‘We are not sheep,I believe it is my choice’: Vaccine hesitancy and institutional agency among middle-class mothers in Russia

Abstract

Scholars frequently associate vaccine hesitancy with the effects of neoliberalism, including healthism culture, intensive mothering ideology, and a decrease in institutional trust. This article contributes to the discussion by exploring this link outside of established democracies, in a society that diverges from liberal principles on both political and institutional levels. Using qualitative interviews with middle-class Russian mothers, I trace how their doubts about vaccination reflect the specificities of neoliberal parenting in the contradictory post-socialist context. Research findings show that the mix of statist and neoliberal trends in Russian welfare translates into parents’ different perspectives on (state) institutions. This heterogeneity, in turn, leads to variation in their vaccine hesitancy, with parents oscillating between civic and consumerist critiques. Disunity of views and political restrictions on grassroots activism hinder mothers’ open opposition to vaccination. However, my interviewees still demonstrate institutional agency. They exercise it by developing informal workarounds and navigating paid healthcare options. As mothers repeatedly enact those diverse solutions, they routinize vaccine-hesitant parenting scripts and stimulate the development of organizational niches for unvaccinated children at the margins of the established welfare system.

Introduction

Mass vaccination constitutes an essential component in modern approaches to controlling infectious diseases. However, with a global increase in population distrust in immunization, vaccine hesitancy is once again coming to the forefront of public health discussion and sociological scholarship. Scientists define vaccine hesitancy as a delay or refusal of vaccination despite its availability (MacDonald and The SAGE Working Group on Vaccine Hesitancy, 2015) and use this category to address the context-dependent ways in which individuals make sense of and engage with vaccines (Dube et al., 2021). While a multitude of factors influence vaccination reasoning, recent cross-country studies point at a strong connection between vaccine hesitancy and the worldwide spread of neoliberalism (Cole et al., 2023). In the era when individuals are ‘empowered’ vis-à-vis institutions and urged to take responsibility for their well-being, neoliberal subjects’ reflexivity, and agency regarding health issues frequently coincide with vaccination skepticism (Gottlieb, 2016; Hobson-West, 2007; Leach and Fairhead, 2007; Numerato et al., 2019).

Vaccine hesitancy among privileged parents provides an exemplary case of how neoliberalism shapes vaccination attitudes and practices. Focusing on the intersection of class and gender, researchers explore how, for middle-class mothers, personal responsibility for their children’s health translates into doubts about institutionalized expertise, preference for customized services, and resource-intensive (anti)vaccination strategies (Peretti-Watel et al., 2019; Reich, 2014; Sobo, 2015). The majority of literature on the topic, however, considers the linkage between neoliberalism, parenting, and vaccination in the developed liberal democracies of the ‘West’. This study seeks to expand the discussion on neoliberal parenting and vaccine hesitancy by investigating how neoliberal ideology influences vaccination choices in a society, which in many ways departs from liberalism. To achieve this aim, I analyze the perspective of Russian middle-class mothers who do not adhere to the child immunization schedule.

Post-Soviet countries consistently demonstrate one of the lowest levels of trust in the safety and effectiveness of vaccines compared to other world regions (Costa-Font et al., 2023). In Russia, according to a nationwide survey conducted in September 2019, only 45% of population believed that vaccination is essential for children (FOM, 2019). The international Vaccine Confidence Project (2022) confirms these findings, stating that in 2022, only 49% of Russians deemed childhood vaccination necessary. There is certainly a variety of reasons behind this remarkable distrust in vaccines. In this article, however, I use the Russian case to look at the connection between vaccine hesitancy and neoliberal parenting (in particular, mothering) amid contradictory post-Soviet transformation.

Since the end of the 20th century, the welfare systems of Central and Eastern Europe have represented a distinct instance of rapid neoliberal reforms (Ghodsy and Orenstein, 2021), while also serving as a site of social class formation in what was previously structured as classless societies (Temkina and Zdravomyslova, 2018). Vaccination attitudes and practices have reflected these societal changes, demonstrating how individuals reimagine themselves in relation to government authorities, gender norms, and newly emerged market institutions (Bazylevych, 2011; Pop, 2016). Moreover, across the region, the amalgamation of socialist legacies and neoliberal influences has resulted into distinct forms of parental mobilization, including opposition to children vaccination, that do not quite fit in the ‘Western’ definitions of neoliberal subjects (Fábián and Korolczuk, 2017).

Relying on qualitative interview materials, in what follows, I further elaborate on the peculiarities of neoliberal parenting under post-socialism and its connection to vaccine hesitancy. I do this by (1) unpacking how Russian mothers’ perspectives on the state institutions translate into different vaccine-hesitant views and (2) examining contextualized forms of parental institutional agency in regard to childhood vaccination (or rejection thereof).

Vaccine hesitancy and neoliberal parenting: a conceptual framework

Perceptions of vaccines are not confined to the dichotomy of enthusiastic support versus stubborn refusal, but stretch across the continuum that encompasses active demand for vaccination, delayed and selective vaccination, and complete rejection of vaccines. The growing number of sociological and anthropological studies calls for adopting a context-sensitive approach to address this diversity comprehensively (Dubé et al., 2021). Instead of straightforwardly linking vaccine criticism to individual ignorance and misconduct these works suggest acknowledging parental concerns about vaccines and analyzing the social, political, and historical influences that shape these beliefs. This article builds on this line of research by exploring how parental doubts regarding childhood vaccines and corresponding parental agency have been framed by the inconsistent introduction of neoliberal principles in post-Soviet Russia.

The connection between neoliberalism and the proliferation of vaccination skepticism has already attracted significant academic attention. Researchers highlight two factors that are formative for vaccination decision-making: (1) the view on health as a matter of moral importance and individual responsibility (healthism) and (2) the erosion of confidence in institutions and expert systems (Cole et al., 2023; Peretti-Watel et al., 2015; Yaqub et al., 2014). Under neoliberal health governance, health becomes a separate value and an issue of personal control. Vaccine hesitancy, in this sense, denotes individuals’ efforts to be critical healthcare customers who take health matters seriously, assume an agentic stance, and refrain from trusting doctors blindly.

Studies of parental views and practices regarding vaccination add another dimension to this discussion (Attwell et al., 2018; Dubé et al., 2016; Peretti-Watel et al., 2019; Reich, 2014; Sobo, 2015). They amend the analysis of vaccination attitudes by examining how neoliberalism, along with molding modern patient-hood, shapes cultural expectations about ‘good’ parenting. This literature depicts neoliberal parenting as an individualistic project, in which different experiences – from pregnancy, to infant feeding, to vaccination – become subjects of active parental management and risk avoidance (Reich, 2014, 2016). This project is gendered and carried out predominantly by women, reflecting what Sharon Hays (1996) has called the ideology of intensive mothering, that is, the moralized view on women as the primary caretakers who are expected to heavily invest in children’s well-being.

Relations (and tensions) between parents and the state that mandates vaccinations occupy a particularly important place in understanding vaccine hesitancy among neoliberal mothers. Some studies boil vaccine hesitancy down to an opposition between liberal-minded individuals and the government, whose public health interventions limit citizens’ autonomy for the sake of common good (Reich, 2018; Sobo, 2016). Authorities usually enforce children vaccination, requiring it for admission to healthcare, childcare, and education facilities. However, individualistic parents may see such requirements as an unwelcome intervention into their privacy and a challenge to their discretion (Reich, 2014).

Another line of argumentation emphasizes parental reflexivity about external influences, most notably pharmaceutical companies’ market interests that contaminate the production and usage of medical knowledge (Attwell et al., 2018; Carrion, 2018; Gottlieb, 2016). The state is supposed to effectively control those influences on the institutional level. However, parents frequently question the government’s ability to do so due to corruption, political figures’ dubious statements on vaccines, or other factors (Numerato et al., 2019; Trent et al., 2022).

Yet other studies, especially those conducted in the United States, connect vaccine hesitancy to social inequalities perpetuated by state institutions. For parents disadvantaged because of their race and/or migration status, interactions with healthcare and childcare facilities are associated with close governmental surveillance as well as experience of systemic discrimination. They develop an accumulated distrust for the authorities and welfare system, and this criticism extends to vaccination (Decoteau and Sweet, 2023; Thornton and Reich, 2022). This pattern strikingly contrasts to one prevalent among privileged parents. Middle- and upper-class mothers despise institutionally endorsed vaccines for representing the one-size-fits-all approach. When these women reject or postpone child vaccination, they act as competent citizens–consumers who compare different service options and overcome bureaucratic hurdles (Reich, 2014, 2018).

While the studies on (state) institutions, parenting, and vaccine hesitancy highlight the agency of neoliberal parents, they also underscore mothers’ inclination to individualism and lack of interest in collective action (Reich, 2014). Drawing on the literature, one can roughly define three ways in which mothers from the upper classes invest their efforts. First, they spend time and resources on managing health risks and strengthening their children’s immunity through lifestyle choices, like dieting, exercising, arranging the home environment, and so on (Peretti-Watel et al., 2019; Reich, 2014). Second, mothers build online and offline networks of like-minded parents. They use these networks to share information on vaccines, and also to create gated communities that they see as safe from (social) contamination (Estep and Greenberg, 2020; Reich, 2014). Finally, mothers assert agency by navigating childcare and healthcare services. In the realm of healthcare, they do not subscribe to any ‘whole-sale package’, but carefully choose and combine elements from biomedicine, complementary and alternative medicine (Attwell et al., 2018; Reich, 2020). This frequently entails negotiating with service providers and dealing with bureaucratic formalities.

This article further explores the interplay between vaccine-related institutional arrangements and parental choice by focusing on Russia, where neoliberal trends coincide with extensive governmental intervention into healthcare and parenting issues. In the following parts, I outline the institutional context and specific features of neoliberal parenting in the country. Using interview materials, I proceed to describing how middle-class mothers’ relation to (state) institutions conditions their vaccination views. I also pay attention to the efforts that vaccine-hesitant parents invest in navigating the welfare landscape and argue for considering these as a form of institutional agency.

Parenting in post-Soviet Russia

Russian vaccination arrangements, as well as parental vaccine-related choices, mirror broader changes that have occurred in the country’s welfare system and state–citizen relations since the dissolution of the USSR. In the late-Soviet era, the state played a central role in providing welfare to citizens, with mothers being a particular focus of attention. The country’s centralized healthcare system ensured that medical services, including children vaccinations, were universally available to the population at no cost. Moreover, the government advanced pronatalist agenda and offered a wide range of family support measures, such as affordable and accessible day care, extended paid maternity leave, and numerous parental benefits (Chernova, 2013: 123–136). However, the collapse of the Soviet Union plunged Russian welfare, along with the country’s residents, into profound and rather traumatic institutional changes.

Since its inception in the 1990s, this transformation has been fraught with flaws and contradictions. On one hand, neoliberal reforms gave rise to the country’s health insurance system and private clinics (Shishkin, 2018). They also fostered the growth of the ‘childhood industry’, which provided parents with commercial childcare and educational services (Shpakovskaya, 2015). On the other hand, as the state reoriented from universalist to means-tested social benefits, many families felt abandoned by the government (Chernova, 2013: 143). In public healthcare, the authorities tried to maintain a universal health coverage system. However, this was usually done at the expense of service quality (Twigg, 2002). In sum, reforms resulted in the segmentation of the country’s welfare and considerable disparities in access to it. A divide emerged between often under-equipped and overburdened state facilities and a growing number of private clinics, schools, and kindergartens offering wealthy parents a broad array of services (Cook, 2014; Shpakovskaya, 2015).

The sudden reduction of government support and the somewhat hectic introduction of market principles contributed to the proliferation of informality in the healthcare sector. Amid the radical institutional changes happening in the medical field, Russian citizens turned to their social networks to find a ‘good’ doctor and obtain the needed treatment. They maintained personalized relationships with medical professionals via informal payments and gift-giving. These tacit activities were usually carried out by women, who navigated the health system on behalf of their family members (Brown and Rusinova, 2010).

Yet, another shift in state–citizen relations occurred in Russia in the mid-2000s, when the state reclaimed its leadership in welfare provision. The authorities revived late-Soviet pronatalist rhetoric, which coincided with increasing governmental support for and control over families with children (Rivkin-Fish, 2010). The flagship initiatives of this new policy trend consisted of the Priority National Projects in healthcare and education, as well as the Maternity Capital baby-bonus program. However, there has been a significant difference compared to the Soviet period. This time the statist model has been implemented selectively, with neoliberal restructuring continuing even in spheres associated with state demographic concerns, for example, in maternity care (Matveev and Novkunskaya, 2022).

Scholars document the spread of intensive parenting ideology and the emergence of agentic neoliberal parents, in particular mothers, in this volatile socio-political environment (Isupova, 2024; Shpakovskaya and Chernova, 2022; Temkina and Zdravomyslova, 2018). Like their counterparts in other countries (e.g. Reich, 2014), mothers from the newly arisen Russian middle class have increasingly embraced individual responsibility for their children’s well-being, linking the fulfillment of their maternal role to significant investments in the child’s health and development. Along with the similarities, sociologists outline several features that are distinct to the Russian strand of neoliberal mothering.

First, in Russia, neoliberal mothering has evolved in close dialog with the Soviet past. For the new generation of women, the adoption of intensive parenting ideology meant the conscious brake from the socialist approach to childrearing, which they experienced and resented (Sivak, 2018). However, since many aspects of the former welfare model have persevered and been strengthened by the pronatalist policy in the mid-2000s, scholars delineate structural continuity between Soviet and post-Soviet parenting patterns. That is, despite the proliferation of commercial services and attempts to increase fathers’ involvement in childcare, the axis of mother–state relationship has remained central to Russian parenting (Chernova, 2012).

Second, there is ambiguity in how the intensive mothering model interacts with the conservative gender ideology of the Russian state. On one hand, both of them foster the image of mothers as ‘natural’ and best caregivers, while simultaneously underscoring motherhood’s centrality for women’s self-actualization. On the other hand, the authorities’ perspective significantly differs from the neoliberal notions of parenting since the government prioritizes ‘national interests’, namely, demographic concerns and preservation of ‘traditional (gender) values’, over individual preferences. This mismatch is harshly manifested in the state’s attempts to control the public discourse on reproduction by restricting, if not eradicating, any initiatives that advance the liberal agenda (Gradskova, 2023; Rivkin-Fish, 2013).

Third and finally, the inconsistent post-socialist reforms have translated into a rather uneven quality of Russian healthcare and childcare services, making them unsupportive of intensive mothering. Middle-class parents have to channel substantial amount of energy and resources toward navigating welfare system and locating services, which satisfy their expectations (Shpakovskaya, 2015; Shpakovskaya and Chernova, 2022; Temkina and Zdravomyslova, 2018). Because of this institutional inefficiency, coupled with an ideological emphasis on maternity and limited opportunities to voice discontent, Russian women often describe intensive mothering as a burden rather than a choice (Isupova, 2024). On the positive side, however, parental efforts to cope with problems can result in new solidarities and grassroots organizational innovations, for example, the development of moms clubs (Chernova, 2012).

In sum, multifaceted changes in post-Soviet welfare and healthcare have led to the emergence of critical neoliberal mothers who doubt government promises of social support, accept that family well-being is an issue of individual responsibility, and demonstrate readiness to invest time and resources in it (Shpakovskaya, 2015; Temkina and Rivkin-Fish, 2020; Temkina and Zdravomyslova, 2018). In what follows, I expand on the connection between this parenting pattern and vaccine hesitancy.

Materials and method

This study uses qualitative methods to understand vaccine hesitancy among privileged Russian parents. While this methodology does not allow for general claims about the prevalence of particular attitudes or behaviors in this social group, it is indispensable for exploring contextualized sense-making behind parents’ vaccination choices. The study’s empirical base consists of 29 in-depth interviews with mothers who did not vaccinate their children, vaccinated them selectively, or delayed vaccination. I used purposive sampling to select middle-class informants who had recent experience with child vaccination decisions.

I employed the following criteria to form the sample: First, as income level alone is not sufficient for defining social class in Russia (Gontmakher and Ross, 2015), I have recruited informants with higher education and professional backgrounds (i.e. the professional middle class). The resulting sample included people who worked in fields, such as acting, architecture, arts, banking, design, the diplomatic service, healthcare, information technology (IT), journalism, management, non-governmental organization (NGO) activism, psychological counseling, and secondary and higher education. Second, interviews were conducted with informants who had children aged 7 years (the average age of entering primary school in Russia) or younger, thus the materials reflect acute parental encounters with Russian day care and healthcare organizations. The interviews were collected from autumn 2019 to spring 2021. The interviewed parents lived in the county’s biggest cities of Moscow and St Petersburg with developed healthcare infrastructures. The informants’ age in the resulting sample ranged from 29 to 44 years; 20 of them were married or cohabitating with a partner. The number of children varied from one child to five children per family.

At first, a call for informants was posted online in Russian-language parental and vaccine-critical groups on social media. However, due to the topic’s sensitivity, only three people responded. To ensure potential informants’ trust, I switched to snowball sampling and recruited the rest of participants via my social networks. To represent the diversity of vaccination-related views and to minimize bias, I used up to three contacts provided by the same person.

The interview guide contained questions about parents’ attitudes and practices regarding vaccination, as well as broader questions about their experiences with Russian healthcare, childcare, and educational organizations. I initially conducted interviews in person, but switched to online interviews after the COVID-19 pandemic began. In each case, the informant selected the communication method. All interviews were recorded, transcribed verbatim, and anonymized. The Ethical Committee of St Petersburg Sociological Association approved the research design.

In 2020, the COVID-19 pandemic and the associated public debate over vaccination significantly impeded the recruitment of informants. Parents expressed apprehension about the study, suspecting that it had a hidden agenda of exposing vaccination critics to the state. These difficulties echo other studies’ findings: the pandemic exacerbated parental distrust in experts and the authorities, and this skepticism extended to the work of social researchers (Hilário et al., 2023).

I analyzed the interviews with the ATLAS.ti software using a modified thematic analysis method (Deterding and Waters, 2018). I started by indexing the transcripts with the broad categories (themes) that reflected the study design and preliminary conceptualization. The following categories were used at this stage: knowledge about vaccines, vaccine attitudes, vaccination practices, interactions with healthcare institutions, interactions with childcare institutions, and parental responsibility. I also produced analytical memos, pointing out connections between the categories, and specifics of informants’ cases. Then, I coded the selected pieces of interviews using fine-grained codes constructed from the data. These codes, for example, included ‘healthy lifestyle’, ‘state control’, ‘personalized trust’, ‘Internet on vaccinations’, ‘vulnerable child’, and so on.

From this analysis emerged a polyphony of vaccination critiques, including parental desire for more ‘natural’ immunity in their children, skepticism about pharmaceutical companies’ market interests, discontent with the ‘insensitive’ statistical approach to vaccination risks, and so on. However, in this article, I concentrate on parents’ relationships with (state) institutions – a topic that is prominent in all the interview texts.

Strands of mothers’ vaccination criticism

According to the national vaccination calendar, every child in Russia must be vaccinated against hepatitis B, tuberculosis, pneumococcal infection, diphtheria, pertussis, tetanus, measles, rubella, and mumps. In addition, every year children should have a Mantoux tuberculin skin test, which parents often consider a vaccination because the injection is made with a substance of bacterial origin. Although Russian parents can refuse vaccinating their child, the authorities employ institutional means to enforce it – a vaccination certificate is requested upon admission to kindergartens, schools, and universities; unvaccinated children may be suspended from visiting summer camps or day care facilities in the event of an infectious disease outbreak, and so on.

While all the participants in this study have opted to violate from the vaccine schedule endorsed by the state, they harbored different reasons for that. Below, I elaborate on how the range of mothers’ concerns about the state and its institutions conditioned the variation in their vaccine hesitancy. In doing this, I concentrate on the two types of vaccination critique expressed by the informants: civic distrust and consumerist distrust.

Civic distrust in vaccination

Research participants formulated a distinctive line of vaccination critique that is indicative of neoliberal citizens’ discontent with state intervention into their private lives. My informants frequently referred to a category they called ‘the system’ when talking about such interventions. This category functions as a summative term for Russian state institutions – hospitals, kindergartens, schools, universities, and army. Rather than distinguishing between particular policy measures and actions of different governmental bodies, informants were concerned with the seemingly monolithic state that demands its citizens’ blind obedience and restricts their autonomy. This state ‘system’ appeared in the interviews as a disciplining entity, driven by reasons other than public health and conflicting with the interests of parents.

It is beneficial for the state that the majority of people do the same thing, the same thing, which fits the conventions. It is strange to me that in different areas it is all so similar. It is beneficial [for the state] that people don’t read, don’t think, don’t rely on their own immune system. (43 y.o., 3 children)

Vaccine hesitancy manifested the tension at the interface between the authoritarian state and neoliberal mothers. Interpreting vaccination primarily as a product of ‘the system’ and as a vehicle of state control over the population, informants believed that eluding it is a matter of one’s own sensibility and self-preservation. In the excerpt below, a mother describes her efforts to protect children from institutionally endorsed vaccinations. She also expresses fear that ‘the system’ embodied in the military conscription will eventually harm her sons when they grow up.

You really have to butt hard against the [children summer] camps [to avoid vaccination]; with the schools, it is a little easier. And we don’t go to the medical clinics at all [. . .] But what worries me the most about this whole system, it is, of course, vaccination in the army, because I have three sons. There they give shots of some random solutions to anyone who didn’t run away [. . . ] This really scares me, because there the system will press upon us with all its might. And it can crush us . . . (42 y.o., 5 children)

Discontent with institutional incentives for vaccination coincided with mothers’ complaints regarding the practicalities of ‘the system’s’ ground-level operation. The informants voiced resentment at the authoritative communication pattern in state clinics and kindergartens, which did not take parental perspective and preferences seriously. The following interview quotation presents an example of such complaints.

What is happening now in Russia, at least what is happening regarding the vaccination, it just does not suit me. Because I feel such a tough manipulative pressure. I strongly disagree on being manipulated, like ‘if you don’t bring a [vaccination] certificate, we won’t take your [child] to the kindergarten’ [. . .] We are not sheep. I believe it [vaccination] is my choice. (44 y.o., 1 child)

This civic line of critique translated into a behavioral pattern that I call ‘dissident’. The informants not only tried to avoid vaccinating their children entirely but also refrained from interacting with any elements of ‘the system’ – state healthcare, day care organizations, schools, and so on. These mothers typically opted for home births, home schooling, Waldorf and Montessori education, and alternative medicine or self-medication.

The state [institutions] haven’t seen my children at all. We live in our Inner Mongolia [the informant metaphorically refers to the St. Petersburg suburbs]. The children are in home schooling. They don’t fit into the state school, and I don’t have the strength to put them there, so [they study] according to an individual program. (42 y.o., 3 children)

Consumerist distrust in vaccination

Another variation of Russian parents’ vaccine hesitancy is represented as a consumer critique of the country’s healthcare. This critique is also neoliberal in essence, but while the civic distrust in vaccination reflects mothers’ discontent with excessive state control, consumerist distrust is focused on the quality of services in state-funded medical organizations, including vaccination services.

Several dimensions of such consumerist critique emerged from the data. The interviewees were not satisfied with the organizational aspect of vaccination. Some parents complained that a typical Russian pediatrician is bogged down in bureaucratic work and has neither the time nor the energy to delve into the nuances of a child’s health condition, which might result in missing a contraindication to vaccination. Others voiced fears that a vaccination might lead to complications for their child’s health, and then instead of receiving immediate medical advice they would have to waste precious time on waiting for a doctor’s appointment. One informant, a medical doctor herself, pointedly summarized these concerns as a mismatch between parental demands for more personalized services and the reality of standardized care in Russian state clinics.

We have free-of-charge healthcare services, and a pediatrician should look after us. But the pediatrician [in the state clinic] is actually unable to do this, when she has eight hundred children in her district. Will she attend to every one of them? No, of course not. This will be the standard approach [to all patients]. (36 y.o., 1 child)

Some informants doubted doctors’ competence, in particular whether they had sufficient knowledge about vaccines. This line of skepticism closely intertwined with the previous one, as the informants assumed that institutional regulations neither encourage nor provide resources for physicians to gain more expertise. Professional middle-class mothers dig deeply into the sources on vaccination, including academic articles, consequentially seeing themselves as better informed on the subject than medical doctors.

There can be complications [for the child’s health] if you have not properly prepared for this vaccination. But we just don’t have this [preparation] here. I mean, they [doctors in state clinics] just don’t know about it, because they haven’t been taught particularly about the immunity, about the vaccines, and how they are made, and what they are made of. (30 y.o., 1 child)

The informants also expressed concerns about the vaccines’ quality. Using different criteria – inactivated or live-attenuated vaccines, vaccines of Russian or foreign origin, vaccines that contain certain preservatives, and so on – they developed their own customized classifications, accepting some of the vaccines, but considering the others harmful. These doubts stack on top of the consumerist discontent with doctors’ expertise – parents complained that doctors neither provided comprehensive information about the vaccines’ composition nor explained how exactly these substances affect the organism.

Those parents who expressed consumerist critique did not oppose vaccination per se. They longed for more personalized services and demanded more intense interaction with medicine, for example, thorough medical check-ups and consultations with different medical specialists before vaccination. Unlike the mothers who voiced the civic critique, these interviewees were not trying to escape ‘the system’, but exercised their consumer choices via delayed or selective vaccination, particularly by opting for paid medical services in private clinics. These clinics offered a wider array of vaccination-related options (including pre-vaccination medical tests) and generally provided more comfortable conditions for the customers.

I began to think about what I should do so that the vaccination was done correctly. Well, of course, these were paid [medical services]. I agreed for this vaccination, but under certain conditions [. . .] The doctor examined [the child], examined him very carefully. It was not just a pediatrician, but a pediatric-allergist. (36 y.o., 1 child)

To sum up, the data show how middle-class Russian mothers embrace individual responsibility for their children’s well-being, which, in turn, conditions their vaccine hesitancy. However, their perception of state institutions and their corresponding behavior are not homogeneous. Those parents who gravitate to the civic standpoint see their duty in sheltering children from ‘the system’ as completely as possible. They try to do this by avoiding vaccination altogether, along with other forms of state-provided welfare. Those parents who articulate consumerist discontent associate responsible mothering with carefully choosing between available service options. Consequently, they oscillate between delayed or selective vaccination.

Notably, both groups resort to pragmatic individual solutions for their children’s well-being by either adopting an ‘alternative’ lifestyle, or by choosing paid medical services. Several interviewees emphasized that they do not identify as ‘anti-vaxxers’ since their goal is not to advocate for any particular stance on vaccines, but to care for their own children as they see fit.

Moreover, the study participants consciously differentiated themselves from vaccine-hesitant parents with different views. Some interviewees proudly pointed out how in online discussions, they unmasked those who only pretended to be against vaccines but who actually collaborated with the state (i.e. postponed vaccination or selectively vaccinated their children). The others quite ironically described how they met dedicated anti-vaxxers and proponents of alternative medicine on the Internet.

There are things that sometimes slip through this chat, like ‘how to treat bronchitis with beetroot juice enemas’. Such things make me feel sick (. . .) There are different [people], but I look up for the anti-vaccination stuff there. (40 y.o., 1 child)

Taken together, these mismatched vaccination views and this preference for personalized solutions undermined any form of collective effort among the informants. However, the interviewed parents were not entirely devoid of agency. In what follows, I explore ground-level activities through which vaccine-hesitant mothers navigated and sometimes changed the landscape of Russian childcare and welfare institutions.

Institutional agency of Russian vaccine-hesitant mothers

As Russian authorities incentivize vaccination through institutional means, the study participants had to navigate various organizational environments, including maternity hospitals, medical clinics, kindergartens, and schools, to locate or create niches tolerant of unvaccinated children. Some of the organizational niches developed in the private sector with the support of parental investments; the others were part of state institutions informally converted into vaccination-free zones. Although the interviewees themselves described negotiations with childcare and educational facilities as individual solutions, the study materials suggest that their efforts accumulated into more or less routinized ways of doing things, thus introducing changes in the life of organizations. The following example demonstrates how parental opposition to immunization at a public school prompted school administrators to mitigate the pressure on parents to vaccinate their children. The informant also could not resist emphasizing her expertise in comparison to the pro-vaccination majority.

For two years, my son attended one of the best schools in the city. And all parents there were smart, well, almost all. We were not the only one there [who avoided child vaccination]. The [school] administration just gave up ‘if you don’t want it [vaccination], you don’t have to do it’. (42 y.o., 5 children)

Many of these institutional spaces for unvaccinated children emerged in organizations that provided ‘alternative’ services (usually on a paid basis). According to the interviews, such organizations as natural childbirth centers or Waldorf kindergartens often were interconnected, creating a somewhat stable institutional trajectory for vaccine-hesitant parents. Several mothers recalled enrolling in ‘vaccine-skeptical’ childbirth preparation courses and then proceeding to a maternity hospital that did not insist on child vaccination. Interviewees reported maintaining contacts with other course participants and sharing further information about vaccination-skeptical pediatricians or day care facilities.

While developing a scenario of vaccine-hesitant parenting, the informants navigated not only institutional spaces, but also healthcare bureaucracy. Mothers told about studying different kinds of regulations to locate what documents grant their children with exemption in case of different vaccines. For instance, they found out that the Mantoux test for tuberculosis, which is mandatory in all Russian schools and kindergartens, can be replaced with the less invasive T-spot blood test offered in some clinics as a paid service. Another bureaucratic workaround was related to the measles vaccine: during a measles outbreak, unvaccinated children are barred from kindergarten, but this restriction can be lifted for those with a proof of measles immunity. The following excerpt summarizes how the combination of regulatory exceptions and healthcare marketization has provided vaccine-hesitant mothers with a room for maneuver in terms of children’s vaccination.

There are already all kinds of [workarounds, for instance] in order to avoid having a shot of measles [vaccine], you can take an antibody [test]. So, when I have some question, [for instance, if to the kindergarten] a health officer comes and says: ‘Well, how about [vaccination]?’ I call my anti-vaxxers: ‘What should I do?’ And they [respond]: ‘Go there, buy this, do this’. (43 y.o., 3 children)

Since many informants reframed child vaccination as a bureaucratic problem, they referred to vaccination-related documents as ‘the papers’ reducing them to material form. With ‘papers’ acquiring importance in their own right, a shadow market for vaccination and test certificates developed. Informants described different schemes of purchasing fake medical documents: from buying blank certificates, which they later filled in themselves, to attending a doctor, who disposed of a vaccine dose but used its actual serial number to issue a certificate. The calculating informants evaluated different workarounds and occasionally favored counterfeit certificates, deeming this solution to be more cost-effective.

Generally, you can buy more or less any certificate [. . .] For kindergarten, it is mandatory that there be some kind of certificate stating that the child is not sick with tuberculosis. So, we just bought it [the certificate]. We didn’t do it [the T-spot test for tuberculosis] because it’s expensive, we just bought a test [result certificate]. (35 y.o., 2 children)

Overall, despite the institutional pro-vaccination incentives and lack of solidarity between vaccine-hesitant parents, the informants demonstrated significant amount of agency in navigating Russian healthcare and childcare environment. While parents did not explicitly aim to change institutional arrangements, their dispersed efforts resulted in the development of relatively stable organizational spaces and pathways that helped the interviewees in pursuing their preferred (anti)vaccination strategies. The study materials also show how marketization and informality, two institutional features associated with the post-Soviet welfare transformation, facilitated these parental efforts.

Conclusion

Throughout Central and Eastern Europe, healthcare constituted one of the core spheres of dramatic neoliberal reforms, which have included the introduction of new principles of institutional regulation, profound shifts in state–citizen relations, and a significant increase in social inequality. Using in-depth interviews with middle-class Russian mothers, this article unpacks how these complex and rather inconsistent changes have shaped parental sense-making and choices regarding childhood vaccines.

The connection between neoliberal parenting, in particular mothering, and vaccine skepticism is an established trope in social science literature (Reich, 2014, 2016; Sobo, 2015). However, it is relatively understudied in relation to post-socialist societies. Sociologists have already described how post-Soviet reforms have led to the emergence of neoliberal subjects – both neoliberal parents and neoliberal healthcare customers – in contemporary Russia (Shpakovskaya, 2015; Temkina and Rivkin-Fish, 2020). Such individuals tend toward neglecting public good, opting for personalized health solutions, and separating themselves from less privileged population. My interviewees fit into this social category. They identified as competent healthcare customers, who take responsibility for their own well-being and weight the risks of medical procedures. The informants viewed children’s vaccination as a matter of personal discretion and questioned mass immunization as a form of external intervention into their private life. They justified this stance by contrasting mothers’ concern for their children with the inefficient care provided by the public healthcare system. This perspective reflects the spread of intensive mothering model (Hays, 1996) in Russian society – an ideology that emphasizes individual choice and empowerment vis-à-vis institutions while simultaneously foregrounding women’s traditional gender role as the primary caretakers of children.

Importantly, the research materials demonstrate the lack of homogeneity in parents’ reasoning about vaccination. Two lines of vaccine criticism are particularly noteworthy: distrust in the authoritative state and distrust in the quality of public healthcare services. For the first line of criticism, mothers saw the state as an unfriendly entity, whose mass vaccination efforts are targeted at disciplining citizens rather than attaining public health objectives. The second line of critique consisted of different consumerist complaints over the delivery of childhood vaccines in Russia. Parents voiced concerns regarding the doctors’ proficiency, clinic schedule and work standards, the quality of vaccines, and so on.

These findings confirm other scholars’ conclusions about the centrality of the state–citizen relationship for Russian parenting (Chernova, 2012), extending this assumption to the case of vaccine hesitancy. The study shows how excessive government intrusion into citizens’ private lives and inconsistent service quality in state-funded facilities have ignited parental concerns over state-endorsed vaccination. The contradictory mix of statist and neoliberal logics in Russian welfare has translated into different views on state institutions and parental responsibility. Those interviewees, who voiced civic critique, saw their duty in protecting children from the state by avoiding vaccination along with other conventional healthcare and childcare services. Consumerist-oriented mothers focused on navigating healthcare services on behalf of their children and carefully selecting options that would suit them best. These informants were inclined toward delayed and selective vaccination.

Of course, the state plays a critical role in mandating vaccination in many countries, and in many countries, this pro-vaccination pressure clashes with notions of parental choice (for e.g. Hobson-West, 2007; Reich, 2018). However, this study delineates how the cultural effects of neoliberalism, namely, healthism culture and intensive mothering model, shape parental attitudes toward vaccines within the institutional setting, which does not consistently adhere to liberal principles. While middle-class Russian mothers’ decision-making in many ways corresponds to that of neoliberal parents in developed liberal democracies, in other ways it differs from it significantly. For instance, those my interviewees who expressed civic critique took on an (anti)vaccination stance that is surprisingly similar to that of less privileged groups in ‘Western’ countries (Decoteau and Sweet, 2023; Thornton and Reich, 2022). Rather than acting as ‘empowered’ consumers, they demonstrated general distrust in the controlling state and tried to minimize interactions with it. These findings yet again underscore that the influence of neoliberal ideas and social class on vaccination decision-making is not direct but mediated (and converted) by a particular sociopolitical context.

Furthermore, this study delineates the forms of agency available to neoliberal parents in a socio-political setting that is not supportive of citizens’ active engagement with health issues. The discussion on agency – from individualistic consumer choice to ‘anti-vax movement’ – forms the backbone of social science literature about vaccination skepticism (e.g. Attwell et al., 2018; Kata, 2012; Reich, 2014). In Russia, there is not much room for open opposition to vaccination. The limiting factors include the official pro-vaccination pressure, the political restriction of grassroots activism, as well as vaccine-hesitant parents’ disunity and preference for individual solutions. Despite these, my informants still exerted tacit agency by devising (informal) ways of dealing with medical bureaucracy and manipulating paid healthcare options. Through these dispersed activities, they routinized vaccine-hesitant parenting scripts and encouraged the development of organizational niches for unvaccinated children. Importantly, these efforts by vaccine skeptics relied on and somewhat aggravated the notorious features of post-Soviet welfare institutions: inequality in access to services and the wide spread of informal workarounds.