Is it Worth the shot? Ontario Women's Negotiations of Risk, Gender and the Human Papillomavirous(HPV) Vaccine

This research project has been an endeavor in understanding how Human Papillomavirus (HPV) vaccine policy became gendered in Canada, how women in Ontario negotiated the concepts of “risk” and “gender” deployed in pharmaceutical marketing and public health programming, and how they folded these mediations into decision making about the vaccine. Eighteen months of ethnographic fieldwork revealed that the federal and Ontario governments developed HPV vaccine policy by using gender based analyses frames, based on the parameters of Merck Frosst’s gender-based marketing. This case study of the HPV vaccine highlights how corporations and governments work hand and hand to set public health policy in the neoliberal era of public health. However, these sales/governance strategies and the gendered at-risk subject formation they created and circulated were not passively integrated by women into their daily lives. The women interviewed – mothers of daughters affected by the grade eight school vaccination program, women university students and patients at a hospital vaccine clinic – demonstrated that the concepts of “risk” and “gender” are productive and movable ontological modes of being, which shift in and out of focus depending upon the context. Mothers were intensely focused on gender and doing mothering, students were doing gender politics and intermittent risk, and patients were living with risk. What sales/governance strategies had tried to “fix,” women continually unfixed. These accounts of situated risk and gender demonstrated that when assembled, women’s experiences helped transform their ethical being or sense of self. This knowledge of the self then informed vaccination decisions. Thus, decision making was not a discrete event or a linear, cost-benefit analysis. Instead it was an inherently social and cultural process, which was embedded in women’s experiences of finding meaning in their efforts to be good mothers, strong young women emerging into adulthood and pre-cancerous patients seeking respite amid the anxiety of protracted medical procedures. Women’s ontological decision making provides an analytical framework through which to tie together risk- and gender-related theory, individual accounts of risk encounters and the social, political, historical and economic context in which these mediations occur.