HPV vaccination discourses and the construction of “at-risk” girls

Abstract

Objective

The objective of this study was to investigate the deployment of HPV vaccination (HPVV) discourses and their impact on Canadian girls, parents, nurses and physicians.

Methods

Qualitative methods were favoured and included interviews with participants (n = 146) from four Canadian provinces and diverse socio-cultural locations. Using a poststructuralist discourse analysis, we examined HPVV campaigns as well as interview transcripts to document how girls, parents and health professionals make sense of HPVV as well as how they position themselves within and/or resist discourses coming from industry and public health sources.

Results

The results speak to HPVV campaigns as morally laden, gendered, heteronormative and factually misleading. Emerging from the analysis of interviews is the girls’ and parents’ lack of information regarding HPVV. For mothers, results show how they construct themselves as responsible biocitizens at the cost of the powerlessness, uncertainty, anxiety and fear they feel alongside the perceived imperative to act upon their daughter’s cancer risk. As for health professionals, they generally appropriate dominant HPVV discourses and use fear of HPV infection as a strategy to manufacture consent for HPVV among girls and parents. We discuss the ways in which opportunities for broader dialogue about HPVV and girls’ sexual health are foreclosed and how subject positions for all types of participants are problematic.

Conclusions

We ask whether public health is advanced when HPVV discourses transform healthy bodies into “at-risk” bodies and when the fear of cancer is instrumentalized in the pharmaceuticalization of public health.

Résumé

Objectif

L’objectif était d’étudier le déploiement des discours sur la vaccination contre les VPH (VVPH) et leur impact sur les filles, les parents, les infirmiers/infirmières et les médecins canadiens.

Méthodes

Des entrevues ont été réalisées avec des participant(e)s (n = 146) de quatre provinces canadiennes. Une analyse poststructuraliste du discours a permis d’examiner les campagnes de VVPH et les transcriptions d’entrevues pour documenter la façon dont les participant(e)s interprètent les VVPH et se positionnent comme sujets au sein des discours de l’industrie ou des agences de santé publique.

Résultats

Les campagnes de VVPH sont sexistes, hétéro-normatives et trompeuses. Émergeant de l’analyse des entrevues est le manque d’information des filles et des parents en ce qui a trait à la VVPH. Les mères se construisent en tant que bio-citoyennes responsables, mais au prix de l’impuissance, de l’anxiété et de la peur ressenties parallèlement à l’impératif d’agir pour minimiser le risque de cancer de leur fille. Quant aux professionnel(le)s de la santé, ils s’approprient les discours dominants sur la VVPH et utilisent la peur comme stratégie pour fabriquer le consentement pour la VVPH. Les occasions de dialogue sur la VVPH et la santé sexuelle des filles sont perdues et les positions en tant que sujets sont problématiques pour tous les types de participant.

Conclusions

Nous nous questionnons à savoir si la santé publique est bien servie quand les discours sur la VVPH transforment des corps en santé en corps « à risque » et quand la peur du cancer est instrumentalisée pour la pharmacologisation de la santé publique.

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Acknowledgements

This paper is part of a broader project on HPV vaccination discourses, practices, and spaces (Rail, G., Fusco, C., Burns, K., Russel, K., Bryson, M., MacDonald, M., Moola, F., Norman, M.E., Petherick, L., and Polzer, J., 2012–2017). The authors dedicate this article to the memory of Dr. Abby Lippman, who inspired them and provided assistance throughout this project.

Funding

The authors acknowledge the generous financial support of the Canadian Institutes of Health Research for this project.

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Correspondence to Geneviève Rail.

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Rail, G., Molino, L., Fusco, C. et al. HPV vaccination discourses and the construction of “at-risk” girls. Can J Public Health 109, 622–632 (2018). https://doi.org/10.17269/s41997-018-0108-8

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Keywords

  • HPV
  • Vaccination
  • Girls
  • Cancer
  • Consent
  • Medicalization

Mots-clés

  • VPH
  • Vaccination
  • Filles
  • Cancer
  • Consentement
  • Médicalisation