In Canada, women with disabilities have historically been targeted for coercion and forced sterilization, and they remain vulnerable to these practices even today.

Canada was of course influenced by the eugenics movement throughout the 20th century. In fact, both Alberta and British Columbia had legislation enabling sterilization for anyone diagnosed as “mentally ill” or “deficient”. Data from the Alberta Eugenics Board case files indicate 1,154 women with disabilities were sterilized under these practices. Close to 40% of these were sterilized after 1955.

Sterilization laws in Alberta were not repealed until 1972. Unfortunately, in the case of British Columbia, records of these practices have been lost or destroyed. While other provinces may not have had official sterilization laws, countless women with disabilities were likely sterilized, as these procedures were often performed on young women with disabilities through parental consent. As well, sterilization practices in Canada have also been sexist, racist and imperialist and have disproportionately targeted indigenous women.

There are two examples of case law that show the vulnerability of women with disabilities to forced sterilization, as well as the possibility for legal protection. In 1995, Leilani Muir, a woman with an intellectual disability, successfully sued the Alberta government over the practice of forced sterilization. Muir, who had been admitted to the Provincial Training School for Mental Defectives in 1955, had been sterilized at age 14. Her advocacy led to an official apology from the Alberta government and compensation for hundreds of others.

There was also the 1986 Supreme Court of Canada decision known as the Eve decision. The case involved a 24-year-old woman with an intellectual disability. The mother had argued that, as her daughter's substitute decision-maker, she wanted to be authorized to have her daughter undergo tubal ligation. The Supreme Court ruled against the mother, saying that the procedure was “non-therapeutic”.

This landmark decision was a critical turning point in the struggle for recognition of the rights of persons with intellectual disabilities. It ended the long-standing practice of non-therapeutic sterilization of people with intellectual disabilities and other mental disabilities and affirmed that, regardless of cognitive ability, all persons have a fundamental right that cannot be overridden.

Despite these cases, parental influence continues to be a factor for young women with disabilities, as parents still wield power and control that can influence access to and decisions around reproductive health.

In our own research, the recently released “More Than a Footnote” report, we spoke to one woman who shared that her parents had made reproductive health choices on her behalf without her consent and against her will. Much of the existing research here deals with women with intellectual disabilities, as they appear particularly vulnerable to this. They have inadequate access to education and they're more likely to experience poor reproductive health outcomes.

We also want to note that in terms of reproductive coercion young women and girls with disabilities may be subject to problematic forms of power and control over their reproductive health because of the role of adult decision-makers in their lives. Of course, here is the intersection of paternalism and ableism.

One recent Canadian study framed these ongoing forms of coercion as violence enacted upon young women with disabilities and drew attention to some of the most prevalent forms. These include birth control sabotage, pregnancy coercion and controlling the outcomes of a pregnancy.

For young women with disabilities, there are unique dynamics that require our attention. On this note, the continued use of Depo-Provera as a contemporary practice is something to which we must pay attention. Depo-Provera remains controversial, and its side effects can be serious and are not well understood. There is evidence that this was prescribed to women with disabilities before it was approved in Canada as a contraception. As well, one Canadian study found that young women with intellectual disabilities were commonly prescribed this in response to family and caregiver concerns about pregnancy and menstrual hygiene.

One of the most disturbing things we've come across is the practice of applying invasive growth attenuation treatments, commonly referred to as the Ashley treatment, to children with complex disabilities and medical conditions. It's aimed at keeping them small, presumably to make it easier for their caregivers to provide care. Procedures can include things such as high doses of estrogen, hysterectomies and breast bud removal. While this practice seems more prevalent in the U.S., it has spread to other countries and it's difficult to gauge what is happening here in Canada. There is a need for a dedicated space to explore these things.

Finally, in DAWN Canada's research, it has also been illustrated how widespread reproductive coercion is for women with disabilities. Women with disabilities share that while they may not be the victims of forced sterilization, as they would have been historically, they continue to be actively pressured against motherhood. There are continued reminders from family, friends and medical professionals that shape their decision-making.

Of course, there are several factors that increase vulnerability among this group. These include limited contraception options and a lack of knowledge among health care providers about disability.

We have recommendations to reduce this vulnerability. These include supporting self-advocacy so women and girls with disabilities become partners in their own care, teaching health care providers about disability to avoid ignorance and ableism, and conducting more research and policy analysis to examine the many insidious ways in which women with disabilities and their bodies are controlled by caregivers, parents and support workers.

Finally, in terms of broader action, DAWN Canada points to the promise offered through the Nairobi principles, which seek to affirm sexual and reproductive rights through an intersectional lens that is inclusive of both a gender analysis and the very real impacts of ableism on the lived experiences of women and girls with disabilities. These principles move us collectively to a place that affirms both the need for access to safe abortion and the need to consider the ways ableism shapes autonomy and access to reproductive health.

Thank you.