臺灣肢體障礙女性生育健康及權利之保障與實踐

Abstract

生育權為基本人權之一，在許多國際人權公約中皆已明文保障，但長期以來障礙女性受不能與不全的刻板印象影響，使得生育權難以實踐，甚至受到侵害，即便我國已將多項國際人權公約國內法化，在歷次國家報告與國際審查中，仍顯示國家少有積極作為，忽視障礙女性生育權利。此外，障礙女性在孕產過程中也將經歷許多阻礙，如缺乏障礙友善環境、生育輔助資源不足、就醫可近性低、缺乏自主權等。作為權利主體，了解臺灣障礙女性生育權實踐的經驗與看法便顯得十分重要。本研究在2021年12月至2022年3月間，對6位於過去10年間有生育經驗之肢體障礙女性進行半結構式深度訪談，了解其生育意向與孕產經驗，再以系統性資料分析方式，彙整我國2009年至2022年之《消除對婦女一切形式歧視公約》（Convention on the Elimination of All Forms of Discrimination against Women，下稱CEDAW）與《身心障礙者權利公約》（Convention on the Rights of Persons with Disabilities，下稱CRPD）國家報告與平行報告資料，梳理國家在保障障礙女性生育權之具體作為，及非政府組織監督與倡議論述，探討我國肢體障礙女性生育健康及權利保障與實踐情況。 從歷次國家報告中發現，障礙女性生育權最初在CEDAW第2次平行報告中被提及，但在經歷第1次CRPD審查後才被廣泛重視，並且多在健康權、家庭權與教育權中被保障。而雖然我國對生育權之保障略有進步，但仍存在進步空間，比如多半呈現現況而少有長期規劃，而《優生保健法》修法以及提供無障礙之孕產與親職服務與資訊、輔具及人力支持等服務方案改善的進展則較為有限，也是非政府組織持續倡議的方向。 在深度訪談中發現，本次受訪之肢體障礙女性普遍被家中長輩認為無法生育或勝任傳統女性社會角色工作，故不被鼓勵結婚生育，但受訪者認為此為對障礙者之刻板印象，並認為自己具有生育能力，也未消除其生育意願，但仍會因為障礙因素而對生育感到沒把握；當受訪者們發現懷孕時，內心感到驚喜之餘也伴隨憂慮，包含如何應對父母感受、遺傳疾病與妊娠併發症、難尋合適孕產服務等困境，但其周遭支持資源尚算充分，也能從活用網路來補充相關資訊；生產方式則以剖腹產為主，大部分是醫師給予建議後，再由受訪者自行決定生產方式，溝通過程平等並相互尊重；而受訪者中僅有1位自行決定結紮，但也有受訪者提到過去曾被建議接受節、絕育手術；在產檢與生產時則遭遇無障礙環境建置不足的阻礙，部分醫事人員因缺乏應對障礙者懷孕的經驗，所以未必能及時提供協助，而懷孕產生的身體變化，也使其遭遇如移位困難、體力衰退等挑戰；部分受訪者有使用孕產培力資源，但認為部分服務未做出合理調整，故無法完全滿足其需求，並認為應該改善輔具與個人助理等服務方案；而受訪者在經歷孕產後能加強其社會參與，為母則強的感受也使其更重視自身權益，更勇於反抗不合理待遇。 在比較國家、非政府組織與肢體障礙女性之論述後，歸納出肢體障礙女性面臨社會誤解與不友善、缺乏無障礙孕產與育兒資訊與服務、孕產期間運動資源以及專屬孕產補助等困境與未滿足需求，其中前二項需求牽涉對障礙者之歧視，將使其無法平等近用生育服務資源，屬於需迫切保障之權利，並受到非政府組織持續監督，但國家尚無積極改善作為，明顯未履行保障人權之國家義務；運動需求則可促進障礙女性之性與生育健康，屬於能逐步實現之權利；專屬孕產補助在過去尚無非政府組織提出相關意見，國家也較少呈現相關保障作為，但其有助於彌補障礙女性所面臨的結構性歧視，國家應確保提供特定補助項目予障礙者，並持續擴大生育支持服務之提供。 綜合上述，我國肢體障礙女性存在生育意願且能藉此充權，但期間仍遭遇多重挑戰，說明我國在CEDAW與CRPD國內法化後，國家保障肢體障礙女性生育權之義務未完全履行，部分未滿足需求構成歧視需立即改善，針對可逐步實現之服務，國家也應反映現況逐一落實，以完整保障我國肢體障礙女性之生育權。

Reproductive rights are fundamental human rights, and they have been explicitly guaranteed in many international human rights conventions. However, women with disabilities (WWD) have been labeled as “incapable” and “incomplete” for a long time, which has made them challenging to fulfill their reproductive rights. Moreover, the rights may even be infringed. Although Taiwan has internalized five international human rights treaties in its domestic legal framework, only a few positive actions and policies have been mentioned in the previous State Reports, indicating the government’s neglect of the reproductive rights of WWD. However, WWD normally experience many obstacles regarding pregnancy and childbirth. As the rights-holding subject of reproductive rights, WWD’s experiences of and views on the practice of reproductive rights in Taiwan are important and deserve exploration. Thus, this study aims to depict the practices of protection and practices regarding the reproductive health and rights of women with physical disabilities (WWPD) in Taiwan. To do so, six semi-structured in-depth interviews with WWPD, who had reproductive experience in the past ten years, were conducted from December 2021 to March 2022. A systematic approach to documentary research, including data collection and analysis, was applied to contextualize the protection and practices regarding reproductive health and rights from the perspectives of government and non-governmental organizations in recent years. All the reports and related textual materials of Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) and the Convention on the Rights of Persons with Disabilities (CRPD) in previous states parties' reporting procedures from 2009 to 2022 were reviewed. The issues related to reproductive rights of WWD were first mentioned in the CEDAW shadow reports in 2014 and were expressed in broad discussion after CRPD reporting in 2017. Most of them are often mentioned in the previous reports in education, family, and health rights. There is some progress in the institutional protection of the above rights, but State Reports have shown no continuous implementation plans. Moreover, the progress in amending the Genetic Health Law and the support for accessible reproductive health information, assistive devices, and human resources, which have been repeatedly mentioned in previous reports, are relatively limited. The lack of progress on these issues indicates that the protection of the reproductive rights of WWD in Taiwan is not complete yet. Findings of interviews demonstrate that the WWPD were generally considered infertile or lacking the capabilities to fulfill the traditional expectations regarding women’s social roles by their senior relatives, so they were not encouraged to marry and have children. Taking such discouraging attitudes stemming from the stereotypes against WWD, the interviewees still recognize their abilities in pregnancy and want to have children. But, they have still felt uncertainties about pregnancy because of their disabilities. When the interviewees found out that they were pregnant, they felt not only surprised but also worried because of, for instance, their parents’ judgment, hereditary diseases, pregnancy complications, and the difficulties in finding suitable maternity services. They dealt with these worries by searching for information on the internet and receiving sufficient support from their friends and relatives. Following the advice from their doctors and based on their own opinions, most interviewees delivered with cesarean section surgery. The process of discussion was with equal and mutual respect. Only one of the interviewees underwent ligation surgery after pregnancy, and two of them mentioned they were recommended to have sterilization surgery in the past. They commonly experienced obstacles when receiving obstetric examinations and delivery due to the unfriendliness of the environment. Some medical staff lack the experience in dealing with the pregnancy of WWPD, so they may not be able to provide timely assistance. In addition, the changes in the body and physical functions also make them encounter other challenges, such as difficulty in shifting and decline of physical strength. Some empowerment services were not adjusted reasonably, so their needs could not be satisfied sufficiently. They argued that the services related to assistive devices and personal assistant services should be improved so that they can pursue to realize their reproductive rights easily. Finally, experiencing pregnancy and becoming a mother increases their social participation. The feeling of “obtaining strengths as a mother” has made them braver in resisting unreasonable treatments. Above all, WWPD faced obstacles and unmet needs including unfriendliness from society, inadequacy of disability-friendly services related to reproductive health, the lack of subsidies during pregnancy and appropriate sports resources. From the perspective of human rights protection, the material and institutional barriers that are discriminatory and may limit WWPD access to basic reproductive health services should be eliminated as soon as possible. Other unmet needs that are supportive services in fulfilling the state’s obligation to facilitate a friendly environment should also be addressed progressively. Through this study, I have found that WWPD are capable and willing to go through pregnancy. Though CEDAW and CRPD have internalized in Taiwan, they still face many challenges during pregnancy. Therefore, I argue that the government should eliminate the discriminatory situations related to the pregnancy of WWPD and guarantee their rights to access suitable reproductive health services to protect their reproductive rights completely.