‘MMR talk’ and vaccination choices: An ethnographic study in Brighton

Abstract

In the context of the high-profile controversy that has unfolded in the UK around the measles, mumps and rubella (MMR) vaccine and its possible adverse effects, this paper explores how parents in Brighton, southern England, are thinking about MMR for their own children. Research focusing on parents' engagement with MMR has been dominated by analysis of the proximate influences on their choices, and in particular scientific and media information, which have led health policy to focus on information and education campaigns. This paper reports ethnographic work including narratives by mothers in Brighton. Our work questions such reasoning in showing how wider personal and social issues shape parents' immunisation actions. The narratives by mothers show how practices around MMR are shaped by personal histories, by birth experiences and related feelings of control, by family health histories, by their readings of their child's health and particular strengths and vulnerabilities, by particular engagements with health services, by processes building or undermining confidence, and by friendships and conversations with others, which are themselves shaped by wider social differences and transformations. Although many see vaccination as a personal decision which must respond to the particularities of a child's immune system, 'MMR talk', which affirms these conceptualisations, has become a social phenomenon in itself. These perspectives suggest ways in which people's engagements with MMR reflect wider changes in their relations with science and the state. r

Vaccine hesitancy

“…Social science research has shown that vaccination decision-making should be understood in a broader sociocultural context. 25,[46][47][48] In fact, vaccination is part of a "wider social world" 49 which means that different factors (past experiences with health services, family histories, feelings of control, conversations with friends, etc.) can influence the decisionmaking process regarding vaccination.…”

“…This theory is based on a view of the immune system as an individual characteristic needing individualized healthcare and on the idea that there is a possible risk of immune overload due to individual "weakness" of a child. 49,127 As Casiday has shown in her qualitative study on parental measles, mumps and rubella (MMR) vaccination decision-making, this view often implies a "holistic notion of the immune system, (…) in which the immune system is viewed as central to the body's overall health, but is itself intricate and delicately balanced; it must be maintained so that it can flexibly and effectively cope with a multitude of challenges from the environment." 48 From this point of view, vaccines are seen as something that would perturb rather than boost the immune system.…”

“…129 Fear of needles and of pain after vaccination has shown that in the decision-making process regarding vaccination, most parents consider the risk of a VPD or of side effects of vaccines not from a population-based perspective as in epidemiology, but rather based on their perceptions of their own child's health and vulnerabilities. 46,49 For a review of the implications of risk perception in the decision to vaccinate at the individual level, please see Serpell and Green. 144 …”

To vaccinate or not to vaccinate: how teenagers justified their decision

“…Even if the teenagers in this study are often of age, as teenagers their parents still had a large impact on their decision. The conclusion is that parents' influence over children's vaccinations and importance of personal experiences reported by Poltorak et al (2005) and Ideland (2007) also seems to be valid for adolescents. But the fact that six of the seven students in the study vaccinated themselves indicates that the consideration of the effects of the disease has been important to the students.…”

“…The precautionary principle is often emphasized. Mike Poltorak et al (2005) found how important different personal histories are in determining the willingness to vaccinate one's children against MMR (mumps, measles, and rubella). These histories include parenthood experiences, knowledge, ways of validating and engaging with information and expectations of health professionals.…”