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It’s taken me a while to process how I feel about the overturning of Roe v. Wade. I had to process how I felt about this personally, and then clinically.
Remember, we are sexual beings first, and OT professionals second.
I speak often about the importance of self-reflection and processing of our sexual values, beliefs, attitudes, and biases to ensure they aren’t influential in our clinical decision making. As painful or uncomfortable as it might be, I encourage all OT professionals, if you haven’t already, to really sit with the personal thoughts and feelings that come up in self-reflection about what this means for you as a sexual person.
The overturning of Roe v. Wade disproportionately affects people that already belong to marginalized groups. This means that there will be additional barriers and dangers around abortion, contraception, reproduction, pregnancy, and child care for all people that can get pregnant, but especially for people with marginalized identities, for example among many, disabilities, people in poverty, people of color, people with health conditions, and single working parents. Many OT professions have identities that intersect with these groups and, additionally, many of us have had abortions. So part of understanding how this impacts our clients is first, thinking about us and our experiences. While our experience is so salient to us, it might be a look into the experiences of our clients but never is the whole picture.
Ok, good… Now here is what this might mean for our clients. Below are some first hand accounts of reactions to the overturning of Roe v. Wade from people with disabilities, queer people of color, and single parents:
Many of them speak of body autonomy. They talk about how any restriction placed on the decisions they make about their bodies is another blow to their body autonomy. Body autonomy is sexual autonomy.
Let’s just consider a person with a diagnosis of cancer. They have experiences of poking, prodding, and touching for chemo, radiation, and surgery. This client will likely have to reorient to sexual touch and body control. Many folks with disability, illness, injury have fought tooth and nail to reclaim and sustain a sense of autonomy and control in their bodies. Whenever sexual decisions are externally controlled, people can lose a sense of connection and autonomy with their bodies. I hear this time and time again in my treatment sessions.
Here are some strategies that OTs can utilize for helping people reclaim or sustain their sexual autonomy. Sexual autonomy is hard for a lot of people, and can be harder for folks who have had restrictions, control, trauma to their bodies reinforced. For a few examples among many: illness, injury, disability, sexual assault, anti-queer legislation, fatphobia, bullying, trauma. In my experience, working on sexual autonomy is a common focus of sexuality OT interventions. The below strategies can be used whenever sexual autonomy is a goal.
- Somatic is #1! In order for people to have body autonomy, they have to be in their bodies. Many people physically (and mentally) check out during sexual activity, but checking in to their physical bodies is where the pleasure is at. Somatic exercises and education will help our clients tune out the cognitive crap and tune into their body pleasure.
- Your clients need to know they run the sexual show! Asking and receiving is highly erotic and it gives control back to the asker. Sexual advocating and giving sexual instructions is not something that is taught in high school Sex Ed. Helping our clients understand that they can and need to be giving sexual directions to their partner is huge. Many people struggle telling their partners “faster,” “softer,” “stop,” “don’t stop,” "slower," "right to left, not up and down," "lick don't suck." These are all instructions that control the sensations people receive from their partners. When clients can script this out and practice it with their partners they can get the pleasure they want that works for their body. They realized the pleasure their body is able to provide them and it makes it easier to be in their bodies.
- Include sexual decision making in OT goals. OT professionals are well equipped with the skills to work on decision making skills with clients. This can look like making sexual health information accessible to folks with intellectual and developmental disabilities, or exploring the decision to become or not become pregnant. Here is a decision tree developed to assist in pregnancy decision making for women with physical disabilities.
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