For many women in the UK today, obtaining contraception is an event of little fanfare or difficulty - it involves a discussion with a doctor and a prescription, little more.
But many disabled women do not even get so far as that discussion. Disabled women are often denied contraceptive and other sexual healthcare by omission, as physicians totally discount the possibility of their sex lives.
How are women to make the best decisions about their sex lives, when their own doctors assume those to be non-existent?
At a bpas and RCOG event on 27 June, 2017, noted speakers from across the disability space highlighted just how difficult it can be for disabled women to access basic, necessary sexual and reproductive healthcare. The myriad obstacles they face come in a variety of forms--many insidiously invisible.
For many, these barriers begin even as children. As Dr Frances Ryan, the Guardian journalist, indicated, there is a serious deficit in necessary sex education for disabled children for whom the topic may be neglected entirely. This often carries through into adulthood. As the author of one 2006 paper puts it, disabled women are "erroneously presumed to be asexual." This, of course, severely reduces the quality of sexual healthcare these women receive--not the least of which is their contraceptive options.
Indeed, every woman needs to be treated as an individual. Yet that seems frequently disregarded for disabled women. Doctors may not take into consideration the individuating circumstances of disabled women when prescribing contraception. Dr. Jane Dickson, Consultant in Sexual and Reproductive Healthcare and Vice President of the Faculty of Sexual and Reproductive Healthcare (FSRH), highlighted this in her presentation. For example, wheelchair-users are often at risk for blood clots--a risk that increases with use of the pill, making that a potentially less advisable option. As she also pointed out, the self-administered contraceptive injection is a good option for women with limited mobility, owing to its convenience and ability to be injected elsewhere besides not-easily-reachable large muscles. Disabled women, like all women, face a variety of factors which may influence contraceptive choice--but doctors often don't adjust to take those into account.
Disabled women may not fit the standard mold of doctors' female patients--but rather than tailoring their services in order to provide the same quality of care, disabled women find their contraceptive options drastically reduced, and sexual health care neglected. As Dr Ryan emphasized, women with physical constraints may be unable to get onto a standard examination table. These small acts of implicit refusal to expand accessibility lead to systemic denial of sexual healthcare. Failure to provide accessible examinations, for example, leads to severe underrepresentation of disabled women in smear test statistics.
As speakers at the bpas and RCOG event discussed, when disabled women do enter into considerations of reproductive health the focus is frequently centred on physical disabilities in particular, at the expense of attending to the experiences of women with other types of disabilities as well. Far from being immune from obstacles to care, women with intellectual disabilities face a whole host of possible limiters on reproductive health care and choice.
Research has found that women with intellectual disabilities frequently do not make the choice to start contraception, nor the choice of particular method themselves--rather, that deeply personal decision is left up to someone else entirely. In one 2011 study comprised of in-depth interviews of women with intellectual disabilities, the vast majority of women reported that starting contraception had been the decision of someone else, usually GPs, staff, or parents. As the same study reports, doctors do not adapt to give disabled women the information they need: "None of the women [in the study] had been given any accessible information about contraception to take away from their doctors, although some had been given leaflets aimed at the general population, which were way above their reading and comprehension level." Disabled women are left out of the conversation about their own care. Doctors are often more likely to seek the consent of and to speak to carers than the disabled woman herself.
This is an issue beyond the physician's office. The silent attack on disabled women's reproductive rights comes from all sides, including from the government. The cutting of social care packages often has the effect of limiting disabled women's reproductive choices. Several different sources of financial assistance for disabled mothers have been cut in recent years: historically, disabled women have always been more likely to be in poverty than their non-disabled peers, but this disparity has increased in recent years.
As I write this from the bpas office, I am acutely aware that reproductive rights organizations are not wholly innocent in the systematic suppression of disabled women. Far too often, disabled women are left out of discussions around reproductive rights entirely, a point emphasized by Dr Ryan. In many conversations, the intersection of reproductive rights and disability begins and ends with abortion and issues of fetal anomaly. This is especially so in the current political discourse with Lord Shinkwin's Abortion (Disability Equality) Bill, which in preventing women from ending a pregnancy after 24 weeks for reasons of fetal anomaly would cause enormous harm to women. Adding insult to injury, the focus on fetal anomaly means the actual difficulties faced by disabled women fall to the wayside in political advocacy. Any campaign for women's reproductive rights means pragmatically little if it is not intersectional in its approach - if it excludes a whole segment of the population it purports to assist. It is imperative that we continuously include the unique experiences and needs of disabled women within our advocacy.
HuffPost UK Lifestyle has launched EveryBody, a new section calling for better equality and inclusivity for people living with disability and invisible illness. The aim is to empower those whose voices are not always heard and redefine attitudes to identity, lifestyle and ability in 2017. We'll be covering all manner of lifestyle topics - from health and fitness to dating, sex and relationships.
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