Gender, sex and equal health: school nurses’ strategies and experiences of including boys in the HPV vaccination programme in Swedish primary schools

ABSTRACT

Since autumn 2020, boys in the fifth year of school (11-year-old students) in Sweden have been offered human papillomavirus (HPV) vaccination for free. Drawing from individual interviews with 21 school nurses working in primary schools in one of Sweden’s regions, the aim of this study was to explore nurses’ strategies and experiences of informing students and their guardians about the new vaccination programme, HPV and sex. Drawing on feminist theories on respectability and heteronormativity, findings indicate that heteronormative understandings of sexual relations frame school nurses’ narratives when informing students about HPV. The results also indicate that including boys in the vaccination programme has been fairly straightforward and when guardians hesitate or refuse to include their children in the vaccination programme, it is often girls’ guardians who do so. School nurses’ narratives suggest that guardians’ main argument for not vaccinating their daughters is because they believe they are too young. These narratives are framed around an understanding of the ‘respectable girl’. The results of our study highlight the importance of addressing equality, sexuality, sex and HPV as part of sexuality, consent and relations (sexualitet, samtycke och relationer) education in Swedish schools.

KEYWORDS:

• Equal health
• HPV vaccination
• gender
• sex
• sexuality
• school nurses

Acknowledgments

We express our gratitude to the school nurses for giving up their valuable time and sharing their insights and experiences about their work. We would also like to thank the two anonymous reviewers for constructive comments and suggestions, which have significantly improved our article.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1. Rotavirus infection, diphtheria, tetanus, whooping cough, polio, infections caused by Haemophilus influenzae type b, measles, mumps, rubella, serious diseases caused by pneumococcus and human papillomavirus.

2. Primary school in Sweden spans the first to sixth school year (school children 7–12 years of age).

3. Sweden is divided into 21 regions. Each respective region has responsibility for, for example, hospitals and healthcare as well as public transport.

4. In Sweden, the subject area is called ‘sexuality, consent and relations education’ (our translation). In Swedish, the subject area is called: sexualitet, samtycke och relationer). It should be integrated into all school subjects from preschool (i.e., 6-year-old school children) onwards. A new revised curriculum will be available from 1 July 2022.

Additional information

Funding

This study was supported by FORTE (In English: Swedish Research Council for Health, Working Life and Welfare) under grant number 2020-01232.