Wednesday, May 09, 2007

Cultural attitudes, vaccine rejection and homebirth

A recent article in the journal Sociology of Health and Illness explores the cultural attitudes that lead to vaccine rejection. This is relevant for an understanding of homebirth advocacy, because promotion of the same cultural attitudes undergirds homebirth advocacy as well.

It is important to understand that both vaccine rejection and homebirth advocacy are not based on science. There is no scientific data that supports vaccine rejection. Indeed vaccines are one of the greatest public health achievements of all time and virtually every accusation about vaccines by vaccine rejectionists is factually false. Despite the fact that vaccine rejectionists have been 100% wrong in their understanding of vaccines, statistics, risks and claims of specific dangers, they still have a large following. In large measure that is because the cultural claims of vaccine rejectionists resonate with prevailing cultural assumptions. Vaccine rejection (and homebirth advocacy) are social constructs that have little if anything to do with objective reality or science.

'Trusting blindly can be the biggest risk of all': organised resistance to childhood vaccination in the UK (Hobson-West, Sociology of Health & Illness Vol. 29 No. 2 2007, pp. 198–215) explores these cultural attitudes. The first social construct is a re-imagining of the meaning of risk:
A primary way this is achieved ... is to construct risk as unknowns... [This] serves as an example of how the realist image of risk as a representation of reality is undermined. In the realist account, uncertainty and unknowns may be recognised but are usually framed as temporary phases that are overcome by more research. For the [vaccine rejectionists], there is a more fundamental ignorance about the body and health and disease that will not necessarily be overcome by more research. Interestingly, this ignorance is constructed as a collective – ‘we’ as a society do not know the true impact of mass vaccination or the causes of health and disease.
The problem that vaccine rejectionism is based on false premises is elided by ignoring the actual scientific data and focusing instead on whether parents agree with health professionals or refuse to trust them. Agreement with doctors is constructed as a negative and refusal to trust is constructed as a positive cultural attribute:
Clear dichotomies are constructed between blind faith and active resistance and uncritical following and critical thinking. Non-vaccinators or those who question aspects of vaccination policy are not described in terms of class, gender, location or politics, but are 'free thinkers' who have escaped from the disempowerment that is seen to characterise vaccination...
This characterization of vaccine rejectionists can be unpacked even further; not suprisingly, vaccine rejectionists are portrayed as laudatory and other parents are denigrated.
... instead of good and bad parent categories being a function of compliance or non-compliance with vaccination advice ... the good parent becomes one who spends the time to become informed and educated about vaccination...

... [vaccine rejectionists] construct trust in others as passive and the easy option. Rather than trust in experts, the alternative scenario is of a parent who becomes the expert themselves, through a difficult process of personal education and empowerment...
The ultimate goal is to become "empowered":
Finally, the moral imperative to become informed is part of a broader shift, evident in the new public health, for which some kind of empowerment, personal responsibility and participation are expressed in highly positive terms.
So vaccine rejectionism (like homebirth advocacy) is about the mother and how she would like to see herself, not about vaccines and not about children. In the socially constructed world of vaccine rejectionists, risks can never be quanitified and are always "unknown". Parents are divided into those (inferior) people who are passive and blindly trust authority figures and (superior) rejectionists who are "educated" and "empowered" by taking "personal responsibility".

These social constructs on on display in homebirth advocacy as well: The "risks" of hospital birth are "unknown". Women who trust their doctors are passive, sheep like beings who cannot think for themselves. In contrast, homebirth advocates are "educated", "empowered" and taking responsibility for their own health.

This view depends on a deliberate re-definition of all the relevant terms, however, and that re-definition is unjustified and self aggrandizing. The risks of hospital birth are not unknown. Believing that doctors lower neonatal and maternal mortality is not a matter of "trust", it is reality. Questioning authority is not the same as being "educated"; indeed, it isn't even related. Lacking even basic knowledge childbirth and rejecting medical facts is not a sign of education, independent thinking or taking personal responsibility. It is a lack of education at best, and self serving, self aggrandizing ignorance at worst.

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