ANNEX I. PERSONS WITH DISABILITIES IN USAID PROGRAMS

Disability sector snapshots and promising approaches to disability-inclusive programming across USAID portfolios

All of USAID’s programming and interventions are relevant to persons with disabilities. Intentional and meaningful inclusion of persons with disabilities across all areas of the Agency’s work is key to countries meeting their development goals and potential for the benefit of everyone. Across the broad scope of USAID’s work, intentional inclusion of persons with disabilities is necessary for high-quality programming that advances equity and benefits persons with disabilities. Conversely, failure to include persons with disabilities in our programming may limit persons with disabilities and other participants who will not have the benefit of their participation. Failure to include persons with disabilities may also violate the principle of do no (more) harm by depriving individuals of opportunities for meaningful engagement or reinforcing societal barriers that adversely affect persons with disabilities long after programming has ceased.

The following snapshots are not intended to be a substitute for more detailed, sector-specific technical guidance documents. However, they provide a brief overview of the situation of persons with disabilities—as well as non-exhaustive examples of promising approaches for disability-inclusive programming—across the following range of sectors of USAID’s work:

  • Agriculture and Food Security
  • Climate
  • Democracy, Human Rights, and Governance
  • Digital Access and Technology
  • Economic Growth and Trade
  • Education
  • Environment, Energy, and Infrastructure
  • Gender Equality and Women’s Empowerment
  • Global Health
  • Humanitarian Assistance
  • Nutrition
  • Peace and Security
  • Water Security, Sanitation, and Hygiene

Regardless of sector, the following approaches should be undertaken so USAID programming is maximally inclusive of persons with disabilities.

  • Meaningfully engage with disabled persons’ organizations/organizations of persons with disabilities (DPOs/OPDs) early, often, and throughout the project life cycle—consistent with the principle of “nothing without us”—to ensure project design, implementation, and monitoring and evaluation are undertaken with and not for persons with disabilities.
  • Uphold the interrelated and interdependent application of “nothing without us” and the other operating principles of this policy: accessibility, accountability, anti-ableism, do no (more) harm, gender equality, and nondiscrimination.‌
  • When collecting data and performing research to inform programming, take an approach that considers the complex, cumulative ways in which the effects of multiple forms of discrimination combine, overlap, or intersect.
  • Develop project budgets to proactively and transparently plan and account for accessibility and reasonable accommodations to facilitate the equitable participation of persons with disabilities.
  • Disaggregate project data by disability status at a minimum, and disability type where feasible, to determine whether project participants are inclusive of persons with disabilities.Support strengthening of DPOs/OPDs and work with local DPOs/OPDs to adapt policies and program practices to foster locally sustained change that generates positive outcomes for persons with disabilities.

Agriculture and Food Security

Smallholder farmers’ produce accounts for 70 percent of the world population’s food source.29 In some contexts, a majority of households in a region may be involved in agriculture and reliant on agriculture for their livelihoods.30 However, poor access to services, markets, and assets marginalizes smallholder farmers and small- to medium-enterprise (SME) operators with disabilities, resulting in their inequitable participation in the agriculture sector.31 Barriers to equitable participation by farmers and SME operators with disabilities can include physical barriers, such as a lack of access to adapted agricultural tools and machinery, and attitudinal barriers, which may cause financial institutions to fail to extend credit or crop buyers to mistakenly believe the produce of farmers with disabilities is of lower quality.32

Persons with disabilities are also more likely than non-disabled persons to experience food insecurity. Even outside low- and middle-income countries (LMICs), data indicate the average percentage of persons with disabilities unable to afford a meal with protein every other day is almost double that of non-disabled persons.33 The gender gap in terms of access to meals with protein is also greater among persons with disabilities, with a larger number of women with disabilities experiencing this situation compared to male peers. In LMICs, data indicate that persons with disabilities and their households are more likely to not have food to eat compared to non-disabled persons and their households.34

Promising Approaches

  • Promote leadership of persons with disabilities in decision-making, governance, research, and food-systems organizations at all levels as well as in managing and governing land, freshwater, marine, and other natural resources.
  • Address disability discrimination in agricultural cooperatives, financial institutions, and agricultural financing schemes so farmers with disabilities may benefit from their support on an equitable basis with others.
  • Promote access of farmers with disabilities to affordable, adapted agricultural tools and machinery and digital agricultural technologies.

Climate‌‌

Of the world’s 1 billion persons with disabilities, 80 percent live in LMICs,35 countries that are often more exposed to extreme weather events.36 Persons with disabilities face multidimensional inequalities, including higher rates of poverty, ableist norms, inaccessible environments, discrimination, and other forms of exclusion.37 This contributes to persons with disabilities being at especially high risk of injury and mortality during climate-related extremes, including natural disasters and extreme weather events.38 Persons with disabilities may be unable to evacuate in the face of extreme weather events or fully use migration as a climate change-adaptive response due to inaccessibility of the built environment, transportation, information and communication, and emergency shelter facilities as well as poor access to financial and other resources, leading to increased risk of injury, secondary disabilities, or mortality.39

Promising Approaches

  • Bolster the resilience of persons with disabilities to the effects of climate change, including by promoting disability- inclusive approaches to urban planning, disaster risk management and response, development of accessible early warning systems, and inclusion of persons with disabilities in the design and implementation of financial protection strategies and instruments.
  • Promote a “just transition” to a green economy for persons with disabilities on an equitable basis with others,40 including facilitating the participation of persons with disabilities in current and emerging “green jobs” that seek to de-carbonize the economy, bring down emissions of greenhouse gasses, promote fuel efficiency or the use of renewable energy sources, or otherwise contribute to climate change mitigation.
  • Support the contribution of persons with disabilities to climate change response, including climate change mitigation, by fostering collaborative partnerships among DPOs/OPDs, environmental groups, governments, and humanitarian agencies; meaningfully including persons with disabilities in the development of climate change response and mitigation policies, strategies, and activities at regional, national, and subnational levels; and advocating for climate action by governments and other actors that is informed by, and responsive to, the unique ideas and contributions of persons with disabilities.

Democracy, Human Rights, and Governance

Despite widespread adoption of the Convention on the Rights of Persons with Disabilities (CRPD), discriminatory laws and policies still exist in many countries, including laws that limit the right of persons with disabilities to marry, exercise legal capacity, and participate in political and public life. Only 36 percent of countries hold no legal restrictions for persons with disabilities to marry; only 13 percent have no limitations to vote; and only 9 percent have no restrictions on persons with disabilities being elected to public office.41 In many countries, persons with intellectual or psychosocial disabilities experience denial of their right to exercise legal capacity through guardianship, conservatorship, and legislation depriving them of the ability to have agency and control of their lives.42

The evidence from five LMICs suggests that approximately one in five persons with disabilities has been beaten or verbally abused due to their disability.43 However, access to justice is also limited in many contexts, with more than 30 percent of courts and police stations not accessible in some countries and more than 90 percent of persons with disabilities in need of legal advice unable to receive it.44 In some countries, more than one in ten persons with disabilities experience discrimination in public services; globally, only two-thirds of countries have access to online government services designed for persons with disabilities.45

Promising Approaches‌

  • Address barriers to the full, meaningful, and equitable participation of persons with disabilities in all areas of political and public life, including supporting their representation, leadership, and agency in political organizations, legislatures, and governmental agencies.
  • Support the political empowerment of persons with disabilities and DPOs/OPDs, including through participation in accessible elections at all levels of government, access to information needed to understand these processes and make informed political decisions, access to civic education inclusive of disability rights, and removal of legal limitations on participation based on disability.
  • Address ableist norms, policies, and inaccessibility that deprives persons with disabilities of equitable access to justice via the police and court systems.

Digital Access and Technology

Despite the transformative impacts of digital technology on people’s access to information, communication, goods, and services, and the essential role mobile devices and services play in people’s lives, many persons with disabilities remain “unconnected and digitally excluded.”46 Many websites, including government portals, fail to comply with accessibility standards (e.g., the Web Content Accessibility Guidelines) that would facilitate access for persons with a wide variety of disabilities.47 Affordability of technology also remains a barrier, with some data indicating that in LMICs, “persons with disabilities are half as likely to afford Internet costs and less likely to be able to afford radio, TV, and a mobile phone.”48 Although emerging technologies such as artificial intelligence (AI) hold the potential to benefit persons with disabilities, the encoding of ableist norms and assumptions in some AI applications has raised concerns about AI discrimination against persons with disabilities.49

Assistive technology (AT)—including wheelchairs, hearing aids, prostheses, eyeglasses, and digital services—plays a key role in the lives of many persons with disabilities. By supporting access, including to education and employment, it is estimated that providing AT has a 9:1 return on investment.50 Facilitating access to AT for a child in an LMIC has the potential to make a difference of $100,000 in lifetime income, in addition to health and social benefits.51 However, it is estimated that in LMICs, only 10 percent of persons have access to the AT they need.52

Promising Approaches

  • Close the digital gap for persons with disabilities by promoting compliance of products and services with accessibility standards and principles of universal design (UD), affordability of digital products and services for persons with disabilities, and access to information and training to provide persons with disabilities the skills to fully leverage the potential of digital technologies across different areas of life.
  • Address disability discrimination in digital ecosystems by avoiding the encoding of ableist norms and assumptions in AI-driven products and services (including through the adoption of standards and regulations and by promoting disability-inclusive hiring of coders and product developers) and supporting laws and regulations to hold technology platforms and individual perpetrators accountable for discrimination against persons with disabilities (including technology-facilitated gender-based violence, or TFGBV).53
  • Promote lifetime access to appropriate and affordable AT through user-centric innovation; consistent product and service delivery standards; inclusion of AT in insurance and national health schemes; training of personnel; coordination by stakeholders at all phases of the supply chain; and removal of import tariffs that can decrease affordability.

Economic Growth and Trade‌‌

In 22 countries, national constitutions explicitly guarantee the right to work for persons with disabilities.54 More than 60 percent of countries include provisions in their labor laws prohibiting discrimination in employment and guaranteeing equal pay for persons with disabilities.55 However, the employment-to-population ratio of persons with disabilities aged 15 and older is almost half that of non-disabled persons.56 Only one in three persons with disabilities is employed, on average, and they are two times less likely to be employed than non-disabled persons.57 Persons with disabilities who are employed tend to earn lower wages than their non-disabled counterparts.58 Lack of accessible workplaces and reasonable accommodations, discrimination in hiring, and denial of access to education and skills development all pose obstacles to the equitable employment of persons with disabilities.

At least 168 countries have disability schemes that provide periodic cash benefits to persons with disabilities, while lump-sum benefits are provided in 11 countries.59 However, many persons with disabilities remain unable to access social protection, and in some countries, more than 80 percent of persons with disabilities cannot access needed welfare services.60 In half of the countries with periodic benefits, children with disabilities and persons with disabilities may be excluded from benefits as they have not had the opportunity to sufficiently contribute to social insurance.61

Promising Approaches

  • Promote access of persons with disabilities to skills and training to participate in the economy and engage in decent work in mainstream work environments that do not segregate persons with disabilities, do not reinforce stereotypes of “suitable” jobs for persons with disabilities, and ensure wage parity with non-disabled workers.
  • Promote adoption and effective enforcement of nondiscrimination laws in employment and work with employers to understand their obligations, including with respect to provision of workplace adjustments and reasonable accommodations.
  • Address social protection systems to account for the added costs many persons with disabilities face due to societal inequities and barriers and ensure persons with disabilities need not fear loss of access to social protection or other supports as a consequence of participation in the labor market.

Education

Globally, school-age children and youth with disabilities face extreme barriers that limit their access to high-quality, equitable, and inclusive education. For the nearly 240 million children and youth with disabilities across the world—or one in ten children and youth aged 0 to 17 years—they are on average more likely than learners without disabilities to be out of school and less likely to complete primary, secondary, or higher education; possess basic literacy and numeracy skills; and receive school-related support.62 These disparities can be exacerbated by a lack of systems to screen, identify, and link learners with disabilities to appropriate supports. Only 16 out of 195 countries mention inclusive education in their general education laws, effectively removing marginalized children and youth, including those with disabilities, from policymaking and programming decisions affecting their lives.63 Youth with disabilities are far less likely to be employed than non-disabled youth; and among individuals with disabilities who are employed, youth, women, and individuals with mental and cognitive disabilities receive lower wages.64 These data reflect that societal stigma and attitudes—including low expectations of the capacity of persons with disabilities to learn or contribute economically—remain major barriers to accessing education and employment for persons with disabilities.

With accessible and appropriate resources, children and youth with disabilities can prosper academically, gain meaningful employment, and exercise self-determination. Principles of UD—which consider the design of policies, allocation of resources, training and support for teachers and employers, availability of support services, and overall accessibility of materials, infrastructure, transportation, and assistive technologies—can improve education and workforce outcomes for all students and employees, including persons without disabilities, and inform a holistic approach for persons with disabilities.‌

Promising Approaches

  • Support partner-country governments to develop and implement education sector and workforce development policies and plans that further inclusive education for persons with disabilities, as articulated in CRPD Articles 24 and 27, and align with the needs and priorities of persons with disabilities and their representative organizations.
  • Build capacity to deliver disability-inclusive education among educators by embedding disability-inclusive education pedagogy—including principles of UD for learning (a research-based set of principles to guide the design of learning environments that are accessible and effective for all)—throughout pre-service and in-service teacher training programs. Support the establishment of post-secondary degree and certificate programs in inclusive education to build human resource capacity. Remove access barriers at institutions of higher education and prioritize recruitment of individuals with disabilities as staff and students in teacher training programs.
  • Develop inclusive and accessible teaching and learning materials for all learners, not just learners with disabilities, that align with principles of UD for learning. Design and administer inclusive and accessible learning assessments that align with principles of UD for assessment, including materials for workforce development and training efforts.

Environment, Energy, and Infrastructure

Persons with disabilities are harmed by environmental degradation, and environmental hazards are risks for disability. For example, overfishing and climate change have been tied to the acquisition of neurologic injuries and paralysis by Indigenous Miskito divers in Honduras, who risk decompression syndrome by diving to increasingly dangerous depths.65 When communities migrate to escape environmental pressures, persons with disabilities and other marginalized groups are often left behind to cope with drought, flooding, or other hazardous conditions.66 Yet persons with disabilities are often excluded from environmental advocacy movements and not consulted in environmental decision-making, leading to policy and infrastructure choices that create significant barriers for persons with disabilities.67 In some countries, more than 30 percent of persons with disabilities find that transportation and public spaces are not accessible.68

In 37 out of 44 LMICs, access to electricity is lower for households with persons with disabilities than households without.69 In 17 countries, less than half of households with persons with disabilities have access to electricity.70 Traditional fuels, such as biomass and coal, are still used for cooking in many LMICs, with persons with disabilities at greater exposure to household air pollution due to longer periods at home.71 Access to clean, affordable, safe, and reliable energy is crucial to the well-being of persons with disabilities, including their abilities to power assistive devices, durable medical equipment such as ventilators, lighting, heating and cooling, cooking, and refrigerated food storage.

Promising Approaches‌

  • Advance programs and policies to protect the rights of environmental human rights defenders with disabilities; promote collaboration between environmental, indigenous, and disability rights communities; and facilitate the meaningful inclusion of persons with disabilities in environmental policymaking, conservation, and natural resource management.
  • Engage persons with disabilities in energy sector interventions to promote access to clean, affordable, safe, and reliable energy for persons with disabilities. Advance disability-inclusive economic opportunities for persons with disabilities in the energy sector through recruitment, human resource policies, training, and education.
  • Facilitate the meaningful engagement of persons with disabilities in informing and influencing accessible and disability-inclusive infrastructure design and decision-making, encompassing all aspects of infrastructure, such as communications, transportation, housing, and broader urban planning.

Gender Equality and Women’s Empowerment

The average disability prevalence rate in the female population of 18 years and older is 19.2 percent (compared to 12 percent for males), representing about one in five women.72 Women, girls, and gender-diverse individuals with disabilities of all ages and life stages face a double nexus of inequality. This, in turn, places them in doubly vulnerable situations where they do not receive access to services, face compounding safety and security challenges, and enjoy less agency and autonomy.

Women and girls with disabilities are up to ten times more likely to be subjected to gender-based violence (GBV) than their non-disabled peers73 and experience TFGBV as an evolving form of GBV. Sterilization of women with disabilities without their knowledge or consent is also a widespread form of violence and violation of reproductive rights.74 Inaccessible justice systems, in turn, hinder the ability of girls and women with disabilities to access justice and seek or obtain redress. Women and gender-diverse individuals with disabilities are often further discriminated against because they are even more likely to be economically poor.75 GBV affecting women, girls, and gender-diverse individuals with disabilities is further neglected due to researchers too often failing to consider disabilities or gender within their data collection.

Promising Approaches

  • Build awareness of and capacity to address gender-based issues within DPOs/OPDs and disability-serving organizations. Advance and support women and girls with disabilities’ agency, equitable leadership, representation, and meaningful participation across all development, humanitarian, social, and political sectors of society.
  • Identify and address the differential gaps, barriers, needs, and opportunities of women and girls, men and boys, and gender-diverse individuals by conducting and integrating the findings from gender analyses for disability- focused programming and disability-inclusive gender analyses for all USAID programming, strategies, and policies.
  • Advance gender-sensitive learning by disaggregating disability-focused data and research by gender identity, accounting for gender-based differentials, and incorporating gender-based learning questions. Disaggregate by disability status and, as feasible, disability type, age, gender identity, sexual orientation, sex characteristics, and other relevant disaggregates.

Global Health‌

Although life expectancy for those living with disability has increased by 69.4 percent between 1990 and 2019, persons with disabilities remain behind in life expectancy by 10 to 20 years.76, 77 Mortality rates are 2.4 times higher among persons with disabilities than their non-disabled peers.78 During the COVID-19 pandemic, persons with disabilities were 2.8 times more likely to die from COVID-19.79 Persons with disabilities are also three times more likely to be denied health care.80 According to the World Health Organization (WHO), LGBTQI+ persons are “less likely to access health services and engage with health care workers due to stigma and discrimination, resulting in adverse physical and mental health outcomes.”81 Societal barriers for persons with disabilities can create additional barriers to accessing high-quality care. For example, research indicates that transgender individuals with disabilities who are deaf are likely to be treated by practitioners who have little to no understanding of at least one aspect of their identities.82 Only 21 percent of adults with disabilities have comprehensive knowledge about HIV prevention and transmission, compared to 28 percent of non- disabled persons.83 As a result of the gap in comprehensive knowledge, persons with disabilities are two times more likely than their non-disabled counterparts to have HIV/AIDS.84

Such disparate health outcomes are not the consequence of persons with disabilities’ underlying health conditions, but rather are the consequence of unfair and avoidable societal conditions that disproportionately affect persons with disabilities.85 Adopting disability-inclusive approaches to health prevention and care has the potential to bring dividends to individuals and communities. It is estimated that for every $1 spent on disability-inclusive noncommunicable disease prevention and care (i.e., ensuring equitable access to these services for persons with disabilities), the return on investment could be $10.86 For children with disabilities, promoting primary health care systems that are equipped to monitor children’s development is a key component to early intervention and provision of appropriate support services to children and families. Providing access to high-quality health care for persons with disabilities contributes to their wider participation in society, is consistent with state parties’ obligations under Article 25 of the CRPD, and is critical to achieving universal health coverage and UN Sustainable Development Goal 3 (“good health and well-being”).

Promising Approaches

  • Promote health care systems that effectively serve all, including persons with disabilities of all ages, by ensuring that such systems “expect, accept, and connect”87 persons with disabilities with high-quality and inclusive health care. Ensure such approaches respect and respond to the diverse and intersecting identities of persons with disabilities, including identifying and addressing health care access barriers experienced by persons with disabilities.
  • Support empowerment and meaningful participation of persons with disabilities and DPOs/OPDs in health sector interventions, including the areas of health sector governance, financing, physical infrastructure, health policy, digital technologies for health, development of the health and care workforce, and systems of monitoring and evaluation.
  • Address the provision of rehabilitation services,88 ATs,89 and person-centered and rights-based mental health care services—recognizing these services are beneficial to all persons, not only those with disabilities—as part of high-quality, disability-inclusive health care.

Humanitarian Assistance‌‌

Humanitarian crises—whether armed conflict or other violence, economic and political collapse, or disasters caused by natural hazards—disproportionately affect persons with disabilities. During crises, the mortality rate of persons with disabilities may be two to four times higher than that of non-disabled persons.90 Crises also increase the prevalence of disability due to new injuries and disruptions to health and essential service systems.91 Persons with disabilities are more likely to have unmet basic needs due to significant barriers in accessing humanitarian assistance, such as inaccessible sanitation infrastructure or food assistance that is not responsive to specific nutritional needs.92 The systems, services, and informal networks that persons with disabilities rely on are more likely to be dysfunctional or inaccessible during crises. Persons with disabilities also face specific protection risks, including targeted violence and abuse, loss of or damage to assistive devices, and increased dependency on others.93

Disability intersects with other identity factors to increase marginalization during crises. For example, children with disabilities are more likely to be abandoned or neglected during displacement, and women and girls with disabilities face higher rates of GBV than their non-disabled peers.94, 95 With older women more likely to be widowed and living alone,96 this isolation can exacerbate the risks for older women with disabilities. Understanding how the different aspects of a person’s identity can expose them to overlapping forms of discrimination and marginalization, enhancing the participation and leadership of persons with disabilities in humanitarian decision-making, and enabling DPOs/OPDs access to funding is critical to disability-inclusive humanitarian assistance.

Promising Approaches

  • Promote the leadership of persons with disabilities and their representative organizations in humanitarian coordination and decision-making at the regional, national, subnational, and global levels.
  • Implement the Inter-Agency Standing Committee Guidelines on Inclusion of Persons with Disabilities, including the four “must do” actions: promote meaningful participation; remove barriers to accessing humanitarian assistance; empower persons with disabilities to develop their own capacities; and monitor for inclusion.97
  • In line with the twin-track approach, ensure each humanitarian response sector (e.g., health, nutrition, protection, shelter, etc.) integrates disability inclusion into all programmatic activities and provides interventions to address the specific risks or barriers persons with disabilities face related to that sector.

Nutrition

Persons with disabilities of all ages experience barriers in accessing adequate nutrition. Barriers to education and skills acquisition as well as employment discrimination can harm their standards of living and ability to afford nutritious food. Inaccessible housing and transportation can make even affordable food difficult to obtain, and lack of access to reliable power can jeopardize safe storage and cooking of food. Consequently, persons with disabilities are at higher risk of living in food-insecure households and are less able to afford a meal with protein than non-disabled persons and their households.98 Lack of access to education also means that children and youth with disabilities are “less likely to benefit from school-based malnutrition reduction efforts” than their non-disabled peers.99

Children with disabilities are two to three times more likely to be malnourished and twice as likely to die from malnutrition as their non-disabled peers.100 In addition to wider societal barriers that limit access to nutritious food, lack of access to nutrition- specific supports can foster malnutrition for persons with disabilities who experience feeding difficulties such as difficulty chewing or swallowing. Although 25 to 45 percent of typically developing children experience such difficulties, that figure jumps to 33 to 80 percent of children with disabilities.101 The frequent exclusion of children with disabilities, including those experiencing feeding difficulties, from nutrition programs and services as well as lack of access to supports for their families and other caregivers means these children are at enhanced risk of malnourishment, wasting, and death.‌

Promising Approaches

  • Address societal barriers in education, employment, and elsewhere that hinder the ability of persons with disabilities to achieve and maintain an adequate standard of living and support policies and programs that uphold their ability to live independently and be included in accessible communities where they can access affordable, healthy food and adequate nutrition.
  • Promote social protection policies and programs that encompass the nutrition needs of persons with disabilities and their households across the life course.
  • Make nutrition supports and services—and malnutrition reduction interventions—accessible to and inclusive of persons with disabilities on an equitable basis with others, including through early identification of and outreach to persons with disabilities who may experience feeding difficulties.

Peace and Security

Persons with disabilities who are living in, or attempting to flee from, conflict zones face numerous threats to their physical and mental health and well-being, further aggravating pre-existing disability or leading to secondary disability.102 Conflict also increases the prevalence of disability within the population through newly acquired disabilities for combatants and civilians alike. At the same time, persons with disabilities are “among the most excluded groups” in peacebuilding.103 When
peacebuilding programs and initiatives are not disability-inclusive, they deny persons with disabilities “their right to participate and fail to benefit from their expertise, both on conflict-related disability issues and on broader conflict dynamics.”104

Independent of broader situations of conflict, persons with disabilities are at elevated risk of being victims of crime. Reasons include reliance on in-person assistance,105 inaccessible transportation, limited access to information and communication, social isolation, and lack of access to justice that reduces the chances of perpetrators being held accountable.106 In addition to crimes common to non-disabled persons, persons with disabilities may also experience specific forms of crime influenced by their disability context. For example, persons with disabilities who are victims of intimate partner violence may be subject to “denial of care or assistance, destruction of medical equipment, destruction of equipment for communication purposes, or manipulation of medications, in addition to more common controlling and abusive behaviors.”107

Promising Approaches

  • Recognize and support persons with disabilities and their representative organizations as agents of change in transforming conflict, interrupting violence in communities, and participating in inclusive and accessible peacebuilding processes and programming to promote attitudes, structures, and institutions that underpin and sustain peaceful societies.
  • Promote the meaningful inclusion of persons with disabilities and their representative organizations into security and governance mechanisms, including disarmament, demobilization, and reintegration processes.
  • In addition to addressing ableist norms and inaccessibility of justice systems, develop services intended to support victims of crime that are accessible and responsive to the specific needs of persons with disabilities.

Water Security, Sanitation, and Hygiene‌

Globally, 2.2 billion people around the world do not have safely managed108 drinking water services, 4.2 billion people do not have safely managed sanitation services, and 3 billion lack basic109 handwashing facilities.110 Access to safe and clean water and sanitation facilities is a basic human right of all people, including persons with disabilities.111 However, in many LMICs, persons with disabilities are “less likely to live in households with access to improved water and sanitation, and less likely to live in a dwelling with hygiene and sanitation facilities on the premises.”112 In some LMIC contexts, “more than one in seven persons with disabilities finds the toilet at home hindering or not accessible.”113 Even in mostly developed country contexts, crowdsourced data indicates that “only 69 percent of public toilets are accessible for wheelchair users.”114

The denial of access to safe and clean water and sanitation facilitations has extensive implications for the well-being, dignity, and self-reliance of persons with disabilities. Inaccessibility of water sources and facilities can hinder the ability of persons with disabilities to participate in community activities, education, health services, and employment. For example, inaccessible toilet and water facilities are major contributing factors for school dropout among children with disabilities, especially girls.115 Inaccessible facilities can also force dependency on others, increasing “the risks of sexual and financial exploitation, as well as deteriorating health and hygiene,” especially for women and girls with disabilities.116

Promising Approaches

  • Strengthen national, municipal, and local system capacity to deliver accessible and equitable water and sanitation services for persons with disabilities, including through governance and financing reforms and utilization of principles of UD and accessibility standards.
  • Support the meaningful engagement of persons with disabilities and their representative organizations to develop gender- and disability-sensitive water, sanitation, and hygiene design and location recommendations that increase accessibility, affordability, and safety.
  • Advance disability-inclusive economic opportunities for persons with disabilities by improving the ability of water and sanitation service providers to train, hire, retain, and promote persons with disabilities so that they can work in the water and sanitation industry.

Footnotes

  1. Global System for Mobile Communications Association (GSMA), “Inclusive Digital Agriculture: Making Value Chains Work for Farmers with Disabilities” (2021). Back to text

  2. Precious N. Sango, Mohammed Bello, Roy Deveau, Kevin Gager, Belinda Boateng, Hauwa K. Ahmed, and Mohammed N. Azam, “Exploring the Role and Lived Experiences of People with Disabilities Working in the Agricultural Sector in Northern Nigeria,” African Journal of Disability Vol. 11 (2022). It is estimated more than “75.0 percent of households in sub-Saharan Africa are involved in agriculture. Back to text

  3. Ibid. Back to text

  4. GSMA, “Inclusive Digital Agriculture.” Back to text

  5. UNDESA, “Disability and Development Report.” Back to text

  6. Ibid. ”Back to text

  7. UNDESA, “Factsheet on Persons with Disabilities.” Back to text

  8. OHCHR, “Policy Guidelines for Inclusive Sustainable Development Goals: Climate Change and Disaster Risk Reduction” (2020). Back to text

  9. Sarah L. Bell, Tammy Tabe, and Stephen Bell, “Seeking a Disability Lens within Climate Change Migration Discourses, Policies, and Practices,” Disability & Society Vol. 35, no. 4 (2020). Back to text

  10. Cadeyrn J. Gaskin, Davina Taylor, Susan Kinnear, Julie Mann, Wendy Hillman, and Monica Moran, “Factors Associated with the Climate Change Vulnerability and Adaptive Capacity of People with Disability: A Systematic Review,” Weather, Climate and Society Vol. 9, no. 4 (2017). Back to text

  11. UNISDR, “Living with Disability and Disasters: UNISDR 2013 Survey on Living with Disabilities and Disasters – Key Findings” (2014). Outlines reasons why persons with disabilities are killed or injured in disproportionately high numbers in disaster contexts. Back to text

  12. ILO, “‘Nothing About Us Without Us’: Realizing Disability Rights Through a Just Transition Towards Environmentally Sustainable Economies and Societies” (2022). Back to text

  13. UNDESA, “Disability and Development Report.” Back to text

  14. Ibid. Back to text

  15. Ibid. Back to text

  16. Ibid. Back to text

  17. Ibid. Back to text

  18. GSMA, “The Mobile Disability Gap Report 2021” (2021). Back to text

  19. UNDESA, “Disability and Development.” Back to text

  20. Ibid. Back to text

  21. OHCHR, “Report of the Special Rapporteur on the Rights of Persons with Disabilities on Artificial Intelligence and the Rights of Persons with Disabilities” (2021).” Back to text

  22. ATscale, “The Case for Investing in Assistive Technology” (2020). Back to text

  23. Ibid. Back to text

  24. ATscale Global Partnership for Assistive Technology, accessed August 2024. Back to text

  25. Technology-facilitated gender-based violence (TFGBV) is any action by one or more people using the internet or mobile technology that harms others based on their sexual or gender identity or by enforcing harmful gender norms. Some of these actions are unique to digital contexts, including doxing, gender trolling, hacking, cybergrooming, using fake accounts, and image-based abuse. Back to text

  26. UNDESA, “Disability and Development Report.” Back to text

  27. Ibid. Back to text

  28. ILO, “New ILO Database Highlights Labour Market Challenges of Persons with Disabilities” (2022). Back to text

  29. ILO, “International Day of Persons with Disabilities.” Back to text

  30. UNDESA, “Disability and Development Report.” Back to text

  31. Ibid. Back to text

  32. Ibid. Back to text

  33. Ibid. Back to text

  34. UNICEF, “Seen, Counted, Included: Using Data to Shed Light on the Well-being of Children with Disabilities” (2022). Back to text

  35. UNESCO, “Global Education Monitoring Report 2020: Inclusion and Education: All Means All” (2020). Back to text

  36. Kamal Lamichhane, Emma Venetis, Amy Mulcahy-Dunn, and Kate Batchelder, “Approaches to Increase Employment and Quality of Employment Among Youth with Disabilities: Evidence and Good Practice Paper,” EnCompass LLC and MSI, a Tetritech company (2022). Back to text

  37. Ximena Saskia Warnaars, “The Unknown Ally in the Fight for Environmental Justice,” Ford Foundation (2020). Back to text

  38. Ibid. Back to text

  39. Melissa Parker, “For Disabled Environmentalists, Discrimination and Exclusion Are a Daily Reality: From Straws to Street Design, Disabled People Are Often Left Out of the Environmental Decisions That Affect Them Most,” Greenpeace (2022). Back to text

  40. UNDESA, “Disability and Development Report.” Back to text

  41. Ibid. Back to text

  42. bid. Back to text

  43. Ibid. Back to text

  44. UN Women, “The Empowerment of Women and Girls with Disabilities: Towards Full and Effective Participation and Gender Equality” (2018). Back to text

  45. UNFPA, “Young Persons with Disabilities.” Back to text

  46. UNDESA, “Disability and Development Report.” Back to text

  47. USAID, “Advancing Women and Girls with Disabilities” (2023). Back to text

  48. Institute for Health Metrics and Evaluation (IHME), WHO Rehabilitation Need Estimator (2021). Back to text

  49. The Missing Billion Initiative, “The Missing Billion Report.” Back to text

  50. Ibid. Back to text

  51. Ibid. Back to text

  52. Ibid. Back to text

  53. WHO, “Improving LGBTIQ+ Health and Well-being with Consideration for SOGIESC,” accessed March 2024. Back to text

  54. Nathan Gale, “Oppression Squared: D/deaf and Disabled Trans Experiences in Europe,” Transgender Europe (2017) Back to text

  55. Ibid. Back to text

  56. Ibid. Back to text

  57. WHO, “Global Report on Health Equity for Persons with Disabilities” (2022). Back to text

  58. Ibid. Back to text

  59. The Missing Billion Initiative, “The Missing Billion Report.” Back to text

  60. IHME, WHO Rehabilitation Need Estimator. It is estimated that approximately 2.4 billion people would benefit from rehabilitation. Back to text

  61. ATscale The Global Partnership for Assistive Technology. Two and a half billion people globally need to use at least one type of AT, such as wheelchairs, hearing aids, prostheses, eyeglasses, or digital services. Back to text

  62. Katsunori Fujii, “The Great East Japan Earthquake and Disabled Persons: Background to Their High Mortality Rate,” Disability Information Resources (2015). Back to text

  63. Handicap International, “Disability in Humanitarian Contexts: Views From Affected People and Field Organisations” (2015). Back to text

  64. UNDESA, “Disability-Inclusive Humanitarian Action,” accessed August 2024. Back to text

  65. Handicap International, “Disability in Humanitarian Contexts.” Back to text

  66. UNICEF, “Children with Disabilities in Emergencies,” accessed August 2024. Back to text

  67. Women’s Refugee Commission, “Disability Inclusion: Translating Policy Into Practice in Humanitarian Action” (2014). Back to text

  68. UNDESA, “An Inclusive Approach to Older Persons in Emergencies” (2019). Back to text

  69. Inter-Agency Standing Committee, “Guidelines: Inclusion of Persons with Disabilities in Humanitarian Action” (2019). Back to text

  70. UNDESA, “Disability and Development Report.” Back to text

  71. Ibid. Back to text

  72. The Missing Billion Initiative, “Reimagining Health Systems.” Back to text

  73. Maureen A. Lefton-Greif, Joan C. Arvedson, “Pediatric Feeding and Swallowing Disorders: State of Health, Population Trends, and Application of the International Classification of Functioning, Disability, and Health,” Seminars in Speech and Language 28, no. 3 (2007), 161–165. Back to text

  74. UN General Assembly, “Report of the Special Rapporteur on the Rights of Persons with Disabilities” (2022). Back to text

  75. Elizabeth Murphy, “Disability-Inclusive Peacebuilding: State of the Field and the Way Forward,” United States Institute of Peace (2021). Back to text

  76. Ibid. Back to text

  77. For persons with disabilities who rely on personal assistants or caregivers to, for example, assist them with activities of daily living such as washing, getting dressed, eating, toileting, etc., the necessarily close nature of that assistance— and the high level of access assistants have to an individual’s person, home, and possessions—can increase the risks of experiencing violence and other forms of abuse (including through withholding of those services) as well as crimes such as theft, financial crimes, etc.

  78. The National Center for Victims of Crime, “Crimes Against People with Disabilities” (2018). Back to text

  79. Ibid. Back to text

  80. The WHO defines “safely managed drinking water and sanitation services” as drinking water from sources located on premises, free from contamination and available when needed, and using hygienic toilets from which wastes are treated and disposed of safely. Back to text

  81. The WHO defines “basic services” as having a protected drinking water source that takes less than 30 minutes to collect water from, using an improved toilet or latrine that does not have to be shared with other households, and having handwashing facilities with soap and water in the home. Back to text

  82. UNICEF/WHO, “1 in 3 People Globally Do Not Have Access to Safe Drinking Water” (2019). Back to text

  83. See CRPD Article 9 (“Accessibility”) and Article 28 (“Adequate Standard of Living and Social Protection”). Back to text

  84. UNDESA, “Disability and Development Report.” Back to text

  85. Ibid. Back to text

  86. Ibid. Back to text

  87. Gilliet Chigunwe and Deliwe Tembachako, “Public School Toilets: A Curse or Blessing for Girls with Physical Impairment,” African Educational Research Journal Vol. 5 (2017), 200–206. Back to text

  88. World Bank, “Including Persons with Disabilities in Water Sector Operations: A Guidance Note” (2017). Back to text

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