Reich researches issues behind parental choice to not vaccinate children

Published: Feb. 25, 2015

Associate Professor of Sociology, Jennifer ReichFew healthcare topics are currently as hotly debated as vaccination choice. Fear and anger on both sides of the argument have fueled highly emotional public discourse and questions about changes in policy and regulation. Lately, the news is full of stories about outbreaks of vaccine-controlled infectious diseases like measles and whooping cough that, until recently, were all but eradicated in this country. Social media is buzzing with celebrity-driven anti-vaccination campaigns, as well as posts from scared and angry parents who don't want their kids exposed to unnecessary risks at school or in childcare. To some it may seem like this controversy cropped up overnight, but Sociology Associate Professor Jennifer Reich has been watching tension build for more than seven years, since she first began researching the parental choice to not follow vaccine recommendations for children. Her recent research published in Gender & Society, a top-ranked journal in the Gender Studies and Sociology fields, and in her forthcoming book, shows that unvaccinated or under-vaccinated children from higher income backgrounds generally have parents who intentionally choose to refuse or delay vaccinations out of a belief that they are protecting their children. These children are in stark contrast to other under-vaccinated children from families with lower incomes who tend to be under-vaccinated because they lack access to resources or consistent care.

At the time Reich was finishing up her doctoral study and thinking about new research projects, President Bush announced a plan to revaccinate against smallpox because of fears of bioterrorism. Meanwhile fears about a possible link between Thimerosal (a preservative used in vaccines since the 1930s) and autism were also beginning to circulate. It became clear to Reich that vaccination was going to become an important discussion for parents and a critical issue for public health. She decided she wanted to better understand it. After earning her doctorate from the University of California, Davis and finishing a fellowship in health policy at UC San Francisco, she began her career and vaccination choice research at the University of Denver. Though her obvious compassion and scientific curiosity make her a natural fit for a career in social science, sociology was actually her fifth major in college. Says Reich, "When I found sociology, it seemed to provide a way of making sense of the world that matched how I already looked at things." She has taken a big picture approach to studying vaccination choice, conducting in-depth interviews with people on all sides of the issue—parents, healthcare providers, policy makers, researchers, and lawyers—to gain insight into the reasons parents make the choice not to vaccinate, who this choice affects, and how this choice interacts with the communities these families live in.

During the initial stages of her research on vaccination, Reich and her family moved to Colorado, a state that has one of the lowest vaccination rates and highest rates of personal belief exemptions in the nation. While 48 states allow parents to opt out of vaccinations because of religiously held beliefs, Colorado is one of fewer than 20 that allows parents to opt out because of a personal philosophy that objects to vaccination. The process of obtaining an exemption in Colorado is particularly uncomplicated compared to other states, which accounts for its high utilization. Of our state's high rate of exemptions, Reich notes that "Colorado is clearly a state where people want to do their own thing, enjoy a high quality of life, are committed to their independence, and all of those factors make it a great place to live—but also a place that has a high level of acceptance for individual choices on a range of topics and issues. It's not surprising that people here want to make their own choices to not follow recommendations that they feel don't fit their families."

Though fear about the link between vaccines and autism may have been the factor that initiated a general sense of public unease, the decision not to vaccinate is far more complex for most families. National epidemiological research suggests that there are two groups of under-vaccinated children (apart from those who cannot participate for medical reasons): children whose families don't vaccinate because they lack access to care tend to have an annual family income under $30,000, are likely to be black and have a single, working mother; children who are not vaccinated by parental choice are overwhelmingly from families with an annual income over $80,000 and are likely to have a white, college-educated mother.

Reich's work primarily explores this second demographic. Her interviews were mainly conducted with affluent, educated, and proactive mothers who felt like they were making careful, informed, and responsible decisions for their families. Their decision not to vaccinate was not a singular choice but existed in a landscape of other similar choices that reflected both mistrust of public agencies, and a strong desire to control risk factors they perceive are present in their families' lives. While not all may agree with these parents' final decision, Reich notes that they work hard to reach their decisions. "We've mostly talked about parents who don't vaccinate as though they were ignorant and they just don't understand disease or they don't care, and I think that's a mistake," says Reich. "These are very educated parents. They spend a lot of time reading and gathering information to try and make the best decisions they feel they can make for their children. Whatever motivates them, they are trying to be good parents and it's disrespectful to suggest otherwise."

This autonomous style of parenting may work well for many families, but when it comes to infectious disease it does not. Infectious disease illustrates how we share risk with others in our communities and how the façade of autonomy is flawed. Health officials are increasingly voicing concern about the dropping rates of vaccine protection and how this affects what is known as herd immunity. Herd immunity, a kind of firewall against infectious disease that is created when a significant percentage of the population is vaccinated, helps to prevent the spread of infectious disease and protects those who cannot receive vaccines due to age, access, or medical issues. Reich's work highlights the limits of making decisions only for one's own children. Says Reich, "As a sociologist this question is really compelling to me because we have to address some questions about what we owe each other as a community, how much responsibility we take for each other and each other's children." Reich empathizes with parents who choose not to vaccinate, "I do agonize because I'm a proponent of community responsibility and public health, but I'm sympathetic in lots of ways to how they came to this choice, even if I disagree with the choice."

With her research, Reich is working towards finding the points of connection and disconnect between parents who are making this choice and the care providers and public policies that are intended to serve their families as well as their communities. Reich hopes Colorado and the rest of the nation will weather this period of uncertainty about vaccination choice and policy with a better understanding about the collective information gaps and policy failures that have led us here. When it is time to move on and focus her research on other issues, chances are good that she won't be wandering far. Her passion is in studying the places where family choices and public health issues intersect. "I remain really fascinated by the ways families make decisions and parents make choices for their children in dialogue with healthcare and law" she says. "In thinking about what's next for me, it's clear that these intersections continue to be compelling. Making sense of how parents make the choices they make and what options they have available, those questions will continue to drive me."

This is the not the first time Reich has conducted qualitative research on parental rights or healthcare issues. Her first book Fixing Families: Parents, Power, and the Child Welfare System (Routledge, 2005) was based on her doctoral dissertation. She has also written about breastfeeding, reproductive rights, and other topics related to family choices and public health policies. Now in her second semester at CU Denver, Reich teaches Sociology of Childhood and Adolescence, Sociology of the Family, and has taught a special topics course on Law and Politics of Reproduction. Reich and her work have been enthusiastically received at CU Denver, and, as a teacher, she is enjoying the diversity of the student population on the Auraria campus. She is happy with her choice to raise her own family in Colorado and of her work says, "I have the best job in the world. I get to talk to people about the things they struggle with in their life and try to identify patterns and how they are connected to others like them and think about what that means for our communities. I can't think of a better job."


If you want to read more about Reich's research into this complex topic, you can click on the links below. Her forthcoming book, now under contract with New York University Press and due out this fall, is tentatively titled, Vaccine Decisions: Parents' Rights, Public Health, and the Meanings of Citizenship.

Better-Educated People More Open to Dubious Health Info on Web: Study
U.S. News and World Report, Sept 24

The Best Way to Combat Anti-Vaxxers Is to Understand Them
New Republic, Jan 5

Who are anti-vaxxers?: Understanding the anti-vaccination movement
CBC Radio's The Current, Jan 28

Rianna Riegelman is a CU Denver and CLAS alumna (1999) with a BA in English Writing. She works as a freelance writer, editor and graphic designer in Denver and Boulder.