We’re in the midst of a measles outbreak, and the headlines make clear where the blame lies: parents. “The Real Reasons That Parents Have Stopped Vaccinating Their Kids.” “The Ethical Negligence of Parents who Refuse to Vaccinate Their Kids.” “Sue Parents Who Didn’t Vaccinate? Absolutely.” A headline on a popular Slate essay on growing up unvaccinated referred to “my ’70s health-nut parents.”
But that essay itself makes clear that it’s the author’s mother who was the primary nut in the family. And there are plenty of other reasons to raise the extremely uncomfortable question: Do we have a problem with parents making bad decisions about vaccines, or do we have a problem with mothers making bad decisions about vaccines?
First, the obvious: Women make the vast majority of health care decisions for their children. A 2013 report from the Kaiser Family Foundation found that three-quarters of mothers choose their children’s doctor and follow through with recommended care. Just 16 percent of fathers have primary responsibility for taking their children to the doctor. Even assuming that most couples discuss major family medical decisions together, it’s women who direct and implement those decisions.
When it comes to making decisions about vaccines, however, women turn out to be likelier than men to place trust in the wrong places. A remarkable 2011 report in the journal Pediatrics found that mothers were more inclined than fathers to trust vaccine-safety information (er, “information”) coming from television shows, magazines, and celebrities. Thirty-one percent of mothers said they trusted vaccine information from celebrities “some” or “a lot,” compared with 19 percent of fathers.
The study’s lead author, Gary Freed, is careful to point out that women as a whole are still much more likely to trust their children’s doctors than to trust other sources. Indeed, women and men report similarly high levels of trust in the safety of the measles-mumps-rubella vaccine. So it’s important to note that we are talking about a small subset of parents who are doubters. But, he added, “We did find that women look at or trust—either some or a lot—information sources that are not necessarily well informed, and not necessarily based on anything other than anecdotal experience.”
Freed, the founding director of the Child Health Evaluation and Research Unit at the University of Michigan, argues that the public-health community needs to be more sensitive to the fact that different people find and respond to information in different ways. What that should look like, precisely, isn’t yet clear, as journalist Seth Mnookin recently reported in the New Yorker. Last year, Freed co-authored a study based on a randomized trial that offered parents different vaccine-information “interventions,” including dramatic anecdotes about an infant who almost died of measles. None of the interventions increased the parents’ intentions to vaccinate.
Freed’s 2011 study also found mothers were likelier than fathers to place trust in stories from fellow parents who claim their children were injured by vaccines, which is more understandable but still alarming considering the overwhelming scientific evidence in favor of vaccine safety. As Jenny McCarthy put it in her 2008 book Mother Warriors, “Who needs science when I’m witnessing it every day in my home?”
Research suggests women are likelier to fall for pseudoscience in some other areas, too. We are 10 percentage-points more likely than men to believe that humans have not evolved over time (they have), and 19 percentage-points more likely to say genetically modified foods are unsafe (they aren’t). Women are also likelier to use alternative medicine, which suggests overlap with the anti-vaccine community’s rhetoric about toxins and impurities.
To put it delicately, women also seem to rely on a wider network of sources when it comes to medical information. A paper published last year found that we are 30 percent likelier than men to rely on anecdotal health care information from the Internet. In a way, this makes sense: If men were doing the health care research for their families, perhaps we would see this number reversed. Women also experience distinct periods in their lives, including pregnancy, which require specialized medical care—and make Googling strange new symptoms practically irresistible.
So, how about some anecdotal evidence? (Hey, I’m a woman!) Every Facebook conversation I’ve seen on vaccines has been dominated by, if not exclusively populated by, women. For a recent story I reported on a particular subset of vaccine-doubting parents, I didn’t find a single male source with those concerns. A January New York Times article on anti-vax parents quoted five mothers (including one who had changed her mind) and no fathers. And this is nothing new. In a recent interview with the L.A. Times, historian Elena Conis identified a similar gender breakdown in a 1982 NBC news report titled “Vaccine Roulette”: “All these mothers speaking about their children's vaccine reactions: ‘I went to the Physicians’ Desk Reference, we need to be skeptical.’ And all these male doctors: ‘Vaccines are safe, the mothers don’t know what they’re talking about.’ ” Conis argues that the current anti-vaccine community has roots in the feminist health movement of the 1960s and 1970s.
Yes, there are men involved in the anti-vaccine movement. The researcher whose fraudulent 1998 study linked vaccines and autism is a man, and so was the founder of the Autism Research Institute, which promoted spurious links between mercury-containing vaccines and autism. There are plenty of fathers and other men who are outspoken on the issue. And on the politically charged question of whether children should be required by the government to be vaccinated, men are actually slightly more likely than women to say that parents should be allowed to make the final decision. But when it comes to the purported dangers of vaccines, all the evidence we have seems to point to women as the ones driving the conversation.
It’s dicey to discuss this gender disparity for a number of reasons, including the fact that “blame moms” is not a thesis that tends to endear one to the sisterhood of womankind. “Women like stories, men like data” is also one of the most tired stereotypes around. Most troubling, perhaps, is that women’s accounts of their own medical issues have historically been belittled by the mainstream medical establishment, their symptoms—fatigue, chronic pain, anxiety—have been dismissed, and they have been blamed not just for their own problems, but for their children’s. Researchers spent decades accusing insufficiently warm “refrigerator mothers” of causing their children’s autism.
“There is a history of paternalism in medicine,” said Jordynn Jack, an associate professor of English at the University of North Carolina at Chapel Hill whose 2014 book Autism and Gender explores how ideas about gender have affected debates about autism, including the vaccine controversy. “The language that’s used by the scientific community to communicate that vaccines are safe sometimes falls into that paternalistic model. ‘I’m telling you what’s right, and I’m telling you as a scientific authority,’ ” Jack said. “For some people that’s persuasive, but for others it’s not.” In her book, Jack dissects how contemporary mothers often think of themselves as “warriors” on behalf of their sick children, fighting first for a diagnosis and then for treatment. If procuring basic care for a sick child feels like a battle, then why trust the enemy’s propaganda?
In the end, however, it’s possible to have all the sympathy in the world for vaccine-skeptical parents and still conclude that they are dangerously wrong about one of the most important public-health questions of the moment. To move forward, maybe it’s time to appeal more directly to the parents who are driving these decisions: mothers.