Unlocking Reproductive Autonomy for the Disabled Under International Law

Introduction

The feeling of being not seen as women, not as a mother but just as a label or a diagnosis. The sensation of only being recognized as a person with a disability. The reproductive rights of one of the most marginalized populations in today’s world, the disabled are frequently overlooked despite the constant discussion of marginalized groups, discrimination against them, and their rights. The international community’s lively debates about women’s reproductive rights, the rights of disabled people and human rights highlight the strong need for a thorough examination of their intersection.

Keywords: Disability, Reproductive rights, international framework, Inclusion, Sexual Autonomy

Disability: What is it?

According to the World Health Organization, disabilities are conditions that limit one’s ability to participate in activities and are actually caused by environments that aren’t designed to accommodate people with different abilities. The WHO defines disability in three dimensions: 

1. Impairment in a person’s body structure, physical functioning or mental functioning such as a limb impairment or memory loss. 
2. Activity limitation such as difficulty seeing, hearing or walking. 
3. Restrictions on participation in everyday activities like socializing, working, or leisure pursuits.

There is a wide range of disabilities. Their etiology varies; some are present from birth, while others arise as a consequence of illness or disease. They can advance slowly or quickly, depending on the situation. And they vary based on how they affect you, whether it’s your life expectancy or your quality of life.

Here, disabilities are defined as conditions that affect your ability to move, such as cerebral palsy or spinal cord injuries; they also include sensory disabilities that affect your vision and hearing; psychiatric disabilities that affect your emotions and behaviour; and, lastly, intellectual disabilities that affect your ability to think clearly and act in adaptive ways. What effect does this have on women who are of reproductive age? At the intersection of sexuality, compared to disabled men, disabled women are at the bottom rung of the ladder. Globally, an estimated 300 million women suffer from physical and mental disabilities. The impact is extensive because one in ten women between the ages of 15 and 44 who are of childbearing age have a disability. It has been reported that many of these women have been denied appropriate prenatal and postnatal care, as well as sexual autonomy. We must delve deeply into the history of disabled people’s sexual rights in order to comprehend why this is the case.

In the past, people with severe disabilities, whether they be physical or mental, were frequently institutionalized in large settings. Their ability to build families, establish relationships, and have children will undoubtedly be limited by this. There is a disgraceful history of forced sterilization in many developed nations, where people with disabilities were forced to undergo sterilization procedures in order to prevent them from becoming parents. The eugenics movement and the desire to reduce the proportion of people with disabilities in our population served as the main driving forces behind this. Despite the historical context, it is astonishing how embedded many of these practices are in our culture. In our society, there is social prejudice that assumes a disabled woman is incapable of understanding her sexuality. As a result, family members frequently decide for them. The issue of forced sterilization of the disabled population was not addressed until 2006, when the UN Convention on the Rights of Persons with Disabilities was adopted by the UN General Assembly and ratified by 185 countries. Children and people with disabilities have equal rights to reproduce and maintain their fertility under Article 23(1) of this Convention.

The assumption that women with disabilities are asexual and the treatment of their bodies differently than those of other childbearing women are examples of the unethical extent to which social stigma and stereotyping have spread. In addition to social prejudice and historical influences, certain medical conditions contribute to preconceived notions about the sexuality and reproductive needs of people with disabilities. The drugs needed for the disability and the pregnancy need to be taken at the same time. If not, both the mother and the foetus may suffer negative consequences. But times are changing, and disabled women are now giving birth alongside non-disabled women. One in ten women who bear children, or approximately 240 million people, are disabled. It is therefore past time that we had a conversation about defending the disabled’s right to procreate and making sure they have access to quality healthcare.

If we start inspecting from the childhood, children with disabilities are less likely than their peers without disabilities to receive sexual education in the classroom. They consequently become adults without realizing their sexual and reproductive rights. Disabled girls who menstruate are frequently coerced into having a hysterectomy because it is believed that they cannot maintain their menstrual hygiene with little to no assistance. In addition, people with disabilities encounter obstacles in their pursuit of education and work, which leads them into a cycle of poverty characterized by insecure housing, inconsistent access to food, and inadequate healthcare. Due to their diabetes and hypertension, women with disabilities (WWDs) are more likely to experience pregnancy-related complications. They are also more likely to have a caesarean section, which is risky in and of itself. Their babies typically have lower birth weights at birth and are more likely to arrive earlier than anticipated. Infections and haemorrhage are among the postpartum complications that pregnant women with disabilities are more susceptible to. In addition to the biological risks they encounter, they also deal with a good deal of stereotypical problems. The idea that they are irrational, hypersexual, helpless, and uncontrollably sexualized are among the damaging stereotypes. Due to these preconceived notions, there are stereotypes that WWDs are extremely susceptible to sexual abuse and assault, which is why society has placed them under excessive protection. Another stereotype is that caregivers of disabled women assume automatic responsibility for the child’s upbringing after the woman gives birth. Eugenics-influenced thinking and the notion that sexually active women with multiple partners are more likely to spread sexually transmitted infections (STIs) are examples of dangerous extent of these prejudices. Therefore, from the perspective of healthcare, the disabled are marginalized, just like in any other sector, and all of these factors highlight the need of giving this community additional support.

A robust framework of resolutions and declarations by international bodies like the United Nations has laid the cornerstone for safeguarding these rights. These include the Universal Declaration of Human Rights, the Declaration on the Rights of Disabled Persons, the Standard Rules on Equalization of Opportunities for Persons with Disabilities, the Principles for Protection of Persons with Mental Illness and Improvement of Mental Health Care, and the World Programme of Action Concerning Disabled Persons. 

The 1993 Vienna Declaration and Programme of Action is significant for its assertion that “special attention” must be given in order to ensure “non-discrimination, and the equal enjoyment of all human rights and fundamental freedoms by disabled persons, including their active participation in all aspects of society”. Reproductive rights are among these fundamental freedoms, including: the right to equality and non-discrimination; the right to marry and find a family; the right to comprehensive reproductive health care including family planning and maternal health services, education and information; the right to give informed consent to all medical procedures including sterilization and abortion; and the right to be free from sexual abuse and exploitation.

Taking into consideration the stigma attached to them, the main focus should be on mental health facilities, which are inherently highly patriarchal and oppressive, lack patient sexuality education programs, and have no policies regarding patients’ sexuality. These are not secure areas where women with disabilities could be able to use facilities related to sexual and reproductive health. Recalling an instance in which the infant child of a woman with disabilities was removed and placed for adoption, it is indisputable that disabled women represent a significant risk of rights violations.

Reproductive Rights of Women

The critical aspects of reproductive rights of women are as follows:

1. Right to bodily autonomy: Women have the right to make decisions about their bodies, including whether or when to have children. This includes the right to access contraception, the right to terminate a pregnancy (where legal), and the right to choose when and how to become a parent.
2. Access to contraception: Women have the right to access a range of safe and effective contraceptive methods to make informed choices about family planning. This includes access to education about contraceptive options and affordable, barrier-free access to contraception.
3. Safe and Legal Abortion: In places where abortion is legal, women have the right to access safe and legal abortion services. Access to abortion is a critical component of reproductive rights, and restrictive abortion laws can have negative consequences for women’s health and autonomy.
4. Prenatal and maternal care: Women have the right to access quality prenatal care, safe childbirth, and postnatal care. Adequate healthcare during pregnancy and childbirth is crucial for the well-being of both the woman and her child.
5. Freedom from coercion and discrimination: Women have the right to make reproductive choices free from coercion, discrimination, and violence. This includes the right to refuse sterilization, abortion, or other reproductive medical procedures without their informed consent.
6. Education and information: Women have the right to access comprehensive, accurate, and non-biased information about their reproductive health. This includes sex education that empowers individuals to make informed choices.
7. Access to assisted reproductive technologies: Women who wish to have children through assisted reproductive technologies, such as in vitro fertilization (IVF) or surrogacy, have the right to access these services and to make decisions about their reproductive future.
8. Protection from harmful practices: Women have the right to be protected from harmful practices, such as female genital mutilation (FGM), forced marriages, and child marriages, which can have severe consequences for their reproductive health and rights.
9. Reproductive healthcare services: Women have the right to access comprehensive reproductive healthcare services, including screening for sexually transmitted infections, treatment for reproductive health conditions, and access to skilled healthcare professionals.
10. Privacy and confidentiality: Women have the right to privacy and confidentiality when seeking reproductive healthcare services. Medical information should be kept confidential unless the woman chooses to disclose it.
11. Support for parenting: Women who choose to become parents have the right to support and resources to ensure the well-being of themselves and their children. This includes access to parental leave, childcare, and support for working mothers
12. Advocacy and legal protection: Women have the right to advocate for their reproductive rights, and governments are responsible for enacting and enforcing laws and policies that protect and promote these rights.

The issue is how to find ensure and guarantee that women with disabilities receive the same respect and consideration as other women, that justice is served, and that their rights to sexual orientation and reproduction are safeguarded. Women with disabilities need to know their rights in order to lay the groundwork.

Three levels of accessibility and awareness need to be guaranteed: 

Physical Accessibility: This includes upgraded medical facilities, services related to sexual and reproductive health, and accommodations for women with disabilities, such as wider doors, ramps, and equipment that has been modified.

Accessibility of Information: Records pertaining to sexual and reproductive rights should be available in audible, sign language, braille, and other accessible formats. Health care providers need to be trained in inclusive communication that takes into account people with disabilities. 

Disability Awareness Training: It is imperative that those working in the medical field, social services, government, and the general public receive training on the rights of people with disabilities and the unique needs that disabled women have in relation to their sexual and reproductive health.

Conclusion

Making sure disabled women do not lose their ability to give informed consent is something that needs to be emphasized. In order to empower girls and women with disabilities to make informed decisions about their bodies and relationships, this includes offering them comprehensive and disability-inclusive sexual education. We must respect the autonomy of disabled women to make their own decisions. It is imperative to provide accessible assisted decision-making support that upholds the autonomy and agency of individuals with severe disabilities. Though sexual pleasure is generally viewed as unimportant for people with disabilities (WWDs), discussions and campaigns are beginning to acknowledge WWDs as sexual beings with the right to pleasure, intimacy, love, relationships, and sexual preferences. This is in addition to the discourses on sexual violence and the lack of maternity care. In order to establish sexuality and reproduction as universal rights, we must move past the framework of violence and create a framework for sex positive rights. It is imperative to broaden the opportunities for women with disabilities to participate in conversations about their experiences of pleasure, desire, intimacy, and relationships—all of which are influenced by their sexuality and constitute a significant but understudied aspect of human rights.

As long as their abilities permit, women with disabilities must have the freedom to choose how they want to reproduce. It is important to remember, though, that women with disabilities are more susceptible to exploitation and sexual abuse. Their sexual freedom should not be restricted, and they should not be forced to use reproductive health services like abortion and contraception, even though these risk factors should be taken into consideration. Like any other women, women with disabilities have the right to refuse care as well as the right to receive it. A substitute judgment can only be considered in cases of extreme mental disability, where the woman is unable to give informed consent. No rights are infringed. To guarantee that a woman’s rights are not infringed upon, any denial of her ability to consent and make decisions must be supported by reasoned arguments, proper protocol, and legal protections. A qualified expert’s assessment of a disabled woman’s capacity for consent and decision-making must be finalized and appealable.

In making our world fairer and more equal, it’s really important that we support the right of disabled people to have relationships and make choices about their bodies. By breaking down barriers, changing unfair ideas, and talking openly about these issues, we help disabled individuals have control over their own lives. Let’s work towards a world where everyone, no matter their abilities, has the basic right to love, be close to others, and decide what’s best for their own bodies. When we celebrate differences and include everyone, we move closer to a future where these rights are true for everyone, and no one is left out of the human story.

References

[1] World Health Organization, International Classification of Functioning, Disability and Health (ICF) (WHO 2001, Geneva).

[2] Mental Disability Rights International, Annual Report (Mental Disability Rights International, 1993)

[3] UN Women, Facts and Figures 2021 (United Nations Entity for Gender Equality and the Empowerment of Women 2021).

[4] UNGA Res 3447 (XXX) (9 December 1975) Declaration on the Rights of Disabled Persons.