Reconceiving the field: Infant mental health, intersectionality, and reproductive justice

2.1 The right not to have a child

The move away from the narrowly construed, either/or logic of “right-to-life” versus “choice” is a hallmark of the paradigm shift from a reproductive rights framework to reproductive justice. Rights and justice are inextricable, but whereas reproductive rights agendas tend to be focused at the level of individual entitlements, reproductive justice agendas are broader, focusing on interlocking social justice and human rights issues (Asian Communities for Reproductive Justice, 2005). As Loretta Ross, a founding leader of the reproductive justice movement, recounted in remembering the moment when the term reproductive justice was coined by women-of-color activists, “We were dissatisfied with the pro-choice language, feeling that it did not adequately encompass our twinned goals: To protect the right to have—and to not have—children” (Asian Communities for Reproductive Justice, p. 5). The movement views these rights as inextricable; only if one is truly free to choose to safely have a child may one freely choose not to have a child (and vice versa), and every individual has a right for either choice to be a viable and respected option. The movement exposes the systemic forces that disproportionately weigh on disenfranchised groups along both axes, constricting choices, impeding autonomy, and foreclosing self-determination. The reproductive justice framework also brings historical and systemic analysis to each present-moment circumstance, so, for example, contemporary African American women's choices and experiences around childbearing would be considered in light of the historical trauma of slavery, including the routine rape of enslaved women by White slave owners as a tactic of domination and a business practice, and the fact that the children these women bore in bondage would themselves be held as property.

Short of brute force—which is not a relic of the past—the right not to have a child may be infringed or blocked via myriad mechanisms, including restricted representations of potential paths to self-actualization at all developmental phases (i.e., socialization); lack of protection from sexual violence, objectification, and exploitation; lack of access to reproductive health education and information as well as lack of access to reproductive health care (including, but not limited to, abortion); and/or lack of access to rewarding pursuits other than parenting. The field of infant mental health could protect the rights of disenfranchised groups not to have children by intervening around any and all of these junctures. Examples of possible infant mental health interventions in this arena follow.

2.2 The right to have a child

As noted earlier, the right to have a child is inextricable from the right to not have a child. Self-determination is the linchpin; however, interlocking forces of oppression impede self-determination for particular social and cultural groups. Just as the systemic forces described earlier may conspire to overtly or covertly push women and girls into having children in many instances without genuinely, freely choosing this, so too do systemic barriers prevent particular groups of people from becoming parents despite their wishes to do so.

Infant mental health (in the sense of the health and thriving of infants) for first-nation communities and those who serve them must incorporate a reckoning with this staggering magnitude of historical trauma, which is also a contemporary trauma in light of the dispossession and oppression that continue to afflict native peoples. Distinct, but parallel, histories of atrocity and trauma impact other communities of color, constraining individual people's choices and capacities to have children.

Loretta Ross (2016) offered “population control” as a lens for analyzing such forces of constraint. She wrote, “I urge attention to the multiple ways that Indigenous peoples and communities of color are constrained through a constellation of public policies that aim to maintain white supremacist economic, social, and political hierarchies [through regulating such domains as] food distribution, labor patterns, [and] migration” (p. 72). She asserted further that “peoples of color worldwide are targeted for containment and elimination in order to control their land and natural resources (p. 76).”

Policy-level forces of reproductive oppression are manifest in institutional practices that block access to safe and healthy conception, pregnancy, and childbirth for particular groups. Access to reproductive technology is blocked for many based on economic exclusion, but also based on overt racism or implicit bias on the part of healthcare providers who might support White women in pursuing pregnancy despite fertility challenges, but not do the same for women of color. In her article “What's Killing America's Black Infants?” Zoe Carpenter (2017) summarized contemporary research into the causes of the grossly disproportional infant mortality rates for Black infants. She noted that “a growing body of evidence points to racial discrimination … as the dominant factor in explaining why so many black babies are dying” (p. 6). Solomon (2018) summarized research documenting the fact that racism is also responsible for the disproportionate mortality rates of African American mothers. Julia Chineyere Oparah with the group Black Women Birthing Justice (2016) described the emergence of the birth justice movement (a branch of the reproductive justice movement) in this way: “The struggle for access to birthing alternatives is inseparable from struggles for racial, economic, and social justice and the fundamental transformation of global maternal-care systems” (p. 15).

Infant mental health professionals can join forces with reproductive justice advocacy efforts to ensure access to respectful and culturally competent care for these vulnerable populations; eradicate coerced conception restriction and sterilization of incarcerated youth and adults; stop the criminal prosecution of pregnant and parenting women who struggle with addiction; and end shackling of pregnant prisoners during labor. Just as in the case of protecting people's rights not to have children, infant mental health efforts to protect people's rights to have children must be grounded in awareness of historical and contemporary forms of reproductive oppression, manifest in culturally competent practice, germinated and cultivated via preservice training and workforce development standards, and reinforced via advances at the level of policy.

2.3 The right to parent children in safe and healthy environments

This third tenet of the reproductive justice movement is perhaps the most readily recognizable as overlapping with infant mental health. When environmental toxins related to industry disproportionately harm neighborhoods where people of color reside, for example, leading to high rates of asthma for infants of color, the infant mental health implications are clear. Infant mental health professionals might work to educate parents about asthma management, or to mitigate the potential adverse effects on parent–child relationships of the need to administer albuterol treatments, or advocate with pediatric providers regarding parent/caregiver inclusion in treatment protocols. What is newer for the field of infant mental health is the idea that the “upstream” work of environmental activism and policy is likewise within the purview of infant mental health, and that the core goals of the infant mental health field cannot be realized without engaging at these levels. The reproductive justice movement can teach the field of infant mental health how to gain ground upstream.

The reproductive justice movement builds coalitions among wide-ranging advocacy and activist groups to advance common causes. A prime example—and one that makes clear the links with the WAIMH position paper—is the issue of workplace leave. Bowman et al.’s (2016) report on paid leave advocacy efforts in the United States has documented “growing momentum in states and communities across the country to support workers and families by passing or improving upon workplace leave policies” (p. 1) emphasizing that “these winning campaigns are a testament to the power of organizing and worker-centered campaign strategies as well as diverse and robust coalition building” (p. 1). The WAIMH position paper calls for “policies that support adequate parental leave so that parents can provide optimal care for their infants during the crucial early years of life” (p. 4). This plea demonstrates not only that the field of infant mental health and the reproductive justice movement have overlapping concerns but further that protecting infant mental health depends on securing reproductive justice. Additional areas of overlap between infant mental health and reproductive justice relate to the third tenet, include repealing family caps in social welfare programs, eliminating race- and class-based disparities in child welfare involvement, ensuring food and environmental justice (access to potable water, support for breast-feeding when desired, access to healthy formula as needed/desired that is free of corn syrup and endocrine disruptors, access to organic food, breathable air, etc.), achieving universal access to childcare and preschool, and ending interpersonal and community violence.

2.4 Sexual autonomy and gender freedom for every human being

This has come to be embraced by the reproductive justice movement as inextricable from and a necessary condition for the other three tenets. The implications for infant mental health are discussed later.

3.1 Reflective tool

Intersectionality theory can function as a mirror for the field of infant mental health, enabling us to reexamine who we are. The intersectionality framework pushes for transparency regarding power structures and exposes how each of us is positioned within complex networks, holding (in the words of Patricia Hill Collins, mentioned earlier) “varying amounts of penalty and privilege” (p. 225) in diverse moments and contexts. As Banjeree Brown (2007) noted, “privilege and discrimination are made possible because of one another. Both are products of a paradigm and a mindset defined by hierarchy and exclusion, in which value is accorded to a few at the expense of the many” (p. 19).

Many fields and discourses obscure the operations of power, privilege, and discrimination in their own coming-into-being and day-to-day workings, promoting instead a myth of their organic emergence, apolitical nature, and progress based in inherent value. These Enlightenment-era ideas continue to shape the ways many contemporary areas of study and practice understand themselves, and they blind us to the vested interests, systematic exclusions, inequitable access issues, and uneven resource allocations that follow from the interlocking systems of oppression pervasive in the current social order (Flax, 1990). Critical race theory came into being by levying this critique of the field of law, demonstrating how the legal field and legal structures, rather than being outside of racism, are implicated in the reproduction of institutional and systemic racism. Undoing racism from a critical race theory perspective involves not only using the law to fight racism but, via intersectionality theory, exposing and countering operations of racism within legal discourse, institutions, and practices. Intersectionality can likewise be used to reveal blind spots, hidden inequities, and covert repetitions of injustice in the field of infant mental health.

Furthermore, researchers, writers, and cultural workers in a wide array of disciplines and traditions, including all of the arts and humanities, might be included in infant mental health discourse when their work is centered around infancy, parenting and caregiving, or related matters. Finally, grassroots organizations, community and advocacy groups, and activists striving to ensure infant/family well-being and counter forces of oppression negatively impacting infants and families ought to be regarded as leaders and authorities in the field of infant mental health. Reproductive justice has since its inception embodied such movement-based authority and approach to scholarship. As the authors of a classic reproductive justice text, Undivided Rights: Women of Color Organize for Reproductive Justice, reflected in the preface to the new (2016) edition, the book underscored “the potential and ability of the reproductive justice movement and its multiple constituencies to produce new theories, new knowledge, and new forms of activism” (p. vii). This community-based, overtly political, grassroots approach to theory-building, knowledge production, and agenda-setting offers an alternative to conventional infant mental health approaches, which have often imagined that infant mental health knowledge comes from the laboratory, the academy, or one profession or another and is dispensed from there to infants and families.

In addition to broadening the scope of which disciplines, practices, and voices might be considered germane to the field of infant mental health, the intersectionality framework as a reflective tool also exposes the ways in which intersecting forces of oppression limit, via systemic barriers, who enters particular fields, who excels within them, who gets published, achieves tenure, garners authority, and so on. Glass ceilings, compounded adversity factors, implicit bias, resource-hording, gate-keeping, and the like all contribute to an uneven playing field wherein not only economic wealth but also social capital, decision-making power, mobility, authority, and access are distributed in predictable, well-documented, grossly disproportionate ways across social groups. This is how racism, classism, sexism, able-ism, homophobia, xenophobia, and other systems of oppression work, both outside of and within the disciplines conventionally comprising the field of infant mental health (e.g., see Hanks, Solomon, & Weller, 2018). Embracing an intersectionality framework demands that representatives of the field of infant mental health take steps to change these patterns.

Oparah and Bonaparte (2016) offered an excellent example of this practice. As the editors described in their coauthored introduction, an initial call for contributions to this volume on birth justice yielded a wealth of material, but there were significant gaps as well, not surprisingly including some of the most disenfranchised constituencies. They wrote that, “after reviewing the proposals, we identified voices that were missing or underrepresented … and made efforts to recruit contributors who could speak about these particularly marginalized experiences” (p. 16). Tenet 8 demands exactly this kind of “effort” toward intentional inclusion, and suggests that exclusionary practices, even when they reflect the norm or default procedures, must likewise be held accountable as being purposeful (A common feature of privilege involves a convenient naiveté regarding systematic exclusions and barriers to access.) Taken together, the Tenets offer a road map for implementing an intersectionality framework within the field, beginning with Tenet 1, “Self-Awareness Leads to Better Services for Families,” which calls on infant mental health practitioners to reflect on the impact that multiple systems of oppression have had on our own lives.

3.2 Analytical framework

In addition to serving as a reflective tool enabling a reexamination of who comprises the field of infant mental health, intersectionality theory can also function as an analytical framework guiding the field in critically examining its work. D. W. Winnicott (1960) once famously quipped that “There is no such thing as an infant” (p. 587), meaning that human infants cannot be understood separate of the caregiving relationships on which they depend for survival. It follows that as we develop understandings about infants, we are simultaneously—whether we are aware of this or not—developing understandings about other people and other things as well. Indeed, while the field of infant mental health produces knowledge about infants, it is also contributing to knowledge production regarding parents and caregivers, professionals of various sorts, systems of care, cultural practices, institutional structures, social norms, and global constructs. Sometimes these concomitant knowledge-production projects are explicit. Frequently, however, they are implicit and sometimes entirely unintended.

Intersectionality theory is a useful system for analyzing knowledge-production projects that the field of infant mental health engages in that may be inadvertent, but have significant and often harmful effects. A prime example of this is the heteronormative bias that exists in the vast majority of infant mental health discourse. Families are commonly imagined and represented as heterosexual, nuclear families despite the fact that as the Center for American Progress noted, “According to the Unites States Census, 80 percent of households today depart from the nuclear family model of a married couple and their minor children, as compared with 57 percent in 1950” (Bowman et al., 2016, p. 5). The field of infant mental health is thus grossly out of step with the lived reality of most families when it continues to represent heterosexual nuclear families as a norm against which “other” family and household structures are defined as “alternative,” if not deviant. More complicated than simply failing to keep up with the times, this systematic representational distortion has the effect of regulating norms, reproducing processes of inclusion/exclusion, and assigning disparate values to different families. Adrienne Rich described the injurious effects of invisibilization in this way: “When someone with the authority of a teacher, say, describes the world and you're not in it, there's a moment of psychic disequilibrium, as if you looked into a mirror and saw nothing” (as cited in Burt, Gelnaw, & Lesser, 2010, p. 1). In addition to inflicting such psychological wounds, the consistent omission of a wide range of family structures has detrimental material consequences, as the needs and strengths of these “other” families go unaccounted for.

The common theme is the assault to self-determination regarding reproductive experience, which can only be tolerated by a society that represents certain individuals and groups as less entitled to reproductive autonomy and well-being than are other groups. Infant mental health discourse contributes to this broader social project of meting out reproductive worthiness when it refers to such categories as “the family”, in ways that decontextualize, universalize, and idealize a particular family constellation while obliterating the existence of all others.

Closely related to the pattern of heteronormative bias in infant mental health discourse is what has been identified by the authors of the Diversity-Informed Tenets as “matricentric bias.” This is described as “idealizing (and conversely blaming) biological mothers while overlooking the critical child-rearing contributions of other parents and caregivers including second mothers, fathers, kin and felt family, adoptive parents, foster parents, and early care and educational providers” (p. 15). Terms such as maternal deprivation or maternal sensitivity, powerfully organizing concepts in infant mental health discourse, both signal and perpetuate the matricentric bias in the field, marginalizing nonmaternal caregivers and suggesting via closed-circuit logic that when such caregivers do demonstrate sensitivity or centrality as caregivers, they are functioning as mothers.

To achieve gender equity, note the extent to which this kind of labor falls to women, freeing men to spend their time and energy otherwise—engaged in activities involving remuneration, for example, or in leisure or other self-fulfillment activities. Sociologist Arlie Hochschild's well-known 1989 study The Second Shift documented the fact that even after many middle- and upper class White American women—that is, groups that had previously not worked outside of their homes—entered the labor force in the 1970s, they continued to be responsible for most of the work of social reproduction, maintaining roughly the same gendered division of labor as prior to their being employed, but working double time. Patterns of gender-based disparities in social reproductive labor persist in the 21st century around the globe.

But recognizing that women tend to be disproportionately responsible for childrearing and other aspects of social reproduction does not necessitate or justify representing biological mothers as the only salient caregivers. Indeed, the matricentric bias often impedes accurate perceptions of who is actually doing what kind of caregiving. Often the considerable childrearing labor of paid caregivers that is a reality for many families, for example, is entirely obscured in infant mental health accounts of typical socioemotional development, attachment patterns, family dynamics, and so on. Within an intersectionality framework, the experiences and contributions of paid caregivers would be registered and attended to, enabling a fuller understanding of small children's actual relational matrix, but also laying the groundwork for understanding and advocacy on behalf of this workforce, which is easily exploited as long as it remains invisible, and has been referred to as a “shadow” labor force (Macdonald, 1998). The matter of paid childcare is a concern of the reproductive justice movement, as women comprising this labor force are frequently disenfranchised and face many barriers to self-determination around their own parenting. Patterns of globalization and immigration influence which groups of women contribute caregiving labor to which employing families where. As the field of infant mental health embraces an intersectionality framework, it becomes clear that the well-being of all the infants and caregivers in these scenarios, not just that of the employers and their offspring, must be safeguarded. This instantly moves the field in the “action-oriented” direction noted earlier, as gross class- and race-based inequities currently divide the families in question.

Closely related to the heteronormative and matricentric biases in infant mental health discourse is the common pattern of reproducing the gender binary system. Representing heterosexual nuclear families as the norm and biological mothers as default primary caregivers usually goes hand in hand with shoring up discursive and institutional practices that admit of only two preordained genders. As sex assignment typically occurs at birth (if not during pregnancy), and gender is often a highly charged construct for families and a prime axis of socialization and intergenerational transmission, it would seem that the field of infant mental health would be uniquely positioned to protect gender fluid and nonconforming people (both infants and parents) and to open up possibilities of understanding and insight related to gender for everyone. On the contrary, however, the facts of gender-diverse parenthood and transparenthood, intersex infants, and gender fluid and nonconforming toddlers are almost entirely repressed in infant mental health discourse.

Ross and Solinger advocated the use of people who can get pregnant and give birth as more inclusive than “women.” Oparah and Bonaparte (2016) similarly argued for the terms birthing parent and pregnant people “to remind us that people who give birth do not universally identify as women” (p. 16), and they also sought out and include the perspective of a “transdad” in their volume to counter the invisibilization of transparents.

In his book Transgender Children and Youth: Cultivating Pride and Joy with Families in Transition, Elijah Nealy (2017) asserted that “neither parents nor children are required to justify their affirmed gender; it is understood that even young children are fully capable of recognizing and naming their gender identity, whether trans or cisgender” (p. 48). Nealy also described a historical shift in nomenclature from gender-variant or gender-nonconforming to the more affirming terms gender-diverse, gender-expansive, and gender-independent. The intersectionality framework enables the infant mental health field to recognize and support the healthy existence of trans and gender-expansive families, developing trans and gender literacy as a basic professional competency rather than a rarified area of specialization.

As an analytical tool, then, the intersectionality framework supports the field of infant mental health in critically examining the unintended by-products, implicit biases, systematic exclusions, and harmful repetitions of structural inequities in our research, writing, and practice. In so doing, this framework opens up possibilities for the field to work in more inclusive ways, center the experiences and voices of silenced and disenfranchised infant/family communities, and counter historical injustices.

3.3 Methodology for promoting social justice

Infant mental health practitioners likewise often have “up-close and personal relationships” with the devastating impact of interlocking systems of oppression on infants and families, and can draw on the intersectionality framework as praxis—as a strategy for doing infant mental health work as social justice work. Reproductive justice offers a road map.

Answers to these questions offer springboards into infant mental health work as intersectional praxis. Race, gender, and class-based inequities are abundantly evident in health, well-being, resource, and access disparities impacting the infants and families served by infant mental health practitioners. Arenas sorely in need of intersectionality-based intervention by infant mental health practitioners include child welfare, the prison industrial complex, early care and education, immigration policies, and the field of obstetrics and gynecology. Points of departure must be grounded in recognition of the particular histories of oppression within each system, and the specific historical trauma suffered by diverse groups in relation to each system. At the heart of the matter is the radical conviction that the rights of infants articulated by the WAIMH must be upheld universally, and the recognition that this will entail a great deal more advocacy in partnership with and on behalf of some infant/families than others to counter historical and contemporary injustices. The promise, to borrow from Asian Communities for Reproductive Justice (2005), is no less than “the complete physical, mental, spiritual, political, economic, and social wellbeing” (p. 1) of all infant/families.