“Good mothers, lazy mothers”: Analyzing impacts of individual responsibility discourse in maternal and child healthcare in Vanuatu

Frequently health care workers around the globe are trained in traditions of Western biomedicine, traditions that emphasize neoliberal ideas of personal responsibility for achieving and maintaining health. This mindset is often communicated through the hidden curriculum, when students are socialized in the culture of Western biomedicine. In this article, we analyze how biomedical health care providers use affective health care encounters at maternal and child health clinics in the South Pacific Island nation of Vanuatu to reinforce emotional labels of “good” and “lazy” mothers based on mothers' abilities to enact health and nutrition advice provided in clinical care—a place we see the hidden curriculum reproduced in patient-provider interactions. We present a series of ethnographic vignettes illustrating how ubiquitous healthy eating messages are infused with affective ideologies, reinforcing the idea that by providing healthy food, a mother is properly caring for her children. However, a mother's ability to achieve these recommendations relies on factors beyond her control, including structural violence and persistent poverty. Nevertheless, the ability of mothers to follow nutrition education recommendations from healthcare practitioners is used as evaluative discourse on motherhood during clinical encounters—loving, “good” mothers feed their children healthy, local foods, while neglectful and “lazy” mothers feed their children store-bought, unhealthy food. Through the analysis of moral discourse during well-baby visits, our data show how neoliberal ideology of individual responsibility permeate health care exchanges, despite cultural ideology that prioritizes community well-being. Applying critical friendship, ethnography and decolonial feminism to theorize new pathways toward healing, we call for changes to health professions education that improve patient-provider communication to limit the reproduction of harmful neoliberal discourse on personal responsibility, ultimately improving health outcomes and health equity.