Wheelchairs and braille aren’t generally images associated with maternal child health. But up to 20% of women and 150 million children around the world are estimated to live with a disability, making people with disabilities the largest minority in the world (CBM, n.d.; United Nations, 2006; UNICEF, 2013). These mothers and children with disabilities deserve just as much consideration in public health initiatives as anyone else. However, in today’s world, inclusion of people with disabilities in public health, including maternal child health, is far from reality. Women with disabilities are less likely to be counseled on family planning than women without disabilities and face extensive stigma and barriers to high quality services during pregnancy and delivery. Children and adolescents with disabilities are at increased risk for malnutrition and, though they are more likely to acquire HIV, are less likely to receive prevention, treatment, and support services related to HIV. Even in countries that have reduced under-five mortality to less than 20%, children with disabilities still face mortality rates of up to 80%, often due to inaccessibility of health services and significant unmet health needs (UNICEF, 2013).
Disabilities, both visible and invisible, have historically been an under-emphasized issue in global health. In the past, disability and public health have intersected primarily on the principle of primary prevention. Public health programs have and continue to work tirelessly toward the important goal of preventing disability in the world. But public health and development initiatives, including the Millennium Development Goals, have often neglected to address those who already live with disability – and who are often the most vulnerable to other comorbidities. Neglecting to include people with disabilities in public health efforts not only makes access to services difficult or impossible for them, but also can undermine progress by excluding those who are most vulnerable.
The social model of disability, in contrast to the previously used medical model of disability, identifies non-inclusive environments, rather than just bodily impairments, as the major contributor to the experience of disability (Michigan Disability Rights Coalition, n.d.). Using this model also allows disability to be viewed not as the opposite of health, but as something that can be lived with while pursuing and achieving an individual’s optimal state of health. By viewing disability through this framework, our public health programs can help people with disabilities to thrive in their bodies and environments.
The majority of people with disabilities live in low- and middle-income countries (United Nations, 2006). In many cases, disability and poverty exist in a vicious cycle, with poverty often leading to disability through illness and lack of appropriate services and disability often exacerbating poverty due to lack of employment and economic opportunity (UNICEF, 2013).
Not only do people, especially women and children, with disabilities often lack necessary disability-specific services, they are also often excluded from mainstream health and development programs. Though the unmet need has not been thoroughly investigated, the significant gap in maternal and reproductive health services for people with disabilities is widely recognized (WHO & World Bank, 2011). This kind of exclusion is often unintentional; in many areas, people with disabilities are hidden from society, causing them to go unnoticed in needs assessments and research efforts. Other times, people with disabilities are excluded from public health programs due to physical inaccessibility, like latrines that can’t be accessed by wheelchair users, or social stigma, like bullying and discrimination that keeps them from utilizing immunization services.
Women and girls with disabilities face compounded vulnerability and are at increased risk for human rights violations. Girls with disabilities are highly likely to be illiterate and unable to attend school (UNICEF, 2013). Women with disabilities are up to ten times as likely to be physically or sexually abused as women without disabilities (Human Rights Watch, 2012). Therefore, including these stakeholders in conversations about community needs is vital to overcoming some of the most important issues in our world today.
In the new era of the inclusive Sustainable Development Goals, we have the opportunity to make a tangible difference in the lives of the most vulnerable in our world by promoting disability-inclusion in public health efforts. But in order to do this, disability must be mainstreamed within maternal and child health and global development efforts. We must empower and encourage participation by people with disabilities as we design programs that meet the needs of everyone – not just the able-bodied. And we must advocate for increased efforts to research global disability in order to create a clearer picture of the need and blaze a path forward. It’s time for our public health programs to not only prevent the physical conditions that lead to disability, but also to address social and physical barriers that lead to disability by increasing disability awareness and promoting universal access.
(1) CBM. (n.d.) Women with disabilities. Retrieved from https://www.cbm.org/article/downloads/78851/CBM_Disability_Inclusion_-_Women.doc.
(2) Human Rights Watch (2012). Human Rights for Women and Children with Disabilities. Retrieved from https://www.hrw.org/sites/default/files/related_material/0912_disabilities_brochure_0.pdf.
(3) Michigan Disability Rights Coalition (n.d.). Models of Disability. Retrieved from http://www.copower.org/leadership/models-of-disability.
(4) United Nations (2006). Convention on the Rights of Persons with Disabilities: Some facts about persons with disabilities. Retrieved from http://www.un.org/disabilities/convention/facts.shtml.
(5) UNICEF (2013). Children and Young People with Disabilities: Fact Sheet. Retrieved from https://www.unicef.org/disabilities/files/Factsheet_A5__Web_NEW.pdf.
(6) WHO and World Bank (2011). World Report on Disability. Retrieved from http://www.who.int/disabilities/world_report/2011/report.pdf.