Sasheenie Moodley // We are told that a “good mother” is the trope of a mother who is loving and nurturing (Chess, 1982; Mercer, 1985). She prioritises and protects her infant. This mother has a good relationship with her “happy” infant (Benedek, 1959). It is a good mother’s job to understand her child’s behaviour and “raise the next generation” (Coser, 1982:695). Being a good mother is not only a social commentary on a woman’s mothering abilities, but also a social commentary on and expectation of her womanhood. In achieving the status of a good mother, a woman summits her social rank (Badinter, 1981). Being a good mother is everything that is “desirable and good” for a woman (Chess, 1982:213). Given the high regard for good mothers, there can be immense pressure to perform this trope. Many mothers can experience stress, guilt, or anxiety if they feel they are just ‘average’ mothers (Bernard, 1974; Chess, 1982; Chodorow, 1978; Rich, 1976; Rossi, 1977).

Can HIV-positive women be good mothers? If so, how do they achieve this status?

HIV can make it difficult for a woman to fulfil the social expectations of good mothering (Ingram & Hutchinson, 2000, 1999a). For starters, the stress and guilt ‘average’ mothers can feel may be heightened by HIV (Ingram, 1996). Being HIV-positive means that women cannot always be good mothers in the ways that are socially prescribed or expected. As such, HIV-positive mothers can be labeled as ‘not good’ mothers (Coll, Surrey & Weingarten, 1998). Why? One theory is that a ‘sick’ mother is a ‘not good’ mother. Sickness or disability can negatively impact a woman’s opportunity to be a mother physically or emotionally (Grue & Laerum, 2002; Thorne, 1990). Another theory is that an HIV-positive mother is a ‘not good’ mother because she risks infecting her “innocent child” with HIV (Sandelowski & Barroso, 2003a:476). A good mother protects her child from harm like HIV. A not good, HIV-positive, mother allows her child to be harmed. Because a ‘not good’ mother is transmitting a life-threatening virus to her baby, she is also considered a ‘not good’ woman. Despite, or at times because of, this ‘not good’ social status, HIV-positive mothers want to get away from their ‘sick’ social identities. Some women may therefore use pregnancy to shift closer to new identities, which better describe their roles as mothers (Siegel et al., 1997). This shift requires ardent work as sick women strive to “pass” as mothers (Grue & Laerum, 2002:678). Yet some scholars argue that this shift is not feasible. A woman’s identity as a mother experiencing sickness is sadly “marginalized” (Jacobs, 1997; Saleebey, 1992; Tangenberg, 2000:32). Her identity as a sick woman is all that remains. Social identities seldom transform completely from ‘sick woman’ to ‘mother’—instead, identities become layered as a woman moves from ‘sick woman’ to ‘sick mother’ or ‘not good’ mother (Logan Kennedy et al., 2014).

I have spent the last fifteen months working with HIV-positive teenage mothers in resource-constrained South African communities. Through thoughtful and intense  ethnographic discussions, I began to understand how much they felt for their babies. As is supported in the literature, I found that motherhood—and being a good mother—remains important to many HIV-positive women. Perhaps this is because motherhood is greatly valued in society (Badinter, 1981; Cooper et al., 2007:275; Gerson, 1985). Some HIV-positive women have therefore recreated what it means to be a “good” mother with new motherhood tropes (McMahon, 1995; Sandelowski & Barroso, 2003a:473). These tropes, briefly outlined below, describe new types of motherhood that HIV-positive mothers can exercise.

By practicing “redefined motherhood,” mothers can hold onto their mothering roles by looking out for their children, not just looking after their children (Van Loon, 2000). Proactively planning child custody is one way a mother can look out for her child, when HIV physically limits her ability to care for her child. Barnes and colleagues (1997) propose that mothers practicing “eternal motherhood” can look out for their children even after maternal death. Ingram (1996) and colleagues (1999a, 1999b, 2000) suggest that mothers can practice “defensive motherhood” when they work to protect themselves and their children from stigma and HIV infection, respectively. Valdez (1999, 2001) proposes that when mothers morph into la protectora, to protect their children from HIV infection and death, these mothers practice “protective motherhood.” Sandelowski and Barroso (2003a) suggest that mothers reconceive motherhood as “disembodied and transcendent” (Sandelowski & Barroso, 2003a:476). This can lead a mother to practice “virtual motherhood” when she promises her children that she will protect them even after she has passed away. As such, good mothers not only physically “watch their children,” but also “watch out for them” in disembodied ways that transcend life (Sandelowski & Barroso, 2003a:476).

Current discourse suggests that pregnancy can influence HIV by motivating HIV-positive women to recreate the meaning of good motherhood. Reciprocally, HIV can change HIV-positive women’s pregnancy experiences when women feel condemned (Sandelowski & Barroso, 2003a:477). One theory is that condemnation grows from, and is fueled by, HIV stigma (Deacon, 2006; Delius & Glaser, 2005; Gagnon, 2014; Goffman, 1963; Greene et al., 2016; Okoror et al., 2014; Vasas, 2005). Some women can do “work” to overcome stigma and change their pregnancy experiences. Sandelowski and Barroso (2003b) propose that HIV-positive women do mothering work with two goals: to protect their children from HIV infection or HIV stigma, and to guard a “positive maternal identity” (Sandelowski & Barroso, 2003a:473). Importantly, HIV may not always change women’s experiences. Some HIV-positive women can feel that HIV plays a “minor” role in experiences with pregnancy and motherhood (Wesley et al., 2000:300). HIV-positive women can feel that their experiences parallel other women’s experiences. This may be the case, for HIV-positive women, regarding desires to have a baby and decisions to terminate pregnancy (Johnstone et al., 1990; Pivnick et al., 1991; Selwyn et al., 1989; Siegel & Schrimshaw, 2001; Sunderland et al., 1992). Depending on circumstances, it seems that HIV may, or may not, change HIV-positive women’s pregnancy experiences. Reciprocally, pregnancy may, or may not, change women’s HIV experiences. Such is the case when HIV-positive women—perceived to be ‘not good’ mothers—recreate the meaning of ‘good’ mothering and motherhood.

It seems that HIV-positive women can be good mothers. In fact, the discourse suggests that being a good mother is so important that it leads some women to rework motherhood practices. Redefining motherhood—and doing daily mothering work—can therefore change HIV-positive women’s experiences with HIV and mothering. By recreating the meaning of motherhood, HIV-positive women can be good mothers or, at worst, “good enough mothers” (Hanna, 2001; Scheper-Hughes, 1993:361; Winnicott, 1965).

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Works Cited

Badinter, E. (1981). Mother love: Myth and reality, motherhood in modern history. United States.

Barnes, D., Taylor-Brown, S., & Wiener, L. (1997). “I didn’t leave Y’all on purpose”: HIV-infected mothers’ videotaped legacies for their children. Qualitative Sociology, 20(1), 7-32. doi:1024760113945.

Benedek, T. (1959). Parenthood as a developmental phase. Journal of the American Psychoanalytic Association, 7, 389-417.

Bernard, J. (1974). The future of motherhood. New York: Penguin.

Chess, S., & Thomas, A. (1982). Infant bonding: Mystique and reality. American Journal of Orthopsychiatry, 52(2), 213-222. doi:10.1111/j.1939-0025.1982.tb02683.x

Chodorow, N. (1978). The reproduction of mothering. Berkeley: University of California Press.

Coll, C., Surrey, J., & Weingarten, K. (Eds.). (1998). Mothering against the odds: Diverse voices of contemporary mothers. New York: Guilford Press.

Cooper, D., Harries, J., Myer, L., Orner, P., & Bracken, H. (2007). “Life is still going on”: Reproductive intentions of HIV-positive women and men in South Africa. Social Science & Medicine, 65, 274-283.

Deacon, H. (2006). Towards a sustainable theory of health‐related stigma: Lessons from the HIV/AIDS literature. Journal of Community & Applied Social Psychology, 16(6), 418-425. doi:10.1002/casp.900

Delius, P., & Glaser, C. (2005). Sex, disease and stigma in South Africa: Historical perspectives. African Journal of AIDS Research, 4(1), 29-36. doi:10.2989/16085900509490339

Hanna, B. (2001). Negotiating motherhood: The struggles of teenage mothers. Journal of Advanced Nursing, 34(4), 456-464. doi:10.1046/j.1365-2648.2001.01774.x

Ingram, D. (1996). HIV-positive women: Double binds and defensive mothering (Unpublished doctoral dissertation). University of Florida, USA.

Ingram, D. & Hutchinson, S. (1999a). Defensive mothering in HIV-positive mothers. Qualitative Health Research, 9

Ingram, D., & Hutchinson, S. (1999b). HIV-positive mothers and stigma. Health Care for Women International, 20

Ingram, D., & Hutchinson, S. (2000). Double binds and the reproductive and mothering experiences of HIV-positive women. Qualitative Health Research, 10(1), 117-132. doi:10.1177/104973200129118282

Jacobs, C. (1997). On spirituality and social work practice. Smith College Studies in Social Work, 67, 171-175.

Johnstone, F., Brettle, R., MacCallum, L., Mok, J., Peutherer, J., & Burns, S. (1990). Women’s knowledge of their HIV antibody state: Its effect on their decision whether to continue the pregnancy. British Medical Journal, 300

Gagnon, M. (2014). Rethinking HIV-related stigma in health care settings: A research brief. Ontario, Canada.

Gerson, K. (1985). Hard choices: How women decide about work, career, and motherhood. Berkeley, CA: University of California Press.

Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. New York: Simon & Shuster.

Greene, S., Ion, A., Kwaramba, G., Smith, S., & Loutfy, M. (2016). “Why are you pregnant? what were you thinking?”: How women navigate experiences of HIV-related stigma in medical settings during pregnancy and birth. Social Work in Health Care, 55(2), 161. doi:10.1080/00981389.2015.1081665

Grue, L., & Laerum, K. (2002). ‘Doing motherhood’’: Some experiences of mothers with physical disabilities. Disability & Society, 17

Logan Kennedy, V., Serghides, L., Raboud, J. M., Su, D., Blitz, S., Hart, T. A., . . . Loutfy, M. R. (2014). The importance of motherhood in HIV-positive women of reproductive age in Ontario, Canada. AIDS Care, 26(6), 777-784. doi:10.1080/09540121.2013.855295

McMahon, M. (1995). Engendering motherhood: Identity and self-transformation in women’s lives. New York: Guilford Press.

Mercer, R.T. (1985). The process of maternal role attainment over the first year. Nursing Research, 34(4), 198-203. doi:10.1097/00006199-198507000-00002

Okoror, T., Belue, R., Zungu, N., Adam, A., & Airhihenbuwa, C. (2014). HIV positive women’s perceptions of stigma in health care settings in Western Cape, South Africa. Health Care for Women International, 35, 27-49.

Pivnick, A. (1991). Victims and saviors: The meaning of motherhood and children among poor, HIV infected, drug using women (Unpublished doctoral dissertation). Columbia University, USA.

Rich, A. (1976). Of woman born. New York: Norton.

Rossi, A. (1977). A biosocial perspective on parenting. Daedalus, 106

Saleebey, D. (1992). Biology’s challenge to social work: Embodying the person-in-environment perspective. Social Work, 37, 112-118.

Sandelowski, M., & Barroso, J. (2003a). Motherhood in the context of maternal HIV infection. Research in Nursing & Health, 26(6), 470-482. doi:10.1002/nur.10109

Sandelowski, M., & Barroso, J. (2003b). Toward a metasynthesis of qualitative findings on motherhood in HIV-positive women. Research in Nursing & Health, 26(2), 153-170. doi:10.1002/nur.10072

Scheper-Hughes, N. (1993). Death without weeping: the violence of everyday life in Brazil. Berkeley: University of California Press.

Selwyn, P., Carter, R., Schoenbaum, E., Robertson, V., Klein, R., & Rogers, M. (1989). Knowledge of HIV antibody status and decisions to continue or terminate pregnancy among intravenous drug users. JAMA, 261(24), 3567-3571. doi:10.1001/jama.1989.03420240081031

Siegel, K., & Gorey, E. (1997). HIV-infected women: Barriers to AZT use. Social Science and Medicine, 45, 15-22.

Siegel, K., & Schrimshaw, E. (2001). Reasons and justifications for considering pregnancy among women living with HIV/AIDS. Psychology of Women Quarterly, 25(2), 112-123. doi:10.1111/1471-6402.00013

Sunderland, A., Minkoff, H., Handle, J., Moroso, G., & Landesman, S. (1992). The impact of HIV serostatus on reproductive decisions of women. Obstetrics and Gynecology, 70(6), 1027–1031.

Tangenberg, K. (2000). Marginalized epistemologies: A feminist approach to understanding the experiences of mothers with HIV. Affilia, 15(1), 31-48. doi:10.1177/08861090022093813

Valdez, M. (1999). La protectora (the protectress): A metaphor for HIV Hispanic women (Unpublished doctoral dissertation). Texas Women’s University, USA.

Valdez, M. (2001). A metaphor for HIV-positive Mexican and Puerto Rican women. Western Journal of Nursing Research, 23(5), 517-535. doi:10.1177/01939450122045357

Van Loon, R. (2000). Redefining motherhood: Adaptation to role change for women with AIDS. Families in Society: The Journal of Contemporary Human Services, 81(2), 152-161

Vasas, E. B. (2005). Examining the margins: A concept analysis of marginalization. Advances in Nursing Science (ANS), 28(3), 194-202. doi:10.1097/00012272-200507000-00002

Wesley, Y., Smeltzer, S., Redeker, N., Walker, S., Palumbo, P., & Whipple, B. (2000). Reproductive decision making in mothers with HIV-1. Health Care for Women International, 21(4), 291-304. doi:10.1080/073993300245159

Winnicott, D. (1965). The maturational process and the facilitative environment. New York: International Universities Press.

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