My Nerves Are Bad: Puerto Rican Women Managing Mental Illness and HIV Risk

6. Motherhood

95 6 Motherhood Si mis hijos no hubieran llegado yo me suicide. [If my kids wouldn’t have arrived, I would have committed suicide.] . . . I am here for my kids. I dedicate myself to them. So I have a meaning to live. It has always been that way. Mi autoestima esta por el piso. [My self-esteem is on the floor.] Only my kids keep me going. —Yadra Mis hijos son mi vida. [My children are my life.] —Typical saying in Puerto Rico Among women with severe mental illness, motherhood may fulfill a particularly important role in their lives, serving as an affirmation of their importance and providing a mechanism for the expression of feeling and the fulfillment of an important social role.1 This is not surprising, since parenthood provides many individuals with a way to demonstrate creativity and nurturing.2 Parenting that is perceived as successful may boost an individual’s self-esteem and feelings of self-worth and competence . Accordingly, women with severe mental illness may begin their childbearing early and have multiple children.3 Motherhood is a particularly important role in the context of Puerto Rican culture.4 Although the males of the family are to be respected and often hold significant power, it is the mothers who are perceived as the glue that binds the family together.5 U.S.-born Latinas often begin their childbearing years at a younger age compared to females of other racial/ ethnic groups in the United States and tend to have a higher fertility rate.6 Compared to both other Latino subgroups and non-Latinos, Puerto Ri- 96 “My Nerves Are Bad” can females are more likely to begin their childbearing during their teenage years, are less likely to have an abortion, and are more likely to have a greater number of children.7 Historical events may have also shaped the culture’s views of the importance of reproduction and motherhood. America’s quest for racial purity through the legalized forcible sterilization of often unknowing women was brought to Puerto Rico, then a territory of the United States, in the 1930s.8 With the approval of the established eugenic sterilization board, a total of ninety-seven eugenic sterilizations were performed during the years 1937 through 1950; the eugenic sterilization law remained in force until its repeal in 1960.9 Although many voluntary sterilization procedures were performed during this same period of time, the extent to which they were truly voluntary in the larger context of limited family planning options remains contested to this day.10 Family planning efforts instituted in Puerto Rico were, and continue to be, similarly controversial, viewed by opponents of these programs as an American effort to erase the island’s population and by proponents as a step toward modernization, the reduction or elimination of island poverty , and the improvement of maternal and child health.11 However, because of the limited availability of contraception and contraceptive advice, a great number of women turned to contraceptive field trials as a means of obtaining these products. Many of the products used in these trials were ineffective and substandard, leaving women feeling that the products were worthless. Researchers later conducting Puerto Rico–based field trials of birth control pills often dismissed women’s complaints about the pills’ side effects as unscientific, psychosomatic in nature, and the result of women’s “emotional superactivity.”12 The extent to which women opted for “voluntary” sterilization under such circumstances remains uncertain. Whether the participants of our study were knowledgeable about these historical details is unclear, although at least a few had heard vague murmurings about the use of Puerto Rican women as guinea pigs in birth control experiments.13 Regardless of the reasons, motherhood and children played a critical role in the lives of a great majority of the women in our study. Almost all of the women (90.6 percent) had at least one child, and some had as many as eight. Even those women who already had several children often expressed a wish for more. Adalia, who already had four children, had lost them to her ex-husband and to social services because she had been unable to care for them as a result of her severe depression. Frustrated, she had had her Motherhood 97 tubes tied (a tubal ligation). Now, she missed her babies and was trying to save enough money to have surgery to untie her tubes...