A MOTHER-of-three with learning disabilities, whose children are all in care, has been fitted with a contraceptive device against her will.

Specialists told Mrs Justice Gwynneth Knowles that the 22-year-old woman, who cannot be named for legal reasons, was pregnant again and was due to give birth soon.

Doctors and professors said that it was in her best interests to be fitted with an intrauterine contraceptive device, often known as an IUD, during her caesarean, to reduce the risk of unplanned pregnancies and to enforce ‘family spacing’ – rest time between births.

The procedure was put forward by Oxford University Hospitals ahead of the 22 year-old giving birth to her fifth child.

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The woman, who was referred to simply as ‘Z’ on court documents, has a rare condition known as ‘Chromosome 17q12 microdeletion’ and as a result suffers from cognitive impairment and a bicornate (heart-shaped) uterus.

Doctors in charge of her care at Oxford University Hospitals NHS Foundation Trust (OUH), said that she also has a number of physical health problems like diabetes, anaemia, and a severe vitamin D deficiency. They said further pregnancies could pose a significant risk to her, with a likelihood of her bleeding out in a future pregnancy.

In the court documents, Mrs Justice Knowles outlined details of the woman's background.

She said: “Of her four children, one sadly died when only six-days old and her other three children have been taken into care. [The woman] has developed complications in all her previous pregnancies and this pregnancy is considered to be medically high risk.

“Due to her biconate uterus, [she] is at risk of a pre-term birth and fetal malpresentation. Given these risk factors, she is booked in to deliver her baby by cesarean section.”

The operation to remove her baby was her second planned caesarean and was due at the beginning of the month.

However, the woman objected to being fitted with a device, instead agreeing to have contraception via three-monthly injections.

She told the judge: “It’s my body. I should have a choice on what I want.”

Mrs Justice Knowles explained in the court documents: “[She] told me that she was willing to have long-lasting injection but did not want [the IUD] fitted. She told me that she would be helped by the nurse to go to regular appointments which would be necessary.

“She was unable to articulate why a long-lasting injection was her preferred method of contraception other than by saying ‘its my body’.”

Doctors were concerned that she would not turn up to appointments for the injections and that fitting a device was the best option.

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In a telephone conversation with the woman before her ruling was made, the judge floated the idea that it might be in her best interests, but the woman hung up on her.

Dr Camden-Smith, a consultant psychiatrist, said that during another appointment, carried out over the phone because of Covid-19 restrictions, the woman was polite but annoyed at the questions.

She said: “She did not understand why the court might be involved with respect to her decision about contraception.”

Mrs Justice Knowles analysed the case at a recent hearing in the Court of Protection, where judges consider issues relating to people who may not have the capacity to make decisions for themselves and outlined her decision in a written ruling published last month.

In the ruling she looked at documents from all health professionals, one of which said the woman had an assessed IQ in the range of 60-69.

In a statement, independent obstetrician and gynecologist Prof Walker said the patient had an ‘inability to control her fertility’ and was becoming pregnant ‘yearly’.

Despite this, she had been assessed of having capacity to make decisions about her ante-natal care generally and how she would deliver her baby.

But the judge decided that fitting a contraceptive device would be in the woman’s best interests and concluded that she did not have the mental capacity to make decisions about her contraception.

The hearing was conducted via skype and the woman spoke to the judge from her home.