Culture versus the law in the decision not to vaccinate children: meanings assigned by middle-class couples in São Paulo, Brazil

Abstract

This study aimed to learn how middle-class parents in the city of São Paulo, Brazil, interpreted the country's prevailing vaccination requirements, based on their experiences with vaccinating, selectively vaccinating, or not vaccinating their children. A qualitative approach was used with in-depth interviews. The analytical process was guided by content analysis and the theoretical framework of the anthropology of the law and morality. For parents that vaccinated, Brazil's culture of immunization outweighed the feeling of compliance with the law; for selective parents, selection of vaccines was not perceived as deviating from the law. In both, the act of vaccinating their children was a matter of moral status. Meanwhile, the non-vaccinators, counter to the legal perspective, attributed their choice to care for the child on grounds that mandatory vaccination was contrary to their way of life; they experienced a feeling of social coercion and fear of legal impositions. Vaccination is an important practice in public health, but it can reveal tensions and conflicts from normative systems, whether moral, cultural, or legal.