Lateral Caregiving: Rethinking Models of Maternal Care in Pandemic Times

Pamela J. Downe

How do mothers strive to take care of each other as well as their children during times of pandemic precarity? This is the central question that I address in this paper, advancing a call to action rather than a clear answer.  Whereas most models of maternal care understandably focus on women’s nurturance of children (Apple, 2006; Brant, 2012; Furedi, 2002; Lee et al., 2014), I argue that extending the discussion to consider lateral networks of support – wherein mothers help and sustain each other – is much needed. I issue this call on the basis of over twenty years of research in partnership with Indigenous women in western Canada who embrace an ethic of collective care to raise their children and support each other. They do so while navigating health-related risks of chronic stress, avoidant coping strategies (including drug use) as well as racism and social marginalization. 

The main focus of my research throughout the past two decades has been how pandemics shape prevailing understandings of motherhood and patterns of maternal care. This work has been undertaken during the SARS outbreak in 2003, H1N1 influenza in 2009, and the current COVID-19 pandemic, all of which occurred amidst the ongoing HIV/AIDS crisis. Over 100 women have participated in a series of six separate but related projects that involved partnerships with three community-based organizations that provide services to Indigenous mothers who routinely face poverty, racism, and housing insecurity in their daily lives. All the projects have entailed qualitative and ethnographic methodologies as well as a participatory action approach that involves participants in all stages of research design, data collection, and analysis. Across these projects, I have been struck by the consistency with which the participants discuss engaging with and supporting each other as mothers. References to networks of maternal support are almost as frequent and involve the same degree of narrative elaboration as references to childcare. Yet, in the literature on motherhood, lateral care among mothers is rarely mentioned (cf. Block & McGrath, 2019). A stronger focus on how mothers support each other in pandemic times will provide greater understanding of how pandemics, such as COVID-19, both exacerbate the vulnerabilities that marginalized mothers experience as well as strengthen the mothers’ inter-reliance.   


Indigenous Peoples in Canada constitute almost 5% of the national population and 16% of the population of Saskatchewan (Parrott 2020), the central prairie province where the majority of my research has been conducted. “Indigenous Peoples” is a collective term. It refers to Inuit of the Artic regions, First Nations Peoples of the territories south of the Arctic Circle, and Métis Peoples of mixed Indigenous and European (predominantly French) heritage. The majority of the women with whom I have worked are First Nations (from Cree, Dene, and Saulteaux communities across prairies) and Métis. All are now residing in urban areas, though many still have homes in their reserve communities. 

As I write this in the summer of 2021, COVID-19 is in its third wave and continues to make front page news. In Canada, the identification of the unmarked graves of over 1,000 children located on the grounds of former Indian Residential Schools is also making news. The residential school system was established in the late 19th century in order to advance the colonial government’s agenda of assimilation and genocide. Between 1840 and 1996, some 150,000 Indigenous children were forcibly removed from their families and sent to one of 139 schools that were established and subsequently run by Christian churches with the full support of the federal government. The purpose of the schools was to separate Indigenous children from their home communities and assimilate them into European settler society. James Waldram (2004, pp. 229-30) explains that residential schools were “total institutions in which every aspect of the child’s life was regulated. Sleeping, eating, playing, working, and learning were all regulated and supported by strict codes of conduct and corporal punishment.” Residential school staff imposed harsh and violent reprimand if children spoke their Indigenous language, refused European clothing, or their adherence to Christianity was deemed inadequate

Canada’s Truth and Reconciliation Commission (2015a, 2015b) documents thousands of testimonies of former students who were traumatized by physical and sexual violence, starvation, psychological distress, and emotional abuse while attending these schools. Thousands of students died in residential schools from malnutrition and starvation, injuries from the physical abuse perpetrated by school and religious officials, and a lack of adequate medical care that allowed diseases such as tuberculosis to go untreated (Daschuk, 2013). Many of the children were buried on school grounds in unmarked graves that are only now being recovered.  This is, as one research participant put it, “the summer of sorrows and fear.”

There are hundreds of studies across the medical and social sciences that demonstrate how the intergenerational effects of residential school trauma have eroded family cohesion and Indigenous health: “When there is no support for dealing with it, trauma will be passed from one generation to the next. Higher rates of addiction, abuse, and child neglect can be found in families of residential school survivors” (Olynick et al. 2016, p. 154). Many Indigenous People who grew up during, and in the shadow of the residential school era, therefore learn coping skills (including drug use and avoidant behaviours) that are deleterious to their health. 

The apprehension of children and the disruption to Indigenous families continued after the last residential school closed in 1996. Today, there are over three times more Indigenous children in government care across Canada than during the height of the residential school days (Cull 2006, p. 140). According to the Government of Canada (2021), Indigenous children represent over 50% of all those in care despite constituting only 7.7% of the total child population. Indigenous women are subjected to unrelenting surveillance by social service personnel and they therefore live with the ongoing fear that their children will be taken away from them.  This fear is well founded.  In 2000, the Supreme Court of Canada endorsed the rule that Child and Family Services (CFS) workers do not need a warrant to apprehend children they feel may be in potential danger. “This ruling,” Randi Cull (2006, p. 150) points out, “opens the door for ‘crystal ball’ apprehensions; child welfare agents are provided the authority to ‘predict’ whether abuse ‘might occur.” Many CFS workers as well as service providers are well trained to make judicious decisions. However, the latitude in predicting potential risk opens the door for racism and classism to drive the process. 

The historical and ongoing apprehension of Indigenous children foments a deep distrust of medical and social service providers. This is the context in which Indigenous mothers in Saskatchewan (and elsewhere in Canada) must navigate the health-related risks and challenges of the HIV/AIDS, influenza, and coronavirus pandemics. “My guard is always up,” a young mother of two toddlers told me in 2009 when she was concerned that they were among those suffering from the H1N1 influenza. “My little one is real sick, but I am petrified that if I go to the doctor, I’ll be put under the microscope. I’m scared that they’ll just look for any reason at all to take my babies away from me.”

Lateral Care in Pandemic Times 

Mothers are central to the prevention, treatment, and recovery efforts during pandemic times (just as they are during non-pandemic periods as well). How they accomplish these tasks will depend on their social locations, resources, and broader networks. I argue that for women whose social location is marked by structural violence – wherein systemic forces of colonialism entail discrimination, resource depletion, and uprootedness that cause enduring harm – the pandemic response relies on community-based collective care rather than state-sanctioned public health protocols. Mothers work together to support each other by pooling resources, assessing and sharing information, and offering advice and counsel. They coordinate their efforts in order to alleviate the everyday fear that the colonial history of child apprehension engenders. This is lateral care.  Many of the women who have participated in the research projects have partners and family members on whom they routinely rely for support and childcare. However, the bonds forged among the mothers who share a community and similar life circumstances are consistently described by research participants with significant narrative elaboration and emotion. Lateral care is depicted as its own form of support. 

I use the term lateral care to distinguish the support that mothers provide each other from the intergenerational nurturance that they provide children and elders.  Lateral care is undertaken among women who hold comparable social positions in their community and are located similarly amidst the intersectional forces of power and oppression.  Indigenous women in Saskatchewan who live with poverty, housing precarity, and food insecurity rely heavily on lateral care to get by. Lisa, originally from a Dene community in the provincial north, explained: 

I wouldn’t be able to look after my kids, or even get through the day, if I didn’t have the other moms here in this ramshackle neighbourhood pulling together. They can count on me to welcome their kids into my apartment any time, to make them bannock (bread), and to do whatever I can for them. And I know they do the same for me. We take care of each other so that we don’t got to ask the schools or clinics or social workers for help. As soon as any one of us asks one of them for help, we are risking everything. When any one of us Aboriginal moms ask for help, we are risking having our kids snatched away. It has always been like that. So even when the whole world is worried about this influenza, even if we get real sick, even when we need medicine for HIV, we don’t ask for anyone else’s help. We take care of each other.     

Lisa’s comments are not anecdotal. They were echoed by well over 90 other women who participated in the research projects that span the last two decades. Mothers forge bonds with each other in order to avoid the risk of racist judgment and the kind of child apprehension that Indigenous women in Canada have endured for generations. This is most apparent in relation to the HIV/AIDS pandemic.        

HIV/AIDS has hit Saskatchewan particularly hard.  The provincial rates are almost three times higher than the national rates, with Indigenous People representing over 75% of the those affected by it (Downe, 2021). HIV/AIDS-related death rates in Saskatchewan are four times the national average, with Indigenous people dying at over twice the rate of their non-Indigenous counterparts (Salloum 2015). Unlike the rest of the country, where the most common mode of transmission of HIV is penetrative sex, Saskatchewan’s HIV epidemic is driven primarily by injection drug use (Downe 2021). The HIV/AIDS pandemic therefore overlaps with the opioid and addiction crisis that currently poses one of the major health challenges of the decade. 

HIV and addiction are highly stigmatized. Seeking medical treatment entails confronting that stigma and risking harsh judgment.  Research participants reported that they avoided seeking medical care or social service support whenever they could.  “It’s just not worth the risk,” Lisa said, emphasizing the points she had made earlier in our conversation: 

I mean, I got the other moms here. They take good care of me when I feel so sick and need a break, or when I’m scared to go out ‘cause it’s flu season, and because my immune system is crap and the flu could be deadly to me. 

She then added once again: “Us moms look after each other so we don’t got to take risks.” Indeed, during the 2009 H1N1 (“Swine Flu”) pandemic, the lateral care among the mothers with whom I worked provided what one mother called “a lifeline.” 

The 2009 H1N1 pandemic affected approximately 10% of the Canadian population, causing a total of approximately 430 deaths (Low & McGeer, 2010). The fear of contracting the viral illness was heightened among the research participants who, like Lisa, were HIV-positive and therefore immunocompromised. Sarah, a Métis woman from the northern urban centre of Prince Albert, was adamant that one of her primary roles as a mother now living in the province’s largest city of Saskatoon, was to support the mothers in her neighbourhood:

We got to take care of our kids. That’s job one. But right up there with doing that is looking after the other moms. What would this place be without us moms? As Métis and First Nations mothers, our job is to raise strong, safe, and resilient kids. But our job is also to support each other. To link arms, hold each other up, and keep us strong and healthy. We do this by working together to keep us out of hospitals, doctors’ offices, and away from CFS. 

Sharing resources is a one of the ways that mothers care for each other, but so too is sharing information. Sarah continued: 

When Swine flu hit, a lot of us were really scared. I mean, it was a real threat, right? But, there was some good information on Facebook. It wasn’t all the crazy [stuff]. So, whenever we would get together, which was pretty much every single day, we would talk about it. I’d pass my phone around, and we’d read about it. We’d talk about what we needed, and what we had to do. We made soup for each other, and we always had a thermos of tea ready to drop off to somebody whenever we went out. That’s the kind of thing we did. It started with getting the right information right here at home so we didn’t have to risk anything by going to the doctor. 

Together, then, the women assessed and shared health-related information as well as food, tea, and friendship in order to avoid the risk of judgement and child apprehension. 

As an extension to sharing information that the women collectively assess as trustworthy, they also share advice. Mothers rely on each others’ counsel during times of hardship, including pandemic times. “I trust the advice from the moms here way more than I trust the scheming doctors, teachers, or social workers,” Sarah said, echoing the same sentiment that Lisa and others frequently expressed. Sarah continued: “I mean, Graciela’s baby would have been taken away from her if we weren’t there when she needed us. And Graciela did nothing wrong except be an Aboriginal foster kid.”  In 2003, Graciela was a young Cree mother who lived in the same neighbourhood as Lisa and Sarah. Graciela quickly became integral to the network of mothers who worked together to offer support and guidance.  She had grown up in a series of foster homes until she turned 18 when she moved into the Lisa’s apartment complex. Her involvement in the provincial childcare system as a child in addition to her Indigenous heritage meant that when she was pregnant at 19, one of her nurses at the prenatal clinic issued a birth alert. As journalist Bonnie Allen (2021) explains: 

Under the birth alert system, a mother-to-be could be red-flagged on her medical records as a potential threat to an infant if she faced challenges – such as homelessness or domestic violence – or if she had previous interaction with the child welfare system. Then, at the time of birth, the hospital would alert social workers who would often take the baby into provincial care. 

After learning that the birth alert had been issued, Graciela was scared. “I thought for sure they’d take the baby away, that the baby would end up in foster care like I had been. I didn’t know what to do,” she recalled. She continued:

So, I hopped on a plane and went to Toronto. My boyfriend had moved there right after I got pregnant so I thought, ok, I’ll go be with him for a while. We weren’t doing so good but I thought we could work things out, and I could get away from the birth alert stuff. But I didn’t know how bad SARS was or how bad the trip would look. 

Things did not go well between Graciela and her boyfriend and they broke up. She spent two weeks with her Toronto-based friend, Li, in her Chinatown apartment before running out of money and heading back to Saskatoon. 

When Graciela’s social workers (assigned to her after the birth alert had been issued) asked her where she had been, they admonished her for going to Toronto during the SARS outbreak after a travel-warning had been issued. Graciela turned to Lisa, Sarah, and the other mothers on whom she relied. They counseled her to tell the social workers that she had not stayed in Toronto but, instead, had travelled directly to London, Ontario, some three hours away. One of the mothers knew London well and explained that it was not as affected by the SARS pandemic as Toronto had been. They advised Graciela not to mention her friend Li while the anti-Asian racism was intensifying because of SARS. “Their advice saved my baby,” Graciela explained some 10 years later. The social workers’ concern about her trip to Toronto had been assuaged. “I know it’s not a good thing to lie,” Graciela said, “but I had to get away from that birth alert. I trusted what the moms here said, and sure enough, they were right. We take care of each other.” 


The lateral care that characterized the research participants’ lives during the influenza, SARS, and ongoing HIV/AIDS pandemics is, once again, a source of support during the COVID-19 pandemic. Although research restrictions have prevented me from in-person interviews in the past year, I have been in regular contact with the service providers in the partnering organizations that the research participants frequently access. The workers describe the same kind of lateral care among mothers that emerged in previous pandemics. Indigenous women are relying on other and trusted mothers for resources, information, and advice. They are turning to each other for counsel and comfort as the toll of the pandemic collides with the trauma of the recovery of unmarked graves of children on former residential school grounds. A staff member at Prairie Harm Reduction, the primary HIV/AIDS organization that serves the central and northern regions of Saskatchewan, explained: 

The moms here tell me all the time that there is no way they could be getting by with all the COVID restrictions and now the residential school trauma if they didn’t have each other. They are a tight community of mothers and they are each other’s lifeguard when the waves hit. I know that sounds dramatic but they literally keep each other safe and alive. 

Once research activities can safely resume in Saskatchewan, I hope to explore the dynamics of lateral care more directly. I also hope that other Mother Studies scholars will do so in the context of their work as well. Understanding lateral care as well as intergenerational nurturance will continue to round out and enrich work on motherhood and maternal care. A sustained focus on mothers’ interconnectedness and mutual support will help scholars, advocates, and service providers understand the ways in which pandemics intersect with long-standing and ongoing historical forces to shape motherhood itself.    


Allen, B. (2021, February 1). Mothers call for support not threats, as Sask. And P.E.I. end birth alerts. CBC News. 

Apple, R. (2006). Perfect motherhood: Science and childrearing in America.  New Brunswick, New Jersey: Rutgers University Press. 

Block, E. & McGrath, W. (2019). Infected kin: Orphan care and AIDS in Lesotho.  New Brunswick, NJ: Rutgers University Press.

Brant, J. (2014). Aboriginal mothering: Honouring the past, nurturing the future. In A. O’Reilly (Ed.), Mothers, mothering, and motherhood across cultural differences (pp. 7-40). Toronto: Demeter Press.

Cull, R.  (2006). Aboriginal mothering under the state’s gaze. In D. Memee Lavell-Harvard & J. Corbiere Lavell (Eds.),  Until our hearts are on the ground: Aboriginal mothering, oppression, resistance and rebirth (pp. 141-156).  Toronto: Demeter Press.  

Daschuk, J. (2013).  Clearing the plains: Disease, politics of starvation, and the loss of Aboriginal life.  Regina: University of Regina Press. 

Downe, P.J. (2021). Collective care: Indigenous motherhood, family, and HIV/AIDS. Toronto: University of Toronto Press. 

Furedi, F. (2002). Paranoid parenting: Why ignoring the experts may be the best for your child. Chicago: Chicago Review Press.

Government of Canada. (2021). Reducing the Number of Indigenous Children in Care. Ottawa: Statistics Canada. 

Lee, E., Bristow, J., Faircloth, C. & Macvarish, J. (2014). Parenting culture studies.  New York: Palgrave Macmillan.

Low, D.E. & McGeer, A. (2010). Pandemic (H1N1) 2009: Assessing the response. Canadian Medical Association Journal, 182 (17), 1874-1878. 

Olymick, J., Li, H.Z., Verde, M., and Cui, Y. (2016). Child-rearing practices of the Carrier First Nation in Northern British Columbia. Canadian Journal of Native Studies, 36(1),153-177. 

Parrott, Z., Indigenous Peoples in Canada (2020). In The Canadian Encyclopedia. Retrieved from 

Salloum, A. (2015, December 29).  Rates of HIV deaths in Saskatchewan.  Regina Leader-Post. 

Truth and Reconciliation Commission of Canada (TRC). (2015a).  Honouring the truth, reconciling for the future: Summary of the final report of the Truth and Reconciliation Commission of Canada.  Ottawa: TRC.

— (2015b).  The survivors speak: A report of the Truth and Reconciliation Commission of Canada.  Ottawa: TRC. 

Waldram, J.B. (2004).  Revenge of the windigo: The constructions of the mind and mental health of North American Aboriginal Peoples. Toronto: University of Toronto Press.

%d bloggers like this: