The missing ‘D’ in the
Millennium Development Agenda
Minal Doshi (2006)
Abstract:
This paper establishes disability indicators for the Millennium
Development Goals (MDGs) 1, 2, 3, 5 and 6 to urge inclusion of nearly 10
percent of the world’s total population in its development agenda. This 10
percent constitutes a much higher percentage of those who must benefit if the
Millennium Development Agenda is to successfully achieve its goals.
It further highlights the inherent paradox of goal 4, where lack
of attention to adequate post-natal medical and rehabilitative care will
actually increase the incidence of disabilities in most countries in the world.
The paper reconfirms interdependent links between various indicators
and disability and asserts that no development agenda in the world is fully
achievable unless people with disabilities find an equal and equitable place in
it.
The missing ‘D’ in the
Millennium Development Agenda
The Millennium Declaration and its accompanying Millennium
Development Goals are a measurable set of targets which focus the efforts of
the international community on improving people’s lives in developing nations. Furthermore, people with disabilities[1]
constitute an estimated 600[2]
million people in the world, over two thirds of whom live in developing
countries, with the highest density of their population in Sub-Saharan Africa
and in South and South- East Asia[3].
Despite these statistics, people with disabilities find no direct mention anywhere
the Millennium Declaration. Consequently, one in ten people, those most
affected by poverty, hunger and illiteracy, are not explicitly addressed by the
Millennium Declaration.
How
serious is this omission? In fact, people with disabilities are the largest
group of people vulnerable to extreme poverty and hunger. Their numbers are key indicators and
components in the global effort to eradicate poverty, hunger and
inequality. It follows then, that people
with disabilities within the language and framework of the Millennium
Declaration charter will enable the UN and member states to achieve the targets
set out by the Millennium Development Goals.
Therefore,
We, the
participants from countries in Asia, Africa and Europe having attended Round
Table II on “Mainstreaming Disabilities in Development” hosted in the city of
Ahmedabad, India, and all other signatories to the first draft petition, wish
to bring to the notice of the United Nations and State Parties,
We, the
participants and the signatories agree, in principle, with the agenda of the
MDGs. We submit that addressing the
needs of people with disabilities in the language, framework and goals of the
MDGs will immeasurably improve the capacity of the Declaration to achieve its
goals.
In this
spirit, we wish to call your attention to and emphasize
Reducing
by half the proportion of people living on less than a dollar a day seems
impossible to achieve, when nearly 10
percent of the world’s population has a higher risk to poverty because of the
social, educational, civil and economic obstacles triggered by their disabilities.
In 2002, UNESCAP reported a statistically high correlation
between poverty and disabilities. As
interdependent variables, they create new and formidable barriers to economic
participation[4]
Furthermore, conditions of poverty, namely, inadequate shelter,
unhygienic living conditions, lack of sanitation and clean drinking water
combined with poor access to health facilities greatly influence the occurrence
of disabilities. Disease, injuries and poor medical care not only exacerbate,
but contribute to disabling conditions in developing countries, where people
with disabilities are estimated to make up to 15 to 20 % of the poor.
In addition, people with disabilities in higher socio economic
levels are very vulnerable to poverty, since disabilities translate into loss
of income and demand additional expenditures for access to adequate medical
treatment, rehabilitation, special devices and facilities[5].
Chronic
food insecurity, largely evident in poor populations around the world, leads to
various degrees of malnutrition. Malnutrition in its various forms is not only a cause of disabilities, but also
a contributory factor to other ailments that increase susceptibility to
disabling conditions.[6] The following are some common disabilities
caused by hunger and inadequate access to nutrition:
|
|
DISABLING
CONDITION |
MICRONUTRIENTS |
|
1 |
Blindness |
Vitamin A deficiency |
|
2 |
Beri-beri, Pellagra, Anemia |
Vitamin B Complex deficiency |
|
3 |
Rickets |
Vitamin
D deficiency |
|
4 |
Growth
Failure, Goiter, Intellectual Disability |
Iodine
deficiency |
|
5 |
Anemia |
Iron
deficiency |
|
6 |
Osteoporosis
and other bone related deformities |
Calcium
deficiency |
In Asia
alone, there are estimated 525 million people who are chronically
undernourished. These people account for about two thirds of the world’s hungry[7]. By
the year 2010, it is estimated that there will be some 618 million chronically
undernourished Asians whose disabilities are likely to have roots in
micronutrient deficiencies. Those most vulnerable to an inadequate diet will be
girls, women and older people[8] as
distribution of food is often marked by gender bias.[9]
Malnutrition has an even more
devastating effect on infants. The US Agency for Healthcare Research and Quality (AHRQ),
underscored that the cause of failure to thrive[10]
(FTT) in infants is mostly insufficient usable nutrition.[11] [12] The report further stated that this growth
failure often includes concurrent and potentially persistent disabilities, as
severe malnutrition has been shown to cause permanent damage to various parts
of the brain and central nervous system. The resulting disabilities manifest as
aberrant sensory, behavioral, cognitive, language and motor development.[13]
Many determinants of
fetal growth are established prior to pregnancy, either in the immediate
peri-conceptional period and/or during the life-course of the mother (including
her own intrauterine development). There is a strong positive association
between maternal pre-pregnancy nutritional status and a woman’s ability to
nourish her growing fetus.[14]
Women from poor families have a higher risk of giving birth to infants with low
birth weight, leading to a lower chance of survival and high risk of disability[15]
in cognitive, physical and sensory development spheres.
Moreover, the promise to
ensure that all girls and boys have access to a full course of primary
education will not be realized unless children with disabilities are explicitly
included in the target group[16].
It has been estimated that
85 percent of the world’s children with disabilities under the age of 15 years
live in developing countries[17].
Only 2-3 percent of them are in school,
with girls with disabilities constituting barely 1 percent of the total number of
children with disabilities in schools[18].
With such estimates, universal primary education
cannot be obtained without including children with disabilities.
Children
with disabilities face particular hurdles to attending, and completing, school
in developing countries. While there has been much discussion about various
ways and means to increase access to schooling for children with disabilities,
there is almost no comparable data to support the analysis[19].
In a
recent report, Deon Filmer of Development Research
Group focused on young people with disabilities and analyzed the poverty
status of the household and level of achool participation. The report argues
that, among the factors contributing to poor access to school participation, disability is the most significant and
exceeds the effects of gender, rural residence, or economic status[20].
Furthermore,
the evidence shows that girls with disabilities face an even worse scenario.
Available data, most focused on literacy, indicates that women and girls with
disabilities fare less well in the educational arena than either their disabled
male or non-disabled female counterparts[21].
Attention needs to be paid to the plight of girls and women
with disabilities who face multiple discriminations; that of being women, being
disabled and finally being poor women with disabilities, often times with
limited or no rights. Indeed, gender,
combined with disabilities, is one of the most profound areas of
discrimination.
The biggest barrier to
educational equity for girls and women with disabilities is their invisibility. Concerns of women with disabilities
are not addressed by either those committed to educational equity for women,
who ignore women with disability as a part of their work, or those committed to
educational equity for persons with disabilities, who show similar disregard to
gender.
It is also important to acknowledge that disabilities are
multifaceted. Women’s access to education, participation in decision making and
wage employment is limited not only by their gender and disability but also the
type their of disability, the socioeconomic status of their family, their
race/ethnicity, whether they live in an urban or rural area, and a host of
other factors like cultural bias against women, rigid gender roles, issues of
violence and safety, physical environment and access to special support
services and supports[22].
In
developing countries, approximately 520 million persons may be classified as
the working poor[23],
representing almost 95 percent of the total population of working poor in the
world[24]. Women make up approximately 40 percent of
this labor force[25].
Yet, very little data exists at the macro level on women with
disabilities and employment. The general trend in most countries is that there
is higher unemployment among women than men with disabilities[26]. Studies on women with disabilities in the rural areas of many countries
have found that more than 80 percent of women with disabilities have no independent
means of livelihood, and are totally dependant on others for their very
existence[27].
Similarly, addressing maternal mortality without
due attention to conditions of women who survive difficult pregnancies
increases possibilities of developing disabling conditions later in life. Each
year Each year, more than 500,000 women, predominantly in less developed
countries, die of causes related to pregnancy and childbirth. Yet these deaths
are only the tip of the iceberg: For
every death, at least another 30 women suffer serious illness or debilitating
injuries[28].
Complications of
pregnancy and childbirth are a leading cause of death and disability, or
morbidity
as it is commonly known among women of reproductive age (ages 15 to 44) in less
developed countries. About half of the nearly 120 million women who give birth
each year experience some kind of complication during their pregnancies and
nearly 10 million develop disabling conditions such as severe anemia,
incontinence, damage to the reproductive organs or nervous system, chronic
pain, and infertility[29].
Not only these conditions affect the health and productivity of women, they
also adversely affect family income and well-being[30].
Disabilities
related to pregnancy and child birth are also strongly associated with infant
deaths and poor health and development in children. Some effects of maternal
disabilities that exacerbate the plight of impoverished living conditions and
poor health include[31]:
|
|
LIFE ASPECT |
IMPACT |
|
1 |
Financial Resources |
stretched to meet medical costs,
affecting household consumption |
|
2 |
Productivity- individual as well as family |
less family output and earnings,
forcing children out of school to enter the labor force |
|
3 |
Living conditions |
inferior nutrition, hygiene, and health |
|
4 |
Education |
higher drop out rates among older
children to support household and familial responsibilities |
|
5 |
Health and disabilities |
higher incidence of psychological
problems such as depression and feelings of isolation |
Once again, with at least 10% of the total population having some form
of disability, inclusion of people with disabilities in HIV/AIDS outreach and
prevention and care needs attention.
Individuals
with disabilities are not included in HIV/ AIDS agenda because it is often
assumed that they are not sexually active and therefore at little or no risk
for HIV infection.
However,
the Global Survey on Disability and
HIV/AIDS conducted by Yale University and
the World Bank, has proven this assumption wrong[32].
The study concludes that individuals with disability have equal or greater
exposure to all known risk factors for HIV infection. It further argues that,
1.
Men and women with disabilities are even more likely to be victims of violence or rape, although they
are less likely to be able to obtain police intervention, legal protection or
prophylactic care.
2.
Persons with disability are as
likely as their non-disabled peers to be sexually active.
3.
Homosexuality and
bisexuality appear to occur at the same rate among people with disability as among
the non-disabled.
4.
People with disability are as
likely as non-disabled people to use drugs and alcohol.
Given the size of the global population of
people with disabilities (an estimated 10% of the world's citizens), their
exclusion may be considered, at the very least, shortsighted. The AIDS crisis
cannot be addressed successfully unless individuals with disability are
routinely included in all AIDS outreach efforts.
As per the WHO data available in 2005, 1 out of 5 African women
loses a baby during her lifetime, compared with 1 in 125 in rich countries:
Each year nearly 10.4 million babies die before they reach the age of 5 years.
Out of these, nearly 3.3 million are stillborn, and more than 4 million die
within 28 days of being born. The largest numbers of babies die in the
South-East Asia Region: 1.4 million newborn deaths and a further 1.3 million
stillbirths each year. While the actual number of deaths is highest in Asia,
the rates for both neonatal deaths and stillbirths are greatest in sub-Saharan
Africa.[33].
Yet, infant mortality rates are falling everywhere, most
markedly in South Asia, where rates fell from 80 to 75 per 1000 births between
1990 and 2000[34].
According to the same report, an estimated 10.5 million children aged 0–4 years
died in 1999 all over the world, about 2.2 million less than a decade earlier. Unfortunately, the rising birth
rates do not reveal the total percentage of live births that may be at risk of
developing disabilities later in life. With half of the world’s
population below the age of 15 years, the number of young with disability is
expected to rise markedly over the next decade, particularly in the developing
world. This will simply not be reflected
in a rising birth rate. Better medical
interventions, both in developing and developed countries, will allow
increasing numbers of disabled infants and children, who previously would not
have survived childhood, to grow into adolescence[35].
A WHO report estimates that each
year over a million children who survive birth asphyxia develop problems
such as cerebral palsy, learning difficulties and other disabilities[36].
A report
from the March of Dimes, as reported by Steve Ember, estimates that eight million children each year are born with serious
genetic disorders, making up to 6% of total births world wide. 95% of these are
born in the developing world. A first-time identification of the hidden
worldwide extent of birth defects, the report which collected information on almost
200 countries, further states that every year more than three million children
under the age of five die from birth defects. Those who survive may have
mental or physical problems for life[37].
Out of a
total of 6.5 billion people worldwide, 5.3 billion live in developing nations[38].
Development Indicators for the year 2004 by the World Bank Database show that
these nations have an average annual population growth of 1.23%[39],
meaning 65.19 million new births per year.
|
|
INDICATOR |
COUNTRIES |
|||
|
|
|
Low
& middle income |
Low
income |
Lower
middle income |
Middle
income |
|
1 |
Mortality
rate, infant (per 1,000 live
births) |
58.84 |
79.45 |
31.58 |
30.02 |
|
2 |
Mortality
rate, under-5 (per 1,000) |
86.47 |
121.53 |
39.59 |
37.43 |
|
3 |
Population growth (annual %) |
1.29 |
1.82 |
0.95 |
0.87 |
|
4 |
Malnutrition prevalence, weight for age (% of
children under 5) |
|
43.4 |
11.2 |
11.1 |
Note: Data
for year 2004 generated by entering country types and mentioned development indicators
on http://devdata.worldbank.org/data-query/
Out of
these, approximately 88.40 million are viable births if we take the Infant
Mortality Rate as 71.25/1000[40].
Conservative
estimates suggest that one in every ten individuals is in some fashion personally
affected by some form of disability[41]. It follows that there are nearly 8.84 million
children every year at risk for disabilities in developing nations. This number is uncomfortably close to the
estimated total number of infant deaths.
Not providing
for the medical and rehabilitative needs of “high risk” children will
inadvertently result in a large number of individuals more likely to develop a
disabling condition later in life, endangering an individual’s right to achieve
full capacity.
The direct consequence of this attitude has been the
relegation of disability and development initiatives to the lowest rungs on the
agendas of various governments, financial agencies and other stakeholders. As a result, people with disabilities, who
are potential and willing contributors to family and national economic activity
are instead condemned to the margins of society and remain a perceived and
actual burden[42].
The results of such marginalization are shattering,
to the individuals and their families as well as to the economies of all
developing nations. The need of the hour is to
“Take away the ‘M’ and you establish Development Goals that all may realize”[43].
“Review the ‘D’ in Development and you include a large section of the world’s most
vulnerable population”.
“Ensure that the ‘G’ in Goals truly represents all groups”.
and to acknowledge and integrate appropriate disability indicators in goals 1 to 6 to ensure achievement of targets specified under each of these.
********************
[1] The term "disability"
summarizes a great number of different functional limitations occurring in any
population in any country of the world. People may be disabled by physical,
intellectual or sensory impairment, medical conditions or mental illness. Such
impairments, conditions or illnesses may be permanent or transitory in nature.
(As defined in the UN Standard Rules on the Equalization of Opportunities for
Persons with Disabilities, 1993 available on http://www.un.org/esa/socdev/enable/dissre01.htm)
[2] http://web.worldbank.org/WBSITE/EXTERNAL/TOPICS/EXTSOCIALPROTECTION/EXTDISABILITY/0,,contentMDK:20192533~menuPK:282704~pagePK:148956~piPK:216618~theSitePK:282699,00.html
[3] Disability Manual: National Human Rights Commission,
India, 2005
[4] Regional
Trends impacting on the situation of persons with disabilities: United
Nations Economic and Social Commission for Asia and Pacific, 2002
[5] Susan Erb & Barbara Harriss-
White, Outcast from Social Welfare: adult
disability, incapacity and development in rural south India. Books for
Change, A Unit of Action Aid Karnataka Projects (2002)
[6] Disability Manual, National Human
Rights Commission (2005),
[7] Current
Trends Impacting the Situation of People with Disabilities: Summary Paper,
UNESCAP, (2002)
www.worldenable.net/bmf2004/doc_summarytrends.htm
[8] World
Food Summit, 13- 17 November 1996, Rome, Italy www.fao.org/wfs/main_en.htm
[9] “Gender bias refers to an unequal
treatment in opportunities
and expectations due to attitudes based on the sex of a person or a group of
persons” as derived from http://www.thelawencyclopedia.com/term/gender_bias?gclid=CJGTsKO_l4UCFQczHgodNwhfHg