“Vaccines protect both you and your newborn:” A discourse analysis of risk and uncertainty in information about vaccination in pregnancy

Health governance during pregnancy is grounded in cultural norms about good mothering, which centre around self-sacrifice and perceived conflicts between maternal and fetal bodies. Nonetheless, many health choices in pregnancy should have mutual benefits and risks for maternal and fetal bodies, including vaccination during pregnancy. This manuscript presents results from a discourse analysis of 440 texts about vaccines that are recommended in pregnancy in Canada, including inactivated influenza, tetanus-diphtheria-acellular-pertussis, and COVID-19 vaccines. Texts include publicly available online information (e.g., webpages, printouts, posters, videos, and other materials) developed by various authoritative institutions (e.g., public health services, professional organizations, vaccine manufacturers). This study contributes to feminist and risk theorist critiques of public health discourse by exploring how texts deploy emotionally laden technical discourses that govern pregnant individuals towards divergent goals. Specifically, they are governed towards socially desirable health decisions (e.g., vaccination acceptance) and towards agonizing over decision-making as “good mothers.” I analyze how texts pursue this divergent governance in three ways, by deploying discourses that reify conflict between maternal and fetal bodies, organizing the work of making choices around gendered power relations, and activating emotions around mothering responsibilities. My analysis compares how such governance differs across products by available evidence and by the intended purpose of vaccination to protect maternal and/or fetal bodies. I conclude by discussing the value of combining governmentality and cultural approaches to risk theory to understand how the interface of public health and mothering discourses reproduce power relations, and suggest recommendations on how to lessen that reproduction.