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This section presents results for four indicators on health for adults and their households. The first two are indicators that are proxies for health and capture some of the living conditions of the household an adult is part of: the share of adults living in households with safely managed drinking water (CRPD Article 25, SDG indicator 6.1.1) and the share of adults living in households with safely managed sanitation (CRPD Article 25, SDG indicator 6.2.1). For selected DHS micro-datasets, we also report the share of women who self-report that they have their family planning needs met through modern contraceptive methods (CRPD Article 23, SDG indicator 5.6.1) and the share of women reporting being subject to domestic violence by their intimate partner in the past 12 months (CRPD Article 16, SDG indicator 16.1.3). Domestic violence may be physical, psychological or sexual violence.

Indicators are reported for all adults ages 15 and older except for family planning and domestic violence which are reported for women only and for a smaller age range (ages 15 to 49).

Results

The entire set of results on health for these indicators is available in the Health Results Tables.

For the share of adults with safely managed drinking water and the share with safely managed sanitation, persons with functional difficulties have significantly lower shares in 24 and 20 countries, respectively, out of 39 countries. For about 10 countries, there is a gradient in this gap, with persons with some difficulty having a lower of access to safe water or sanitation than persons with no difficulty but a higher share than persons with at least a lot of difficulty. For a handful of countries, there is a reverse gap with persons with functional difficulties having higher rates of access than persons with no functional difficulties (e.g. Afghanistan, South Africa).

Table 8.1 has results on the share of women who have their family planning needs met. Results vary across countries.  In two of the 11 countries (Cambodia, Haiti), women with any difficulty are significantly less likely to have their family planning needs met through modern contraceptive methods, while in three countries (Maldives, Mali, Pakistan), women with any difficulty are significantly more likely to have their needs met. For the remaining countries, there is no difference across functional difficulty status groups.

Table 8.2 presents results on women reporting being subject to violence by their intimate partner in the past 12 months. In all countries except Haiti, Senegal and Timor Leste, the rate of violence is significantly higher for women with any difficulty compared to women with no difficulty. The disability gap is the largest in Uganda at 14 percentage points, 66% of women with any difficulty reporting violence compared to 52% for women with no difficulty.

Table 8.1: Women Reporting Family Planning Needs Met (%)

Table 8.1: Women Reporting Being Subject to Domestic Violence in the Previous 12 Months (%)

Discussion

This section presented results for four health indicators on water, sanitation, family planning and domestic violence. Access to clean water and adequate sanitation is critical to maintaining public health. They fall under SDG Goal 6 “to ensure the availability and sustainable management of water and sanitation for all”.  We find that persons with functional difficulties have a significantly lower share of access to safely managed water and sanitation in respectively 24 and 20 countries out of 39 countries.

The data used in this report for water and sanitation have important limitations. Persons with disabilities may face more challenges in accessing adequate water and sanitation and hygiene due to a lack of access within the household resulting from a lack of financial resources to adapt water or sanitation facilities. It may also result from barriers in public environments. We do not have any data on how persons with functional difficulties specifically access water or sanitation facilities, as we only estimate the share of persons with functional difficulties who live in households with adequate water or sanitation. Further research is needed with individual level data that might be able to capture such barriers.

Family planning allows individuals to achieve desired family size, birth spacing and improve health outcomes for infants, children, women, and families. Access to contraceptives prevents unsafe sex, abortions, HIV (human immunodeficiency virus), and other sexually transmitted infections, which constitute significant risk factors for women’s mortality and morbidity (Glasier et al 2006). Yet, women with disabilities and their access to these services have been neglected for decades because of the widespread assumption that persons with disabilities are not sexual or sexually active (Milligan et al 2001). This report finds mixed results on family planning across eight countries with some countries with no difference across functional difficulty status, while two countries exhibit a disability gap. The sample size was too small (below 100) to disaggregate further and isolate persons with at least a lot of difficulty (as per disaggregation b and c).

Intimate partner violence is a public health issue and a violation of human rights. Article 16 of the CRPD stipulates that States should put in place legislation and policies to protect women with disabilities from exploitation, violence and abuse. SDG Goal 5 calls for “the elimination of all forms of violence against all women and girls in the public and private sphere”. Despite the international policy efforts undertaken against violence, there is still little cross-country comparable evidence on disability and domestic violence despite anecdotal accounts of a higher risk of violence for women with disabilities in many countries. One exception is the meta-analysis by Hughes et al (2012) covering 26 studies on the relationship between disability and domestic violence. They find that on average women with disabilities are 1.5 times more likely to be subject to violence compared to women without a disability. Their analysis aggregates odds ratios that were computed based on different definitions of disability or violence. The findings of this report with internationally comparable data on disability and violence confirm this result with a disability gap in domestic violence in five out of eight countries. Not finding a disability gap in all countries for domestic violence is surprising and suggests potential limitations in the data and the need for further research on the risk of violence for women with disabilities, especially in LMICs (Dowse et al 2016). During the pandemic, as domestic violence has increased (Cousins 2020), there is an urgent need to strengthen mechanisms to prevent violence and support all women victims of violence, including women with disabilities.