Mentally ill women and parenthood: the big debate

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Women with learning disabilities often face the risk of rape and unwanted pregnancies, marriage for them is fraught, but what about their rights?

A young couple pose on a street for their wedding album in downtown Hanoi. The amended Law on Marriage and Family proposes banning people who have lost their legal capacity, including those with mental illness, from marrying. It would mean any Vietnamese citizen wishing to marry should obtain certification that they do not suffer from any mental illness which makes them unable to control or be aware of their actions. Photo: AFP

Chinh, a mentally ill woman, was 22 when she was raped and became pregnant with a female child. Unable to take care of even her own needs, breastfeeding was the only thing she could do for the child.

Her mother has been forced to take over her parenting duties. But at 75, her mother barely gets by herself. Both Chinh and her daughter face an uncertain future.

According to a World Health Organization (WHO) report last year, people with mental illness account for 10 percent of the Vietnamese population.

Of these nine million people, however, only 10,000 get treatment at mental institutions or financial aid, with the rest either living with their family or on the streets.

The report said 39 percent of those being treated in mental health outpatient facilities are female and 17 percent, children or adolescents.

Women with mental illness like Chinh are susceptible to horrific violence and rape. But these crimes often go unreported and unpunished, leaving the victims with pregnancies and the perpetrators free to continue with the abuse.

"Chinh cannot take care of herself, let alone the child," her mother agonizes.

"When I die, none of my relatives will be able to take her child in because they are dirt poor. I do not know where to turn to."

Falling prey to sexual assaults, heart-rending as it is, is just the most visible aspect of the larger problems faced by people with mental disorders in Vietnam.

Many families hope marriage could be a normalizing experience for them, with parenthood fetching them caretakers for their later life in the form of children.

But there is overwhelming evidence that mentally ill women forced by their families into marriage face a greater risk of gender violence and poverty.

Thoa, 58, was very happy when her daughter who has learning disability got married though she was well aware that the man only married her daughter for financial gain.

A house in Hanoi's Thanh Xuan District was part of the deal for Nguyen Van Luc, her son-in-law, who was a poor unemployed migrant from Ninh Binh Province. But Thoa's happiness did not last very long as Luc often beat his wife brutally and treated his mother-in-law like a slave.

Soon he disappeared after selling both his house and Thoa's and pocketing all the money, leaving behind his wife and small child, who also has a mental disorder, in the care of his destitute mother-in-law.

"I had to request doctors to sterilize my daughter as my grandson also shows symptoms of Down's syndrome," she said. 

Human rights dilemma

As the international community moves toward a wider recognition of reproductive freedom for women, those with mental disabilities are also supposed to be endowed with the full set of human and reproductive rights.

These include the right to marry and set up a family, the right to have children, the right to comprehensive reproductive healthcare, and the right to be free from sexual abuse and exploitation.

But the WHO found that a national mental health human rights agency to safeguard these rights for mentally ill people does not exist in Vietnam.

Meanwhile, society remains unprepared for people with learning disabilities becoming parents, resulting in coerced abortions and even forced sterilization. 

Mentally disabled parents admittedly do not have the emotional, mental, or financial wherewithal to raise their children without the help of their family or society.

This sparks off a debate: should people with learning disabilities have children?

Sterilization of women with mental disabilities is officially encouraged in Vietnam while the practice of coerced abortion is very common, the justification being they are done to ensure the wellbeing of the women and prevent them from having children they would struggle to raise or pass on their illness to.

"Mental disorders are profoundly disabling and people suffering from them frequently endure the worst conditions in life as well as intensive support needs," psychiatrist Dang Thi Anh Thy says.

"Childbearing and parenthood are thus very problematic for psychologically disabled people. The best thing is that the competing demands of parenting and living with mental illness should be avoided."

Medical experts also express concern that many serious mental disorders such as schizophrenia can be passed on from parents to children.

"Children's welfare should come first," Thy says.

"Being a parent and handling the stress of marriage and motherhood are hard work under the best of circumstances.

"If you cannot function enough to take care of yourself, then how do you plan to take care of another life?"

Though the impact of mental disorders is profound, not least when combined with poverty, mass trauma, and social disruption, the aspect of mental health, especially the reproductive rights of women with mental disorders, is frequently absent from health and social policymaking in Vietnam.

Chu Quang Cuong, head of planning and finance at the Ministry of Labor, War Invalids and Social Affairs, admits to authorities' traditional neglect of those with chronic mental problems, saying they focus only on orphans, disabled people, abandoned older people, and veterans.

While sterilization and abortion are a reality, there is also the issue of human rights for women with mental illness.

Forbidding marriage, the solution?

To preclude forced abortions and sterilization of women with learning disabilities, one solution that is being touted is obtaining a certificate of good mental health for marriage.

Article 10 of the amended Law on Marriage and Family proposes banning people who have lost their legal capacity, including those with mental illness, from marrying.

It would mean any Vietnamese citizen wishing to marry should obtain certification that they do not suffer from any mental illness which makes them unable to control or unaware of their actions.

The written certificate should be issued by a competent health organization within six months of application.

Ha Thi Thanh Van, deputy director of the Vietnam Women's Union's Department of Policy and Legal Issues, fully supports this provision.

"Background checks for mental health and sexually transmitted diseases are mandatory in many countries, for instance South Korea. However, the idea is so foreign in Vietnam," she says.

But many legal experts are concerned that this could end up denying the right to marry and set up a family to people with learning disabilities.

While supporting the idea of a health check for marriage, Bui Thi Thanh Hang, a lecturer at the Hanoi National University's law faculty, argues that having a learning disability does not make a person a second-class citizen.

"If they wish to have a family, it is their basic human right," she says.

In response, Van says the provision should be seen as a humanitarian intervention for the well-being of people with mental illness.

"Critics should consider the humane aspects of the proposed amendment. The law bans them from marrying, not from having sex.

"It is true that not all parents with mental disorders pass on their illnesses to their children.

"But mental illnesses seriously affect the parenting abilities of a couple, which eventually harms the child's psychological development.

"There are many instances of mothers with mental disorders stabbing their babies to death."

Clearly, both lawmakers and human rights proponents are scratching their heads about how to adopt the UN Convention on the Rights of Persons with Disabilities, which recognizes the right of mentally ill people to be respected for his or her physical and mental integrity on an equal basis with others and to retain their individual autonomy and independence, including the freedom to make their own choices.

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