Gender-Based Violence Among People With Disabilities: Qualitative Insights on Sexual and Reproductive Health Impacts Across the Life Course

Introduction

Study Procedures Data Analysis Researcher Positionality and Reflexivity

| Pseudonym | Disability | Violence experience | Life course stage when violence occurred | Age | Gender | Sexuality | Race | |---|---|---|---|---|---|---|---| | Jamie | Cognitive; Physical | SA, IPV | Adulthood | 45 | Cis woman | Bisexual | White | | Brenda | Mental; Physical | CSA, IPV, FV | Childhood, adulthood, older adulthood | 58 | Cis woman | Straight | White | | Nicole | Mental; Physical | IPV | Adulthood | 33 | Cis woman | Straight | White | | Melissa | Cognitive; Mental; Physical | CSA, SA | Childhood, adulthood | 44 | Cis woman | Straight | White | | Alisha | Cognitive; Mental; Physical | CSA | Childhood | 40 | Cis woman | Bisexual | White | | Isabell | Mental; Physical | SA | Adulthood | 29 | Cis woman | Straight | White | | Ava | Cognitive; Mental; Physical | CFV | Childhood | 24 | Genderqueer or nonbinary | Queer | White | | Antonia | Cognitive | SA | Adulthood | 42 | Cis woman | Bisexual | White | | Bethany | Cognitive | SA | Adulthood | 38 | Cis woman | Asexual | White | | Sarah | Cognitive | CSA | Childhood | 30 | Cis woman | Straight | White | | Kayla | Cognitive | CSA, SA | Childhood, adulthood | 49 | Cis woman | Straight | East/ Southeast Asian | | Jasmine | Cognitive; Mental | CSA, SA | Childhood, adulthood | 23 | Cis woman | Bisexual | East/ Southeast Asian | | Cameron | Mental | CSA, SA | Childhood | 28 | Genderqueer | Pansexual | White | | Candice | Physical | CSA | Childhood | 45 | Cis woman | Straight | White | | Rowan | Mental; Physical | CSA | Childhood | 26 | Genderqueer | Bisexual | White | | Vanessa | Cognitive; Mental; Physical | SA | Adulthood | 32 | Trans woman | Pansexual | White | | Logan | Cognitive | CFV | Childhood | 23 | Trans man | Straight | East /Southeast Asian | | Irene | Mental; Physical | IPV | Adulthood | 55 | Cis woman | Straight | White | | Audrey | Physical | IPV, SA | Adulthood | 56 | Cis woman | Straight | White | | Lena | Sensory | SA, IPV | Childhood, adulthood | 45 | Cis woman | Straight | White | | Simone | Cognitive; Mental | CSA | Childhood | 44 | Cis woman | Straight | Black | | Blair | Mental; Physical | CFV | Childhood | 27 | Nonbinary, Transmasculine | Queer | Black | | Sade | Cognitive; Mental; Physical | IPV | Childhood | 19 | Cisgender & questioning | Pansexual | Black | | Farah | Cognitive; Mental | CSA, IPV | Childhood, adulthood | 26 | Cis woman | bisexual | South Asian | | Alanna | Mental; Physical | CSA | Childhood | 53 | Cis woman | heterosexual | Black and White | | Stephanie | Cognitive; Mental; Physical | CFV, SA, FV | Childhood, adulthood | 44 | Cis woman | Straight | South Asian | | Theme | Subthemes | Representative quotes | |---|---|---| | Intersections of disability and GBV experiences across the life course | GBV was recurring across the life course for disabled people GBV caused or exacerbated existing disabilities Perpetrators targeted participants due to disability status/disability escalated GBV Disability impacted participants’ ability to report or exit GBV | “My son started hitting me. And, I guess he was just watching his father, right.”—Brenda, 58 “[I have] PTSD, and maybe complex PTSD—I’ve had lots of incidents of trauma throughout my life. A lot of childhood trauma and sexual abuse, and then different other sexual abuses and traumas over the years”—Cameron, 28 “I was sexually assaulted [. . .] I think he took advantage of the fact that I was autistic.”—Jamie, 45 “Occupational therapy [recommended] that I do not take [sex education]. If anyone should be receiving sex ed, it should have been me at that time [. . .] Sexual abuse . . . was something that I was experiencing or had experienced already.”—Alisha, 40 | | Impacts on reproductive health | GBV had reproductive health consequences RH decision-making was impacted by experiences of GBV GBV-related PTSD had direct impacts on other reproductive health issues | “My mom forced me to have an abortion with the first [pregnancy after childhood sexual assault]. [When I had an abortion as an adult], the father was hearing, and he didn’t want a baby with a Deaf person. So, he forced me. [He] thought I wasn’t worth anything.”—Lena, 45 “I was married—and this is one reason I had my tubes tied—he would wait until I was sound asleep, [and then] he’d force himself on me [. . .] I found out because a friend of mine told me, “He’s going around boasting that he rapes you. When you’re sound asleep.”—Audrey, 56 “[My PTSD was triggered and] other symptoms manifested. In addition to the mental symptoms of panic attacks or depression, there’s a chance that some of those symptoms translated into the reproductive issues [i.e., exacerbated endometriosis-related pain]”—Ava, 24 | | Impacts on sexual health | GBV histories impacted participants’ sexual health and well-being GBV histories impacted participants’ intimate relationships | “I was sexually assaulted [by a stranger as an adolescent] and as a result have HPV [human papillomavirus], the strain with genital warts. [A year later I had] day surgery for that—[providers] cauterized the bottom of my cervix because they said there were abnormal cells.”—Melissa, 44 “[My history of child sexual abuse] has made it hard to have healthy sexual relationships. [It] has been challenging for years to not experience pain [during intercourse].”—Jasmine, 23 | | Impacts on access to and experiences with SRH services | GBV negatively impacted participants’ experiences with SRH services GBV prevented participants from accessing SRH services Participants had negative experiences seeking GBV-related supports Participants had positive experiences of GBV-related supports | “I did go to pelvic floor physio[therapy], but I could only manage going I think twice, because it brought up too much for me.”—Cameron, 28 “And so my mom was a bit of an anti-vaxxer. And so I didn't receive the HPV vaccines. And it’s kind of a nightmare to try to get it now as an adult, and as someone in a province where if you don't get it through school it's really expensive.”—Ava, 24 “You walk into a police station and say, “I’d like to report being sexually assaulted,” and they say, “oh yeah?” “Yeah.” “When did this happen?” “It happened yesterday.” “Why didn’t you come in yesterday?” It was harassment right from the beginning and I think it’s because I didn’t present as their standard person having a sexual assault.”—Kayla, 49 My counsellor [encouraged me to leave and] wrote a letter proving I was in an abusive relationship [so I could access social housing]. I’m lucky, it was really fast. [. . .] Everything was over email, and there were interpreters available on [video relay services]. Everything was quickly approved.—Lena, 45 | Intersections of Disability and GBV Experiences Across the Life Course [I have] PTSD, and maybe complex PTSD—I’ve had lots of incidents of trauma throughout my life. A lot of childhood trauma and sexual abuse and then different other sexual abuses and traumas over the years. (Cameron, 28)I have anxiety, depression, and it goes along with PTSD—mainly around abuse and sexual abuse and more [during] childhood, but then also as a mother, a wife, I was abused too. (Brenda, 58)My disability comes from the actions I took to flee [childhood] domestic violence. [Service providers] forced me onto Disability [social assistance], “We can’t expect you to work and we’re going to make a referral to Disability.” (Stephanie, 44) I was raped when I was younger, partly because I was Deaf. [. . .] I was only 14 and I couldn’t hear anything, and I didn’t know what was going on. [A group of boys] chased me [and] raped me on the way home [from school]. I was Deaf, and I was treated like I was no good. (Lena, 45)Being molested [as a child], there was so much shame with that. People with my [developmental/intellectual] disability are very gullible, so if you tell [me I’m] going to get in trouble [if I tell anyone], I’ll believe it, sure. (Kayla, 49) I was in an abusive relationship with my husband. [. . .] Physical, financial, emotional, sexual. [. . .] It escalated [during the pandemic]. I never was allowed to be by myself at home [. . .]. He controlled communication [. . .] he talked about what he wanted. That’s the only time he would sign [i.e., use American Sign language]. (Lena, 45)Part of my disability involves [not] knowing what’s [socially] acceptable [and that you have] the right to be able to [react when] you are being harassed. [. . .] That led to unwanted behaviour [and difficulty being able to] express myself and to use the right behaviour or body language to say, “leave me alone, I don’t want this.” (Bethany, 38)I found myself wondering since that [sexual assault] happened, whether that I would have been in that position if I wasn’t suffering from my physical disability. If I wasn’t on a whole bunch of pain meds and I wasn’t exhausted from pain all day [. . .], would it have even got that far? (Vanessa, 32) To get this housing placement, I filled out paperwork that said I was fleeing domestic violence [. . .] I experienced assault and violence within the first year that I arrived [there]. (Stephanie, 44)I took a long time to leave [. . .] I didn’t feel strong enough because I was so tired with the chronic fatigue and a lot of pain. I thought I wouldn’t be able to do it. (Brenda, 58) Impacts of GBV on Reproductive Health Across the Life Course [My ex-husband] would wait until I was sound asleep, [and then] he’d force himself on me. When I found out I was pregnant with twins, I pinpointed the day I got pregnant and I’m like, I don’t recall doing anything. And I found out because a friend of mine told me, “He’s going around boasting that he rapes you. When you’re sound asleep.” (Audrey, 56)My mom forced me to have an abortion with the first [pregnancy after childhood sexual assault]. [When I had an abortion as an adult], the father was hearing, and he didn’t want a baby with a Deaf person. So, he forced me. [He] thought I wasn’t worth anything. (Lena, 45)Growing up, there was abuse. I left home. I didn’t have any sexual education. I got pregnant. The person who impregnated me, I didn’t know them. They took advantage of the situation. [. . .] Because I’m a survivor of abuse, I dissociated from whether I was pregnant or not. I didn’t know the signs. I went to a doctor [who] imposed their view that I should get an abortion. [They] seemed judgmental of me, [and] I never got the proper information to make a decision. I wasn’t able to talk to anyone. I couldn’t make a decision [so] I kept moving further in the pregnancy. (Stephanie, 44) I’ve had to use emergency contraception a few times [. . .] mostly [for] non-consensual stuff. (Jasmine, 23)My choice to terminate that pregnancy was because I was being abused. (Nicole, 33)[The abuse from my husband] is one reason I had my tubes tied. (Audrey, 56) [My PTSD was triggered and] other symptoms manifested. In addition to the mental symptoms of panic attacks or depression, there’s a chance that some of those symptoms translated into the reproductive issues [i.e., exacerbated endometriosis-related pain]. (Ava, 24)When I had my [hysterectomy], it ended up triggering my severe posttraumatic stress experience [. . .] That triggered memories, experiences, pain, lots of strange things happening in my body. With the instant menopause combined with it, I was a mess. (Alanna, 53) Impacts of GBV on Sexual Health Across the Life Course After being in an abusive relationship, I engaged in risky sexual behavior. I experienced pregnancy. And then I also had to deal with abortion. That was difficult and especially at a very young age, that affected my mental health a lot. (Farah, 26)I was romance scammed. Then I almost killed myself. I walked in front of vehicles. [. . .] I got caught in this cycle, which really was not good because it was tied into my PTSD [from childhood GBV]. It’s almost like I was hurting myself all the time, as I was trying to mess with the scammers. [. . .] I had to get out of an addiction to being an online romance junkie. Part of it was a sexual addiction. Some of them, we had sex over the phone or internet. [. . .] Some, I met them in person and had sex. [. . .] It was not safe. [. . .] I was assessed [and] told it was my PTSD. (Brenda, 58) [My history of child sexual abuse] has made it hard to have healthy sexual relationships. [It] has been challenging for years to not experience pain [during intercourse]. (Jasmine, 23)I wasn’t ever really into [being intimate with my husband] because of my past of being assaulted and abused [. . .] It didn’t click to me as a way of expressing our affection to each other—it was, to me, something that happened to me with people who were scary, people who hurt me. [My husband and I] are openly affectionate but our actual sex life isn’t what I had wished it would’ve been. [I’ve] got this past that is still presenting barriers. (Kayla, 49)I was sexually abused as a young child [and recently] sought some counselling because I was having a lot of pain with intercourse [that] my doctor couldn’t explain [. . .] I’m on a waitlist to see a gynaecologist about the issue. I still have a wonderful intimate life with my husband but there are just some things that we avoid because of pain right now. (Candice, 45) Impacts of GBV on Access to and Experiences with SRH Services I disclosed [childhood sexual abuse perpetrated by a sibling to child protection services]. [My parents] were absolutely horrified and disgusted. They put a lot of blame on me and [my sibling], and said that it was us doing it, and we couldn’t be allowed to be alone together. It was quite a horrible experience. There was no support [from child protection services] at all. I think that solidified those beliefs that it’s not safe to talk about these experiences. (Cameron, 28)[The gynecologist] shamed me. I’m like, “How is [being sexually assaulted] my fault?” He said, “How do you not know who this person is? Why didn’t you keep yourself safe?” [That experience years ago] is why I don’t like disclosing [my history of sexual assault to providers today], because I still feel that judgement. (Melissa, 44). The police didn’t know how to interview me correctly as an autistic person. [. . .] He kept asking me, “why did you go into the house?” Over and over again. [. . .] I felt I was being asked what I was wearing. He kept asking me, “[were you] drinking?” [. . .] [The psychiatrist also said] “if you didn’t go into the house, you wouldn’t have been raped. If you were able to read the social cues, if you weren’t autistic, you wouldn’t have been raped.” (Jamie, 45)You walk into a police station and say, “I’d like to report being sexually assaulted,” and they say, “oh yeah?” “Yeah.” “When did this happen?” “It happened yesterday.” “Why didn’t you come in yesterday?” It was harassment right from the beginning and I think it’s because I didn’t present as their standard person having a sexual assault. I was more calm, or I was too together about it or something. And that seems to really confuse people. Like it blows their mind. They can’t reconcile that a person standing there being calm and communicating clearly. (Kayla, 49)[Service providers] only understand medical [disabilities], not accommodations around violence against women. [. . .] They don’t understand the difference between disclosure and reporting, if I say, “I’m someone impacted by domestic violence.” [. . .] They don’t have a category for people impacted by domestic violence in accessibility [. . .] For example, if you don’t want to be in the waiting room or have them call out your name, how can we arrange it? If I tell the receptionist that, they will say to ask the doctor, and the doctor will say this is not a medical question. (Stephanie, 44) I didn’t have the information [. . .] but the lady that was working [at the 2SLGBTQIA+ community health clinic] actually was a counsellor that does intake. And I was able to get the information, get a pamphlet and go straight to the doctor to get the medical stuff out of the way such as transition‑related care and finding chest binders. I let the family doctor do [the pap test] and [she assumed] I was not sexually active [and that] she could use a smaller probe. She kept digging around and it was one of the worst pap smears I ever had in my life. [. . .] I haven’t had pap smears since [that negative experience]. I need [providers] to understand that our sexuality and our health is intertwined and comorbid. Many [older Black women] have experienced sexual violence or physical violence, which I have as well, which comes along with trust issues with the medical field. (Alanna, 53)Because of the PTSD that I have, anytime I’m going through any menstrual, pelvic floor, or reproductive issue of any kind, there’s a lot of blame associated with that [and] thinking that this is my fault. [I have] pelvic floor [related] muscular pain as well. [. . .] I did go to pelvic floor physio[therapy], but I could only manage going I think twice, because it brought up too much for me. (Cameron, 28)

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