Structural discrimination against mothers during pandemic times makes it impossible for women to access the care they need without discrimination

“You can’t get that time back”: pregnancy, birthing and newborn babies Some of the mothers in our sample were pregnant with their first or second baby during the various New Zealand lockdowns. During the interviews, these mothers described experiencing various health concerns, including a fear of catching COVID19, and concerns about lack of familial support during the birthing process: I was worrying about getting it, what would happen to the fetus? Then when you actually go into birth, when there was an outbreak, people weren’t allowed to have their partners in the delivery room, so we didn’t know what was going to happen. The thought of [partner] not being there really freaked me out. Just having that in the back of your mind and worrying about whether your new-born would have some kind of health issue and then COVID would come. There were all those sorts of things that added that extra layer of anxiety on top of all the things you already worry about being pregnant (Emilla, first pregnancy). Pregnant women were navigating many different sources of information to try to understand the risks of COVID-19 while pregnant. During the early stages of the pandemic, scientific information was emerging very quickly, and there were long periods of time with much uncertainty due to the quickly evolving nature of the virus and its effects on human health. This context caused considerable stress and anxiety for pregnant women and new mothers who felt an “overwhelming sense of responsibility” to their (unborn) babies (Gray and Barnett, 2022). The lack of services during this time caused many of the mothers, particularly those pregnant or with newborns, to experience various forms of uncertainty, stress, and anxiety. Many described logistical challenges in meeting their midwives or other medical professionals due to social isolation restrictions in place: It was a really anxious time because none of the services were available. I was trying to ring the numbers and there was nothing there, no support. It got up until I was throwing up every day and I knew I was pregnant and the hormones were high. I went to a scan on my own, because [husband] wasn’t allowed to come with me (Beth). Some experienced challenges with accessing social and emotional support. For example, one of the mothers experienced a miscarriage during the first nationwide lockdown, and recalls this as a particularly traumatic period of her life: The nurse called me up and said, “You’ve got to go to ED now because you’re still bleeding.” I went there, they dropped me off and she said, “You’ve got to be prepared for a D&C [dilation and curettage]”. So I went there. Going to the hospital was traumatic. They were very busy, I didn’t get any emotional support. I was on my own and it was painful and awful. I came home, recovered. Then weeks after that, I had quite an emotional breakdown, I think because of the events. Some of the mothers expressed sadness and frustration by COVID-19 rules that restricted family support during special moments in their pregnancy journeys, particularly scans and birthing: You can’t get that time back. For me personally, I’ll never get to experience my first birth with my mum there. Or my scans. I had to go on my own, my family waited outside in the carpark. (Shanti, teen mother) Attending medical appointments alone, without family support, was upsetting for some mothers (particularly teenage mothers), whereas others accepted such conditions as part of a national campaign to limit the spread of the virus. In the context of COVID-19, vaccinations were highly politicized “biomedical technologies” playing a significant role in the construction of the fetal and maternal body, and discourses of risk and responsibility (Lupton, 2012, 2022, 329). While the mothers in our study had widely ranging views on vaccination, many experienced various forms of judgement, misinformation, and miscommunication from the public and medical health professionals. For example, first time migrant mother Keeja recalled her distress upon receiving conflicting information about vaccination: The same day I did my home pregnancy test and it was positive was the same day I did my first dose of vaccination, because I had already booked it. They tell you to let them know and I said, “Well, I just found out today that I’m pregnant.” They were like, “Oh, do you want to get vaccinated?” I was like, of course, I can’t believe you’re asking me this! For many mothers, vaccination and masking were important measures to protect themselves and their babies, while others chose not to be vaccinated in fear of side-effects on their babies. With significant social restrictions based on vaccination status, some unvaccinated mothers described feeling angry about missed opportunities for their families to join them at medical appointments (i.e., scans, physiotherapy) and important milestones in their journey into motherhood: I didn’t get vaccinated while hapu (pregnant). . . because I don’t know how that’s going to affect my baby yet. But I would be in so much pain, my midwife would recommend me to go get massages, and chiropractic stuff, and I had to sit at home in pain because of the vaccine rules. (Avi, teen mother) I didn’t like how you had to be vaccinated to go to things, like even scans. My baby daddy didn’t come to my scans because everyone had to be vaccinated. (Hotu, teen mother) For these young Maori mothers, recalling their pregnancies ¯ during lockdowns and vaccination restrictions, evoked strong feelings of loss, grief and even anger toward the government. Herein our findings align with Thornton and Reich’s (2022) research on Black mothers and vaccine refusal in the US, highlighting how structural gendered racism and concerns about state intervention shaped vaccine decisions. Although the women had different views on vaccination, many felt that their competency as a ‘caring and responsible’ mother was being judged by strangers, family members and medical professionals based on their willingness to be vaccinated or not, and their efforts to minimize risk: I had a lot of medical issues with my pregnancy, and I’d go to hospital a lot. And it’s just that constant badgering or the sly, “oh, you’re already not going to be a good mum, because you’re not getting vaccinated”, “Think about your child”, “do what’s best for them”. What happened to, ‘my body, my choice’? I felt discriminated against because I wasn’t vaccinated. (Shanti, teen mother) I remember one lady was in the lift with me and she turned to me and said, “Oh, I hope you’re being careful.” I was like, “yeah, because I’m fucking going around [NZ city] trying to catch COVID. I want to get my baby sick [sarcasm]”. You become like public property when you’re pregnant, but those sorts of comments were a whole other thing. (Emilia) Outside of pandemic times, pregnant women and mothers of newborns experience high levels of “regulation, monitoring and control”, as well as social judgement in their approaches to mothering and the decisions they make to care for their babies and themselves (Longhurst, 1999; Lupton, 2012, 329). During the first two years of the pandemic, the mothers described heightened levels of judgement, particularly as pregnant women and new mothers navigated unknown risks of COVID infection and vaccination, often without the medical and social support required to make informed decisions. In this way, our findings align with Manca’s (2021) research on pregnant women’s experiences of risk and intersectional power relations during the early stages of the pandemic. According to Manca (2021), medical responses to COVID19 were “(dis)organized within pre-existing economic, racial, colonial, and patriarchal power relations that disadvantaged some pregnant women more than others” (321). As our research shows, moral and medical judgements were indeed highly racialized, with young Maori, Pacific and migrant mothers ¯ disproportionately facing the brunt of health professionals questioning and scrutiny. According to a recent report, the “single largest cause of maternal death in Aotearoa is suicide”, particularly affecting wahine ¯ Maori mothers ( ¯ Hoki, 2019). With the pandemic further amplifying mental health issues, and with the absence of many structures of formal and informal support, intersectional approaches that recognize the compounding factors of ethnicity and socioeconomic deprivation (as a result of colonization, and ongoing racism in everyday life and health and social service provisions) on mothers’ health and wellbeing are necessary to provide the culturally-responsive care and support for those most impacted (Barrett et al., 2023).