Graduation Year


Document Type




Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department


Major Professor

Linda Whiteford, M.S., Ph.D

Co-Major Professor

Elizabeth Miller, Ph.D., M.P.H.

Committee Member

Nancy Romero-Daza, M.A., Ph.D.

Committee Member

Ellen Daley, M.P.H., Ph.D.

Committee Member

Alicia Best, M.P.H., Ph.D.


gender, health policy, intensive mothering, neoliberalism, political economy


In 2015, the US experienced a widespread measles outbreak that originated at Disneyland, California and spread to six other states, Mexico, and Canada. That year, California passed Senate Bill 277 (SB 277), which eliminated the personal belief exemption for vaccinations required for school entry; California became the third state in the country to eliminate nonmedical exemptions. In 2019, Washington, Maine, and New York followed suit eliminating all nonmedical exemptions amid the largest measles outbreak in the US in 25 years. Many countries, including the US, are experiencing a rise in vaccine preventable diseases due, in part, to increasing vaccine hesitancy, a fluid and context- and vaccine-specific phenomenon broadly defined as the delay or refusal of vaccine services despite availability. Through in-depth interviews with vaccine hesitant parents in Southern California, this dissertation explores the underlying factors that shape vaccine hesitancy and examines how the passage of SB 277 impacted vaccine-related strategies, decisions, and behaviors. Applying a political economic framework through a feminist lens, three major themes are presented, 1) highly individualized processes of risk assessment and management around vaccines, informed by neoliberal ideologies, 2) institutional distrust that drives parents to challenge biomedical authority and demedicalize their approaches to health, and 3) the gendered processes of vaccine hesitancy that disproportionately burden women and mothers. Findings suggest that efforts aimed at addressing falling vaccination rates and subsequent vaccine-preventable disease outbreaks would benefit from in-depth, qualitative research that considers multiple socio-ecological levels of influence, including interpersonal, socio-cultural, and political economic.