This thesis explores: (1) how young women make decisions about Human Papillomavirus (HPV) vaccination and (2) how they negotiate and evaluate public health discourses that work to promote a responsible female subjectivity to manage the risks of HPV. Public health professionals have promoted HPV vaccination as a responsible and informed choice for young women, whose sexual practices are considered to put them and their sexual partners “at risk” of HPV. I conducted semi-structured interviews with thirteen young women between the ages of 21 and 28. My interviews with women and the public health literature on HPV vaccination reflect cultural and moral priorities regarding the “right” kinds of female sexuality and individual responsibility to manage sexual and reproductive health risks. Many of the women I interviewed were critical of the identification of their sexual practices as putting them and others “at risk” of HPV and maintained that their “safe” sex practices mitigated these risks. All of the women I interviewed prioritized concerns about protecting their reproductive health from cervical cancer over the risks of HPV when discussing their responsibility to be vaccinated. Based on these interviews, I argue that women‟s decisions about HPV vaccination are practices of self-making, through which they strive to enact identities as responsible young women, who endeavour to protect themselves, their bodies and health from harm. These decisions are complex, dynamic and reflect their ability to make competent, informed decisions that are inextricably bound to their social and material circumstances. / Graduate

This thesis reports on a qualitative exploration of the experiences of 30 women designated as ‘high risk’ due to the co-existence of ‘maternal obesity’ (BMI ≥ 30) and Gestational Diabetes Mellitus (GDM)/Type Two Diabetes Mellitus (T2DM) in pregnancy. This is examined in the context of medico-scientific/public health/ popular media discourses pertaining to ‘maternal obesity’/GDM/T2DM in pregnancy. ‘Maternal obesity’/GDM/T2DM in pregnancy are increasingly prevalent and clinically associated in manifold ways. Increasing prevalence is linked to the ‘global epidemic’ of ‘obesity’/diabetes: now commonly referred to as ‘diabesity’. Current biomedical knowledge asserts ‘maternal obesity’ and diabetes (‘maternal diabesity’) synergise in causing adverse pregnancy outcomes, have long term health implications for the offspring and contribute to an ‘intergenerational cycle’ of ‘obesity’/diabetes. This is the first qualitative study to consider pregnancy/post-birth experiences of women with co-existing ‘maternal obesity’ and GDM/T2DM in pregnancy from a sociological perspective. Participants undertook a series of auto/biographical narrative interviews. Longitudinal engagement provided nuanced psycho-social insight into women’s perceptions/experiences and the socio-cultural context of their lives. Analysis of pertinent ‘pregnancy’ Internet fora postings augmented interview data and was utilised for comparative/corroborative purposes. Participants were predominantly of low socio-economic status, congruent with epidemiological data. The concept of pregnancy ‘planning’ was not resonant and few women accessed/felt predisposed to access preconception care. Women did not identify as ‘obese’, and knowledge/perception of risks associated with the medical ‘conditions’ was low. Women perceived themselves to be stigmatised due to their weight in society and specifically within healthcare. Many participants were experiencing acute/chronic stress which appeared to have mediated risk perceptions/compromised diabetic regimen adherence. Expense of ‘healthy’ eating/diabetic diet was considered prohibitive. Women’s material circumstances/socio-cultural milieux may militate against ability to minimise risk and effect lifestyle change. Policy and practice, for the most part, fails to take this into account.

This institutional ethnography relies on observations, interviews, and textual analyses to explore the experiences of mothers and children who attend a women-centered agency in Vancouver, Canada where a hot lunch, child care in the emergency daycare, and participation in group activities are vital forms of support. Mothers who come to the centre have many concerns related to their need for safe housing, a sustainable income, adequate food, child care, and support. And like mothers anywhere, they have concerns about their children. While many of the children, the majority of them First Nations, have never had a diagnostic assessment for fetal alcohol syndrome (FAS) or for the relatively new umbrella category, ‘fetal alcohol spectrum disorder’ (FASD), a number of the mothers were concerned or even knew that their children had FAS. This thesis asks – how does it happen that mothers have come to know their children in this way? The study critically examines how FASD knowledge and practices actually work in the setting and what they accomplish. My analysis traces how ruling practices for constructing and managing ‘problem’ mothers and children coordinate work activities for identifying children deemed to be ‘at risk’ for FASD. In their efforts to help their children and improve their opportunities for a better life, mothers become willing participants in group activities where they learn how to attach the relevancies of the FASD discourse to their children’s bodies or behaviours. They also gain instruction which helps them to confess their responsibility for children’s problems. While maternal alcohol use as the cause of FASD is contested in literature and in some work sites it is, in this setting, taken as a fact. This study discovers how institutional work processes involving government, medicine, and education actually shape and re-write women’s and children’s experiences into forms of knowledge that make mothers and children institutionally actionable. It is only by exposing the relations of power organizing mothers’ work that it may be possible to re-direct attention to mothers’ and children’s embodied concerns and relieve mothers of the overwhelming responsibility for which they are held and hold themselves to be accountable. / Graduate