The 2030 Agenda’s Sustainable Development Goals (SDGs) have placed disability firmly on the international development agenda. In order to monitor progress towards the SDG commitment to leave no one behind, there is a need for reliable, disability-disaggregated data across all SDGs.

While such data are essential to inform and motivate evidence-based advocacy and disability inclusive policy and programmes, they are lacking in many countries. To address this data gap in Guatemala, a national survey was conducted to estimate the prevalence of disability, well-being and equality of opportunity for persons with disabilities in key areas including livelihoods, education and health. The survey findings reveal the impacts of disability, in particular, of meeting four of the 17 SDGs.

The survey, conducted between June and October 2016, was a collaborative project between CBM, The National Disability Council of Guatemala (CONADI), UNICEF Guatemala, the Guatemala National Institute of Statistics (INE) and the International Centre for Evidence in Disability (ICED) at the London School of Hygiene & Tropical Medicine.

Sampling methodology

Using standard sampling methodology, 280 clusters of 50 people (aged ≥2 years) were selected throughout the country (total 13,800). Participants were interviewed using the Washington Group Extended Set of questions for adults and UNICEF/Washington Group extended set of questions for children, which ask about reported difficulties in different functional domains (e.g. seeing, hearing, walking, self-care). Following Washington Group recommendations, people were categorized as having a disability if they reported “a lot of difficulty” or “cannot do” in any one of the core domains of the Washington Group/UNICEF questionnaires.

Participants aged ≥5 years identified in the survey as having a disability together with age, sex and location match controls without a disability were interviewed about socio-economic indicators, work, education, health, quality of life and participation.

What did the survey tell us?

According to the findings of the survey, disability is common in Guatemala. As defined by having “a lot of difficulty” or not able to do activities in key functional domains, we estimated all-age prevalence of 10.2%, and that a third (31%) of all households include at least one person of disability.

The prevalence of disability in Guatemala has notable impacts in at least four areas of the SDGs.

SDG 1: No poverty

In our survey sample, persons with disabilities were more likely to be poorer and less educated compared to the general population. Households including persons with disabilities were poorer and had a higher dependency ratio (the proportion of dependent household members to independent household members, aged 15 to 64) than households without any members with disabilities. Adults with disabilities were less likely to be working and had less stable livelihood opportunities: they were more likely than adults without disabilities to report working only once in a while compared to throughout the year. These findings suggest that persons with disabilities, and households including persons with disabilities, are generally poorer, more vulnerable and less resilient to shocks compared to persons and households without any disabilities.

SDG 3: Good health and well-being

Persons with disabilities self-reported poorer quality of life (measured using the WHO QOL-Bref) compared to people without disabilities. They were more likely to have experienced a serious health problem in the past year, and were slightly more likely to report being disrespected or having difficulties understanding information given to them at health centers. Women of reproductive age (15-49 years) with disabilities were less likely to have sought antenatal/prenatal care in their last pregnancy (within the past five years). However, they were more likely than women without disabilities to have delivered their baby in a health center or hospital (rather than at home) and to have the birth assisted by a doctor. Vaccination coverage was high for children both with and without disabilities.

Illness (30% of persons with disabilities), aging (18%) and trauma (15%) were the most commonly reported causes of disability, and anxiety/depression (prevalence of 9.3%) and mobility (8.0%) were the most commonly reported functional limitations in adults.

SDG 4: Ensure inclusive and quality education for all and promote lifelong learning

In rural areas, 61% of children with disabilities attended school, compared to 82% of children without disabilities. Access to education was lowest for children with physical and cognitive limitations. In addition to the negative social, emotional and health impacts, exclusion from education can also lead to lower employment and earning potential among persons with disabilities, making them and their families more vulnerable to poverty.

SDG 5: Gender equality

The survey findings highlight that girls with disabilities were less likely to be attending schools (69%) compared to girls without disabilities (84%) while no such difference was observed among boys. Women with disabilities were also less likely to be working compared to men with disabilities, whilst men with disabilities reported higher participation restrictions than women with disabilities. These findings highlight the heterogeneity of disability, and the need to be aware of cross-cutting contextual factors including age and gender.

Implications

Given that 10.2% of the national population has a disability, and 31% of all households in Guatemala include at least one person with a disability, and given the associations between disability and the disadvantages identified, inclusion of persons with disabilities is an urgent priority for all public policies and programming related to achieving the SDGs. National surveys such as the National Survey of Disability in Guatemala provide much needed data to serve as a baseline and identify barriers or facilitators to inclusion that policies and programmes must address. Data from these surveys can promote the development of policies and services that increase inclusion. Surveys of this kind should ideally be repeated approximately every five years, so as to assess progress towards meeting the goals of no poverty, healthy lives and well-being and gender equality in the context of persons with disabilities.

By: Sarah Polack, International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine; Islay Mactaggart, International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine; Rafael Cañas, National Council on Disability, Guatemala; Gonna Rota, CBM Latin America Regional Office; Elizabeth Lockwood, CBM International; and Julian Antonio Duarte Jimenez, UNICEF Guatemala