"I Live in a Very Bourgeois World, I Don't Live in the Outskirts": Childhood Non-vaccination and the Intersection of Race, Class and Gender

"Understanding vaccine hesitancy as a social and political phenomenon is essential to avoid the reductionism that associates non-vaccination with misinformation or negligence."

Although more and more national and international health agencies are highlighting the need to understand social, political, and economic contexts related to vaccine hesitancy, less attention has been paid to the institutional and structural dimensions shaping perceptions and behaviours that play a role in health decision-making. This article analyses how race, gender, social class, and spatiality markers intersect and are reflected in decision-making about childhood (non)vaccination in Brazil.

For the qualitative studyin-depth interviews were conducted with 19 caregivers in Florianópolis who chose not to vaccinate (fully or partially) the child(ren) up to age six under their care. Florianópolis is the capital of the state of Santa Catarina, with a good Human Development Index (HDI), a low infant mortality rate, and high coverage of adequate sanitation. Florianópolis has low vaccination coverage for the infant immunisation scheme, and both data from the city and national data point to lower vaccination coverage the higher the social stratum. The guardians taking part in the study were mothers (n = 11) and fathers (n = 8); most of them self-declared white (n = 16), belonging to higher socioeconomic strata (n = 14) and with higher education or postgraduate degrees (n = 12).

The issue of non-vaccination more commonly came from women/mothers, who accessed information about vaccines in their social circles and studies on pregnancy and motherhood. In these families, the man was generally a passive consumer of the information actively brought by his partner, culminating in mutual agreement. In the case of couples who disagree about vaccination, regardless of whether one of them is for or against it, it was the women/mothers who mentioned a fear that something would happen to the child because the father's/man's wishes had not been followed.

The decision to (not) vaccinate was also found to be a reflection of each family's social belonging - that is, the position each family occupies in the structures of social class, race, and spatiality. For example, access to information was mentioned as an advantage these families consider they have. Speaking other languages is considered an important factor in accessing information from other countries, which, according to these families, have a greater accumulation of knowledge about (non)vaccination - referring especially to the European continent and the United States. One parent said, "We're a very privileged family, right? We know what children often come from unstructured families, who don't have the chance to talk to the child about the need for this kind of preventive medicine - in fact, suddenly they don't even know what preventive medicine is."

The socio-spatial organisation of the city was mentioned several times as a factor that should be taken into account when deciding (not) to vaccinate, as well as contact (or the lack of it) with people from certain areas of the city. One respondent said, "My son, who we take more care to feed, who has a more suitable environment, is forced to take [the same] vaccine as that child who lives in the favela, who has poor sanitary conditions, who doesn't eat well, whose mother can’t give him that support, right?" Per the researchers, "racial perceptions are also constructed from the spatial distribution of cities, structuring public life and how racial groups relate to each other in social space."

Although all the families mentioned here belong to the same group in terms of their choice not to vaccinate all or part of their children, their economic status and symbolic capital differentiate them in terms of their use of social facilities. For example, access to private schools allows children to move around freely even if they are not vaccinated.

Thus, the study found that gender was an important marker in intra-family decision-making, while social class, race, and spatiality emerged as important markers in the perception of who are the "us" who don't need vaccines and the "others" who do. "The hesitant caregivers belonging to the middle and upper classes in different countries are the ones who feel authorized to question state policies and bear the possible consequences of non-vaccination..."

The findings are discussed using the theoretical framework of whiteness and neoliberal parenting studies. From an intersectional perspective, the analysis may help enhance the effort to critically understand how class positioning, gender identity, and race shape experiences of vaccination and childcare, revealing unequal distributions of power, prestige, and privilege. In short, the findings show that "the decision not to vaccinate, far beyond a position on vaccines, is also a way of positioning oneself in the social web, of belonging to a group and of communicating values and beliefs."