Of their 39 students, teachers worry the most about Tun.

The 6-year-old girl lives in a flat in Bangkok’s Khlong Toei tenements with her grandmother. Dad is out of the picture. Mom lives with her boyfriend.

Tun is quiet and autistic. Grandma rarely interacts with her except to shut her in a room to prevent her wandering. She also cuts her hair short in a haphazard bid to prevent sexual abuse, the teachers said.

Tun is one of 39 students at the Khlong Toei Community Center Pre-School for the Mentally Retarded, which is run by five teachers. The center is one of 10 branches of the Foundation for the Welfare of the Mentally Retarded of Thailand Under the Patronage of Her Majesty the Queen.

The school is one of few places providing services to youth with developmental disabilities; nine in 10 children with autism receive no treatment or accommodation, according to the Ministry of Health.

Photo: Taylor McAvoy

While the children have a refuge from the difficult conditions in the community, they risk being subjected to a controversial but widespread practice some advocates say unnecessarily deprives them of a fundamental human right.

Soon, if her guardian agrees, Tun will be sterilized.

Sterilization of children with developmental disabilities is a common policy endorsed by both doctors and state health officials. But those advocating for the rights of people with disabilities say it robs them of agency while other, more humane, options are ignored.

Nopphasorn Prasitphichid, the 59-year-old chairwoman of the center, says it is for their own good.

She calls herself “mom” to all the children, most of whom live with varying degrees of autism or Down syndrome. At the school, she and the other women take up a task few in society are willing to do: Educate special-needs children in one of capital’s most squalid communities.

Read: Between Poverty and Disability, Hard Lives Made Harder

The teachers say that while some parents are good-faith partners, others, such as Tun’s mother, do not completely take up the parental task of providing for a child with special needs.

“The mom, simply saying, is not cooperating with us. We took the children to make merit at the temple today,” Nopphasorn said, shaking her head with an audible ‘tsk.’ “The mother said she cannot bear the responsibility of the child, but neither can the grandmother.”

Sterilization as the ‘First Option’

Tun and her grandmother live in one of the flats in Khlong Toei, a community that sprang up around the port at its active peak many decades ago. Today it is shunned by many Thais as a place of abject poverty, low employment and high drug use.

Tun’s grandmother worries the young girl could become a victim of sexual violence. So she cuts her hair to make her look like a boy.

“Even with her hair cut like that, she’s still got a feminine nature,” the director said. “She looks older than she is, and she’s got a pretty face and good skin. This is most worrying.”

The school brings students who reach puberty, especially girls, to get sterilized, if their parents agree. Nopphasorn says sterilization is for their benefit.

“We’re so afraid she will get pregnant with someone who lives near her,” Nopphasorn said.

In Nopphasorn’s worldview, the community’s drug users are all potential predators, despite the fact most sexual violence occurs within the home.

“Drug-addicted people don’t care if the person they’re raping is mentally able or not. They’ll just do it,” she said.

But it’s unclear whether such a problem really exists.

Col. Sombat Kaenwijit said there are usually a couple cases reported each year, usually involving acquaintances or neighbors, with the chance of drug use being involved at “50-50.”

During his three-year assignment at the nearby Tha Rua Police Station, he’s never known of a person with a disability, mental or physical, being assaulted. Still, he said they may go unreported.

“Sometimes the families settles things themselves,” Sombat said.

Activist Nalutporn Krairiksh, who edits an online journal for and by Thais with disabilities, says the logic that sterilization will prevent sexual abuse doesn’t make a whit of sense.

“It doesn’t make sense to say it prevents rape. Now, they can be raped without any risk of pregnancy. This can cause more rapes, both from outside and within the family.”

The World Health Organization considers it a violation, issuing a joint statement with other agencies in 2014 saying that women with disabilities “are often treated as if they have no control, or should have no control, over their sexual and reproductive choices.”

“Obviously this is not a method to avoid or prevent abuse. Sterilization is a violation of the right of personal integrity,” María Soledad Cisternas Reyes, UN special envoy on disability and accessibility, said in an interview. “The Committee on the Rights of Persons with Disabilities in United Nations has been clear in relation to this matter.”

Forced sterilizations as policy were first practiced a century ago in the United States under the pseudoscience of eugenics. Those laws eventually fell out of favor, especially after Adolf Hitler cited them to create genetic courts for forced sterilization of nearly a half million people.

Though a number of nations still forcibly sterilize citizens with developmental disabilities, it is more common to place them on birth control medication or other reversible methods.

In Thailand, it remains the go-to method, despite being illegal except in cases involving children with disabilities whose guardians give consent. No one keeps statistics on how many are performed.

Nalutporn said it’s the “first option” encouraged by physicians and social services workers for dealing with pregnancy scares or menstrual hygiene, despite human rights infringements.

“Doctors often tell parents one-sided information about the benefits of sterilization. Sterilized girls won’t have periods that the parents have to clean up and no accompanying mood swings which are often violent in temperament,” Nalutporn said.

Nattavee Wattanasri, a lawyer who sits on the board of a Bangkok association for parents of autistic children, said that girls should be sterilized but not boys because, she believes, it prevents pregnancy in the former but increases the sex drives of the latter.

Photo: Taylor McAvoy

Although sterilizing girls does not prevent sexual abuse, preventing unwanted pregnancy is enough reason to do it, according to Nattavee.

“How much can you protect against sexual abuse of the disabled? It’s hard even for normal people,” she said. “If they’re raped, then they don’t need to get an abortion. But the prosecution of their attacker must happen.”

Chareeporn Yodfa, president of the Parents of Autistic Individuals Group in Phayao, said that although one-fourth of autistic people are female, they are disproportionately sterilized compared to boys.

“I don’t agree with sterilizing them, but I know parents do it out of care and worry,” said Chareeporn, who has a child with autism. “Autistic people can be easier to trick due to their innocence.”

Nalutporn said it can be a convenient cop out.

“It seems like the easiest way since it’s done once and taken care of forever, and expensive training doesn’t need to be used. But we have to see if the easiest option is the best one for the child,” disability activist Nalutporn said. “It’s like deciding for them what their future will be like, and they won’t have the right to choose later.”

Nalutporn said she worked with a family of three in Nakhon Pathom with a mentally disabled girl. State social security convinced the parents to bring her in to get sterilized, so she did.

“But four to five years later, she started to improve. Her mom said she regretted sterilizing her, because now they don’t know for sure what her future will be like,” Nalutporn said.

Sterilization where the disabled is uninformed of the entire nature of the operation usually happens in rural provinces, and are usually accompanied by other surgeries.

“For example, when delivering a raped baby from a mentally disabled woman, a physician would say, ‘Why don’t we include a sterilization too?’” Nalutporn said. “This kind of leading question from doctors is only asked to abled people if they’ve already had very many kids, or are elderly. Physicians should not have the ability to decide, but their duty is to give rounded information.”

Not all children must be sterilized if a qualified doctor recommends otherwise, said Nattavee of the parents’ network.

“Doctors know how much a mentally disabled child can develop and then they decide based on that. It’s not like everyone is forced to do it. I know one family that didn’t sterilize their disabled daughter, because she developed well. That way, they won’t have regrets.”

Nalutporn, the rights advocate, said she can understand how difficult situations can result in sterilization seeming like the best and only option.

“I really understand why they do it. There are real limitations, like money and environmental factors. Sometimes parents sterilize their children, even if they don’t want to, but because they have no other choice,” she said.

Working parents are often afraid their child will be assaulted and impregnated if left at home, or they don’t want to burden a caretaker with maintaining their personal hygiene.

Photo: Taylor McAvoy

“I never tell them it’s completely wrong if they decide to do this. It’s the surrounding factors that make them do it,” she said. “I understand why the school does it. There are problems, but no real mechanism to provide easier options than sterilization.”

Chareeporn said parents can be so lost at caring for a special-needs child they turn desperate, such as a mother who last year attempted suicide after killing her daughter because she couldn’t handle the burden.

“They feel like there’s no way out,” Chareeporn said.

That sentiment is understandable when the hardships keep piling up.

Tun’s grandmother, the one who wants her sterilized, recently stopped paying her bus fees – the school sponsors her tuition – of 1,400 baht a month ever since her mother came and took their money away.

The Khlong Toei Community Center Pre-School for the Mentally Retarded is willing and able to accept additional students from the Khlong Toei, Silom, Sathorn and Rama III areas. Contact them at Khlong Toei Flat 1 or at 02-2493168 if you know of a disabled child who is not receiving proper care, if you would like to donate to the school or sponsor a child.

Photo: Taylor McAvoy

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