"Nuns Don't Get Cervical Cancer": A Reproductive-Justice Approach to Understanding the Cervical-Cancer Prevention Crisis in Ireland

Abstract

"Nuns Don't Get Cervical Cancer":A Reproductive-Justice Approach to Understanding the Cervical-Cancer Prevention Crisis in Ireland Beth Sundstrom (bio) From 2015 to 2018 scandals surrounding the human papilloma-virus (HPV) and cervical-cancer screening in the Republic of Ireland revealed serious deficiencies in the nation's health-care system. A misinformation campaign conducted in 2015 about the HPV vaccine resulted in a sharp decline in Irish vaccination levels, and in 2018 Ireland's CervicalCheck screening program was revealed to be flawed. In the Scally Report (2018), a scoping inquiry into the problems at CervicalCheck, key informants pointed to the significant gendered failings of the Irish health-care system, noting that "there is a history of looking at women's health services as being secondary," "women and women's rights are not taken seriously," and "paternalism is alive and well." The report identified the need for expert and committed attention to women's issues within the health-care system.1 Through an analysis of two scandals, the CervicalCheck screening program and the HPV-vaccination-misinformation campaign, this study investigates the cervical-cancer prevention crisis in Ireland through the lens of reproductive justice. HPV vaccination and cervical screening are health behaviors that illuminate the intersection of oppressions based on race, ethnicity, socioeconomic position, ability, [End Page 292] age, gender, sexual orientation, and immigration status.2 These categories are best analyzed through an approach that foregrounds concepts of reproductive justice, underscoring intersectional oppressions in women's health care and advocating for truth telling as resistance. Indeed, this article is among the first studies to apply a reproductive-justice approach to the issues surrounding cervical-cancer prevention and HPV vaccination. Both the CervicalCheck screening program and the misinformation campaign about HPV vaccinations were rooted in unethical communication by the state and nongovernmental actors. Unethical communication is ingrained in hegemonic, paternalistic sociopolitical practices that mirror narratives of oppression based on gender, ethnicity, and nationality.3 By contrast, ethical communication is "socially oriented, empathically situated, and responsive to others."4 In the midst of Ireland's cervical-cancer prevention crisis, women and public-health advocates confronted unethical communication through digital intersectional communication by engaging in storytelling and truth telling about health, illness, and the body to confront, challenge, and change Ireland's health-care system. By privileging the voices of activists and experts in this article, I argue that the ways in which women and public-health advocates confronted the cervical-cancer prevention crisis in Ireland may be understood as a triumph of truth telling over the failure of unethical communication. Methods This qualitative study was part of a larger research project investigating reproductive justice in Ireland. This project offers a novel multiple-methods approach incorporating a variety of sources. Through a Fulbright U.S. Scholars Grant, I completed document analysis, interviews with activists, and participant observation in Ireland from [End Page 293] September to December 2018. Developing convergence of multiple sources of evidence provided data triangulation. To strengthen the reliability of the study, I followed Yin's principles to maintain a chain of evidence and organize the data collected for the study into an evidentiary base that included documents, field notes, interview transcriptions, and narrative compilations.5 I received institutional review-board approval for this research. The document-analysis portion of the study includes an investigation of published documentation on cervical-cancer prevention, including archival records and physical artifacts as well as traditional and social media. Archival research was conducted at the Boole Library, University College Cork, in its archival holdings of the records of the Attic Press, which included materials from the Irish women's movement covering the 1970s to the 1990s. I also conducted qualitative in-depth interviews with fifteen Irish activists working on reproductive justice; the quotations from activists in this article come from these interviews. In order to maintain the confidentiality of participants, all quotes from these interviews are included anonymously in this article. I also completed more than twenty hours of informal meetings and participant observation with experts and activists in Ireland. I collected publicly accessible documents (e.g., websites, press releases, reports, tweets, Facebook posts, YouTube videos, etc.) from twenty women's organizations. I...