Article published in:
Narrative Inquiry
Vol. 24:2 (2014) ► pp. 281–308

Risk, responsibility, resistance

Young women’s negotiations of identity and healthy citizenship in human papillomavirus (HPV) vaccination narratives

| The University of Western Ontario, Canada
The introduction of human papillomavirus (HPV) vaccination has resulted in a proliferation of discourse about HPV-related health risks, with a particular emphasis on the link between HPV and cervical cancer. Using a discursive narrative approach, we critically examine how young women navigate and construct their identities in relation to discourses on HPV vaccination, and the master narratives of risk, medicalization and individual responsibility for health that inform these discourses. Drawing on positioning theory, the narratives of three women who accepted, declined and were undecided about vaccination are presented to illustrate how they actively and uniquely negotiate their identities in relation to the positions idealized by HPV vaccination discourse, and in the context of their intimate relations and everyday lives. These findings fundamentally challenge dominant techno-scientific perspectives on health risk that underpin the majority of research on HPV vaccine decision-making, and health promotion research more generally. We suggest that discursive narrative approaches can advance critical understanding of how health risk discourse, and emerging technologies aimed at reducing health risks, are implicated in promoting neoliberal constructions of healthy citizenship that frame health risk management as an individual responsibility and moral obligation.
Keywords: positioning, identity, discourse, risk, human papillomavirus (HPV)
Published online: 24 November 2014
https://doi.org/10.1075/ni.24.2.06pol
References
Allen, J.D., Mohllajee, A.P., Shelton, R.C., Othus, M.K.D., Fontenot, H.B., & Hanna, R
(2009) Stage of adoption of the human papillomavirus vaccine among college women. Preventive Medicine, 48(5), 420–425. CrossrefGoogle Scholar
Ajzen, I
(1988) Attitudes personality, and behavior. Chicago: Dorsey Press.Google Scholar
Ajzen, I., & Fishbein, M
(1980) Understanding attitudes and predicting social behavior. Englewood Cliffs, NJ: Prentice-Hall.Google Scholar
Bamberg, M
(2011) Narrative practice and identity navigation. In J.A. Holstein & J.F. Gubrium (Eds.), Varieties of narrative analysis (pp. 99–124). London: Sage Publications.Google Scholar
(2007) Stories: Big or small – Why do we care? In M. Bamberg (Ed.), Narrative – State of the art (pp. 165–174). Amsterdam, The Netherlands: John Benjamins. CrossrefGoogle Scholar
(2004) Narrative discourse and identities. In J.C. Meister, T. Kindt, W. Schernus, & M. Stein (Eds.), Narratology beyond literary criticism (pp. 213–237). Berlin & New York: Walter de Gruyter.Google Scholar
Batt, S., & Lippman, A
(2009) Chapter 3 - Preventing disease: Are pills the answer? In A. Rochon & D. Saibil (Eds.), The push to prescribe: Women and Canadian drug policy (pp. 47–66). Toronto: Women’s Press.Google Scholar
Caskey, R., Lindau, S.T., & Alexander, G.C
(2009) Knowledge and early adoption of the HPV vaccine among girls and young women: Results of a national survey. Journal of Adolescent Health, 45(5), 453–462. CrossrefGoogle Scholar
Canadian Broadcasting Corporation (CBC)
(2014) HPV vaccine: Why boys are less likely to get it. September 5. Retrieved from http://​www​.cbc​.ca​/news​/health​/hpv​-vaccine​-why​-boys​-are​-less​-likely​-to​-get​-it​-1​.2756037
(2009) The debate over HPV inoculations. August 19. Retrieved from http://​www​.cbc​.ca​/news​/technology​/the​-debate​-over​-hpv​-inoculations​-1​.800185
Centers for Disease Control and Prevention (CDC)
(2008) HPV Vaccine Information for Young Women. Retrieved from http://​www​.cdc​.gov​/std​/hpv​/STDFact​-HPV​-vaccine​-young​-women​.htm
Charles, N
(2014) Injecting and rejecting, framing and failing: HPV Vaccination discourse and the subjectification of citizens’ identities. Feminist Media Studies. CrossrefGoogle Scholar
(2013) Mobilizing the self-governance of pre-damaged bodies. Neoliberal biological citizenship and HPV vaccination promotion in Canada. Citizenship Studies, 17(6-7), 770–784. CrossrefGoogle Scholar
Chase, S
(2003) Talking narrative seriously: Consequences for method and theory in interview studies. In Y.S. Lincoln & N.K. Denzin (Eds.), Turning points in qualitative research: Tying knots in a handkerchief. Walnut Creek, CA: AltaMira Press.Google Scholar
Comeau, P
(2007) Debate Begins Over Public Funding for HPV Vaccine. Canadian Medical Association Journal, 176(7), 913–914. CrossrefGoogle Scholar
Dennhardt, S., & Laliberte Rudman, D
(2012) When occupation goes ‘wrong’: A critical reflection on risk discourses and their relevance in shaping occupation. In G. Whiteford & C. Hocking (Eds.), Occupational science: Society, inclusion and participation (pp.117–133). Oxford, UK: Wiley-Blackwell. CrossrefGoogle Scholar
Dubriwny, T
(2013) The vulnerable empowered woman: Feminism, postfeminism and women’s health. New Brunswick: Rutgers University Press.Google Scholar
Eggerston, L
(2007) Adverse events reported for HPV vaccine. Canadian Medical Association Journal, 177(10), 1169–70. CrossrefGoogle Scholar
Frank, A
(2013) The wounded storyteller: Body, illness and ethics (2nd ed.). Chicago, IL: The University of Chicago Press.Google Scholar
Grantham, S., Ahern, L., & Connolly-Ahern, C
(2011) Merck’s one less campaign: Using risk message frames to promote the use of Gardasil in HPV prevention. Communication Research Reports, 28(4), 318–326. CrossrefGoogle Scholar
Greco, M
(1993) Psychosomatic subjects and the ‘duty to be well’: Personal agency within medical rationality. Economy & Society, 22(3), 357–371. CrossrefGoogle Scholar
Gulli C
(2007, August 27). Our girls are not guinea pigs: Is an upcoming mass inoculation of a generation unnecessary and potentially dangerous? Maclean’s, 1201, 38–42.Google Scholar
Hardin, P
(2001) Theory and language: Locating agency between free will and discursive marionettes. Nursing Inquiry, 81, 11–18. CrossrefGoogle Scholar
Hartley, H., & Tiefer, L
(2003) Taking a biological turn: The push for a “female viagra” and the medicalization of women’s sexual problems. Women’s Studies Quarterly, 31(1-2), 42–54.Google Scholar
Hopfer, S., & Clippard, J.R
(2011) College women’s HPV vaccine decision narratives. Qualitative Health Research, 21(2), 262–77. CrossrefGoogle Scholar
Janz, N., & Becker, M
(1984) The health belief model: A decade later. Health Education Quarterly, 11(1), 1–47. CrossrefGoogle Scholar
Jones, R
(2013) Health and risk communication: An applied linguistic perspective. New York: Routledge. CrossrefGoogle Scholar
Kleinman, A
(1988) The illness narratives: Suffering, healing and the human condition. New York: Basic Books.Google Scholar
Korobov, N
(2013) Positioning identities: A discursive approach to the negotiation of gendered categories. Narrative Inquiry, 23(1), 111–131. CrossrefGoogle Scholar
Krieger, J.L., Kam, J., Katz, M., & Roberto, A.J
(2011) Does mother know best? An actor-partner model of college-age females’ HPV vaccination behavior. Human Communication Research, 37(1), 107–124. CrossrefGoogle Scholar
Lalvani, P
(2011) Constructing the (m)other: Dominant and contested narrative on mothering a child with Down syndrome. Narrative Inquiry, 21(2), 276–293. CrossrefGoogle Scholar
Lenselink, C.H., Schmeink, C.E., Melchers, W.J.G., Massuger, L.F.A.G., Hendriks, J.C.M., van Hamont, D., et al.
(2008) Young adults and acceptance of the human papillomavirus vaccine. Public Health, 122(12), 1295–1301. CrossrefGoogle Scholar
Licht, A.S., Murphy, J.M., Hyland, A.J., Fix, B.V., Hawk, L.W., & Mahoney, M.C
(2010) Is use of the human papillomavirus vaccine among female college students related to human papillomavirus knowledge and risk perception? Sexually Transmitted Infections, 86(1), 74–78. CrossrefGoogle Scholar
Lieblich, A., Tuval-Mashiach, R., & Zilber, T
(1998) Narrative research: Reading, analysis, and interpretation. Thousand Oaks, CA: Sage Publications. CrossrefGoogle Scholar
Lippman, A., Melnychuk, R., Shimmin, C., & Boscoe, M
(2007) Human Papillomavirus, vaccines and women’s health: Questions and cautions. Canadian Medical Association Journal, 177(5), 484–487. CrossrefGoogle Scholar
Lupton, D
(1999a) Risk. New York, NY: Routledge, Taylor & Francis Group.Google Scholar
(1999b) Risk and sociocultural theory: New directions and perspectives. Cambridge, UK: Cambridge University Press. CrossrefGoogle Scholar
Mamo, L., Nelson, A., & Clark, A
(2010) Producing and protecting risky girlhoods: How the HPV vaccine became the right tool to prevent cervical cancer. In K. Wailoo, J. Livingston, S. Epstein & R. Aronowitz (Eds.), Three shots at prevention: The HPV vaccine and the politics of medicine’s simple solutions (pp. 121–146). Baltimore, MA: The Johns Hopkins University Press.Google Scholar
Mancuso, F., & Polzer, J
(2010) “It’s your body but…”: Young women’s narratives of declining human papillomavirus (HPV) vaccination. Canadian Woman Studies, 28(2-3), 77–81.Google Scholar
Morgan, K.P
(1998) Contested bodies, contested knowledge: Women, health, and the politics of medicalization. In S. Sherwin (Ed.), The politics of women’s health: Exploring agency and autonomy (pp. 83–121). Philadelphia: Temple University Press.Google Scholar
Nisker, J
(2007) Letter: Vaccination against human papillomavirus. Canadian Medical Association Journal, 177(12), 1526. CrossrefGoogle Scholar
Page, S
(2007) Everything you wanted to know, but were afraid to ask: Is the HPV vaccine a victory for women’s health or a triumph of aggressive marketing? Ottawa Citizen.
Parkin, M., & Bray, F
(2006) The burden of HPV-related cancers. Vaccine, 24(3), S11–S25. CrossrefGoogle Scholar
Petersen, Alan
(2003) Governmentality, critical scholarship, and the medical humanities. Journal of Medical Humanities, 24(3/4), 187–201. CrossrefGoogle Scholar
Petersen, A
(1996) Risk and the regulated self: The discourse of health promotion as politics of uncertainty. Journal of Sociology, 32(1), 44–57. CrossrefGoogle Scholar
Petersen, A.R., & Lupton, D
(1996) The new public health: Health and self in the age of risk. Thousand Oaks, CA: Sage Publications.Google Scholar
Polzer, J., & Knabe, S
(2009) Good girls do... get vaccinated: HPV, mass marketing and moral dilemmas for sexually active young women. Journal of Epidemiology and Community Health, 63(11), 869–870. CrossrefGoogle Scholar
(2012) From desire to disease: Human papillomavirus (HPV) and the medicalization of nascent female sexuality. Journal of Sex Research, 49(4), 344–352. CrossrefGoogle Scholar
Public Health Agency of Canada (PHAC)
(2012) National Advisory Committee on Immunization’s (NACI) update on human papillomavirus (HPV) vaccines, 38 (ACS-1). 1–62. Retrieved from http://​www​.phac​-aspc​.gc​.ca​/publicat​/ccdr​-rmtc​/12vol38​/acs​-dcc​-1​/assets​/pdf​/12vol​-38​-acs​-dcc​-1​-eng​.pdf
(2007) National Advisory Committee on Immunization’s (NACI) statement on human papillomavirus vaccine. Canada Communicable Disease Report; 33(DCC-2), 1–32. Retrieved from http://​www​.phac​-aspc​.gc​.ca​/publicat​/ccdr​-rmtc​/07pdf​/acs33​-02​.pdf
Riessman, C.K
(2003) Women and medicalization: A new perspective. In R. Weitz (Ed.), The politics of women’s bodies: Sexuality, appearance, & behavior (2nd ed. pp. 46–63). New York: Oxford University Press.Google Scholar
Roberts, M.E., Gerrard, M., Reimer, R., & Gibbons, F.X
(2010) Mother-daughter communication and human papillomavirus vaccine uptake by college students. Pediatrics, 125(5), 982–989. CrossrefGoogle Scholar
Robertson, A
(1998) Shifting discourses in health promotion. Health Promotion International, 13(2), 155–166. CrossrefGoogle Scholar
(2000) Embodying risk, embodying political rationality: Women’s accounts of risks for breast cancer. Health, Risk and Society, 2(2), 219–235. CrossrefGoogle Scholar
Roof, W.C
(1993) The 1992 RRA presidential address: Religion and narrative. Review of Religious Research, 34(4), 297–310. CrossrefGoogle Scholar
Rosenthal, S.L., Rupp, R., Zimet, G.D., Meza, H.M., Loza, M.L., Short, M.B., et al.
(2008) Uptake of HPV vaccine: Demographics, sexual history and values, parenting style, and vaccine attitudes. Journal of Adolescent Health, 43(3), 239–245. CrossrefGoogle Scholar
Society of Obstetricians and Gynecologists of Canada (SOGC)
(2007) Spread the word, not the disease. Retrieved from http://​www​.hpvinfo​.ca​/uploads​/hpvinfo​.ca​/files​/quick​-facts​-general​-info​_e​.pdf
Stretcher, V., Champion, V., & Rosenstock, I
(1997) The health belief model and health behavior. In D.S. Gochman (Ed.), Handbook of health behavior research I: personal and social determinants (pp. 71–91). New York: Plenum Press.Google Scholar
Talbot, J., Bibace, R., Bokhour, B., & Bamberg, M
(1996) Affirmation and resistance of dominant discourses: The rhetorical construction of pregnancy. Journal of Narrative and Life History, 61, 225–251. CrossrefGoogle Scholar
Tomljenovic, L., & Shaw, C
(2011, December 22). Human papillomavirus (HPV) vaccine policy and evidence-based medicine: Are they at odds? Annals of Medicine, 1–12.Google Scholar
Cited by

Cited by 4 other publications

Albert, Katelin
2019. Beyond the responsibility binary: analysing maternal responsibility in the human papillomavirus vaccination decision. Sociology of Health & Illness Crossref logo
Carson, Andrea, Fiona Webster, Jessica Polzer & Sandra Bamford
2021. The power of potential: Assisted reproduction and the counterstories of women who discontinue fertility treatment. Social Science & Medicine 282 ► pp. 114153 ff. Crossref logo
Emerson, Amanda M.
2018. Strategizing and Fatalizing: Self and Other in the Trauma Narratives of Justice-Involved Women. Qualitative Health Research 28:6 ► pp. 873 ff. Crossref logo
Freijomil-Vázquez, Carla, Denise Gastaldo, Carmen Coronado, María-Jesús Movilla-Fernández & Simone Garzon
2019. When risk becomes illness: The personal and social consequences of cervical intraepithelial neoplasia medical surveillance. PLOS ONE 14:12 ► pp. e0226261 ff. Crossref logo

This list is based on CrossRef data as of 10 april 2022. Please note that it may not be complete. Sources presented here have been supplied by the respective publishers. Any errors therein should be reported to them.