothers’ distrust, which informs the medical decisions they make for themselves and their children. The result may be that programs intended to improve children’s health may actually undermine Black families’ access. A deeper understanding of these dynamics should inform public health outreach in communities of color and requires medical professionals to more critically reflect on their power as extensions of the state.
Courtney Thornton is a Master of Arts in Sociology student at the University of Colorado Denver. Her research interests include the influence of state policies and systems on the health and well-being of families, and the intersecting impact of structural gender- and race-based oppression on the lives of Black women.
Jennifer A. Reich is Professor of Sociology at the University of Colorado Denver. Her research examines how individuals and families weigh information and strategize their interactions with the state and service providers in the context of public policy, particularly as they relate to healthcare and welfare. She is author of Fixing Families: Parents, Power, and the Child Welfare System and Calling the Shots: Why Parents Reject Vaccines, and is editor of the books Reproduction and Society (with Carole Joffe) and The State of Families.