Oh my lack of bleeding choice….

It’s International Women’s Day on Sunday, 8 March and the theme is “Make it happen”. For women with disabilities, this means a range of things: having the support they require to live the lives they want; being respected and valued as human beings; having safe and accessible housing; and…having control over how they manage their menstrual flow.

In 2015, most women, who don’t have disabilities, have a myriad of choices about how to manage their menstrual flow – there’s tampons, pads, the increasingly popular moon-cup.

However, women with disabilities who require support with personal care and hygiene do not have these same choices. For women with disabilities it’s either menstrual pads, or continence pads.

For other women there are less ‘choices’ and more consequences and they are sterilised with the sanction of their parents or guardians. Because of the lack of support to manage their menstrual flow, some women with disabilities even ‘choose’ sterilisation because the outcome results in the least restrictions on their lives.

Even when women with disabilities can make a ‘choice’ about how they would like to manage the ‘flow’, they can’t.

‘Why?’ you say.

Why indeed?

These things are not what stop women with disabilities from having a choice of what product/method they use. No, it’s the over-fearful interpretation of Occupational Health and Safety (OHS) legislation that dictates the support women with disabilities receive.

This is legislation that originated in the mining industry because people were dying. It’s legislation which takes the least ‘dangerous’ approach, is applied globally and makes no exceptions. Therefore, it assumes that if a woman cannot move or speak you should use continence pads for every drop of bodily fluid.

The application of OHS and thoughts about support workers not being able to insert tampons have been in force for some years. This follows the logic of: tampons have to be ‘inserted’ into the opening of the vagina, therefore this equates to penetration.

Inserting a tampon for someone is delicate and should be done at their request and with care. However, supporting a woman with disability to use a tampon is no less invasive then supporting someone with a disability with other bodily functions.

Many people with disabilities require support with processes that could be described as penetrating bodily boundaries. This involves enemas, catheters, nasogastric tubes, ear cleaning, nostril cleaning, PEG feeding. Service providers and support coordinators find ways of performing these functions yet are very squeamish about tampons and menstrual cups.

This leaves many women with disabilities with little or no choice…it’s pads or pads…or other invasive surgical measures, such as hysterectomies and endometrial ablation. Only slightly less invasive options involve chemical sterilisation using Depo-Provera or Implanon to medically stop or control the menstrual flow.

Menstruation was discussed in the hearings of the Senate Inquiry into “Involuntary or coerced sterilisation of people with disabilities in Australia in 2013¹. One woman explained that while at home with her family’s assistance she had been using pads and tampons, but once living independently, the situation changed:

So that I could self-toilet, or go to the toilet by myself, I stopped wearing underwear. This meant that pads were no longer an option. When I approached the service—a large service—that was supporting me, about tampons, I was told in no uncertain manner that tampons were not an option.

Eventually I made the choice, given those circumstances, of having no other choice and not being able to use tampons like every other woman, to have endometrial ablation and have my tubes tied².

This is not an uncommon story. But more common is women with disabilities not having a choice about how to manage their menstruation. Also, too common is women with disabilities being sterilised to prevent them, or their families from having to deal with a natural and expected part of womanhood: menstruation.

So this International Women’s Day, let’s make it happen. Let’s have real conversations about supporting women with disabilities to have the support they need. This includes tampons should they make that choice.

About Fran:
Fran Vicary is a well-known advocate for the rights of people with disability. She has a Masters in literature and is former CEO of the Queensland Disability Network. Fran was on the on the NDIS Advisory Group and the NDIS Expert Group and is currently director assistive technology, community living and learning for Yooralla, Victoria’s largest disability service provider.

References: 1. Senate inquiry, 2013: “Involuntary or coerced sterilisation of people with disabilities in Australia” Source: http://www.aph.gov.au/parliamentary_business/committees/senate/community_affairs/involuntary_sterilisation/first_report/c02 2. Senate inquiry 2013: Proof Committee Hansard, 30 January 2013, p. 3.