Is your client at risk of forced marriage?

How nurses can help people with learning disabilities who are at risk of forced marriage

How nurses can help people with learning disabilities who are at risk of forced marriage

When Anne Farmer* was reviewing a referral made to the community learning disability team where she works as a nurse, something seemed wrong.

Picture: iStock

The service user, a man in his thirties with a severe learning disability, was referred for support with health and social needs. ‘His family were very open and said they were planning his wedding,’ says Ms Farmer, who works for an NHS trust in England.

‘Alarm bells immediately began to ring. We knew he had a severe learning disability, and we knew from working with him that he probably had very limited knowledge and understanding about marriage, so we had to take it further. His parents were elderly and said that he would need someone to look after him when they were unable to and that marriage was a way to ensure this.’


The number of forced marriage cases reported in 2018 involving people with a suspected learning disability

Source: Forced Marriage Unit

In the event, it was found that the client did not have the capacity to consent to marriage and the plan was stopped – but it is a good example of how health professionals working with people with learning disabilities should be aware of the risk of forced marriage.

Forced marriage is defined as marriage without the consent of one or both parties, and in which duress is a factor. In cases of people with a learning disability, it can also occur where the person does not have the capacity to consent.

Statistics from the government's Forced Marriage Unit show that in 2018, 93 cases involved victims with a suspected learning disability. This represented 5.3% of all reported forced marriages, although this figure is likely to be an underestimate.

Motivations: why people with learning disabilities are at risk 

According to associate professor of social work at the University of Nottingham Rachael Clawson, who is leading research into forced marriage and people with learning disabilities, many cases will never be reported or even recognised. ‘It’s a hidden issue,’ she says, adding that there are often different motivations for forced marriages for people with learning disabilities compared with those in the general population.

Rachael Clawson:
'It's a hidden issue'

‘For the families of people with learning disabilities, forced marriage is often about obtaining a carer or following cultural norms – or some people believe that marriage will “cure” someone with learning disabilities. In the general population it can be about money, property, or curbing westernised behaviour.

'Although some of those motivators are also possible for people with learning disabilities, by far the most common is securing a carer, so it’s often not recognised as a forced marriage because it’s seen to be parents doing the best they can for their son or daughter.’

This was precisely the case with the man referred to Ms Farmer and in other cases she has seen, and she warns it can create a difficult situation for the family and health and care professionals. ‘People can get confused between arranged marriage and forced marriage. But to have an “arranged” marriage, you would have to understand what marriage is. In a forced marriage, you don’t have the choice,’ Ms Farmer says.

She believes there should be more awareness-raising about this issue with health and care professionals. ‘Because it’s so easily missed, and because it can also be linked to culture and religion, a lot of professionals can be apprehensive about challenging these decisions when actually it’s not a challenge to the families' religion and culture; it’s ensuring that your clients are safe.

‘It’s hard because families feel you’re intruding and questioning their cultural and religious beliefs when that’s absolutely not the case.’

Tips for learning disability nurses 

Rachael Clawson's advice for learning disability nurses who suspect a client may be at risk of forced marriage

  • Understand the motivations that may apply to forced marriage for people with learning disabilities. The most common motive for families is to ensure the person has a carer
  • Recognise the different ‘profile’ of people who have a learning disability who are subjected to forced marriage. There is a higher proportion of men with a learning disability who are at risk of forced marriage compared with women, and the age of people forced into marriage, or who are at risk, are higher in people with a learning disability
  • Calling it ‘forced marriage’ can be unhelpful with families who do not recognise that this is what they are trying to do
  • Don’t ignore a suspicion of forced marriage because you think it’s a cultural issue; it isn’t. You need to protect your client from a potentially unlawful act


Developing skills to manage cases where people are at risk of forced marriage

Other cases have been more positive, she says, mentioning that the team has recently assessed a client as having the capacity to marry and to consent to sex, while other families have approached services for help to support service users to understand the process.

Ms Farmer adds: ‘It’s important that learning disability nurses know there is knowledge out there, there is an evidence base and there are skills to learn when managing these situations. There are people who can help – however challenging it may seem.’

Implications for practice

  • Nurses should be aware that people with learning disabilities can be subjected to forced marriage, usually because their families think it is in their best interests
  • If a nurse suspects that a client is at risk of forced marriage, they should contact the social work team, the police, or the government’s Forced Marriage Unit
  • There might only be one opportunity to protect someone from forced marriage, so it’s important to act quickly

*Some names and details have been changed to protect client confidentiality

Further resources

About the author

Jennifer Trueland is a health journalist

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