Conversations about forced sterilisation of people with disabilities often focus on discussions of ‘what happened in the past,’ and how this sort of thing does not happen any more. Thus, it is not an issue that people need to be concerned with now, and shouldn’t be considered a pressing reproductive rights topic.
This is not true. Forced sterilisation continues to happen to people with disabilities, as well as other marginalised groups; several nations, for example, have policies that effectively force binary trans people to get sterilised if they want their genders to be legally recognised. In order to change their names on their identifications, they have to provide proof of reconstructive surgery, which involves eliminating reproductive capacity.
Forced sterilisation happens to people like Ashley X, who was subjected to a number of nonconsensual medical procedures. It happens in institutions where people appointed as guardians for people with disabilities opt for sterilisation, citing a number of reasons; periods are traumatic for a woman with developmental disabilities, for example, or they are worried about the risk of pregnancy[1. Since pregnancy in institutions is usually the result of rape, there are some sinister underpinnings here.]. In these cases, people are not given agency and autonomy and they are not included in this decision. It is done without their consent and they may be lied to about the nature of the procedure and why it is being performed.
This is considered permissible because institutionalised people with appointed guardians are not treated as full human beings. Just like underage people, their guardians can make life and death decisions for them against their will, and effectively control their bodies. The guardians get to decide which treatments they receive and how. While there would probably be some moral outrage if a parent attempted to have a child sterilised, if that child was disabled, there would be little protest. Likewise for disabled adults who are sterilised at the behest of their guardians.
Or on court order. A judge ruled in January that a mentally ill woman should be forced to have an abortion, followed by sterilisation:
Earlier this [January], a Norfolk probate judge declared a pregnant woman with schizophrenia incompetent and ordered her to undergo an abortion, stating she could be ‘coaxed, bribed, or even enticed’ into the hospital for the procedure…Unbidden, the judge further directed that the 32-year-old woman be sterilized ‘to avoid this painful situation from recurring in the future.’’
This is the world that we live in, one where a judge feels free to directly interfere with the bodily autonomy and reproductive freedom of another human being simply because that human being is considered ‘incompetent.’ This judge also violated ‘Mary Moe’s’ religious freedom, insisting on an abortion despite the fact that Moe is a devout Catholic and considers abortion a sin. Terminating the pregnancy, the judge argued, would allow the patient to take antipsychotic medications that can’t be used in pregnancy due to danger; the judge was issuing an order that told the patient what to do with her body, and how to manage her mental illness.
Thankfully, this decision was later reversed, but it’s certainly not the only one of its kind, it’s simply one that happened to attract media attention. Forced sterilisation of people with disabilities is rarely covered in the mainstream or progressive media because it’s not considered a topic of much interest. This is largely because many people accept the idea that it is something that should happen; even if they may feel slightly uncomfortable about it, they still support the idea overall because they think it is ‘for the person’s own good’ or makes life easier for caregivers. Or, though few will admit this, they believe forced sterilisation of people with disabilities benefits society as a whole.
Yet, this should be a topic of interest, especially in progressive and particularly feminist spaces. People who are fighting for the right to choose must fight for all choices, and that includes full bodily autonomy and the right to retain your capacity for reproduction, to carry a pregnancy to term. The fact that this case attracted very minimal attention in reproductive justice circles was troubling, though not unusual. It did attract attention in the disability community and was viewed as a ‘disability issue.’
But it wasn’t just that. It was a gender issue, and it was a bodily autonomy issue, and it was a reproductive justice issue. The fact that judges can compel people to receive abortions and be sterilised, and tricked, no less, into undergoing these procedures, is a problem. It’s a problem that the reproductive rights movement needs to be paying attention to, because this is no slippery slope argument, here. This is a clear-cut case of the state deciding it has rights over the body of an individual, and believing that it can make complex personal medical decisions by virtue of declaring someone ‘incompetent.’
The evaluation process required for determining legal competence can vary, and many people may be certain that they would never be declared incompetent, and that the system is designed to identify only those who truly lack capacity for decision making, but what does it mean to be able to make decisions? Mary Moe knew what she wanted, and in a second evaluation, authorities independently determined that she would still refuse an abortion if she was legally competent. That sounds a lot like she had the agency and capacity to make a choice in this case, and the court attempted to take that away from her.
This case highlighted the contempt with which society views mentally ill people. Despite considerable gains in recent years, autonomy is still not a given, and capacity hearings are still a potential risk when the people around a patient can make a few phone calls if they don’t like what the patient is doing. Compulsory medication programmes, court orders like this, forced sterilisation in institutions, all of these are tied to the idea that the bodies of mentally ill people are not their own.