The Indian example (see Celia W. Dugger, "Relying on Hard and Soft Sells, India Pushes Sterilization," New York Times 22 June 2001: A1) shows that the state nowadays doesn't necessarily directly coerce men & women (mainly women) into sterilization. More often than not, it morally shames and/or economically bribes the poor into making reproductive decisions according to the raison d'etat. Such shaming & bribing can be organized by non-profits, domestic & international, as well.
I am not against sterilization per se, if chosen by men & women on their own for their benefit. In fact, it's a good thing for men to get vasectomy if they don't like to sire any (or any more) offspring, while continuing to employ condoms & explore non-penetrative sexual pleasures, making sure they don't unnecessarily endanger women. We need a cultural revolution that will make men yearn for the title of the king of cunnilingus. :->
A single-minded push for sterilization, Depo-Provera, & the like (as opposed to the pill, male & female condoms, diaphragms, etc.) for the poor, however, is a product of the elite & sexist wish to deny reproductive decision-making power to the poor.
Further, comparative studies show that (A) egalitarian distribution of incomes & wealth & (B) more education & employment -- thus more social & economic powers -- of women lead to the decline in the fertility rate. Reduce poverty & patriarchy, in short:
***** Chapter 2: The Malthusian Orthodoxy
Betsy Hartmann *
...Once people's physical survival is ensured and children are no longer their only source of security, history shows that population growth rates fall voluntarily. Higher living standards across the board were the motor force behind the demographic transition in the industrialized world. Similarly, those Third World countries, whether capitalist, socialist, or mixed economy, which have made broad-based development a priority have also experienced significant reductions in population growth, often at relatively low levels of per capita income. These include Cuba, Sri Lanka, Korea, and Taiwan (see Chapter 15). Meanwhile, a country like India, where the benefits of substantial economic growth have flowed disproportionately to a small elite, still has high rates of population growth despite the massive amount of resources the government has devoted to population control.
The right to a decent standard of living is necessary but not sufficient. The other critical right is the fundamental right of women to control their own reproduction. This is not just a question of having access to quality family planning and health services. The question of reproductive rights ultimately goes far beyond the bounds of these programs, involving women's role in the family and in society at large. Control over reproduction is predicated on women having greater control over their economic and social lives, sharing power equally with men, and being free of poverty and violence. It requires that their children too have a much better chance of survival.
While reducing poverty reduces birth rates, so does reducing patriarchy. The sheer physical burden of many pregnancies in close succession means that women who are free to control their reproduction seldom opt for having all the children it is biologically possible for them to have. And when women have access to education and meaningful employment, they tend to want fewer children for the obvious reason that they have other options....
...Betsy Hartmann, Chapter 2 of Reproductive Rights and Wrongs: the Global Politics of Population Control (Cambridge: South End Press, 1995), pp. 13-40....
<http://www.hsph.harvard.edu/rt21/globalism/HARTMANNc2.html> *****
That said, back to concerns of the advocates of the rights of the disabled. As Foucault says, power comes from below. Demands to abort a malformed fetus, to sterilize a mentally retarded girl, etc. nowadays come from overburdened parents, more often than not, in the context where families are the main sites of biological & social reproduction:
***** The Dominion (Wellington) October 31, 2000 SECTION: FEATURES; GENERAL; Pg. 7 HEADLINE: Sterilisation debate: who owns a womb? BYLINE: HAINES Leah
The debate over sterilisation of disabled women provides plenty of questions and few answers. Leah Haines talks to some of the parents and child advocates involved.
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EVERY morning, 25-year-old Jane begins her day lying on her back while her mother or father manoeuvres her bent, sore body to remove the giant nappies she spends all day and night in. This morning is one of the rare ones when her nappy is not heavily soiled.
Jane is covered in bruises and bites, which she inflicts on herself, a habit her mother guesses is a way of diverting the pain which she feels in other parts of her body.
Then again, her mother can only guess at what is really bothering her. Today Jane appears to be happy, draped in her swinging chair, the radio on in the corner of their suburban West Auckland home. She's not crying.
With a mental age of between three and nine months, Jane is, her mother says, "exactly like a new baby, but big".
It was for that reason, 14 years ago, as Jane approached puberty, that her parents began inquiries about giving her a hysterectomy.
"Maybe her periods would have been a breeze," her mother explains, "but why take the risk? Why put her through that? I have a husband, and my father, who are both not afraid to help and change her nappies, but I could not see why I should expect them to change her when she had her periods as well."
It is easy to sympathise with this mother, who battles to look after both Jane and a younger handicapped daughter at home fulltime.
In 1990, Jane (not her real name) was known simply as X and was in the headlines due to a landmark hearing which established the right for other parents to seek hysterectomies for profoundly disabled girls under 20 without the need to go to court.
A decade later, the sterilisation debate has been revived by revelations a handicapped Christchurch 12-year-old was given an apparently illegal hysterectomy in June.
The Department of Child, Youth and Family Services is investigating after Christchurch Hospital admitted operating on the girl -- a ward of the department's -- without its permission.
While Jane's mother feels the issue has been well thrashed out, politicians and advocates are again questioning whether hysterectomies should be performed for any reason other than a medical emergency.
Sterilising women with disabilities had its heyday in the 1920s with the eugenics movement, which aimed for genetic purity by filtering out homosexuals, people with brown skin and the disabled.
Though the concept would horrify most of us today, disability researcher Sue Gates argues that nothing much has changed.
She says sterilisations justified by protecting handicapped women against the trauma of menstruation or pregnancy are achieving the same result as eugenics did: social expedience, "but presented in benevolent language. Basically, the menstrual management argument is a load of old cobblers".
Ms Gates, a former IHC advocate who spent years researching the issue, believes many more girls are subjected to hysterectomies on the whim of their parents and a couple of clinicians than anyone admits to.
Figures issued by the Health Ministry show that 11 girls under 20 were given hysterectomies last year, with 55 undergoing the operation in the previous nine years.
That the medical profession even plays a part in decisions about the operation, Ms Gates says, is an accident of history. The issue is not a clinical one, she says, but is about the rights of disabled people to keep their bodily integrity.
"I should not have my body intruded on without my informed consent. It's simple. "
If the woman still doesn't understand, then the health and disability code of rights makes it clear that doctors have to consider what they would do with someone of a similar age who is not disabled.
"Now you cannot tell me that a health professional would sterilise a young girl of 10, 11 or 12 just because their parents asked them to."
Alliance MP Liz Gordon, who, with her husband Garth Lomax fosters two profoundly disabled young women, says period management has nothing to do, generally, with the girl herself. "It's to do with the ability of the caregiver to manage the girl's period. We have no right to whip out (eldest daughter) Vicki's womb because her periods are a hassle. If Garth is not handling her periods it's his fault, not hers."
MS GORDON has begun a campaign to expose the real incidence of sterilisations of handicapped women and wants the law changed to make it illegal to perform hysterectomies without informed consent, unless there is a medical emergency.
She has been an outspoken advocate for the disabled since marrying Mr Lomax who, with his late wife, had fostered Vicki, 19, since she was five, and Francesca, 17, since she was two.
He is their stay-at-home dad. Dealing with Vicki's periods -- Francesca has yet to start menstruating -- is just "not that big a deal", he says.
He can understand why people might think hysterectomies are an option, particularly if it's pointed out to them by a medical professional. "But I personally think that it's an appalling invasion of someone's personal liberty."
But even the IHC, which prefers the idea of an independent body making the final decision on a hysterectomy for a disabled girl, admits that managing periods can be extremely difficult for the parents of the severely handicapped.
"It's a hugely emotive issue. Views are polarised," says IHC chief executive Jan Dowland. "But we have a very strong philosophy which says you should not contemplate an act for a person with disabilities that you would not contemplate for someone else."
However, Wellington Hospital's senior clinician in obstetrics and gynaecology, Adrian Stewart, believes hysterectomies can help to maximise a disabled person's life.
With mental disabilities often compounded by physical disorders such as epilepsy, menstruation is an added burden which families -- whom the disabled rely on -- just cannot manage as well.
"They cannot say what they need. Some, who are well into their teens, are still faecally and urinally incontinent. Some of them are fairly sloppy eaters and when they are menstruating, they can smell. It is embarrassing for the other members of their family, especially when they behave inappropriately as well."
Depo Provera, the contraceptive injection, is unreliable for stopping periods, can make people put on weight and needed to be used for 40 years, he says.
To the human rights camp, who argue that girls should not be made to sacrifice their wombs for their families' convenience, Dr Stewart says: "They do not have to look after the disabled person."
When Jane's parents first decided to seek a hysterectomy they ran head-on into the fallout over informed consent generated by the cervical screening scare at National Women's in the late 1980s.
Her mother says: "They told me they wouldn't touch her with a barge pole."
Jane could not hold a cup, or talk, let alone give her consent to the operation.
Thus began a four-year battle which ended, by an uncanny coincidence, on Jane's 15th birthday when Justice Hillyer made his ruling in the High Court that the operation could go ahead.
Two months later, a sympathetic paediatrician operated on Jane for free. Within weeks, she was healed and well and had even stopped biting herself so badly.
Specialists and advocates, even parents who spoke in court against the operation, made her furious.
"I was just totally angry, and had contempt for everyone for butting their noses in. We were her only caregivers, we know her, what she needs.
"She once had two teeth that had holes in them that were so big, and she was in absolute agony, but she could tell us nothing. She functions as a baby, to have her periods as well . . . no, no, no. Why put her through that?" *****
Yoshie