Loss

Mothers in extreme poverty in the region of Bom Jesus da Mata become resigned to the loss they will face. In this region, the typical woman will watch an average of 3.5 of her children die. She will deliver an average of 1.5 babies who are stillborn. She knows that 70% of childhood deaths occur within the first six months of life, and she becomes accustomed to watching the children of other mothers dying around her almost constantly. As a means of coping, these poverty-stricken mothers must find a way to contend with the realities they face. Thus, they learn to emotionally detach from their pregnancies and newborns until they are better able to ascertain a newborn's likelihood of survival. Scheper-Hughes coins a term called "mortal selective neglect" to explain how these mothers have a high expectancy of childhood death, which produces differing patterns of nurturing between infants who have higher odds of survival compared to those whom the mothers view as born "wanting to die." Underneath these emotional coping mechanisms is the foundation of crippling loss which underpins mothers' existence.

Survival of the Fittest

These mothers have internalized the characteristics of "survival of the fittest" and have applied this theory to parenting their children. With such limited resources and precious little food, these women have learned to focus their efforts on the children who are born strongest and who show the highest likelihood of surviving in nearly impossible conditions. Scheper-Hughes notes that while some childhood illnesses only require simple remedies, such as a sugar/salt/water solution, it is often difficult to convince a mother who is already under great stress to take back a child whom she has already written off as dead. Babies suffering from illnesses producing febrile seizures are "left alone—often on the floor in a back room, and allowed to die." In this way, mothers are better able to focus their resources on their healthy (or at least healthier) and more active children.

Impossible Choices

Scheper-Hughes notes that she has been criticized for "presenting an unflattering portrait of poor Brazilian women" based on their societal neglect. She explains that she has tried to instead paint a portrait of the impossible choices that these destitute mothers face in light of sickness, poverty, and deprivation. She states that the choices that these women are forced to make are the ones any mother might make under similar circumstances. Instead of careful nurturing of each individual child, mothers are forced to implement the best survival strategies they can muster. Pragmatically, they recognize that "not all of one's children can be expected to live," which then guides the choices that they make. Scheper-Hughes also explains that the choices of the women in the Alto do Cruzerio "resembles nothing so much as a battlefield or an emergency room in an overcrowded inner-city hospital." There comes to exist a triage of care, as women are obligated to nurture the children who do seem capable of survival. While these are seemingly impossible choices, women make them in order to continue on with life.