Introduction
For women with intellectual disabilities, reproductive decisions are rarely made in isolation. They unfold within webs of care, clinical authority and family responsibility that quietly organise which futures appear thinkable, responsible and available. When consent is given in these circumstances, it is often sincere and yet produced within conditions that have already structured which options appear possible. This article examines how such conditions are created and why they are so difficult to name as coercive.
Across Europe and other Western contexts, the reproductive rights of people with disabilities have gained increasing legal and political recognition (Flynn and Arstein-Kerslake 2014). Explicit forms of reproductive coercion, including judge-ordered sterilisation, have been formally prohibited in a growing number of countries, and disability rights frameworks emphasise autonomy, legal capacity and supported decision-making (Arstein-Kerslake 2017; United Nations 2006). Yet for many women with intellectual disabilities, the expansion of formal rights has not translated into meaningful reproductive autonomy (Tilley et al. 2012). Research has consistently shown that reproductive control is embedded in everyday family relations, clinical encounters and support arrangements that frame restriction as protection and substitute decision-making as care (Kallianes and Rubenfeld 1997; McCarthy 2009; Wiseman and Ferrie 2020). Reproductive injustice is often experienced not as a violation of rights but as an ordinary feature of intimate life, organised through moral narratives of responsibility, risk and care. The control of intimate life more broadly, including access to relationships, sexuality and unsupervised time with partners, has been equally documented as a feature of disabled women’s everyday experience (Hollomotz 2011; Liddiard 2018).
Spain provides a particularly revealing site for examining these dynamics and as a test case for the limits of legal reform. In 2020, Spain abolished and criminalised judicial sterilisation; in 2021 it replaced guardianship with a model of supported decision-making. These landmark reforms did not directly engage with the informal, familial and medical practices that routinely shape which reproductive decisions are available, nor with the relational context under which consent is produced, interpreted and recorded. Yet the three cases examined in this article, spanning the period before, during and after these changes, show that reproductive control persists across all three legal moments because the mechanism by which reproductive restriction operates is relational and cultural rather than juridical.
To capture this process, I introduce the concept of curated consent: a patterned social process through which consent appears voluntary and relationally supported, yet the authority to define what counts as a responsible reproductive decision remains unevenly distributed, and an expressed reproductive desire can be received, absorbed and foreclosed within relationships that appear supportive. Through reassurance, moral reasoning and the framing of reproductive loss as temporary rather than permanent, irreversible interventions are rendered acceptable without appearing coercive. Curated consent is, in this sense, a form of coercion, one that is structurally invisible precisely because it operates through consent rather than against it. Drawing on ethnographic interviews with women with intellectual disabilities in Spain conducted between 2024 and 2025, this article makes three contributions: it identifies the social mechanism that generates reproductive restriction in the absence of identifiable or legally recognised coercion; it complicates disability rights frameworks that look to supported decision-making as the primary guarantor of reproductive autonomy, by showing how relational support can pre-structure the horizon of reproductive possibility when embedded within contexts shaped by cognitive ableism; and it deepens accounts of contemporary eugenics by showing how reproductive exclusion is organised as consent and sustained beyond the formal moment of signing through the ongoing management of meaning, such that the women themselves cannot name it as restriction. Together, these contributions argue that reproductive justice for women with intellectual disabilities requires sustained attention to the relational and moral worlds in which consent is negotiated and made legible.
Spanish Context
In 2020, after a long campaign from disability rights advocates and organisations, Spain abolished and criminalised forced sterilisation (BOE 2020). The practice had been permitted since 1983 for persons deemed permanently incapable of giving consent and upheld by the Constitutional Court in 1994 on the grounds that sterilisation could free a disabled woman from ‘constant surveillance’ and enable her to ‘exercise her sexuality without the risk of procreation’ (Tribunal Constitucional de España 1994, FJ 4a). In the decade prior to abolition, approximately 1000 people with disabilities were sterilised under this provision, predominantly women and girls with intellectual or psychosocial disabilities (Becerra Basterrechea 2018). At the time of writing, at least 12 EU member states continue to permit forced sterilisation, with three allowing it for minors (EDF 2024), despite its condemnation by the United Nations and the Istanbul Convention as an act of reproductive violence (Council of Europe 2011; CRPD Committee 2014; CRPD Committee 2016).
Qualitative research conducted in Spain in the period immediately preceding the 2020 reform documents how professionals across health, social care and legal settings continued to facilitate sterilisation through informal channels, rationalising decisions in terms of women’s best interests (Yupanqui-Concha, Aranda-Farias, and Ferrer-Pérez 2021). Serrato Calero, Delgado-Vázquez, and Díaz Jiménez (2021) identify a broader shift from macroeugenics, state-mandated reproductive restriction, to microeugenics, the diffusion of reproductive control into everyday family and clinical encounters.
Law 8/2021, in force from September 2021 and seen as a significant step in recognising the rights of persons with disabilities, eliminated guardianship and legal incapacitation, replacing them with supported decision-making under which adults with disabilities are presumed to hold full legal capacity (Ribot Igualada 2023). Yet the legal eradication of forced sterilisation did not in itself guarantee that women with disabilities would see their right to decide freely protected in practice (Prados García 2021), with reports of healthcare providers continuing to make decisions on behalf of those with psychosocial disabilities based on their own judgement rather than the person’s expressed will and preferences (Serra 2025). Ribot Igualada (2023) argues that courts have largely reconstructed substituted decision-making under new legal language, and that informal support arrangements too often operate disregarding the adult’s expressed wishes. A 2023 reform to Spain’s sexual and reproductive health law (LO 1/2023) explicitly named sterilisation and forced contraception as reproductive violence and restored autonomous consent for under-16s, yet remained silent on adult women with disabilities, leaving their reproductive consent governed by an unreformed patient autonomy framework (Prados García 2024).
The three cases in this article span different moments in this legislative history not because the legal framework is the object of analysis, but because the temporal spread demonstrates that curated consent is not a product of legal permission. Edita’s sterilisation took place in the mid-to-late 1990s, when judicial sterilisation was explicitly authorised; Monica’s in approximately 2022, in the immediate post-reform period; and Nora’s in 2024, within a framework that had abolished both judicial sterilisation and legal incapacitation. That curated consent operated across all three moments demonstrates that the mechanism it names operates independently of the legal framework in force, showing why legislative change, however, necessary, cannot alone dismantle it.
Research Design and Methods
Research design and interlocutors
This article draws on ethnographic research conducted between 2024 and 2025 as part of a 2.5-year project on reproductive autonomy and control in the lives of women with intellectual disabilities in Spain. The study received ethical approval from the Ethics Committee on Animal and Human Experimentation at the Universitat Autònoma de Barcelona (Reference number: CEEAH 6879). Semi-structured interviews were conducted with 24 women with intellectual disabilities aged between 20 and 60, living across six regions of Spain including the Canary Islands.
The three cases presented here were selected because they span the three legal moments central to this article’s argument and illuminate with particular clarity how reproductive control can operate through consent; the broader dataset reflects considerable diversity of experience, ranging from approximately a quarter of interlocutors who described relatively high levels of autonomy and decision-making, to those who were denied any sexual or reproductive lives, though infantilisation, whether from family, clinical settings or society more broadly, was a consistent feature across all accounts.
Interlocutors were recruited through disability support organisations, a requirement imposed by the ethics committee that safeguarded interlocutors but limited access to women outside formal institutional networks. The project was originally designed as a participatory, multi-method study; in practice, interlocutors’ dispersed geography, restricted digital access and the deeply sensitive nature of the topic led most women to prefer individual interviews conducted privately. These adjustments preserved the core participatory ethos of enabling women to define the format, pace and depth of their involvement.
Themes of reproductive control can be distressing, and a trauma-informed approach was utilised (Alessi and Kahn 2022). This included conducting the interview in a safe, familiar place, reminding interlocutors before and during the interview that they could pause or skip questions, or stop without any explanation required. Space was given to sit with difficult emotions rather than redirecting away from discomfort, with close attention paid to non-verbal cues throughout.
Ethical and analytical approach
Consent was approached as a relational and ongoing process rather than a one-time signature. Information sheets and consent forms were produced in Easy Read format. Analysis followed an interpretive, grounded approach informed by feminist disability studies. Interlocutors’ narratives were treated as testimonial knowledge: embodied accounts whose epistemic status is structured by the same hierarchies of ability, morality and care this article analyses (Fricker 2007; Nind and Vinha 2014; Walmsley, Strnadová, and Johnson 2018). Transcripts were analysed interpretively, with sustained attention to expressions of love, frustration, guilt, ambivalence and desire as affective registers by which power operates within care. Recurring patterns across accounts were identified and developed into the analytic framework presented here. Quotations have been translated from Spanish with minimal editing to preserve voice and rhythm.
Reflexivity
I am a foreign, visibly disabled and neurodivergent researcher. Whilst my disability did not make me an insider, it fostered what Hartblay (2020) calls relational positionality, a mode of fieldwork shaped by overlapping, though non-identical, experiences of vulnerability. Moments that might otherwise have been awkward, such as when my intermittent speech processing difficulties were present, became points of connection, since the majority of interlocutors have speech differences.
The ethics approval process itself revealed how cognitive ableism shapes research governance. The committee required additional justification for interviewing women with intellectual disabilities, citing concerns about vulnerability and consent, assumptions widely documented in disability research ethics (Nind and Vinha 2014; Walmsley, Strnadová, and Johnson 2018), positioning disabled interlocutors as at-risk subjects of care rather than epistemic agents. The methodological challenges of this project therefore mirror its analytic focus, showing how ableism governs not only disabled women’s reproductive autonomy but also the settings that treat their accounts as credible evidence.
Theoretical Framework
Existing frameworks of relational autonomy and supported decision-making have been crucial in contesting paternalistic substitution of decisions and in identifying that dependency relationships can leave individuals vulnerable to forms of influence that do not announce themselves as such (Arstein-Kerslake 2016; McLeod and Sherwin 2000). These frameworks identify the structural circumstances within which restriction operates and the ways those circumstances shape the self from which choices emerge, but leave unspecified how agreement is organised within particular care relationships before a woman’s expressed preferences can bear on the outcome. Curated consent traces that process.
Scholarship on the reproductive lives of women with intellectual disabilities has established that this population faces disproportionate reproductive restriction (Kallianes and Rubenfeld 1997; McCarthy 2009), with rates of involuntary sterilisation and pregnancy termination significantly exceeding those of the general population. The gap between formal legal protections and lived experience has been documented across a range of national contexts (Hollomotz 2011; Stefánsdóttir 2014; Wiseman and Ferrie 2020).
Cognitive ableism, the systematic linking of cognitive capacity to moral worth, responsibility and legitimate authority over one’s life (Carlson 2001; Carlson 2010), provides the structural architecture underpinning what follows. In reproductive contexts, cognitive ableism positions women with intellectual disabilities as inherently unreliable decision-makers, not incapable of desire, but incapable of responsible desire. The desire to mother is registered and then redirected, reframed and ultimately foreclosed. Clinical and familial authority over that desire appears reasonable rather than exclusionary precisely because cognitive ableism has already positioned that desire as irresponsible (Hollomotz 2011; McCarthy 2009).
In tracing this process, curated consent is situated within, and distinguished from, three existing conceptual tools: reproductive coercion, relational autonomy and hermeneutical injustice. Reproductive coercion names the explicit overriding of a woman’s wishes (Rowlands and Walker 2019). Curated consent is a form of coercion that existing frameworks cannot see because it operates before any identifiable act of overriding occurs by determining which reproductive futures can be desired or considered at all before the question is posed. Relational autonomy theorists (Mackenzie and Stoljar 2000) have shown that autonomous choice is formed within social relationships and vulnerable to their power dynamics, tending to locate the mechanism of restriction in the self, including in damaged self-trust, adaptive preferences or constrained autonomy. Curated consent locates it elsewhere: in the relational apparatus that receives an already-formed desire and organises its foreclosure. Miranda Fricker’s (2007) concept of hermeneutical injustice names the harm that arises when the available vocabulary for describing an experience cannot reach its coercive or harmful dimensions; curated consent builds on this by identifying how that gap is actively produced relationally. It sits within the broader crip theoretical framework (McRuer 2006) and Kafer’s (2013) critique of compulsory able-mindedness, understood as the normalising assumptions and exclusions directed at cognitive and mental functioning. Annamma, Connor, and Ferri’s (2013) DisCrit framework insists that this enforcement is always also about race and class in addition to disability, and the differential valuation of whose reproduction counts as legitimate. I situate curated consent within two interlocking mechanisms: infantilisation, whereby having support needs is read as permanent incapacity to decide; and everyday eugenics, whereby non-reproduction comes to appear as the natural, responsible conclusion of that dependency.
Infantilisation and the dependency trap
Liberal democratic institutions rest on the fiction of a society of equals, a fiction that, as Kittay (1999, 14) shows, obscures both the needs of dependents and the labour of those who care for them. When cognitive difference is present, this fiction intensifies, casting the adult woman with intellectual disability as someone whose dependency is permanent and whose caring relationships, rather than supporting her, become the mechanism whereby adult standing is denied (Kittay 2001). Carers may not experience this as infantilisation, but as knowing what is best.
The dynamic is most acute where disability meets sexuality and reproduction, because it is here that the infantilising logic of permanent dependency finds its sharpest expression. Sanmiquel-Molinero and Pujol-Tarrés (2019), extending Goodley’s (2014) concept of affective disablism, show that disabled women are constituted simultaneously as objects of care and denied access to the position of reproductive subject. This positioning as being someone who requires protection is what makes claiming a reproductive future difficult.
Simplican (2015, 4–5) gives this a precise political name. Liberal membership, she argues, is conditioned on a threshold of cognitive capacity, what she calls ‘compulsory capacity’, deployed most harshly against those who fall furthest from it. The logic of this ‘capacity contract’ aims at ‘domination and disappearance’: exclusion is rendered invisible because the contract appears universal. Even emancipatory frameworks tend to reinscribe compulsory capacity by making inclusion conditional on demonstrated competence (Simplican 2015, 10–11). Law 8/2021 changes what happens once a capacity question is triggered. It leaves largely intact the contractual logic that determines whether the question gets triggered at all.
What disabled embodiment reveals is that autonomy, rational self-governance and bodily separateness are fragile achievements rather than stable facts, and it is this revelation that provokes anxiety (Shildrick 2009, 1–2). The cultural response to the conjunction of disability with sexuality and reproduction is what Shildrick (2009, 64) calls ‘management by non-recognition’, or an effective silence that does the work of erasure. In the accounts that follow, this silence is clinical and material: reproductive wishes were not elicited before decisions were reached, and where information was given at all, it arrived too late for refusal to be possible. McCarthy (2009) documents the same pattern in contraceptive encounters, where the majority of women reported that doctors had asked them nothing. Similarly, Wiseman and Ferrie (2020) find that health professionals routinely directed their questions to carers rather than to the women themselves.
Everyday eugenics and the curative imaginary
McConnell and Phelan (2022) show that eugenic reasoning persists in everyday practices and relationships long after the formal discrediting of the eugenic project. Restriction operates through what appears natural, obvious and responsible rather than through what is mandated. Eugenic practices have not disappeared but devolved, with responsibility for reproductive control shifting from state agencies to the everyday settings of family care, clinical encounters and support arrangements, rendering reproductive exclusion structurally invisible. This maps directly onto Serrato Calero, Delgado-Vázquez, and Díaz Jiménez’s (2021) documentation of the shift from macroeugenics to microeugenics in the Spanish context, whereby in each case, restriction operates through the very relationships formally designated as supportive. Reproductive exclusion, in the cases examined here, does not announce itself as eugenic intervention, but as care and protection.
What makes this possible is a deeper cultural logic. For Kafer (2013, 3), a ‘good future’ is understood as one from which disability is absent: disability is ‘the sign of no future, or at least of no good future’. Disabled reproduction is treated as so undesirable that it demands no argument or deliberation. Kafer’s (2013, 27–28) ‘curative imaginary’ sharpens this further: a cultural framework that ‘not only expects and assumes intervention but also cannot imagine or comprehend anything other than intervention’. Within it, a disabled woman’s desire to reproduce cannot be registered as a desire at all. The curative imaginary names the cultural logic within which reproductive restriction can be organised as care, a logic whose operation in practice the cases that follow make visible.
Reproductive Decision-Making in Practice
The following cases examine how reproductive decision-making unfolds not through overt coercion, but through interpersonal and institutional alignments that organised what counted as responsible choice. Reproductive decisions are often framed as collaborative and supportive, while in practice they are organised through asymmetrical relations of dependency, trust and moral responsibility.
Nora
Nora is 39 and lives with her mother. She attends an occupational centre where she makes crafts to sell. When we met, she spoke warmly about her boyfriend of 14 years. Decisions were made by or with substantial input from her mother. In medical appointments, doctors would often speak to her mother, who would then ‘explain it to me later’. Despite the length of her relationship with her boyfriend, she was not permitted to spend unsupervised time with him.
When I asked whether she herself would like to be a mother, she replied, ‘I would like to, but they did an operation on me’. She had undergone a tubal ligation approximately one year before our interview, at the age of 38. When asked whose idea it had been, she answered: ‘My mum’. Whilst she had shared her desire to have a child with her mother, ‘She told me that I’m not in a position to have a family’. She described her mother’s reasoning in terms of prevention and protection:
[Mum said] it’s so that I don’t bring unwanted children into the world, so that I don’t suffer or have them taken away from me. It’s not because of me. Mum says it’s so they don’t suffer and [the social workers] take them away.
Whilst surgery was her mother’s idea, Nora also located herself within the process of consent. ‘They put a paper like this. I read it, I signed it’, she said, holding her hands apart. Before she signed the consent form, her mother told her the procedure was reversible, easing any anxiety she felt. Furthermore, consent was not directly sought: ‘[the doctor] asked my mum’. Prior to sterilisation, Nora had used a long-term contraceptive implant. When they went to remove it, the family doctor told her it was ‘not as reliable as [the sterilisation] my mother had organised’.
She recalled finding out about what sterilisation would mean ‘when they put me in the operating theatre’. This was the first time Nora had met the surgeon, and while lying on the table, he asked her whether she understood the operation would permanently prevent pregnancy. She described being confused: ‘[I felt] bad, because now I can’t have a child’. Afterwards, her mother reassured her ‘that I should not worry, that this is reversible’, contradicting the surgeon’s explanation of permanence, but one that Nora trusted and retained.
When discussing her experience, Nora was careful to distinguish it from coerced sterilisation:
It wasn’t forced…because forced is when they tie you down and do it without telling you. [This wasn’t me] because I signed. My mum was there. They didn’t force me…that is when they don’t explain anything to you and they just do it.
At the same time, she continued to imagine alternative futures: ‘If one day I can’t have children… if my partner wants to have a child, then we adopt’. These possibilities coexisted with expressions of grief: ‘Many times I feel sad… I feel the need to have a baby’. After the operation, her mother bought her a baby Agapornis bird so she could ‘be its mother’, adding: ‘it’s not a real child, but it’s like one’.
Nora’s narrative illustrates curated consent in its clearest form. Reproductive authority was consistently located outside of her: clinical conversations were redirected to her mother, the decision to sterilise was identified as her mother’s idea and the permanence of the procedure was disclosed only on the operating table, a moment in which she could neither question, refuse, nor leave. Her mother had told her before she signed that the procedure was reversible. The surgeon’s disclosure of permanence arrived too late to affect it. Afterwards, her mother reiterated the reassurance, contradicting the surgeon’s account, and it was her mother’s version she trusted and retained. Her signature marked procedural participation but not decision-making authority. Agreement emerged not from deliberation but from a longstanding structure of trust, dependency and moral delegation in which the terms of reproductive possibility had been settled before the pen touched the paper. And it did not end with the surgery. The post-surgical management (the continued reassurance, the substitute maternity of the bird) shows that curated consent reaches into how that agreement is subsequently understood and lived with.
Monica’s account shares the same structure but differs in one respect: Monica had already begun to imagine a future. Curated consent, in her case, did not operate on an abstract desire but on a plan already taking shape.
Monica
Monica is 35 years old. She lives with her family, studies part-time and works as an assistant in an early childhood education centre. She spoke enthusiastically about her boyfriend, whom she met at the occupational centre. They hope to marry and eventually live together, and they were attending independent living classes in preparation. What she described wanting was modest and specific: to bring him home to watch a film, to eat together, to have, as she put it, a ‘normal life’. Her mother had told her ‘not yet’.
When I asked whether she wanted children, Monica answered immediately, ‘Well, yes, but you see I can’t because I’m operated’, waving her hand across her abdomen. She had undergone a tubal ligation at 32. The decision had begun with a conversation. Monica told her mother that in the future she would like to have children. Her mother responded: ‘It’s very complicated for you. And you get nervous’. Asked to explain the reasoning in her own terms, Monica offered it clearly: ‘My problem is that I’m not very good at maths. And of course, if the child has a fever, I don’t understand that’. When I asked whether this would make it difficult to be a mother, she drew a careful distinction: ‘No, not as a caregiver, but the issue of taking him to the doctor, yes’. She differentiated between the relational work of mothering, which she believed she could do (and indeed, she helped look after other women’s children in the daycare), and the administrative competencies that had framed her as unsuitable. That distinction did not alter the outcome.
At first, Monica said, she felt ‘frustration’. ‘It throws everything back’, she said. ‘It’s very hard’. Her mother responded by offering reassurance: before the operation, she told Monica that adoption would remain possible. Monica signed the consent form; her mother signed as legal guardian. The dual signature formalised a decision that had moved, across several conversations, from Monica’s expressed desire for a future child, through her mother’s risk framing, to a procedure presented as the responsible conclusion. Monica later came to feel that her mother ‘had some reason’. But the desire did not disappear.
Yes, when I see the mothers with the trolley, they feed them or… I feel sad. Yes. And I found out that a friend of mine recently became a mum, that is, one of my best friends from school, who I went to school with, became a mum. And I saw her son. And I felt a bit sad, but well, it’s good. And I took the child, well, her child, I took him in my arms. And I felt a bit sad. But well, I didn’t cry or anything, but then [later] I did, I unburdened myself to my mother, I cried.
That Monica brought that grief to her mother, the same person who had initiated the decision that produced it, captures something essential about how curated consent operates within love. After the operation, adoption developed from a suggestion into a settled plan: ‘I’ve already decided in the future to adopt a girl with Down’s syndrome or something special like that’. The imagined alternative provided a narrative in which Monica could remain someone with a future. Motherhood was not closed off; it was given another shape.
What the sequence discloses is this: maternal initiation, risk framing through cognitive limitation, affective reassurance, dual signatures, the ongoing absorption of grief within the same relationship that generated it. Consent was produced out of love, dependence and the quiet management of disappointment. The normal life Monica described was not refused outright. It was made to appear, through accumulated relational authority, as something that had never quite been available to someone in her position.
Edita’s case extends this analysis into more explicitly clinical terrain. Where maternal care structured the decisions of Nora and Monica, medical expertise was the primary initiating force in Edita’s account. And where the other two women described desires that were gently redirected, Edita described a desire she actively defended and lost.
Edita
Edita, now in her early 50s, has lived with epilepsy since childhood. In our interview, she spoke about repeated experiences of being ‘cancelled out’, spoken over, decided for, made to disappear from conversations about her own life. When the conversation turned to reproductive health, she introduced the fact of her sterilisation directly: ‘I’m operated. I had an operation on my fallopian tubes. I can’t have children, even if I wanted to’.
The decision had begun in a clinical consultation. A doctor asked whether she had any illness. She said yes: epilepsy. The conversation moved immediately to pregnancy. ‘Would you like to be a mother?’ Yes, she said. The doctor then produced a figure: ‘To be able to have a child, you have a one percent chance out of the 99 percent that most mothers have. Yours is one percent’. Pregnancy was dangerous, he explained, because of the medication she had taken since childhood, and because her husband also had epilepsy. The statistic framed what followed: not that pregnancy was difficult or required careful management, but that it was, in practice, foreclosed.
Edita pushed back. She questioned whether there were alternatives to surgery:
If there’s any option before surgery, I would do it. [I told them]: “But you’re telling me now that I don’t have an option for medication, at twenty-six years old. I’ve seen people who have gotten implants, who have taken the pill… and you’re telling me I don’t have an alternative to surgery?”’
The doctor told her there was no option of medication. The procedure was presented as medically necessary: ‘it was decided that, for my health, because of my condition, I had to have surgery, since there was no alternative’. She sought her mother’s support. ‘I asked my mother for permission’, she said. The outcome was ‘a consensus between my mother and me’. Her family confirmed that ‘it would be very difficult for you to give birth’. Clinical risk and familial endorsement converged around the same conclusion.
Then she was in the operating theatre. Before the anaesthetic mask was placed, the surgeon asked: ‘My girl, would you like to be a mother?’ She replied ‘yes’. He told her she could adopt. She described the timing as shocking: ‘That’s something you should be told in an office. Not in the operating theatre’. When she reflected on the adoption suggestion, her eyes filled with tears: ‘How can I adopt if I don’t have work? How would I support it? How do I maintain it? From the air?’
The one percent figure recurred throughout the interview. ‘One per cent… there is still a possibility of being a mother, but they denied me that possibility’. What was presented as closing the question remained, for Edita, open. ‘I know women who have gotten pregnant with one percent’. The permanence of sterilisation did not close a door that had never existed; it closed a possibility she had believed, however faint, was still hers.
Edita was clear that her sterilisation was not forced. ‘Mine was consent’, she insisted. Yet curated consent operated because a real risk was used to foreclose reflection rather than support it. The one percent figure was interpreted for her as a verdict rather than offered as information to weigh. Alternatives were declared absent rather than explored. The adoption suggestion arrived on the operating table at a moment of bodily vulnerability that made evaluation impossible and collapsed immediately against the material reality of her life. Crucially, curated consent does not require passivity: it operated here through and around active resistance, even when it could not gain purchase. The clinical framing did not emerge from nowhere. Epilepsy was among the conditions most frequently cited in early twentieth-century sterilisation legislation (Bashford and Levine 2010), and that history sediments into what counts as responsible clinical advice even when no one in the room is consciously invoking it.
Discussion
It is significant that all three women distinguished their experiences from forced sterilisation. Nora was explicit that forced meant being tied down, being given no explanation, having nothing signed. Edita insisted that ‘mine was consent’. Monica framed the decision as something made together with her mother. These self-understandings are not evidence of false consciousness or internalised oppression. For them, these are accurate descriptions of what happened within the frameworks available for understanding reproductive violation, and they mirror a pattern documented in professional and institutional accounts of sterilisation practice, in which the forced/not-forced boundary is drawn in ways that systematically obscure the coercive dimensions of ostensibly consensual procedures (Tilley et al. 2016; Yupanqui-Concha, Aranda-Farias, and Ferrer-Pérez 2021). What these accounts reveal is that the existing vocabulary for naming reproductive harm cannot reach what these women experienced. Their available grammar for reproductive violation, built around force, refusal and the absence of consent, had no category for an agreement that was sincerely given and yet produced in circumstances that denied genuine choice. The vocabulary gap is not incidental but produced by the same mechanism that organised the foreclosure, and because the desire was received and absorbed rather than overridden, there is nothing in the available grammar of coercion to name what was done to it.
What the three cases make visible is a sequential social process—curated consent—through which reproductive futures are narrowed before any formal decision is reached, secured at moments of greatest vulnerability, and subsequently stabilised through ongoing narrative management. Before any specific intervention was raised, the field of reproductive possibility had already been shaped through established patterns of who speaks for whom in medical settings, which futures are discussed as available, and which forms of motherhood are modelled or withheld. Consent was then formalised in the consultation where alternatives had already been declared absent, through the dual signature that records agreement already reached, or at the operating table where disclosure arrived too late for any reconsideration. After the procedure, the narrative continued to be managed: reassurance was offered, imagined alternatives were kept symbolically alive, and each woman was supported to experience what happened as redirection and not a denial of her desires.
Three mechanisms sustained this process throughout all three accounts. First, risk was narrated in ways that transformed a desire into improbability, and improbability into practical closure. Nora’s anticipated child was imagined as inevitably removed by the state, a fear that reflects the documented reality that mothers with intellectual disabilities face disproportionate child removal proceedings (Mayes and Llewellyn 2012). Monica’s maternal capacity was framed through anxiety and cognitive limitation. Edita’s one percent was the figure that rendered a residual possibility negligible, interpreted as a verdict rather than offered as information to weigh. In each case, reproductive imagination contracted not through overt prohibition but through the structuring of what counted as responsible decision-making.
Second, familial endorsement stabilised these decisions. Mothers functioned as legitimate interpreters of risk and capacity, and women deferred not because they lacked desire but because care relationships had long defined who was authorised to decide responsibly. In Nora’s case, the decision originated with her mother; in Monica’s, the maternal risk framing preceded and shaped every subsequent conversation; and in Edita’s, the clinical verdict was ratified through her mother’s endorsement. Authority was experienced as support, grounded in love, experience and concern. Consent emerged within these alignments rather than outside them.
Third, affective reassurance rendered irreversible interventions tolerable by keeping the future symbolically open. The offering of imagined alternatives, adoption, reversibility, the suggestion that ‘you can still’, transformed reproductive loss into apparent deferral. In Monica’s case, the adoption suggestion developed into a settled narrative that gave her a way of living with the decision without naming what it was. In Edita’s case, it collapsed immediately against the material conditions of her life. For Nora, her mother had told her before she signed that the procedure was reversible and restated this after the surgeon’s disclosure of permanence. As with other decisions of her life, it was her mother’s account she trusted and retained. Consent was a temporally distributed process rather than a discrete event.
The cases reveal a further dimension that the three mechanisms above do not fully capture. Both Nora and Monica, following irreversible sterilisation, remained subject to the same regimes of supervised intimacy that had partly framed the justification for the procedure. Nora could not spend unsupervised time with her boyfriend of 14 years, and Monica could not bring hers home for dinner. If the primary concern had been the women’s wellbeing in relation to pregnancy, the sterilisation would have enabled greater relational freedom, but it only resolved the family’s anxiety. This is affective disablism in practice (Sanmiquel-Molinero and Pujol-Tarrés 2019), whereby disabled women are constituted as objects of protection in ways that persist regardless of whether the specific risk has been eliminated. Curated consent, in this light, is not only a mechanism for producing a particular reproductive outcome. It is a structure via which disabled women’s claim to reproductive and relational subjecthood is deferred and contained, before, during and after any formal consent is given.
These findings complicate celebratory accounts of supported decision-making and relational autonomy. Demic et al. (2024) show that relatives of people with intellectual disabilities act as choice architects who structure the environment of decision-making, often with genuinely care-oriented intentions, and that even those relatives sometimes recognise they are ‘at the intersection of when this becomes coercion’. McLeod and Sherwin (2000) argue that oppression undermines autonomy through its systematic damage to self-trust. Women who have spent decades being repositioned as unreliable decision-makers may enter reproductive consultations with already diminished confidence in their own authority to decide. Arstein-Kerslake (2016, 2017) and others have already identified the risk that support relationships become sites of undue influence, that the line between supporting someone’s will and substituting for it is easily crossed. Curated consent does not dispute this; it names how that crossing occurs rather than only identifying the structural vulnerability at its root.
Where existing frameworks identify structural terrain or psychological consequences of reproductive restriction, curated consent names the interactional process that produces constraint as consent within specific care relationships and explains why the women themselves do not experience it as violation. Serrato Calero’s (2023) central finding sharpens this, showing how internalised oppression runs through sterilisation processes in Spain such that women and their families come to experience restriction as beneficial. Curated consent specifies not the psychological outcome of that internalisation but the sequential social process that produces it.
Running through all the accounts is how the curative imaginary, as Kafer (2013) describes it, operates as the organising logic of intimate relationships, and in each narrative, the women understood those around them as acting from care and protection rather than restriction. This cultural framework had already settled the question of whether disabled reproduction was a legitimate future. Following McConnell and Phelan (2022), this is how eugenic reasoning operates through devolution, not through explicit mandate but through the accumulated logic of care, expertise and moral responsibility that renders restriction not only acceptable but necessary.
The Spanish context makes this visible with particular clarity. Two of the three cases examined here took place after the legal reforms of 2020 and 2021, within a framework that had explicitly abolished guardianship and non-consensual sterilisation. Curated consent operated regardless, because the relational and cultural conditions that shape reproductive decisions operate at a register law does not directly reach. Supported decision-making frameworks must therefore attend to how will and preference are formed: whether reproductive information has been made accessible, whether relational environments are structured by cognitive hierarchy or epistemic equality and whether women are supported to decide for themselves or directed towards agreement. Clinical practice would need to treat the process of reproductive consent, not only its formal documentation, as the site of ethical scrutiny.
The problem is not that support persons fail to recognise when care tips into coercion. It is that curated consent operates through the very relationships and moral frameworks from which that recognition would have to come. Structural changes to how reproductive encounters are designed, such as who speaks to whom, when and with what information, are therefore not supplementary to rights protection but constitutive of it.
Conclusion
Curated consent describes how agreement can be sincere, documented and legally valid, yet assembled within environments that narrow what appears possible before deliberation formally occurs. Through risk framing, familial endorsement, affective reassurance and the symbolic deferral of motherhood, reproductive loss becomes ethically intelligible and emotionally manageable. Authority is aligned across medical expertise, family care and women’s own moral reasoning.
Although grounded in the Spanish context of recent legal reform, curated consent is not context-bound. It offers a framework for analysing how reproductive governance of this kind arises wherever care, expertise and moral responsibility converge around disability and gender, and for asking what it would mean to take seriously the reproductive futures of women for whom that convergence has long settled the question in advance.
Reproductive justice for women with intellectual disabilities requires more than formal recognition of legal capacity. It requires scrutiny not only of whether consent is obtained, but also of how the field of imaginable choice is structured before the woman’s answer could have been otherwise. Reproductive control today rarely announces itself as coercion. It is woven into ordinary practices of protection, responsibility and love. Curated consent makes visible how reproductive lives can be closed off without appearing forced, and how inequality can persist within relationships that remain recognisably caring.
Author Contributions
The author conducted all stages of this research and writing.