A Local Authority v A & Anor

Capacity to decide about contraception is assessed under the Mental Capacity Act 2005 by reference to the immediate medical information relevant to contraception. This includes its purpose, the likelihood of pregnancy without it, available methods, use, advantages, disadvantages, side-effects, changeability and generally accepted effectiveness. It does not require a woman to foresee the practical realities of parenthood or the likely outcome of future care proceedings. Such an expanded test risks confusing capacity with best interests and undermining personal autonomy. A person may understand the medical information yet lack capacity if coercive or dominating influence prevents her from using or weighing it freely. On the facts, the woman lacked capacity because of her husband’s overpowering influence. No best-interests order for contraception was justified at that stage, and no injunction against the husband was presently necessary.

The Local Authority applied in Court of Protection proceedings concerning a married woman with significant learning disabilities. It sought declarations that she lacked capacity to decide whether to use contraception and that contraception would be in her best interests. It also sought potential orders concerning force, restraint and anaesthesia, and an injunction preventing her husband from obstructing professional assistance.

The central questions were the proper statutory test for capacity regarding contraception, whether the woman could use or weigh the relevant information free from her husband’s influence, whether contraception was in her best interests, and whether protective orders were required.

1. Capacity test. Under sections 1 to 3 of the Mental Capacity Act 2005, the relevant information concerned the proximate medical issues of contraception. The woman had to understand, retain, use and weigh: the reason for contraception and what it does; the likelihood of pregnancy without it; available methods and their use; advantages and disadvantages; possible side-effects and how they could be dealt with; how readily methods could be changed; and their generally accepted effectiveness. The test did not require her to foresee the practical realities of raising a child or whether a child might be removed from her care. That would set the threshold too high and risk confusing capacity with best interests.
2. Application. The court preferred the evidence applying the proper medical test and found that the woman understood the relevant contraceptive information. However, section 3(1)(c) also required her to use or weigh it. The evidence established an unequal and coercive relationship in which she deferred to her husband, feared rejection and homelessness, and was subject to his dominating influence. Her decision not to use contraception was therefore not a free decision. She lacked capacity in relation to contraception.
3. Best interests and proportionality. The proposed declaration that contraception would be in her best interests, subject to consent, had no practical effect. Physical coercion, restraint or anaesthesia would raise profound issues concerning autonomy, private and family life, and the resemblance to enforced sterilisation. The court declined to make any best-interests order. If pregnancy occurred, the Local Authority would undertake a pre-birth assessment of both parties’ parenting abilities.
4. Inherent jurisdiction. The court accepted that the inherent jurisdiction could protect a vulnerable person from coercion and create conditions for a free and capacitated decision. No injunction was presently necessary because the husband assured the court that he would permit the woman to receive appropriate professional assistance and would participate in the process.

First-instance decision. The judgment records that interim declarations concerning litigation capacity, residence, contact and care had previously been made by a nominated Circuit Judge, but gives no citation for that decision.