A/67/227 37. Denying access to reproductive health care, or forcing women with disabilities to undergo procedures aimed at controlling their reproductive choices, is a form of violence against women. The Programme of Action of the International Conference on Population and Development recognizes the basic right of all individuals to make decisions concerning reproduction free of discrimination, coercion and violence; to have the information and means to do so; and the right to attain the highest standard of sexual and reproductive health. The Programme of Action also recognizes that these rights apply to persons with disabilities. 38. In institutional settings, women with disabilities are subjected to numerous forms of violence, including the forced intake of psychotropic drugs or other forced psychiatric treatment. Furthermore, forced institutionalization itself constitutes a form of violence. People with mental health conditions and intellectual disabilities are sometimes subject to arbitrary detention in long-stay institutions with no right of appeal, thereby robbing them of their legal capacity. 18 39. Women in institutions who need support services are usually more vulnerable. Vulnerability, both in institutions and in community settings, can range from the risk of isolation, boredom and lack of stimulation, to the risk of physical and sexual abuse. Evidence suggests that people with disabilities are at higher risk of abuse for various reasons, including dependence on a large number of caregivers and also because of barriers to communication. 19 One study found that the majority (68 per cent) of psychiatric outpatients in a hospital had experienced major physical and/or sexual assaults therein, a higher frequency than in the general population. 20 40. Violence against women may be permitted by law or carried out under the authority of the State. 21 States may fail to fulfil their obligation to respond to and prevent violence against women with disabilities either through the adoption and implementation of laws and practices that directly violate rights, or by failing to adopt and implement laws and practices that uphold rights. 41. Women with disabilities face a number of obstacles in the justice system, including the systematic failure of the court system to acknowledge them as competent witnesses. This exclusion is particularly problematic in cases involving sexual assault or other forms of gender-based violence, in which the complaining __________________ 18 19 20 21 10 intellectual disabilities”, Mental Retardation and Developmental Disabilities Research Reviews, vol. 12 (2006); Sonia R. Grover, “Menstrual and contraceptive management in women with an intellectual disability”, The Medical Journal of Australia, vol. 176 (2002); A. J. Stansfield, A. J. Holland and I. C. H. Clare, “The sterilisation of people with intellectual disabilities in England and Wales during the period 1988 to 1999”, Journal of Intellectual Disability Research, vol. 51 (2007). Lisa Adams, “The right to live in the community: making it happen for people with intellectual disabilities in Bosnia and Herzegovina, Montenegro, Serbia and Kosovo”, Disability Monitor Initiative for South East Europe (Handicap International Regional Office for South-East Europe, 2008); and Germana Agnetti, “The consumer movement and compulsory treatment: a professional outlook”, International Journal of Mental Health, vol. 3 (2008). Dick Sobsey, Violence and Abuse in the Lives of People with Disabilities: the End of Silent Acceptance?, Paul H. Brookes, ed. (Baltimore, Maryland, Brookes Publishing, 1994). A. Jacobson, “Physical and sexual assault histories among psychiatric outpatients”, The American Journal of Psychiatry, vol. 146, No. 6 (1989), p. 755. A. B. Andrews and L. J. Veronen, “Sexual assault and people with disabilities”, Journal of Social Work and Human Sexuality, vol. 8, No. 2 (2006); and The International Network of Women with Disabilities, “Violence against women with disabilities”, Center for Women Policy Studies (2011). 12-45120