How can HIV-positive women be good mothers?

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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