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  • br Background and conceptual frameworks br Gender the


    2. Background and conceptual frameworks
    2.1. Gender, the body, and biopolitics
    This study incorporates a postmodern approach to HPV and cervical cancer prevention, which explores meanings of gender, the body, and biopolitics. Foucault (1978) argued that biopolitics led to the medica-lization of women's reproduction, which assigned natural processes to the biomedical paradigm. Scholars define medicalization as the pa-thologizing of women's bodies, allowing medical authorities to define illness by identifying objective signs and symptoms (Bush, 2000; Martin, 2001; Pollock, 1999). The medicalization of the body, which was largely complete by the mid-twentieth century, enabled the med-ical establishment to secure its power over health and illness (Kline, 2011). Extant research has explored the role of biopolitics in the dis-semination of the HPV vaccine (Paul, 2016). The role of biopolitics as a regulatory control of the body and reproduction (Foucault, 1978) provides a lens to investigate women's personal and social identity re-lated to health behaviors (Cline, 2011).
    Vaccination offers a particularly relevant health behavior related to women's personal and social identity, including race/ethnicity, socio-economic position (SEP), ability, age, gender, sexual orientation, and immigration status. Recent research shows that vaccine refusal may be linked to an emphasis on natural health, concerns about science and technology, and distrust of profit-driven pharmaceutical companies (Reich, 2016; Sobo, 2015). The recent backlash against vaccines may be traced to Dr. Andrew Wakefield's fraudulent 1998 study that falsely linked autism with the Measles, Mumps, and Rubella (MMR) vaccina-tion. The modern anti-vaccination movement relies on overstating the frequency of adverse events, misrepresenting the risks of vaccines, understating the benefits of Thonzonium Bromide and the risks of vaccine pre-ventable diseases, and relying on conspiracy theories (Kaufman and Kaufman, 2018). Although the safety of the HPV vaccine has been well established (Andrews et al., 2017; Arnheim-Dahlström et al., 2013), achieving high rates of HPV vaccination globally has been hindered by access, cost, moral or religious concerns about sexual activity, and sensational media coverage of unproven adverse side effects (Sipp et al., 2018). In 2013, anti-vaccination campaigns in Japan led the Ministry of Health, Labor and Welfare to suspend its recommendation for the HPV vaccination, causing vaccination rates to drop from approximately 70% to less than 1% (Hanley et al., 2015).
    The field of feminist science studies explores the intersection of technology with nature and its implications related to gender (Paul, 2016; Weber, 2014; Wyer et al., 2014). Scholars have criticized the  Social Science & Medicine 232 (2019) 289–297
    false duality of the natural versus the technological, which often results in the subjugation of individuals with subjectivities that differ from the dominant hegemonic discourse, such as women, people of color, and those who identify as LGBTQ (Haraway, 2003). Perpetuating a di-chotomy between nature and technology misconstrues how technology may empower women by providing an escape from the reproductive economy (Sundstrom, 2015). Science and technology offer the potential to move beyond essentialism, including the resulting misogyny and homophobia, revealing the harmful consequences of “back to nature” movements, including anti-vaccination (Aengst and Layne, 2014; Haraway, 2003). The impact of biopolitics on gender and the body requires the reconceptualization of normative “natural” processes of women's reproduction.
    Gender interacts at the level of the individual, family and commu-nity to impact personal health (Bird and Rieker, 2008). Social con-structs regarding reproduction contribute to women's understanding of their bodies and health. Butler (2010) suggested that locating social constructions that form women's identities provides an opportunity to intervene and implement subversive strategies. Ultimately, these stra-tegies may empower women to take control of their health through informed, value-based decision-making. Research suggests that women engage in active negotiation and occasional resistance related to cer-vical cancer screening. Bush (2000) argued that cervical cancer screening discourse should move beyond maintaining medical power through control of women's bodies and encourage communication that empowers women to choose Pap tests because they have a complete understanding of the risks and benefits.