Sunday, March 26, 2006

Part IV: To have sex, or not to have sex, that is the question....

Sexuality is defined as “the condition of being characterized and distinguished by sex; concern with or interest in sexual activity; sexual character or potency.” Our Bodies, Ourselves(11) defines sexuality as not merely the physicality of sex, but a woman’s sexual desires, fantasies and the ability to pleasure herself through learning about her own body. The Arc’s position on sexuality is, “Every person has the right to exercise choices regarding sexual expression and social relationships. The presence of mental retardation and related developmental disabilities, regardless of severity, does not, in itself, justify loss of rights related to sexuality.” (13) This paper does not discuss the physicality of sex itself, but instead focuses more on societal perceptions of sexuality with regards to women with visible physical disabilities and the sexual education that does or does not pertain to these women for the purposes of finding out their own sexuality. What is taught in most schools usually focuses on the non-disabled, heterosexual aspect of life, which excludes those who choose to live alternative lifestyles.

Blue Belle(3), a young lesbian woman with several disabilities, and LJ, a young heterosexual woman who is married and has an invisible physical disability, are two women whose voices will be heard throughout the following pages. They wish to remain anonymous and so pseudonyms are used to represent them. Other individuals and documented cases from various disability-specific literature will be cited as well to provide examples in order to illustrate key points.

A woman with a physical disability, seen or unseen, is often thought by able-bodied persons to be “asexual.” Thus are viewed as not having any sexual urges or any desire to be loved by another person. They are typically seen as disability first, woman second: “We are invisible.”(4) In fact, women with physical disabilities (WWPD) can be very sexual and do identify themselves as homosexual, bisexual or heterosexual. Mainstream society tends to advocate that a physical disability of any kind prevents a woman from participating in a communities social functions, such as dating, marriage, or something as simple as going out to a movie and dancing. Sexual health, sex education and gynecological exams are challenges for women with disabilities since they have less access to qualified specialists and accessible exam rooms. In some cases, gynecological exams can cause a great deal of pain if the doctor is unaware of the necessary accommodations required for most women with a physical disability.

There are several different definitions of “disability”. defines it as “the condition of being disabled; incapacitated; A disadvantage or deficiency, especially a physical or mental impairment that interferes with or prevents normal achievement in a particular area; something that hinders or incapacitates”. Victoria Brownworth(5) says that disability is “any condition – disease, illness or syndrome – that impedes or prevents a woman from living what our non-disabled society considers a ‘normal’ life.” The Americans with Disabilities Act(1) broadly defines disability “as nearly any obstacle or impediment to accessing public accommodations, the workplace or institutions of higher learning.” This paper focuses primarily on women with visible physical disabilities though LJ will be mentioned because while her chronic illness is now “invisible”, her experiences with various doctors are pertinent.

Societal Perceptions
Our nation's history in the treatment of persons with physical disabilities is a long and arduous one. Virginia forcibly sterilized women from 1912 to 1979 when, finally, eugenics language was removed from Virginia state law. The main purpose of Virginia’s eugenics law was “to rid society of the ‘burden’ of people who were ‘inadequate’ – by stopping them from breeding.”(12) Approximately 60,000 women in the United States, 8,300 in Virginia, were forcibly sterilized from 1907 onwards and were often not told about it. These women were often given spurious reasons for needing surgery but were sterilized instead because they had been labeled as “insane, idiotic, imbecile, feeble-minded or epileptic”(12) at some point in their lives. Dr. De Jarnette, who later had a state treatment facility named after him, was most influential during this time in pressing for eugenics in Virginia stating, “No person unable to support himself on account of his inherited condition has a right to be born.”(12)

On many occasions, there was no basis for their claim. Psychological evaluations were inept because a societal norm had already been established and anyone who did not meet those qualifications was considered incompetent. Freud speaks well of this, as he was a leading psychoanalyst of this time as well as being a strong supporter of the eugenics movement. Former United States Supreme Court Justice Oliver Wendell Holmes stated in his report on the case of Carry Buck, the first woman in Virginia who was chosen to be sterilized that, “It is better for all the world, if instead of waiting to execute degenerate offspring for crime or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind…Three generations of imbeciles are enough.”

Women with physical disabilities deal with discriminatory attitudes from society because of the mainstream media’s representation of “the perfect body”. Because WWPD are more visible, this will be my main focus. Women with a developmental delay, such as Down syndrome, also receive this kind of treatment, but only because, again, it is outwardly visible. WWPD endure discrimination more from the societal, cultural and economic views of disability than by their own body or limitations. It was found that men with a physical or mental disability make approximately $.87 to every $1.00 that is earned by a man without a disability. Women without a disability make $.77 while women that have a physical or mental disability make only $.2214 for every dollar that is earned by a man without a disability. Divorce is more likely to happen when it is the woman who has the physical disability and WWPD are at an increased risk for emotional, physical and/or sexual abuse.(14)

WWPD tend to experience the effects of disability differently from MWPD in that they are studied, paid and work less. Activists and scholars of the civil rights movement of individuals with disabilities rebuff the view of disability that has been our country’s tradition for centuries – that WWPD have broken bodies that need to be fixed. Instead, they are advocating for the right of WWPD to choose what is best for each woman individually and to make the mainstream society aware that it places much more of a “handicap” on WWPD than they do day-to-day.

A good example of sexual and disability discrimination is the Sharon Kowalski-Karen Thompson case.(5) In November 1983, Sharon had been driving her niece and nephew back to their house when they were hit head-on by a drunk driver. All three were flown to different hospitals, Sharon’s niece later died and Sharon was in a coma for approximately six months. During this time Sharon’s parents learned of the true (lesbian) relationship between Sharon and Karen Thompson and, eventually, did not allow Karen to visit. More than fourteen years passed, and from the beginning, Sharon’s parents did not think she was mentally able to decide what was best or to make her own decisions without a psychological evaluation ever being done on her. Throughout this long, drawn-out court battle, Donald Kowalski had, in more than one interview, stated that Sharon would be better off dead. Still, he was allowed legal guardianship even though he did not have Sharon’s best interests at heart; Karen stated that neither parent had ever discussed with Sharon what she would like to happen.

The judge who presided over the numerous hearings based his decisions on pure homophobic notions about the gay/lesbian community as well as the anti-gay stance that Mr. Kowalski held and had been allowed to introduce during the hearings. The Kowalski’s believed Sharon did not have a chance at a better, more fulfilled life and so, before they had even started, gave up all hope and placed her in a retirement home. Because they did not provide Sharon with access to physical therapy, the proper equipment for her rehabilitation, or psychological therapy, she lost the most precious years for gaining back all that she had lost in her speech and her mobility. However, Karen kept fighting for Sharon and after fourteen years, a final decision was made in April 1993, allowing Karen to finally take Sharon home, which finally became a reality in 1999. The point of the above example is to show that even ones own parents do not think of a WWPD as a whole person, therefore denying them treatment and information that could make for a better life.

WWPD, like all women, are multi-faceted, have different skills and/or interests. A woman who is defined by her disability is like other women being defined by their skin color, how many tattoos/piercings they have or even by their hair/eye color. Every one of these women still has the qualities of a human being. Societal attitudes towards women with physical disabilities can range from complete invisibility to denial that the woman with a disability is in front of an individual, actively seeking information. Some WWPD have reported that other persons without disabilities talk to whoever is accompanying them, thus rendering them invisible. Sharon Wachsler(18), who has Multiple Chemical Sensitivity (MCS), had just this kind of experience in her gynecologist’s office after her exam. The receptionist kept speaking to Sharon’s friend, Heidi, instead of Sharon herself, even when Heidi would direct the receptionist to her. Below is her account of what transpired:

Sharon: Can I pay here?
Receptionist: (to Heidi) Does she have a co-pay?
Heidi: (pointing at Sharon) I dunno.
Sharon: Yes, it’s five dollars.
Receptionist: (still looking at Heidi)
Heidi: (finally) Yes, I guess its five dollars.
Sharon: (tearing out the check and putting it on the counter in front of the receptionist) Here.
Receptionist: Will she be paying now?
Heidi: (pointing to my check on the counter)
Receptionist: (staring with vague expectation at Heidi)
Sharon: (picking up the check and waving it in front of the receptionist’s nose)
Receptionist: (taken aback) Oh.

Sharon stated that this had happened numerous times. She decided to write about this particular visit with hopes of making others aware of their own biases towards WWPD.

Kelly Mack(9) spoke about her growing awareness of the societal perceptions to her physical disability. She feels like her body is broken, something doctor’s feel they must fix and that she is not seen as a whole woman. She says, “a disabled female body is not coveted like the women of magazines or movies: it is hated, feared, and ignored. To be a disabled woman is to be reminded that I am not able-bodied enough to even be a woman. To be disabled means to not have a body of worth. To be a disabled woman means to not even be worth society’s expectations of conformity and femininity.” As she struggles with acceptance within herself and fights this societal perception on a daily basis, she adds how others would refer to her as “the wheelchair” and how the bus driver would announce to other passengers “watch out because the wheelchair was debarking.” Her response is quite humorous as she wondered out loud where her wheelchair was going without her. She feels that she is a constant advocate because societal norms need to be advocated against – they need to change: “Women with disabilities living in this society are not exempt from the influence of messages that attempt to dictate what is desirable and what is not in a woman.”(4) One of the many reasons why women with visible physical disabilities are not accepted into society is because they are not perfect, but who is? Even full-figured women are hardly seen in clothing ads or in television shows, and when they are, the shows do not do well because they, too, do not represent the ideal female body.

How much a woman’s body is portrayed in the media can have a negative affect on those women who do not look like supermodels. So much emphasis is placed on having the perfect body that it can make it quite impossible for women to obtain, which can cause women to have a negative view of their body, which in turn can greatly affect their sexuality;(4) a woman who does not feel she is beautiful will be unable to convey this to others: “Whether we were born deaf or with spina bifida or develop multiple sclerosis or lose a limb later in life, women with disabilities too often find other people assuming that we are not sexual beings.”(9)

Blue Belle stated that she receives mixed reactions from society and it all depends on how much she conforms to the mainstream, as in not having all the daily challenges in her life that she does. She then said that on several occasions she has been told to her face by women and men that she has known for a while that they perceive her as “asexual”, that they believe she does not have her own sexuality or desires. She feels that she is a woman, a writer, a feminist activist and a woman with a physical disability simultaneously, often each identity running parallel and on occasion intersecting, so when others that she has known for a long period of time compartmentalize her, she finds hurtful and degrading.

The following wellness perspective of sexuality for WWPD conveys expectations that empower these women:(14)
* Positive Sexual Self-Image – she is accepting and not ashamed of her body; exercises bodily autonomy and appreciates her own value; the ability to restrict her limitations resulting from her disability to her physical self and not let it impose on her sexual self.
* Sexual Information – she actively seeks credible and reliable information about sexuality and is able to apply it to herself; has knowledge about how her disability affects her sexuality.
* Having Positive, Productive Relationships – she generally feels satisfied with her relationships; feels the ability to communicate well and stability within the relationship; is able to control the nature and amount of contact with others.
* Managing Barriers – she has learned to reduce her vulnerability; is able to recognize psychological, physical and sexual abuse and take necessary actions to reduce and eliminate it; recognizes her right to live in a barrier-free world and takes action to achieve it; confronts societal barriers by using good communication skills to educate her partner, friends and family.
* Maintaining Optimal Health and Sexual Functioning – she participates in health maintenance activities and engages in health promoting behaviors; manages her environment to optimize privacy for intimate activities; is satisfied with the frequency and quality of sexual activity; is able to communicate freely with her partner about limitations and devices, and about what pleases her sexually.

Sexual and Sexuality Education
When attempting to find information on sexual education programs for WWPD, there were none that spoke specifically to women with any disability and instead focused on the heteronormative ableist view of sexuality.

In many cases, parents, educators and medical professionals find no need to discuss the issue of sexuality with women whom they believe might not, nor should, be having sex whether it be homosexual, heterosexual or bisexual. When looking over the SIECUS website(7), I found only two instances where the sexual health of women with disabilities was mentioned within their sexual education curricula. The first was, “all bodies are special, including those that are disabled” and the second was, “people with disabilities can have and care for children.” Granted, this is a widely used curriculum for sexual education in public schools, but in Virginia as well as several other states, the teaching of abstinence is required with no room for deviation. I did not find a specific topic outline concerning the sexual health of WWPD. There were several books listed on an annotated bibliography on the SIECUS website; however, the current school curriculum available in most states does not include those persons with a physical or mental disability which in turn excludes them from participating fully in what is supposed to be a safe and inclusive environment.

One website did include information on what and how to teach youth with developmental disabilities about their sexuality, but that information did not apply to WWPD. The physical act of sex can have different limitations because of a woman’s physical disability and therefore, should not be treated the same as women without a disability in that regard. At the same time, WWPD can have sexual intercourse and physical desires just like women without a disability. The very fact that there is a lack of sexual and sexuality education programs for these women proves they are still excluded from modern society and are not viewed as a whole person.

I posed this question to Blue Belle (3), “What type of sexual education have you had? Did it address issues related to disabilities?” Her response was, “[Plus], none of these courses address people with disabilities as being sexual beings. We are assumed to be, for lack of a better term, ‘asexual’ which I always find upsetting on a variety of levels.” She also mentioned the lack of information she has received from her gynecologists or general practitioners - which would be close to nothing. She figures that because she is a lesbian and not at risk for pregnancy, they assume they do not need to discuss any information with her regarding sexually transmitted diseases, safer sex practices and so on: “Access to accurate sexuality materials is very important for women with disabilities, their families, and health care providers.”(14) Blue Belle has led safe-sex workshops in conjunction with activists groups for lesbians and is always amazed at the lack of fundamental information that is available in her community.

Studies have found that women in general learn about sex from their peers; however, women with a physical disability usually do not have the same type of interactions with their peers in order to get that kind of information. They tend to learn about their sexuality through books, other printed materials, and unfortunately, violent experiences as women with a mental or physical disability are much more susceptible to sexual and physical abuse. Friends, peers, and romantic partners do happen but because of the societal perceptions in regards to physical disabilities, this usually takes a while. This suggests that women with a disability learn through the same sources, just in a different order. Since women without a disability are likely to have a romantic partner or a close peer group first, this is how they might learn of their sexuality, then come the therapy books and other printed materials, as they get older.(10)

The University of Iowa has several publications (printed using funds provided by the state) regarding women with both developmental and physical disabilities. Finding such state funded programs in Iowa instead of Virginia can be quite discouraging and even more so since Iowa ranks amongst the top ten for fiscal effort for Mental Retardation/Developmental Disabilities services since 1992, with Virginia ranking in the bottom ten.(16) There is even one publication that deals directly with the health issues concerning WWPD such as their sexuality and gynecological exams. It seems that the major barrier to women receiving sexual health and sexuality education that deals specifically with their disability is their inability to locate the programs within each state. These programs are not mainstream information and usually get passed around only by word-of-mouth. In fact, WWPD are usually excused from learning about sexuality because they are often thought as “asexual” while in contrast, women with mental disabilities are often excused because they are considered “sexual deviants” and parents or caregivers do not want to entice them into improper behavior.(6)

Most, if not all, sexual health programs leave out any information for women with regards to forms of contraception. A section of Our Bodies, Ourselves(11) is devoted to the pros and cons of certain types of oral contraception, intrauterine devices (IUDs) and barrier methods for WWPD to use that coincide with their specific disability. A chart lists some of the types of disabilities – not all are visible, physical disabilities – and their effects on sexuality and ways to get around those problems such as myocardial infarction (destruction of heart tissue resulting from obstruction of the blood supply to the heart muscle) in which birth control pills are not recommended. Latex allergies are also discussed, whether a woman has sensation in her pelvic area, and what medications she is currently taking since birth control pills might neutralize them. It is important to remember that the types and numbers of medications a woman is on can also have a direct effect on a woman’s sexuality since they can have various side effects such as vaginal dryness, low sexual drive, etc. A lot of patience and understanding as well as creative ways to find sexual pleasure are needed from both partners in order to have an active and satisfying sex life. It is a very useful list and helps to diminish the perceptions of the “asexual” tag that is often attached to women with a physical disability.

In having Crohn’s disease, LJ’s activities are constricted considerably since one of the many symptoms of Crohn’s is to either have diarrhea, constipation, or a combination of both. She has to pick where she is going carefully and make sure she has access to a restroom at all times. She reports that sometimes having sexual intercourse with her husband can be painful and the medications that she used to take had a serious impact on her sexuality. At one point she was on a severe narcotic that kept her dazed and tired all the time, which depleted her sex drive.

Mitchell Tepper, PhD, MPH, posed a question to disability-focused forums and lists found on the Internet.(15) He asked them, “What does your partner find sexy about your disability?” He received several answers from men and women telling Mitchell what they thought: “My babe is 6 months new to a C5-C6 SCI, incomplete injury. I find her extremely sexy. I always have and I always will”; Anonymous notes, “I didn’t know the person I love before (the disability), but I have seen pictures. They are just as sexy to be now as they are in those pictures….more so maybe because of the special person they are inside and out….and gorgeous….gorgeous indeed!”; Darlene, who has cerebral palsy, asked her able-bodied partner, who replied, “Who said I found anything about your disability sexy? How about you send something in that says I find YOU sexy notwithstanding your disability.”

Within the past several decades, society has realized that WWPD can have children and are able to have loving and meaningful relationships with other women and men. An increased amount of research is being conducted to further the comfort level of WWPD and new ways of making public facilities more accessible are becoming readily available in order to make community participation easier. So you see statements like the ones above and think, “Then there is nothing to worry about, nothing to advocate against since all of our problems are closer to being solved.” That could not be further from the truth.

Experiences with Health Care Providers
When visiting a gynecologist, many WWPD get put into very uncomfortable positions in order for the exam to be done properly. In many cases, though, the speculum can be turned upside down so that a woman does not have to be moved. Blue Belle(3) stated that she has to ask for special accommodations when making her doctor’s appointments and then reminds the nurses when she arrives. If they are not willing to provide this, she will leave and search elsewhere for a more accessible doctor, reporting the incident to her insurance company and disability advocate. She recently shared with me some of her experiences when visiting her gynecologist.
She gets put into the same cold room as other women without a disability, is told to strip from her waist down, then make herself comfortable on the table and the nurse will be back in shortly to check on her. Blue Belle has mobility issues so therefore, is usually still sitting in her chair when the nurse comes back in to check on her, flashing everyone in the hall because the nurse had fully expected Blue Belle to be undressed and on the table within five minutes. Because she is not, she gets her next instruction, to “hop up” on the table. She thinks, “Sure, in my next lifetime since I’ve never hopped anywhere in this lifetime.” Then she stares at the door until they come back in and say, “Oh, you’re not on the table.” Sometimes they will have an accessible and/or friendly assistance table but will leave her in the stirrups while they go and get the doctor, which sometimes could take several minutes. Leaving anyone in this position can leave one feeling vulnerable and at a loss for control.

Her body gets placed into all sorts of uncomfortable positions during this part of the exam and she usually leaves in a great deal of pain and so to be left in such a position only exacerbates the problem. The nurses have even suggested for her to bring a friend. Who would you trust to go into a gynecological exam with you? You would have to be able to trust that person to put your feet up in the stirrups, to help negotiate your body into positions that it just does not want to make, or to speak up for you or with you in order to remind the doctor of their “client”: “The client is the woman and person in whom you are treating; she is not just a slab of meat. Please remember your client and talk to her because I am just here to assist with the body but she does have a brain and is able to make pertinent decisions herself.” She then went on to say that her partners usually get extremely angry by the attitudes and treatment before, during and after her exam that they want to go straight to a government office to complain about the state of disabled health care in this country.

The accessible and/or friendly assistance examining table mentioned above was invented by Sandra Welner(19), M.D., in order to make gynecological exams much easier, safer and more comfortable for WWPD. The features of this table include (19):
* The examination table lowers to wheelchair height with the press of a lever to allow for easy transfers.
* No more awkward, dangerous or humiliating lifting will ever be needed.
* Strong, adjustable hand rails for patient safety, independence and security.
* Interchangeable foot attachments allow for choice between regular gynecologic stirrups and custom-designed leg holders that encase the whole foot with soft cushioning and security straps. These foot-leg boot supports can adjust to the most spastic, contracted, or limited range extremity.
* Different leg lengths? Different knee flexion/extension capacity? Different hip joints abduction/adduction capabilities? These concerns are not an issue with this custom-designed table. The table can accommodate any patient's physical ability or limitation. The patient can be treated with dignity and respect.

The attitude of the doctors in which WWPD have chosen to see has also been found to be one of the greatest barriers in their search for accessible care. WWPD have a greater chance of having a negative experience when seeking care from either their gynecologist or primary care physician than a woman without a disability because of the doctor’s, and his/her staff, inexperience and lack of training. Whether male or female, doctors can have a negative attitude, use discriminatory language, stereotype, not have the correct knowledge about the patient’s specific disability and/or lack the proper instruments to give the woman the best care. WWPD report that their health care providers rarely initiate any discussions regarding sexuality. Health care providers need to take responsibility for this but also offer assistance rather than avoiding or overemphasizing the issue.(14)

“Part of the reason why I didn’t see a gynecologist until I was 28 years old was because I was scared to go because I was afraid of what she would tell me. I was afraid that she would say you can’t have sexual relations. And in my early twenties, that wasn’t a problem because I didn’t have a boyfriend. I blocked it out is basically what I did. I just didn’t want to find out. Another scary thing for me is going to the gynecologist and finding out that I may not be able to carry a child.” (33-year old woman with cerebral palsy) (10)

LJ has also reported negative attitudes from doctors, nurses and others in the medical profession. They have seen her as a Crohn’s disease “inflicted person” instead of a woman who just happens to have a chronic illness attached to her. She has retold many nightmarish stories of trips to the emergency room where she is usually left undiagnosed. LJ’s mom and sister constantly blame her for developing a chronic illness and not getting better – they claim she does not “push herself hard enough.” It took two full years of constant testing to get a final diagnosis which is short considering most women will end up waiting ten years to get one. Women in general are the most commonly misdiagnosed so one can only imagine the frustrations when trying to get a disability officially diagnosed.

One such journey was taken by Diane Kholos Wysocki (8) who was correctly diagnosed with von Willebrand’s Disease (a bleeding disorder) after eleven years of fighting for one, at the age of 39. She had a partial hysterectomy in 1983, which resulted in massive bleeding under the skin. This occurrence finally prompted the consultation of a hematologist who first diagnosed her with hemophilia because von Willebrand’s Disease was not possible since it was so rare for women to have a bleeding disorder. Approximately ten years later, this ended up being exactly what she had.

WWPD often have no control over how their bodies are “probed” and looked at, often becoming objectified throughout the medical process. (4) Women recount the numerous medical exams which were done in front of several male doctors who, to them, were just a bunch of strange men who happened to have medical degrees as well as “regular routines such as dressing ourselves, or other activities are observed by doctors while on their ‘rounds’, as this is seen as an excellent training for new doctors.”

Many women have been subjected to the experience of having to display their bodies to groups of male doctors for the sake of “medical treatment.” (4) Sometimes they are asked to strip and walk in front of a group of doctors so they can better assess what the physical problem is, or videos and pictures are taken of that are used in classes as educational tools for future doctors. Blue Belle states that when she was a kid, she thought the phrase, “Dr. X, come in here, you won’t see this again in your career” was part of her name and LJ recalls a time, while having her rectum examined, she looked back to see ten male Japanese doctors staring at her and talking amongst themselves. All of this is done without their knowledge, consent or any regard to their needs to have control over their own bodies or control over who sees them.

Some women who have a physical disability have also undergone difficult surgeries only to end up in more pain or discomfort and sometimes even alter the physical state of their body, all for the hope that they will look “normal”. This can push some women with disabilities to gain control over their bodies through bulimia, anorexia, severe dieting or other forms of bodily mutilation.

Accessibility and the ADA
When Blue Belle had to visit a doctor’s office for a severe sinus infection recently, she found that “their handicapped slots don’t properly accommodate the handicapped and they aren’t aligned with space so cars don’t crowd them. Then, when it snows, the plow just dumps snow next to the slots which makes the concept a joke.” The “restrictions” on most handicap parking spaces have come to include just about everything from someone having a broken ankle or a brain tumor to someone with a learning disability or who really does have a physical disability. While having a broken ankle might feel like a disability, it is temporary; the person will become able again once the cast is taken off.

“Many medical facilities have numerous architectural barriers such as non-elevating exam tables and lack of platform scales to weigh person who use a wheelchair. Even if the facility is architecturally accessible, furniture placement can make the examination room functionally inaccessible.”(14)

The American with Disabilities Act (ADA) (1) does not include accessibility once in a public facility, just that persons with a disability be able to access the facility and have a restroom stall as well as parking spots for them. The number one problem is, until recently, many parking spaces were not accessible to vans nor were the wheelchair accessible stalls in restrooms wide enough for a chair to get through, which is required by the ADA. “Elevators are generally not required in facilities under three stories or with fewer than 3,000 square feet per floor, unless the building is a shopping center or mall; the professional office of a health care provider; a terminal, depot, or other public transit station; or an airport passenger terminal.”(2) It does specify that all accommodations that make it easier for a person with a disability should be made but within reason. In other words, if it is not cost efficient in the long run, than it is not necessary. The problem with the ADA becoming so vague is that those that really do need this get looked upon differently, as if they are just trying to park closer or to get preferential treatment.

General Information on Virginia
Virginia currently ranks 49th out of 51 states (including the District of Columbia) in its total percentage of monies spent on mental retardation/developmental disability (MR/DD) community services while ranking 47th in overall fiscal effort and 46th in the amount spent on education. In 1977, Virginia was ranking among the top thirty.
The Commonwealth ranks 13th in the amount of capital, therefore making its lack of attention a question of priorities for public spending.

As an example, somehow Virginia Governor Mark Warner managed to find the necessary funds to reopen the previously closed DMV offices, yet continues to cut funds for community service programs such as those serving the MR/DD population. Medicaid and Social Services are just two organizations that are taking some of the biggest hits. In addition, from 1977 to 1992, Virginia only spent a little over $100 million on community programs for people with MR/DD.(16)

It is hard to think of something outside of ourselves especially since we get into living our daily lives and tend to not think about it – almost an out-of-sight, out-of-mind philosophy. Hopefully this subject has made readers more aware of their own biases and misgivings. Whenever you go down the street, do not think that women who use a chair can merely get up anytime they want and walk around. Sit down and talk to them instead, do not be afraid. Get down on their level, crouch or sit down next to them so that they will not have to crane their neck. You might find that they have had boyfriends and/or girlfriends, a job, as well as many other experiences just like other able-bodied people have had. You can start being an advocate for disability rights by mailing letters or calling your state representative to show your support for laws and regulations regarding accessibility and funding of community service programs. Or, more simply, you be an everyday voice for inclusion by reminding others in society that everybody is special, no matter what they look like on the outside.