Black Mothers and Vaccine Refusal: Gendered Racism, Healthcare, and the State

"Black women's experiences with healthcare systems and practitioners inform perceptions of and decisions about vaccines."

Research on children who are not fully immunised in the United States (US) tends to identify white affluent mothers as most likely to opt out by choice and Black mothers as more likely to face structural barriers that limit access to vaccines for their children. This paper analyses social media posts and online discussions among Black mothers in an effort to provide a more nuanced picture of their reasons for refusing vaccination.

The paper begins with a review of vaccine refusal in the US context. Parents who do not fully vaccinate their children tend to share information with others in their networks, in person or online. These networks increase perceptions that vaccine refusal is normative and offer support for views of health that challenge information from public health or medical experts. As outlined here, mothering is gendered work that expects women will actively strategise in support of their own children, sometimes embracing or rejecting expert advice. Furthermore, the article reviews literature that has shown how: "Mothers from racial or ethnic minority groups routinely face racist systems and interactions that question their competence as mothers, force them to expend energies to ensure their children's safety, and further erode their trust in and access to experts and institutions....Black mothers' decisions about their children's care reflect a desire to advocate for their children in the context of gendered and racist interactions with healthcare systems and awareness of medicine as a long arm of the state."

The study analysed websites, blogs, social media posts, and comments that reflect vaccine-critical sentiment among Black mothers. In total, the researchers analysed 249 threads with 311 posts. Of those, approximately 250 (about 80%) were from Facebook groups; the remainder were from Twitter.

The "findings highlight how Black mothers discuss plans to refuse vaccines for their children and how these views reveal perceptions of the state as foreclosing their individual choices and threatening their autonomy as mothers." Specifically, the analysis indicates that Black women share the concerns of white women, including about vaccine ingredients, toxicity, and necessity. However, their concerns focus more directly on the role of the state and inequality in how states regulate individual parenting choices and police Black motherhood. In brief, the Black mothers whose online activities are studied here:

• Discuss vaccines as a "white technology" and view them with suspicion, arguing for an Afrocentric approach that questions vaccines and the public health systems that promote them.
• "[I]dentify white women's privilege to reject vaccines without facing the same risks or consequences they perceive they face. In particular, Black mothers highlight how structural gendered racism limits their options and constrains their choices. They identify schools, charged with verifying vaccine compliance, as a challenging space, but note that options to avoid public schools or to homeschool draw on class privilege that might be out of reach for many Black mothers."
• "[D]escribe how interactions with healthcare providers or representatives of government agencies create particular challenges to their desire to reject vaccines. Black mothers caution each other that challenging vaccine recommendations made by those with bureaucratic power may result in reports to CPS [Child Protective Services] or cost them access to public assistance or nutritional support programs." They describe efforts to strategise interactions with paediatricians and school personnel to avoid being reported to the (state) authorities.

Taken together, the findings "reveal how Black mothers view childhood vaccines and the systems that support their use as extensions of state power that are alienating and disempowering....[These] findings highlight the need for public health policies and practices that move away from institutionalized gendered racism that harms Black families, undermines trust in public systems, and may inadvertently increase disease vulnerability among Black children."

The researchers do not suggest that all Black mothers share these views or reject vaccines for their children. Rather, they argue that "analysis of the subgroup who do so reveals the gendered and racialized policing of Black motherhood, which makes what white mothers define as personal choices riskier and of potentially greater consequence."

Per the researchers, this study highlights the need for more research, such as on how Black mothers view state policies and institutions. Further research to measure attitudes toward immunisation among marginalised communities and to identify practices that differ from dominant narratives of white motherhood could also be illuminating, considering that the majority of the measles outbreaks in 2019 in the US were linked to tight-knit ethnic communities. Considering the key role trust plays, a deeper understanding could inform public health outreach in communities of colour and encourage medical professionals to reflect more critically on their "policing" power.

In conclusion: "Black women's experiences with structural gendered racism in interactions with healthcare and education systems shape vaccine decisions and should be taken seriously."