Stephanie Laudone & Marisa Tramontano
Childhood vaccinations have become the subject of much debate in the United States. Until recently, families nearly universally chose to vaccinate, exemplifying a broader trend of trust in expert systems to dispense the benefits of scientific progress without critical inquiry. When there was a decision to be made about vaccination, discussion remained between families and their doctors. Currently, an unprecedented number of families are choosing to delay or refuse vaccination, for example, 25% of parents believe children’s immune system could be weakened by too many vaccines (Reich, 2016). More, there is now a controversial national discourse, involving the medical establishment, politics, and popular culture. What brings families to the decision to delay or refuse vaccination? What informs their choices? How do vaccination choices fit into broader trends in pregnancy, birth, and childrearing? In this paper, we offer one sociological explanation – involving both cultural expectations of contemporary motherhood and its place in the larger sociocultural milieu – for this shift in behavior.
Political theorist Jurgen Habermas (1984) argues that historically, the system (privatized spaces emphasizing goal-oriented activity such as the market economy, the state, and bureaucracies) and lifeworld spaces (geared toward communication and understanding) were coupled and operated harmoniously. Along with other rupturing effects of modernity and industrialization in the West, the system and the lifeworld uncoupled. Operating separately, some spaces were governed by the cold, strategic rationality of the system and others were sovereign spaces free from those logics. Habermas argues the system and its logics increasingly colonize lifeworld spaces. A visit to the family doctor, for example, now often involves the entire ‘medical establishment,’ including but not limited to equipment suppliers, insurance companies, the pharmaceutical industry, and gatekeepers to clinical trials. Key stakeholders in these industries sometimes fund medical research (UC Berkeley: Understanding Science, 2017). This is at once a widespread trend – we see the colonizing logics of ‘the system’ in universities, elections, and co-op boards to name a few – and quite specific to pregnancy, birth, and childrearing. When obstetrics and pediatrics became standard medical specialties in the late 19th century, traditional midwifery knowledge and natural remedies for ailments in children were sidelined. In other words, “mama knows best,” gave way to “doctor knows best.”
In this paper, we suggest one way to think through this complex terrain: mothers are struggling to reclaim the family arena as a lifeworld space; a return to “mama knows best.” This is not to say all mothers are engaged in this work nor that there has been a wholesale rejection of expert knowledge. Rather, among some mothers, there is growing distrust of the intentions of experts who represent the interests of the system in favor of experts who center lifeworld values. According to Bobel (2002), some mothers “have wrested control of their personal lives away from institutions and experts and others who claim to ‘know best’ and returned it to the site of the individual family…this hard-won control does not rest with the individual; rather, it is surrendered to nature. The natural mothers exalt nature as a force to be trusted and respected” (p. 26-27).
In other words, alongside increasing distrust of the colonized medical system in family decision making, there has also been a recent trend toward natural, holistic, intuitive parenting, more generally. Nathman (2014: p. 1) argues a culturally and historically contingent construction of the good mother is “continuously embedded in our lives” through movies, television, and particularly through social media, such as Facebook groups and ‘mommy blogs.’ The pressures to be a good mother have always existed, but the defining features of a good mother change. It is crucial to note from the outset that access to the good mother label is unequally and unevenly distributed, significantly influenced by designations of race, class, gender identity and sexuality. However, the influence of the cultural construction remains: “Motherhood ideology validates only identity claims of mothers who meet a certain criteria […and] endorse[s] the married, white, middle class, hetero family as ideal and a ‘motherhood hierarchy’ rewards those who most closely conform to it” (Padavic & Butterfield, 2011: p. 177-178.
In our current milieu, the good mother is an intensive mother (Hays, 1996). Bobel (2002) explains some intensive mothers often tend toward holistic, natural styles of care over efficient and scientized (Katz Rothman, 2016) approaches to family management and decision making. While not all intensive mothers are natural mothers, we suggest a connection between the centering of children’s needs and desires of intensive mothering, paired with prioritization of naturalness and distrust of the medical system, come together as a reclaiming of the family arena as lifeworld space. When mothers come to reject the systemization of the family and work to make it a lifeworld space, they take many of the decisions onto themselves, including vaccine choice, no longer trusting the word of their pediatrician, a representative of the system of western medicine that disparages intuitive, natural parenting. Jennifer Reich (2016) asserts in her book on vaccine choice, “the shift of responsibility from the state to the individual shapes how parents view vaccine choice” (p. 69). This shift to individualist parenting is central, as the anxieties about parenting and child health that were previously handled within the system are now the responsibility of the lifeworld mother.
In sum, we argue the individual choice of some families who choose to delay or refuse vaccination is informed by 1) the prevailing cultural construction of ‘the good mother’ who practices intensive mothering and 2) a trend toward intuitive and natural mothering, which come together to reveal a larger project of American mothers – often with class privilege – to reclaim the lifeworld space of the family from the medical system. In what follows, we review the trajectory of mothering ideologies, focusing on intensive (and natural) mothering as the current construction of ‘the good mother,’ as well as background on vaccinations. We explain our approach, then explore social media parenting groups, including a secret alt/anti-vaxx group, as crucial informants in users’ vaccine choices. In these spaces, mothers (re)produce the good mother. When this expectation is brought into contact with the broader trend of distrust in Western medical and pharmaceutical industries, more mothers are making different vaccination choices their children.
The Good Mother: Intensive Mothering and Natural Parenting
Addressing the good mother, as developed by Nathman (2014), variants of intensive mothering as described by Hays (1996), and Bobel’s (2002) exploration of the natural turn in parenting, we being with an overview of the historical development of the good mother as “intensive” and “natural.” Our goal in this section is not to give an exhaustive account, but rather to place some ideas about motherhood present in the social media data within its historical trajectory.
The History of Mothering and the Construction of the Intensive Mothering Ideology
The expectations and constructions of a good mother have varied over the past several centuries, and it is not be possible to attend to the full and complete history of mothering here. Instead, we offer an overview of contemporary constructions of the good mother, locating its inception in overarching social and cultural changes. Current constructions of mothering take root during the second half of the 19th century, as the dominant view of children changes from “demonic” and “animalistic” workers in the home or for the family, to innocent people in need of protection and nurture (Hays, 1996: p. 22). Motherhood, specifically white, middle class motherhood, was reimagined and increasingly valorized and protected in patriarchy. It is in this context that the ideology of intensive mothering begins to develop, wherein the mother is central caregiver who should ideally “lavish copious amounts of time, energy and material resources on her children” (1996: p. 8). Hays offers the following summary of intensive mothering: “Good childrearing requires the day-to-day labor of nurturing the child, listening to the child, attempting to decipher the child’s needs and desires, struggling to meet the child’s wishes, and placing the child’s well-being ahead of their [mothers’] own convenience” (Hays, 1996: p. 115).
The cultural and social conditions are especially important for the meanings of mothering and childhood at this time. As industrial capitalism takes over in the West, separate spheres are formed with men leaving the home for paid labor, while women are in charge of hearth and home. In contrast to the cold, competitive public sphere, the home is heralded as a haven and sanctuary, warm and nurturing, of which women and mothers were the keepers. It is in this broader sociocultural context that the lifeworld space of home and family became palpably uncoupled from the system-like qualities of the formal labor economy.
This cult of domesticity quickly took hold as the preferred family formation, but the internalization of the good mother via intensive mothering was uneven and incomplete. On one hand, working class families simply did not have the material resources to adopt this new model of family economy. For working class families, immigrant families and families of color, without the benefits of the protection of patriarchy and a middle-class income, there was little separation between work and family, public and private; fathers, mothers and children were working to contribute to the maintenance of the family, still following the rules of the family economy. Since working class mothers often could not choose to value motherwork over paid work, thereby giving up some authority over childrearing, this, in turn, was used to enforce hierarchical superiority over working class families. Yet, contradictorily, black domestic servants were often employed in the homes of white, middle class mothers, not only in charge of the household labor, but often taking on the responsibilities of childrearing. While mothers had internalized the ideology of intensive mothering and maintained ultimate control over the home and childrearing, they had not done so completely, at times ignoring and outsourcing the labor-intensive work of childrearing. In short, intensive mothering is the dominant, superior childrearing method, which was only made available to white, middle class women. These patterns continued largely throughout the 19th century.
(White, middle class) mothers know best until the turn of the 20th century, when it is determined that the mother’s instincts are no longer sufficient in childrearing, and mothers need to be re-taught and trained through expert and medical intervention. This sea change exemplifies the colonization of the lifeworld space of the family by the logics of the system. Childrearing practices are best left to experts, and it is mothers’ jobs to keep up with the latest science-based advice and strategies. This shift was echoed not only through medical doctors, but mothering magazines and infant care books (e.g. Spock, 1946). As Sharon Hays (1996) documents, “Many of us had mothers or grandmothers who were admonished to refrain from picking up their infants when they cried, told to set rigid schedules for the child’s feeding, changing, sleeping, and play and urged to establish elaborate bookkeeping systems to track bowel movements and childhood diseases” (p. 39). In short, lifeworld maternal instinct was no longer enough, and is replaced with systematized scientific methods. To be clear, the work of childrearing was not outsourced to medical professionals, rather women had to learn and be trained under the expertise of professionals, keeping up with the latest information, advice and scientific research. This difference is crucial: it is not that childrearing was left to the system, rather, the logics of the system and its privileging of scientific, technical expertise had colonized the lifeworld space of the family with the mother at the helm.
Over the course of the 20th century, the role of experts and medical professionals becomes more concretized in the lives of mothers and babies. Referred to as “the permissive era,” childrearing becomes increasingly child-led; the needs and wants of the child centered in many families. Expert-written and science-based childrearing manuals are a primary source of knowledge for mothers. Geographic mobility disrupts the extended kinship networks and childrearing becomes an increasingly individualized task, accomplished by mothers informed via experts and manuals. As women become primarily and solely responsible for the rearing of their children, they are also solely responsible for the outcome of their children. Miller (2007) argues that “contemporary constructions of the ‘good mother’ continue to be shaped by universalistic and essentialist assumptions found in the popular discourse that shape women’s lives” (p. 340). Women are exposed to messages about instinctual maternal capacity throughout much of their lives and certainly their pregnancies, often rooted in biological determinism, where mothering is often framed as an innate ability of women, while being guided by expert, medical professionals whose presence and narratives and figured prominently in contemporary constructions of mothering (Miller, 2007).
One of the most prominent baby care manuals at this time, Baby and Child Care (1946), by Dr. Benjamin Spock, reaffirms essentialist notions of maternal care and capacity, saying, “Trust yourself. You know more than you think you do” (p. 3), while offering a step-by-step instruction manual of expert advice. And while some of the recommendations of Dr. Spock came under fire years after the release of his manual, “the emphasis on maternal bonding, the fear of maternal overindulgence, the centering on the child’s needs and desires, the stress on the child’s psychological and cognitive development, and the belief in the importance of experts persists” as cornerstones of the intensive mothering ideology (Hays, 1996: p. 49). Further, as the cultural and social conditions shift in the latter half of the 20th century, with increasing numbers of women in the paid labor market, the ideology of intensive mothering persists, in part because of the ubiquitous influence of parenting manuals, which demand intensive mothers: child-centered, labor-intensive and expert-guided child care, that is solely the work of women and considered more important than any other paid work (Hays, 1996: p. 54).
Other important cultural movements during this time affected working class and poor families more directly, specifically the enforcement of compulsory schooling, child labor laws and the kindergarten movement. These reforms, disrupting the family economy structures of many working class families, resulted in changing labor and childrearing patterns: as children left the paid labor force and entered schools, mothers stayed home with their young children, entering the labor market once their children entered school. The consequence is that the system also colonized working class families and ideologies and behaviors of the intensive mothering framework become more accessible to women of working class backgrounds.
Natural Intensive Mothering
As the ideology of intensive mothering spreads and mothers become progressively more invested in the work of childrearing and responsible for the outcomes of childrearing, they take on increasing responsibility in the health and wellness of their child. Thus, as the ideology of intensive mothering develops, so too, has a parallel mothering ideology known as natural mothering. Natural mothers choose to dedicate their full attention to intensive mothering, but are marked by three specific elements including a commitment to simple living, attachment parenting, and cultural feminist theory. Natural mothers use their “intuition as a practical guide, […] their notions of mothering at odds with mainstream notions about the proper way to raise a family” (Bobel, 2002: p. 31).
The natural intensive mother exists in contradiction to the “bad other mother” who “goes with the flow of the mainstream, doesn’t question conventional wisdom, ignorant, duped by powerful, child hostile, expert and institution dependent culture” (Bobel, 2002: p. 84). Natural intensive mothers are parenting from an individualist approach; prioritizing their children’s needs within institutions and advocating for them when necessary. To do so successfully, parents invest a significant amount of time into the labor of knowledge consumption and research, talking with friends and family, sharing information online and on the internet, all while centering their children’s uniqueness.
Mothers often come to natural intensive mothering through a series of negative experiences with various institutions and agents including schools and teachers, the medical field and pediatricians, and child care providers which lead them to seek alternatives. As Bobel (2002) says, a “woman taps into a conventional system of care to meet a need, finds the care inadequate, and turns away from conventional care to search for alternatives that take into account ‘basic things’ (read: natural and commonsensical) such as nutrition, lifestyle and state of mind” (p. 114) and “take control from a tradition that she perceives as detached and impersonal and return in to an ancient philosophy of health care that she perceives as integrated and personalized” (ibid). The combination of negative experiences with institutions and the re-valuation of natural remedies is a central component of the struggle to reclaim the lifeworld family from the impersonal, profit-hungry system. Vaccines, as we argue below, constitute one of the most controversial examples of maternal choice in this regard.
Vaccinations and Vaccine Choice
There is a long and complicated history of vaccinations in the U.S., involving a variety of social actors and agendas. Throughout this history, the needs of the state, the market and the family intersect and conflict, the most frequent conflict involving vaccine refusal and concern for individual agency. As most know it, the vaccine story begins with the arrival of smallpox which resulted in the death of thousands in the 1700’s. Exploitative from their introduction, the first version of a vaccine was developed, in part, through testing on vulnerable populations, including prisoners and orphans. Vaccination soon became incorporated into public life, first through state policy, via the 1813 “An Act to Encourage Vaccination” law, the creation of the first national vaccine agency, and then as a requirement to enter schools beginning in 1823 (Boston), and adopted across most schools in the country by the later 1890’s. The earliest objections to vaccinations reflect some of the concern that families have today: violation of individual liberty and the potential dangers of the vaccine. These concerns were brought to light in many court cases, until the U.S. Supreme Court decided in the case of Jacobson v. Massachusetts (1905) that compulsory vaccinations were allowed if necessary for public health, essentially confirming a shared community obligation. This public struggle continues over the next century, a history that is well documented in Jennifer Reich’s work (2016). The current climate of unease and distrust toward vaccines takes shape in the early 1990’s, with mounting concern over the side effects of the vaccines and the potential toxicity of the ingredients. Most notably, concerns over vaccine-induced autism come from a 1998 British medical journal article, which links the vaccine for measles, mumps and rubella (MMR) to autism. The article was widely denounced in the early 2000’s and retracted in 2010, but concerns remain and are part of the reason for vaccine refusal.
Natural Intensive Mothering and Vaccine Choice
As a result of the growing distrust of mainstream medicine, natural intensive mothers come to reject the systemization of vaccines and it becomes the mothers’ responsibilities to make informed choices about their children’s vaccination practices. “Parents who prioritize natural living, aim to have good nutrition for themselves and their families, and voice a commitment to protecting the natural state of the body….” (Reich, 2006: p. 102). In order to make the best choices for their children, parents become the experts in their child’s health care; they know their children best and they are best able to weigh the pros and cons of disease with possible adverse reactions. This is what sociologist Deborah Lupton refers to as “lifestyle risk discourse,” where responsibility is on the individual to avoid health risks, not just for their own benefit, but to benefit of the larger social world (Reich, 2016: p. 68).
In the individualist view, “disease prevention is a process of personal risk assessment, lifestyle adjustment and individual choice” (Reich, 2016: p. 69). More specifically, risk assessment is an individual choice for each parent for each child, which evaluates benefits of vaccines, and severity of disease (if the parents choose not to vaccinate, and the child does get sick), along with an assessment of vaccine risk informed by family history, views of children as vulnerable and perfect, and maternal instinct or intuition. These risk assessments and vaccine choices are informed by the knowledge gathered from friends and family, advocacy organizations, and natural living publications. According to Reich (2016),“This shift of responsibility from the state to the individual shapes how parents approach their choice about whether to vaccinate” (p. 69). Most concretely, the individualist view suggests that mothers know best how to care for their unique children without applying general, universalized standards, such as the Center for Disease Control (CDC) schedule.
Parents who choose to delay or refuse vaccination often focus on natural living as a way to prevent illness and keep their children healthy and safe. These practices are time and labor intensive, but mothers view the work as worthy efforts for the benefit of her child. Privileging the vulnerable, perfect and natural state of their child, mothers rely on natural solutions like breastfeeding and good nutrition, a diet of organic and unprocessed foods, and limiting social contact to manage and control risk. Simultaneously, Reich (2016) argues, “vaccine choices are mothers’ choices…as childhood outcomes reflect most heavily on mothers” (p. 73). Since the lifeworld emphasizes local knowledge and sociality among women, parenting groups on social media, often geared toward a narrow definition of mothers, offer crucial informants on natural parenting choices in general and vaccine choice in particular.
In what follows we draw upon observations from twelve Facebook parenting groups to demonstrate the ways natural intensive mothering, a trend toward individualism in parenting choices, and a broader distrust in institutions emblematic of “the system,” come together as a rejection of the CDC vaccination schedule; a manifestation of reclaiming the lifeworld space of the family.
Located in a feminist methodology, this work is informed through our own experiences in motherhood, as the work informs our experiences in mothering. In this, we acknowledge our own subjectivity as our experiences have influenced how we think about these issues. Drawing from our own lived experiences and giving voice to the experiences of others allows us the opportunity to learn about ourselves and other women, but it is also a key mechanism through which existing power structures can be challenged. These are the contributions of feminist methods (Reinharz, 1992).
Following our own birth experiences and into our children’s infancy, we became immersed in various conversations of parenting that were happening on social media. Beginning with mainstream and public parenting pages, our observations became more focused as our own experiences did. The observations presented here draw from twelve Facebook groups and pages including: three national parenting and mothering pages for New York City-based parenting pages, four natural NYC-based parenting pages, and one secret alternative vaccination group. We refer to these different groups in the following ways: mainstream parenting pages, natural parenting pages, and alt/anti-vaxx pages, and specify whether the pages are local or nationally based. While we only include one group specifically dedicated to anti- and alternative vaccinating parents, it certainly is not the only space where parents discuss vaccine choice and where parents with children on alternative vaccination schedules participate. It is through our subjective position about our long-term observations in these online fora that we come to make our analytic claims about vaccination choice. An inherent limitation of social media research, we do not have access to the intent and reason behind the choices mothers and families make about their vaccination practices.
As noted here and in previous research (Bobel, 2002; Reich, 2016) the ideology of intensive mothering, and further, of natural intensive mothering certainly does not characterize all, or even most, mothers. Further, mothers who refuse vaccinations for their children or select vaccines to be administered on an alternative schedule are a relatively small, but growing group of mothers (Reich, 2016: p. 6-7). That said, in this work, we are studying a subset of mothers: those who indicate their positions on vaccination are inspired by one or a combination of the following: 1) natural, intensive approaches to mothering, 2) an individualist, intuitive approach to decision-making, and 3) a broader distrust of state power and profit-driven industries. The observations presented here offer an in-depth and intimate account of a small group of mothers and are illustrative of how growing social media discourse informs vaccine choice.
The analytic claims we make about vaccine choice as a manifestation of mothers reclaiming the lifeworld family are our own, informed through these observations, though never explicated by the social media users. Much like the literature reviewed about mothering styles, we use our authorial interpretation to place social media posts into thematic categories. However, Hays (1996) demonstrates the relationship between natural intensive mothering and the privileging and (re)valuing of the warm, communal logics of the lifeworld over the cold artificiality of the system:
Even the emphasis on the natural quality of children and childrearing speaks to its caring and cooperative rather than impersonal and competitive character. It is implied that there is something unnatural, false and therefore bad about life in the outside world, while that which is natural is good. … What is natural and good is the purity of love, caring, and sharing, untouched by what Rousseau called the “deceit, vanity, anger, and jealousy” of civilization (p. 66).
In her work, Bobel (2002) notes natural parenting has implications for every aspect of parenting (e.g. healthcare, feeding, discipline styles) and on how parents navigate choices throughout every social institution (e.g. education, medical establishment). First, we explore the ways the notion of naturalness and alternative knowledge production play a role in vaccine choice, then move to intuition and individualism, and conclude by discussing the role of systematized institutions.
The Natural Body and Natural Remedies
The tendency toward natural and alternative healthcare is immediately apparent in the conversations on vaccine choice. This comes through in some of the observations in two different ways: 1) natural illness prevention, and 2) perception of disease as natural. Conversations on the local natural and alt/anti-vaxx pages often center on illness prevention through natural measures, which include questions and comments on ways to naturally boost immunity and support the body so it has less of a chance of catching disease and illness, as well as best practices to fight off infection and illness (e.g. “We are skipping the rotavirus vaccine for my 6-month-old. What are the best supplements to give to keep their immune system strong?”). The answers to these sorts of queries, depending on the age of the child, tend to fall into alternative or homeopathic remedies, and very often breastfeeding is recommended as first defense. For example, there are quite a few posts where parents look for alternative ways to aid the body in ridding a fever, and while the responses include over-the-counter fever reducers, such as acetaminophen and ibuprofen, the suggestions received most positively were natural remedies such as vinegar and warm water compresses and elderberry tinctures. In other posts, parents seek alternatives to prescribed antibiotics for ear infections, upper respiratory illnesses and the like, expressing a strong desire to avoid the use of antibiotics, particularly. Among some parents that are more stringently anti-vaxx, is the view that some diseases (e.g., chicken pox) are immune boosting and offer better protection from disease recurrence. In these exchanges, vaccines are constructed as a barrier to health, an unnatural intervention that gets in the way of the body doing what it is supposed to do, naturally (Reich, 2016). As Reich (2016) points out, everything about vaccines is unnatural: the way in which they enter the body, the immunity they grant, and that they “undermine [the] natural state” of a child’s first days (p. 98). As the lifeworld represents a return to nature, idealization of the natural body and use of natural remedies is an act of reclaiming, in and of itself.
For some parents, opting out of vaccines all together is not a real option – especially if they are enrolling their children in public schools – and they do vaccinate their children on schedule, despite reservations. Some of these parents come to the local natural and alt/anti-vaxx Facebook community looking for ways to detox their children from vaccines, receiving advice for remedies that are holistic and natural, including apple cider vinegar and bentonite clay. While parents have not changed their minds on the danger of vaccines, and are forced to comply with state policy, they are looking for mitigate the risk and for natural ways to keep their children safe. In this sense, mothers can moderate the colonizing effects of the system, even if they cannot prevent them.
Natural Knowledge Production
The local, natural group pages are meant to serve as resources for parents, offering knowledge on various solutions, treatments and remedies that are rooted in alternative healing and non-western medicine. Groups like this often use the “files” section to share information on various topics including: group rules and philosophy, healthcare provider suggestions, brands to use, natural and organic recipes, and school choices. In many ways, these communities have become more culturally significant in the lives of mothers and replaced the parenting manuals of the 70’s, 80’s and 90’s. In her work, Hays (1996) offers a review of three specific manuals published between 1983 and 1994, all best-selling works and the most referenced by mothers during this time (e.g. Brazelton (1987) on family reflections; Leach (1994) on a stage theory of child development). While some differences appear in format and focus of the books, Hays argues that the advice given in each follow the same philosophical model of intensive mothering and emphasize the same things: the mother is primarily responsible and should use intensive childrearing methods.
More recently, as social media figures more prominently in the lives of mothers, they turn to social media group pages for community-generated resources and advice, similar to how their mothers may have relied on the expert guided parenting manuals. Among many of the groups we observed, intensive mothering is still the preferred philosophy. Yet, the changes in the ways parenting and childrearing knowledge are produced and disseminated is representative of the larger cultural shifts in the natural intensive parenting movement. Less trusting of the mainstream experts, mothers take the advice of other mothers more seriously: it often aligns with their own existing values, and it holds more value because it is considered to be based on lived experience.
There is one major exception to the strong preference for community-generated knowledge and the advice of alternative or holistic doctors and pediatricians. Dr. William Sears and his wife, Martha, a nurse, are the leaders of the attachment parenting philosophy, and authored several books on childrearing, covering birth, feeding, breastfeeding, discipline including the most popular title, The Baby Book. Among their children, two of whom are medical doctors, Dr. Bob is most known for his work, The Vaccine Book, which is the single most recommended manual among anti/alternative vaccinating mothers in our observations. Though the entire Sears family, particularly Dr. Bob, has come under some criticism from mainstream media for their delayed and selective immunization schedules, they remain trusted sources to parents who seek alternative medical advice. While natural intensive mothers generally avoid expert childrearing advice, they do turn to the experts who are considered outsiders to the establishment. In this sense, it is almost as if the mainstream criticism of Dr. Bob helps to establish his credibility among mothers who reject mainstream medical systems.
Individualism and Instinct
Some mothers we observed on social media report they make different vaccinating choices, not solely motivated by a commitment to naturalism, but also because they see their parenting choices as deeply individual for their unique child, often relying on intuition to make decisions. In many of the conversations on vaccine choice, instinct emerges as an important justification. While not explicitly referred to as maternal, childrearing instinct is gendered. It is overwhelmingly mothers who are participating in these discussions and debates, and the instinct referred to belongs to the mothers of the group. Cultural expectations of mothering mean that much of the labor and childrearing decisions are the mother’s responsibility. As Reich (2016) argues, “vaccine choices are mothers’ choices” (p. 73). The issue of vaccine choice tends to fall under the mother’s responsibilities, and this is represented in the observations where most of the conversations about vaccine choice are happening among mothers. Because they are the ones investing the time, energy and resources into learning about vaccines, and natural health more generally, mothers are often the ones making the choices about their children’s health and wellness (Bobel, 2002; Lareau, 2003; Nathman, 2013).
Gender also plays a role when for some mothers, the father of their children did not agree with the choices they made about vaccines, leading them to the alt/anti-vaxx community to best decide how to convince their children’s father otherwise. They perceive their children’s father to be trusting in system knowledge and come to their community looking for ways to convince the father of the dangers of vaccines, of the benefits of natural living, and the dangers of “big pharma.” In other words, mothers come to their community for strategies to keep the patriarchal privileging of science over traditional women’s knowledge and intuition out of the family to ensure its purely lifeworld qualities. In one specific conversation, one mother is seeking help explaining her justifications for delaying vaccines, and it becomes clear in the conversation that she needs to show her husband not only the potential negative effects, but also that she is competent and capable of handling the choice. In our current social world, where mainstream medicine is the respected and expected choice of parents, those choosing otherwise need to validate their choices. While these frames only reinforce the heteronormative family arrangement, in our observations we find mothers are the parents turning to the lifeworld space, back to the community and shared knowledge via social media to convince the child(ren)’s fathers, who represent the colonizing system, of the validity and credibility of alternative knowledge sources.
In closed group conversations among alt/anti-vaxx mothers, intuition and instinct in child-rearing choices are central. The notion that each mother does what is best for her child is invoked constantly among anti/alt-vaxx parents, leading parents to make medical (and other childrearing) choices based only on the needs of their own children. Individualized intuition is valued, and the conversations among anti/alt-vaxx parents reflect this. Mothers rarely make suggestions about what other parents should do, and hardly ever are those suggestions framed as community protection or benefit. This pattern does not devalue the significance of community for anti/alt-vaxx families, but is informed by an individualist and intuitive parenting perspective.
Parents are also assessing risk at the individual level in these conversations: risk of disease, risk associated with vaccine, and natural ways to manage those risks. Importantly, mothers indicate in these conversations that they are the ones best qualified to make these assessments, and even though risk is uncontrollable and unknowable, “parents claim expertise and focus on the ways they can individually maintain control and promote health: through diet, breastfeeding, social contacts or evaluation of possible vulnerability. As parents, they are uniquely qualified to manage uncertainty for their children. As such, they insist it is their call to make” (Reich, 2016: p. 208). Parents do consult their Facebook communities when making individual choices about vaccines, which to skip or delay, and which, if any, to get. In nearly all the groups we observed, discussions of vaccines often begin with a parent posing a question about the risks and benefits of various vaccines and the dangers of possible illnesses (e.g. “How bad could the chicken pox be? I had it!” “What can I expect if my baby gets pertussis?”). Once armed with what they perceive to be scientific knowledge and evidence-based data provided by community members and friends, and a renewed confidence in their instinct, parents are often reassured about the choices they are making.
The significance of instinct reemerges when vaccine debates break out, as they often do, on the mainstream neighborhood parenting pages. In these debates, alt/anti-vaxxers are often disparaged by pro-vaxxers as being selfish (making choices that endanger the community at large) and anti-science (resistant to the evidence-based studies pro-vaxxers share to defend their positions.) Both of these characterizations are not how alt/anti-vaxxers seem to experience themselves and serve to further the sense of individualism some parents feel. These general debates often begin with a parent inquiring about a specific vaccine’s effect, or even about the general vaccine schedule. It does not take long for these posts to gain traction, developing into heated and lengthy debates among the pro-vaccination parents and anti/alternative-vaccination parents. While pro-vaxx parents cite allopathic medicine and pediatric advice as their justification, anti/alt-vaxx parents draw on justifications that are rooted in individual choice and parental instinct. “Trust your gut, mama!” “You know what’s best for your child!” and “Listen to your instinct!” are common types of responses in these kinds of conversations.
However, this tendency among alt/anti-vaxxers is often framed in a disparaging way by pro-vaxxers in online debates as a part of the overall ostracization of anti/alt-vaxx parents (e.g. “Haven’t they ever heard of herd immunity? I’m not letting my child near theirs. I’ll know who to thank when my child catches an entirely preventable disease”). Herd immunity, the indirect protection from preventable disease that occurs when virtually all members of a population are vaccinated, emerges as an important justification for vaccinations, one that pro-vaxx parents used often in their debates, reinforcing to questioning parents that “this is bigger than your child” or “this is about protecting the community” and “this is a public health issue.” In these justifications, pro-vaxx parents seem inherently concerned for community health, placing the needs of the public over the individual at times.
In these debates, the notions of evidence-based research and scientific research are invoked, often wielded by the pro-vaxx crowd in efforts to debunk the beliefs of anti/alt-vaccinating families. Within these discussions, the frame of individualist parenting is again visible, a defense for parents who choose to follow a vaccine schedule that is alternative to the CDC schedule. Despite the evidence presented, parents often cite their own instinct and expertise of their child as the most important indicators. It is this framing that, in part, fuels mothers’ desires to question the system and regain authority over their children’s healthcare choices (Bobel, 2002: p. 114). Often, intuition and individual experiences are prioritized over science and parents with “vaccine injured” children (the vaccine injury label is applied to mild reaction of fever or rash, processing disorders, autism and other neurological damage, and perceived toxicity) often cite their own experiences as evidence that the science is not right for everyone.
Although anti/alt-vaxxers are often cast as anti-science by the larger pro-vaxx community and within mainstream parenting groups, they do not experience themselves to be anti-science. In fact, many of the conversations we observed, particularly on the anti/alt-vaxx and natural pages, but even within vaccine debates on mainstream parenting pages, mothers who are defending their choice to deviate from the CDC vaccine schedule do so with what they refer to as “evidence-based research” and draw from what they believe to be scientific research. In addition to the natural knowledge production raised above, some of the more popular pages from which alt/anti-vaxx mothers draw their sources from include the Living Whole website, the Healthy Home Economist website, the Sears family website, all of which report on vaccine injury, toxicity, and corruption within big pharma. Overwhelmingly, mothers believe themselves to be informed and to be making the best choices for their children, based on evidence-based research and of course, instinct.
In sum, mothers are producing and sharing alternative expert knowledge within social media groups that values naturalness, gendered instinct, and individual choice. While this knowledge is often dismissed by pro-vaxxers, quick to label alt/anti-vaxxers as anti-science, anti-expertise, and anti-evidence, we argue this is yet another manifestation of the conflict between the system and the lifeworld. Pro-vaxxers trust the expertise of scientific studies. Some alt/anti-vaxxers see these scientific studies as products of the system’s steering media, always corrupted by a profit motive and a quest for power. These mothers are not rejecting expertise; they are generating new expertise that upholds the values of the lifeworld.
Distrust in ‘Systematized’ Institutions
In describing the ideological components of natural mothering, Bobel (2002) points out that resistance against mainstream culture and western medicine is central to natural mothering,
Natural mothers rail against systems of control in the form of institutions and so-called experts. Tiny acts of rebellion fill their days. When a mother treats her child’s ear infection with garlic oil instead of the doctor-recommended antibiotic, she resists. […] When she ignores another school enrollment period or state-mandated vaccination date, she challenges the generally accepted norms of “good parenting” (p. 105)
Throughout our social media observations, we noticed some parents who deviate from the CDC vaccination schedule also shared a distrust of and even contempt for institutions that, in our frame, represent the corrupted and constraining logics of “the system.” While general distrust of the pharmaceutical industry is evident in many of the vaccine debates on various pages, parents on the natural and anti-vaxx pages spent time discussing the various specific concerns they have, including profit motivation, toxicity, and transparency
Much suspicion exists around the pharmaceutical industry and their capacity for profit from vaccines, though indications of this distrust appear more frequently on the natural parenting pages. Western medicine is considered profit-motivated and this colors parents’ views of the current vaccine schedule. The measles, mumps and rubella vaccine (MMR) is used as an illustrative example in this argument. The vaccine is given in two doses, the second of which is given for the small percent (around 4%) of the population who do not build immunity from the first dose. In theory, patients could have a blood draw to check titers and verify immunity after the first dose, but instead, a second dose is given to everyone to cover the gap, and the concern among some parents is that the reasoning for the mandated second dose is profit-motivated. This case represents many of the concerns parents expressed over western medicine and “big pharma.”
In addition to the profit-driven culture, concern over the vaccine ingredients was a significant for parents that came up in many of the observations. Sourced with the inserts from the vaccines themselves, parents discuss at length the potential toxicity of the vaccine ingredients, particularly concerned about the interactive effects among vaccines that are given at the same time or combined into the same vaccine. MMRV (measles, mumps, rubella, varicella) is a good example of this and emerges frequently on most of the Facebook groups whenever the vaccine discussion comes up. The consensus for many parents seems to be that since adding varicella to the MMR formula, the risk of febrile seizures increased slightly, it is not worth it, and thus, mothers will ask for the vaccines separately.
Much of the concern over vaccine toxicity stems from distrust in big pharma to be transparent with them about the ingredients in the vaccine. Distrust in big pharma represents not just a distrust of knowledge production or science, but a distrust in corporations and institutions, who do not represent individual best interests, but the interests of the public, and in the view of individualist parenting is thereby less trustworthy (Reich, 2016). Simply put, parents do not trust the vaccine-makers to tell them what is in vaccines, or that those ingredients are not toxic. Tying these concerns together, on general pages, when people debate about scientific studies about vaccines, the role of big pharma in financing studies that show vaccines to be harmless so they can continue to make money off them often comes up.
Distrust of big pharma also extends to mainstream medicine. Mothers have much more direct exposure to and experience with doctors than they do the pharmaceutical industry. Therefore, while interconnected, rejection of mainstream medical expertise and procedures is often based on negative personal experiences.
As mentioned, it is clear from our observations that some parents are distrustful of mainstream medicine because of its system-like logics and not because they understand themselves to be rejecting “science.” It bears repeating that the notion of science itself is subject to much interpretation and filtering by parents, depending on their own perspectives. Among the local, natural and anti-vaxx pages, parents express a distrust of mainstream scientific knowledge due to concerns over corruption within medical research and institutions, which then calls into question the validity of the research. Further, the broad brush with which parents are painted as either pro- and anti-science based on their vaccine choice is an oversimplification that does not actually represent what parents believe about their choices. Parents who vaccinate on alternative/delayed schedules or not at all believe their choices are supported by science, often citing pediatricians and medical doctors who practice holistic or alternative medicine, and what is presented as evidence-based research. Essentially, these differences are rooted in a distrust of mainstream medicine and big pharma, and ultimately the system, rather than a rejection of “science.” While many parents do not appear to have the necessary training to determine “real” science from “pseudo” science, what is important to note is that many of them represent themselves as open to science and evidence-based fact.
The other common concern when seeking recommendations for new doctors was fear of a “paper trail.” In many practices, doctor’s will document the vaccine refusal and ask parents to sign the paper. Parents are worried about the documentation, fearful of the potential backlash from other institutions (schools, for example) and are often searching for doctors who will allow them to refuse vaccine without documenting the refusal. The concern is great enough that when looking for pediatrician recommendations, mothers often inquire about the record keeping practices as a key deciding factor.
Parents often turn to their Facebook group pages for recommendations of various types including doctors and medical professionals. This is particularly common in the local natural and anti/alt-vaxx groups, and among parents who are following different vaccine schedules for their children and are looking for doctors who will not only accept them as patients (it is not uncommon for mainstream doctors to deny patients who do not vaccinate their children per the CDC schedule), but respect their right to make their own choices about vaccines without judgment or pressure. Parents discuss the discomfort and fear that comes up when facing new doctors, unsure of their policies and philosophies, concerned about being judged for their choices.
To attend public schools in New York City, children need to comply with the CDC vaccination schedule. The exceptions to this rule are for children for whom immunizations would be detrimental to their health and children whose religious beliefs prohibit them from vaccination. Compliance with state mandates are required for participation in the institutional and for anti/alt-vaxx parents, this presents a problem for which the solution is filing for a religious exemption, no matter their religious beliefs. Filing for a religious exemption is a long and uncertain process, causing parents significant anxiety as they go through great efforts to prove that they are sincere about their religious beliefs. For those who make it through the religious exemption process, the fear does not subside. On the natural and anti/alt-vaxx pages, mothers who have secured religious exemptions for their children talk about the insecurity of the position they are in. In one example, a mother shared her story of her son, who had a religious exemption, who was moved from his classroom because there was an immuno-compromised child in the same room. After the move, which the mother understood but was unhappy about, a case of the chicken pox broke out in her child’s new classroom, during which her unvaccinated child was removed from the school for 21 days for fear of infection. In this case, the mother had done everything she needed to legally circumvent the vaccine mandate and ensure her son’s participation in the educational system, and it still seemed to her that he was being excluded and ostracized for his vaccination status, almost as if she could not escape the backlash. Other mothers express fear of quarantine or other such exclusions, although they do not seem to common among this group of students. These concerns stem from the general social exclusion of anti/alt-vaxx families but also documented cases of state involvement with parents who opt out. For example, several participants talk about Child Protective Services (CPS) intervening directly after hospital births in the cases of rejection of vitamin K or the erythromycin eye drop, taking temporary custody of the child in order to administer the interventions. These claims are not substantiated but they need not be; the possibility alone is enough to generate further fear and distrust of the system. After all, “parents who opt out of vaccination for their children do so in a social and legal context in which their decisions are met with disapproval and even legal sanction” (Reich 2016, p. 233).
Over time, a clear pattern emerged within the natural and anti/alt-vaxx groups on distrust of systematized institutions. The control said institutions exert over the lives of parents and their child-rearing decisions are something that mothers struggle with, navigate around and invest significant time and resources to avoid. In their view, big pharma cannot be trusted, as it is driven by profit. Mainstream pediatricians are complicit in the system, rarely voicing their own objections or validating the concerns of parents. Schools comply with the same standards of health care and wellness that are set by the state, and are motivated by ulterior forces. And it seems, to some parents at least, that these institutions are in conversation with each other, working together to reassert state power and compliance into the lives of the individuals who work within the systems.
Habermas (1984) argues that the system turns people into clients of the state. Rather than being understood as informed citizens capable of making choices, they are merely clients who use services, including education and health care, and who must be managed. This results in the state interfering in domains that were once free of such influence and thus undermining individual choice in favor of tight social control. Therefore, we see mothers turning to each other to work through how to maintain their families as lifeworld spaces through alternative knowledge that draws on traditional practices as well as strategies to navigate the corruption and entrenchment of system-like logics in their families, in the face of institutional management. Natural intensive mothering, a distrust of systematized institutions, and the prominence of individualist choice come together as a reclaiming of the lifeworld space of the family from the system: its unnaturalness, its subjugation of traditional knowledge, its corruption, its judgments, and its privileging of the collective over the individual. Taken together, using feminist methodology to understand social media users through their own sets of definitions and priorities, some mothers who delay or refuse vaccination do so within this complex sociocultural terrain. Given the limitations of social media (specifically the inability to capture subjective intent and experience), our future research on this topic will include in-person interviews to further understand how families make choices about vaccinations and how they navigate the broader cultural terrain as anti/alt-vaxx families.
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 Broadly, there are two different sets of reasons that children are not vaccinated. Children who are not up to date on vaccines due to unequal access and resources in health care are undervaccinated. Children who are not up to date on vaccines due to personal choice are unvaccinated. According to Smith, Chu, and Barker (2004: 187), “Undervaccinated children tended to be black, to have a younger mother who was not married and did not have a college degree, to live in a household near the poverty level, and to live in a central city. Unvaccinated children tended to be white, to have a mother who was married and had a college degree, to live in a household with an annual income exceeding $75 000, and to have parents who expressed concerns regarding the safety of vaccines and indicated that medical doctors have little influence over vaccination decisions for their children.” Our intention is to understand some of the parents with class privilege who are motivated by the factors discussed throughout our analysis to voluntarily opt out of vaccination. It is beyond the scope of this paper to examine inequality in access to vaccines.
 Cultural feminism asserts there is an innate “female essence” and works to empower women by owning and re-valuing traits and behaviors traditionally associated with femininity.
 We observed national natural parenting pages, local parenting groups based in New York City (ones that were neighborhood based, others that focus on natural parenting), and two groups for parents whose children followed an alternative vaccine schedule (or none at all).
 On social media, mothers tend to refer to “different vaccination choices” for their children. This refers to any to any deviation from the schedule suggested by the Center for Disease Control. Those who make different vaccination choices are not a monolithic group. “Slow-” and “alt-vaxxers” spread out over time and/or delay vaccines or pick and choose among the 14 required by the state. “Anti-vaxxers” oppose vaccines entirely. There is also variation within these designations in terms of choice and motivation. Throughout the analysis we primarily refer to pro-vaxxers and alt/anti-vaxxers as two distinct groups.