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Children withDisabilities
THE STATE OF THE WORLDS CHILDREN2013
EXECUTIVE SUMMARY
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CHILDREN WITH DISABILITIES
EXECUTIVE SUMMARY
THE STATE OF THE WORLDS CHILDREN2013
Key recommendations
International commitment to building more inclusive societies has resulted in improvements in the
situation of children with disabilities and their families, but too many of them continue to face barriers
to their participation in the civic, social and cultural affairs of their communities. Realizing the promise
of equity through inclusion will require action to:
1 Ratiy ad impemet the Cveti the Rights Perss with Disabiities ad theCveti the Rights the Chid.
2 Fight discrimiati ad ehace the awareess disabiity amg the geera pubic, decisi-makers, ad thse wh prvide essetia services r chidre ad adescets i such ieds as
heath, educati ad prtecti.
3 Dismate barriers t icusi s that a chidres evirmets schs, heath aciities, pubictrasprt ad s aciitate access ad ecurage the participati chidre with disabiities
agside their peers.
4 Ed the istitutiaizati chidre with disabiities, startig with a mratrium ewadmissis. This shud be accmpaied by the prmti ad icreased supprt r amiy-
based care ad cmmuity-based rehabiitati.
5 Supprt amiies s they ca meet the higher csts ivig ad st pprtuities t ear icmeassciated with carig r chidre with disabiities.
6 Mve beyd miimum stadards by ivvig chidre ad adescets with disabiities ad theiramiies i evauatig supprts ad services desiged t meet their eeds.
7 Crdiate services acrss a sectrs s as t address the u rage chaeges acig chidread adescets with disabiities ad their amiies.
8 Ivve chidre ad adescets with disabiities i makig decisis that aect them t just asbeeiciaries, but as agets chage.
9 Prmte a ccerted gba research ageda disabiity t geerate the reiabe ad cmparabedata eeded t guide paig ad resurce acati, ad t pace chidre with disabiities mre
ceary the devepmet ageda.
The ultimate proof of all global and national efforts will be local, the test being whether every child
with a disability enjoys her or his rights including access to services, support and opportunities on
a par with other children, even in the most remote settings and the most deprived circumstances.
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1
Victr, a 13-year-d with cerebra pasy, has u i the water
i Brazi. Adre Castr/2012
InTRoDUCTIon
Reprts such as this typicay begi with a statistic
desiged t highight a prbem. The girs ad bys
t whm this editi The State of the Worlds
Childrenis dedicated are t prbems. Rather, each
is a sister, brther r ried wh has a avurite
dish, sg r game; a daughter r s with dreams
ad the desire t ui them; a chid with a disabiity
wh has the same rights as ay ther gir r by.
Give pprtuities t urish as thers might,
chidre with disabiities have the ptetia t ead
uiig ives ad t ctribute t the scia, cu-
tura ad ecmic vitaity their cmmuities.
Yet survivig ad thrivig ca be especiay diicut
r chidre with disabiities. They are at greater
risk beig pr tha peers withut disabiities.
Eve where chidre share the same disadva-
tages, chidre with disabiities crt additia
chaeges as a resut their impairmets ad
the may barriers that sciety thrws i their way.
Chidre ivig i pverty are amg the east ikey
t ejy the beeits educati ad heath care,
r exampe, but chidre wh ive i pverty ad
have a disabiity are eve ess ikey t atted the
ca sch r ciic.
I may cutries, respses t the situati
chidre with disabiities are argey imited t isti-
tutiaizati, abadmet r egect. These
respses are the prbem, ad they are rted i
egative r pateraistic assumptis icapacity,
depedecy ad dierece that are perpetuated by
igrace. What is eeded is a cmmitmet t these
chidres rights ad their utures, givig pririty t
the mst disadvataged as a matter equity ad
r the beeit a.
Chidre with disabiities ecuter dieret rms
excusi ad are aected by them t varyig
degrees depedig the type disabiity they
have, where they ive ad the cuture r cass t
which they beg. Geder is as a crucia actr:
Girs with disabiities are as ess ikey t get
a educati, receive vcatia traiig r id
empymet tha are bys with disabiities r
girs withut disabiities.
Chidre with disabiities are te regarded as ie-
rir, ad this expses them t icreased vuerabiity:
Discrimiati based disabiity has maiested
itse i margiaizati rm resurces ad decisi-
makig, ad eve i iaticide. Excusi te
stems rm ivisibiity. Few cutries have reiabe
irmati hw may their citizes are chi-
dre with disabiities, what disabiities they have
r hw these disabiities aect their ives. Chidre
thus excuded are ukw t, ad therere cut
rm, pubic services t which they are etited.
These deprivatis ca have astig eects by im-
itig access t gaiu empymet r participati
i civic aairs ater i ie, r exampe. But access t
ad use supprtive services ad techgy ca
EXECUTIVE SUMMARY
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THE STATE OF THE WORLDS CHILDREN 2013: Children with Disabilities2
On the numbers
By e widey used estimate, sme 93 mii chidre r 1 i 20 thse aged 14 r yuger ive with amderate r severe disabiity sme kid.
Such gba estimates are essetiay specuative. They are dated this e has bee i circuati sice 2004
ad derived rm data quaity t varied ad methds t icsistet t be reiabe. I rder t prvide a
ctext r ad iustrate the issues uder discussi,The State of the Worlds Children 2013presets the resuts
atia surveys ad idepedet studies, but eve these must be iterpreted with cauti ad shud t be
cmpared t e ather. This is because deiitis disabiity dier by pace ad time, as d study desig,
methdgy ad aaysis.
psiti a chid with a disabiity t take her r his
pace i the cmmuity ad ctribute t it.
The uture is ar rm grim. By their cmmitmet
t uphdig the Cveti the Rights the
Chid (CRC) ad the Cveti the Rights
Perss with Disabiities (CRPD), gvermets
arud the wrd have take up themseves
the respsibiity esurig that a chidre,
irrespective abiity r disabiity, ejy their
rights withut discrimiati ay kid. The
Cvetis bear witess t a grwig gba
mvemet dedicated t the icusi chidre
with disabiities i cmmuity ie. They estab-
ish that chidre with disabiities have the same
rights as thers.
Icusi ges beyd itegrati. T take a
exampe rm the ied educati, itegrati
might be attempted simpy by admittig chidre
with disabiities t reguar schs. Icusi,
hwever, is pssibe y whe schs are
desiged ad admiistered s that a chidre ca
ear ad pay tgether. This wud etai prvid-
ig such eeded accmmdatis as access t
Braie, sig aguage ad adapted curricua.
Icusi beeits everye. T ctiue with the
exampe educati, ramps ad wide drways
ca ehace access ad saety r a chidre,
teachers, parets ad visitrs, t just thse wh
use wheechairs.
I erts t prmte icusi ad airess,
chidre with disabiities shud be abe t eist
the supprt their amiies, disabed pepes
rgaizatis, parets assciatis ad cm-
muity grups. They shud as be abe t cut
aies urther aied. Gvermets have the
pwer t hep by aigig their picies ad pr-
grammes with the CRPD ad CRC. Iteratia
parters ca prvide assistace cmpatibe with
the Cvetis. Crpratis ad ther private
sectr etities ca advace icusi ad attract
the best taet by embracig diversity i hirig.
May the deprivatis edured by chidre
with disabiities stem rm ad are perpetuated
by their ivisibiity. The research cmmuity
is wrkig t reder mre chidre visibe by
imprvig data cecti ad aaysis. Their wrk
wi hep t vercme igrace ad discrimia-
ti, t target resurces ad itervetis ad
gauge their eects. But decisi-makers eed t
wait r better data t begi buidig mre icu-
sive irastructure ad services: A that is eeded
is r these erts t remai exibe s they ca
be adapted as ew data cme t ight.
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ExEcutivE Summary 3
Six-year-d nemaja (ar et) sits with cassmates i nvi
Sad, Serbia. His primary sch was the frst t itegrate
chidre with disabiities uder a aw aimed at reducig
istitutiaizati. UnICEF/HQ2011-1156/Ht
FUnDAMEnTAlS oF InClUSIon
The CRC ad CRPD chaege charitabe
appraches that regard chidre with disabii-
ties as passive recipiets care ad prtecti.
Istead, the Cvetis demad recgiti
each chid as a u member her r his am-
iy, cmmuity ad sciety. This etais a cus
t traditia tis rescuig the chid,
but ivestmet i remvig the physica, cu-
tura, ecmic, cmmuicati, mbiity ad
attitudia barriers that impede the reaizati
the chids rights icudig the right t active
ivvemet i makig decisis that aect
chidres daiy ives.
The uderestimati the abiities pepe
with disabiities is a majr bstace t their icu-
si ad t the prvisi equa pprtuities.
Dismissive attitudes exist thrughut sciety
rm pressias, piticias ad ther decisi-
makers t amiies ad peers as we as pepe
with disabiities themseves, wh i the absece
evidece that they are vaued ad supprted
wi te uderestimate their w abiities.
Changing attitudes
litte wi chage i the ives chidre with
disabiities uess attitudes chage. Igrace
abut the ature ad causes impairmets,
ivisibiity the chidre themseves, serius
uderestimati their ptetia ad capaci-
ties, ad ther impedimets t equa pprtuity
ad treatmet a cspire t keep chidre with
disabiities sieced ad margiaized. But brig-
ig disabiity it pitica ad scia discurse
makes it pssibe t sesitize decisi-makers
ad service prviders as we as demstrate
t sciety at arge that disabiity is part the
huma cditi.
The imprtace ivvig chidre with dis-
abiities cat be verstated. Prejudice ca be
reduced thrugh iteracti, as demstrated by
activities that brig tgether chidre with ad
withut disabiities. Scia itegrati beeits
everye, ad chidre wh have experieced
icusi i educati, r exampe ca the
be scietys best teachers i reducig iequai-
ties ad buidig a icusive sciety.
Icusive media as have a key part t pay. By
icudig uaced prtrayas chidre ad
aduts with disabiities, media ca sed ut psi-
tive messages that they are members amiies
ad eighburhds ad ca as cuter mis-
represetatis ad steretypes that reirce
scia prejudices.
Simiary, participati i scia activities heps
t prmte a psitive view disabiity. Sprt,
i particuar, has heped vercme may sci-
eta prejudices. Seeig a chid surmut the
physica ad psychgica barriers t partici-
pati ca be ispiratia ad ca prmte
respect athugh care must be take t t
make chidre with disabiities wh d t
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THE STATE OF THE WORLDS CHILDREN 2013: Children with Disabilities4
perrm such physica eats ee ierir t thse
wh d.
Sprt has as bee hepu i campaigs t
reduce stigma, ad athetes with disabiities are
te amg the mst recgized represetatives
pepe with disabiities. Experieces i a um-
ber cutries have shw that access t sprt
ad recreati is t y direct beeit t chi-
dre with disabiities, but as heps t imprve
their stadig i the cmmuity as they are
see t participate agside ther chidre i
activities vaued by sciety.
Because the CRPD recgizes the amiy as the
atura uit sciety ad puts the State i
the re supprtig it, the prcess uiig
the rights chidre with disabiities begis
with supprtig their amiies ad estabishig
a hme settig cducive t eary iterveti.
Supporting children and families
Uder the CRPD, chidre with disabiities ad
their amiies have the right t a adequate sta-
dard ivig ad are as etited t such subsi-
dized r ree supprt services as day care, respite
care ad access t se-hep grups. Scia pr-
tecti r chidre with disabiities ad their
amiies is especiay imprtat because these
amiies te ace a higher cst ivig ad st
pprtuities t ear icme. Estimates the
additia csts disabiity bre by amiies
rage rm 9 per cet icme i Viet nam t
1169 per cet i the Uited Kigdm. I addi-
ti t medica, rehabiitati ad ther direct
expeses, amiies as ace pprtuity csts,
as parets ad amiy members must te
give up r imit their empymet i rder t
care r chidre with disabiities.
A review 14 devepig cutries ud that
pepe with disabiities were mre ikey t
experiece pverty tha thse withut disabii-
ties. Pepe with disabiities teded t be ess
we i terms educati, empymet, iv-
ig cditis, csumpti ad heath. Higher
heath-care csts tha thse husehds with-
ut members with disabiities ca urther reduce
a husehds stadard ivig.
States ca tacke the icreased risk chid
pverty with such scia prtecti iitiatives
as cash traser prgrammes, which have bee
shw t beeit chidre. A grwig umber
w- ad midde-icme cutries are buidig
prmisig resuts rm brader erts ad have
auched targeted scia prtecti iitiatives that
icude cash trasers speciicay r chidre
with disabiities. Rutie mitrig ad evaua-
ti the trasers eects the heath, educa-
tia ad recreatia attaimet chidre with
disabiities wi be essetia t make sure these
prgrammes achieve their bjectives.
Ather t gvermets ca use is disabiity-
speciic budgetig, whereby a gvermet sets
speciic gas r chidre with disabiities withi a
brader iitiative ad acates a suiciet prti
the avaiabe resurces twards them. Eective
access t services icudig educati, heath care,
habiitati, rehabiitati ad recreati shud
be prvided ree chage ad i a maer that
prmtes the uest pssibe scia itegrati
ad idividua devepmet the chid.
Community-based rehabilitation
Cmmuity-based rehabiitati (CBR) pr-
grammes which seek t esure that pepe
with disabiities have equa access t services ad
pprtuities reatig t heath, educati ad
iveihds are a exampe a iterveti
that is desiged ad ru by ca cmmuities
criticay, with the active participati chidre
ad aduts with disabiities.
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ExEcutivE Summary 5
CBR ca prve eective i addressig mutipe
deprivatis, such as thse acig chidre with
disabiities wh ive i rura ad idigeus
cmmuities. I a utreach iitiative r idig-
eus chidre i oaxaca, Mexic, r exampe,
CBR teams rm the Cetre r Research ad
Pst-Secdary Studies i Scia Athrpgy,
i cabrati with UnICEF, prmted the
rmati ca supprt etwrks amg
the amiies chidre with disabiities. over
three years (20072010), the iitiative saw the
icreased acceptace chidre with disabiities
by their w amiies ad cmmuities, imprved
prvisi scia services, cmmuity-ed c-
structi wheechair ramps t pubic spaces,
arragemets r ree services rm state ad
edera hspitas, ad 32 ew ermets
chidre with disabiities i maistream schs.
Icusive appraches are buit arud the c-
cept accessibiity, with the aim makig the
maistream wrk r everye rather tha creat-
ig parae systems. A accessibe evirmet
is essetia i chidre with disabiities are t
ejy their right t participate i the cmmuity
ad t have the chace t reaize their u pte-
tia. S, r istace, chidre with disabiities
eed access t a schs t reap the maximum
beeits educati. Chidre wh are educated
agside their peers have a much better chace
becmig prductive members their sciet-
ies ad beig itegrated i the ives their
cmmuities.
Depedig the type disabiity, a chid
may eed a assistive device (a prsthesis, r
exampe) r service (such as a sig aguage
iterpreter) t ucti uy i varius aspects
ie. Accrdig t WHo, hwever, i may
w-icme cutries y 515 per cet
thse wh eed assistive techgy are abe
t btai it. The csts such techgy ca
be prhibitive, especiay r chidre, wh eed
their devices repaced r adjusted as they grw.
Access t assistive techgy ad ay ther
speciaized supprt that chidre eed t aciitate
their iteracti ad participati shud be ree
ad avaiabe t a.
Uiversa desig is a apprach t accessibi-
ity that seeks t create prducts, structures ad
evirmets that a pepe ca use regardess
age, abiity r situati t the greatest extet
pssibe, withut the eed r adaptati r spe-
ciaized desig. Rea-wrd appicatis icude
curb cuts, audi bks, Vecr asteigs ad
w-r buses.
The cst itegratig accessibiity it ew
buidigs ad irastructure ca be egigibe,
amutig t ess tha 1 per cet the capita
devepmet cst. By ctrast, adaptatis t
cmpeted buidigs ca reach as much as 20 per
cet the rigia cst. It therere makes sese
t itegrate accessibiity csideratis it prj-
ects at the eary stages the desig prcess.
Accessibiity shud as be a csiderati
whe udig devepmet prjects.
Weju, 9, waks with her ster mther i Chia.
UnICEF/Chia/2010/liu
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THE STATE OF THE WORLDS CHILDREN 2013: Children with Disabilities6
A teacher with a hearig impairmet teaches a cass
hearig-impaired chidre i Guu, Ugada.
UnICEF/UGDA2012-00108/Sibii
A STRonG FoUnDATIon
Icusive heath ad educati services have a
critica re t pay i buidig a sid udati
which chidre with disabiities ca buid
uiig ives.
Inclusive health
Uder the CRC ad the CRPD, a chidre have
the right t the highest attaiabe stadard
heath. Chidre with disabiities are thus equay
etited t the u spectrum care rm
immuizati i iacy t prper utriti ad
treatmet r chidhd aimets ad ijuries,
t cidetia sexua ad reprductive heath
irmati ad services durig adescece
ad it eary aduthd. Equay critica are
such basic services as water, saitati ad
hygiee (WASH).
Esurig that chidre with disabiities actuay
ejy these rights a par with thers is the
bjective a icusive apprach t heath. It is
a matter scia justice ad respectig the
iheret digity a huma beigs, as we as
a ivestmet i the uture as heathy chidre
grw it mre eective prducers ad parets.
Immuizatis, amg the mst successu ad
cst-eective pubic heath itervetis, are a
key cmpet gba erts t reduce chid-
hd iess ad death. Mre chidre tha ever
bere are beig reached but chidre with dis-
abiities are sti t beeitig rm icreased
cverage. Icudig these chidre i immuiza-
ti erts is t y ethica but as imperative
r pubic heath ad equity; uiversa cverage
cat be reached i they remai excuded.
Whie immuizati ca pre-empt sme diseases
that ead t disabiities, it is ess imprtat
t immuize chidre wh are aready disabed.
Deied the u rage immuizatis, chidre
with disabiities are at risk devepmeta
deays, avidabe secdary cditis ad
prevetabe death.
Icudig chidre with disabiities i erts t
prmte immuizati r exampe, raisig
awareess by shwig them agside thers
i psters ad ther prmtia materias, ad
reachig ut t parets ad disabed pepes
rgaizatis wi hep t icrease immuiza-
ti cverage amg them.
nutriti is as critica. Isuiciet d r a diet
shrt certai vitamis ad mieras ca eave
iats ad chidre vuerabe t speciic cdi-
tis ad a hst iectis that ca ead t
physica, sesry r iteectua disabiities. Fr
exampe, betwee 250,000 ad 500,000 chidre
are csidered t be at risk becmig bid
each year rm vitami A deiciecy. This sy-
drme is easiy preveted by ra suppemeta-
ti cstig just a ew cets per chid. Simiary,
w-cst measures are avaiabe t prevet dis-
abiities arisig rm ther utritia deiciecies.
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ExEcutivE Summary 7
Pr utriti ad episdes diarrhea i
eary chidhd ca ead t stutig, idicated
by w height r age, which i tur ca resut
i pr cgitive ad educatia perrmace
that wi have csequeces thrughut ie.
Mautriti i mthers ca ctribute t a
umber prevetabe chidhd disabiities.
oe the mst prevaet causes disabiity
i the wrd is aaemia, which aects apprxi-
matey 42 per cet pregat wme i
w- ad midde-icme cutries (ver ha
suer ir deiciecy aaemia); it as aects
mre tha ha presch-aged chidre i
devepig cutries.
Whie mautriti ca be a cause disabiity,
it ca as be a csequece. Ideed, chidre
with disabiities are at heighteed risk ma-
utriti. Physica impairmets assciated with
cditis such as cet paate r cerebra pasy
may iterere with the mechaics csumig
d; certai cditis, such as cystic ibrsis,
may impede utriet absrpti; ad sme
iats ad chidre with disabiities may eed
specia diets r icreased carie itake t
maitai a heathy weight.
Yet chidre with disabiities may be hidde
away rm cmmuity screeig ad eedig
iitiatives. Thse wh d t atted sch
miss ut sch eedig prgrammes. I
additi t physica actrs, attitudes may as
adversey aect a chids utriti. I sme
scieties, mthers may t be ecuraged t
breasteed a chid with a disabiity; disabed
chidre may be ed ess, deied d r pr-
vided with ess utritius d tha sibigs
withut disabiities. Chidre with sme types
physica r iteectua disabiities may have
diicuty eedig themseves. It is prbabe that
i sme cases what is assumed t be disabiity-
assciated i heath ad wastig may i act be
cected with eedig prbems.
Thrughut the devepig wrd, perss with
disabiities rutiey ace particuar diicuties i
accessig sae drikig water ad basic saita-
ti. Faciities are te physicay iaccessibe,
ad i sme paces, ew es are sti beig
desiged ad buit withut adequate ccer r
chidre with disabiities. Eve thugh w-cst,
w-tech itervetis such as step atries are
icreasigy avaiabe, irmati abut them
has yet t be widey dissemiated ad icrp-
rated it WASH picies ad practice.
Scia barriers as impede access. Chidre with
disabiities te ace stigma ad discrimiati
whe usig husehd ad pubic aciities, r
exampe, because uuded ears that they
wi ctamiate them. Whe chidre with
disabiities, especiay girs, are rced t use
separate aciities, they are at icreased risk
accidets ad physica attack, icudig rape.
Chidre with disabiities might t atted sch
r wat a accessibe tiet; they te reprt
tryig t eat ad drik ess t cut dw the
umber visits t the tiet thus edagerig
their utritia status.
Chidre ad yug pepe with disabiities have
bee amst etirey verked i sexua ad
reprductive heath ad HIV/AIDS prgrammes,
as they are te icrrecty beieved t be sexu-
ay iactive, uikey t use substaces ad at ess
risk viece tha their peers withut disabii-
ties. May yug pepe with disabiities d t
receive eve basic irmati abut hw their
bdies devep ad chage, ad because they are
te taught t be siet ad bediet, they are at
heighteed risk abuse. I csequece, they are
at icreased risk HIV iecti.
Pepe with disabiities a ages wh are
HIV-psitive are ess ikey t receive apprpri-
ate services tha peers withut disabiities, as
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THE STATE OF THE WORLDS CHILDREN 2013: Children with Disabilities8
42%with
disability
53%
51%
61%
with
disability
without
disability
without
disability
Estimated rates of primaryschool completion
Source: Wrd Heath orgaizati, based surveys i 51 cutries.
aciities ad prgrammes rarey csider their
eeds, whie heath-care perse ack disabiity-
speciic traiig.
Because chidre devep rapidy durig the
irst three years ie, eary detecti ad iter-
veti are crucia r thse with disabiities.
Devepmeta screeig is a eective meas
detectig disabiity i chidre ad reerrig
them t urther assessmet ad iterveti
r exampe t treat ir deiciecy, admiister
ati-epieptic drugs r prvide cmmuity-based
rehabiitati as we as prvidig vita ir-
mati t amiy members. Such itervetis
are becmig icreasigy avaiabe i w- ad
midde-icme cutries.
The detecti ad treatmet impairmets is
t a separate area medicie but a itegra
aspect pubic heath. Whe picymakers ad
researchers characterize these measures as beig
i cmpetiti r resurces with measures t
prmte the heath pepe withut disabiities,
they perpetuate discrimiati ad iequity.
Heath-care services avaiabe t chidre with
disabiities may be pr quaity. Heath wrk-
ers ad ther pressias stad t beeit
rm beig educated abut chid devepmet
ad disabiity ad rm beig traied t deiver
itegrated services, with the participati the
exteded amiy where pssibe. Additiay, the
eedback chidre with disabiities shud be
sicited s that aciities ad services ca better
meet their eeds.
Inclusive education
Chidre with disabiities are disprprtiatey
deied their right t educati, which uder-
mies their abiity t ejy the u rights citi-
zeship, id gaiu empymet ad take up
vaued res i sciety. Husehd survey data
rm 13 w- ad midde-icme cutries shw
that chidre with disabiities aged 617 years are
sigiicaty ess ikey t be ered i sch
tha their peers withut disabiities.
As g as chidre with disabiities are deied
equa access t their ca schs, gvermets
cat achieve uiversa primary educati
(Mieium Devepmet Ga 2), ad States
parties t the CRPD cat ui their respsi-
biities uder Artice 24.
Rather tha segregatig chidre with disabiities
i specia schs, icusive educati etais
prvidig meaigu earig pprtuities t
a studets withi the reguar sch system.
Ideay, it aws chidre with ad withut dis-
abiities t atted the same age-apprpriate
casses at the ca sch, with additia, idi-
viduay taired supprt as eeded. It requires
physica accmmdati as we as a ew, chid-
cetred curricuum that icudes represetatis
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ExEcutivE Summary 9
the u spectrum pepe ud i sciety
ad reects the eeds a chidre.
Studies acrss cutries shw a strg ik
betwee pverty ad disabiity, which is i tur
iked t geder, heath ad empymet issues.
Chidre with disabiities are te caught i a
cyce pverty ad excusi: Girs becme
caregivers t sibigs rather tha atted sch,
r exampe, r the whe amiy may be stigma-
tized, eadig t a reuctace t reprt that a chid
has a disabiity r t take the chid ut i pubic.
Educati thse wh are excuded r margi-
aized, hwever, brigs abut pverty reducti.
The irst steps twards icusi are take at
hme durig the eary years. Withut the ve,
sesry stimuati, heath care ad scia icu-
si t which they are etited, chidre ca miss
imprtat devepmeta miestes ad their
ptetia may be uairy imited, with sigiicat
scia ad ecmic impicatis r themseves,
their amiies ad their cmmuities.
A chid whse disabiity r devepmeta deay
is idetiied at a eary stage wi have a much
better chace reachig her r his u capacity.
Eary chidhd educati is imprtat because
80 per cet the brais capacity deveps bere
the age 3; the perid bere primary sch
prvides pprtuities t tair devepmeta
educati t the chids idividua eeds. Studies
suggest that the chidre wh are at greatest dis-
advatage stad t beeit mst. With amiy ad
cmmuity supprt rm the eariest days their
ives, chidre with disabiities are better paced
t make the mst their sch years ad t
prepare themseves r aduthd.
I sch, creatig a icusive ad eabig
earig evirmet r chidre with disabii-
ties depeds i arge part teachers havig a
cear uderstadig icusive educati ad
a cmmitmet t teachig a chidre. A t
te, teachers ack apprpriate preparati ad
supprt i teachig chidre with disabiities
i reguar schs, ad this ctributes t their
stated uwiigess i may cutries t sup-
prt the icusi chidre with disabiities i
their casses.
Resurces r chidre with disabiities ted t
be acated t segregated schs rather tha
t a icusive maistream educati system.
This is t y iapprpriate, but ca as prve
csty: I Bugaria, r istace, the budget per
chid educated i a specia sch ca be up t
three times higher tha that r a simiar chid
i a reguar sch.
Whe teachers ad perse are traied t
csider disabiity-reated issues, they k
up icusi chidre with disabiities mre
psitivey. The mst psitive attitudes a
have bee ud amg teachers with actua
experiece icusi. It has bee shw that
psitive attitudes amg teachers trasate it
ess restrictive pacemets r studets with
disabiities.
Yet pre-service traiig rarey prepares teachers
t teach icusivey, ad existig traiig is vari-
abe quaity. The ack pepe with disabiities
amg teachig perse presets ather cha-
ege t icusive educati; aduts with disabii-
ties te ace csiderabe bstaces t quaiyig
as teachers. I Cambdia, r istace, teachers
must by aw be ree disabiities.
Parterships with civi sciety are prvidig
ecuragig exampes ways t ehace
teacher traiig ad diversity. I Mzambique,
the atia nGo Ajuda de Desevvimet de
Pv para Pv has wrked with the atia
disabed perss rgaizati ADEMo t trai
studet teachers t wrk with chidre with
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THE STATE OF THE WORLDS CHILDREN 2013: Children with Disabilities10
disabiities ad t trai studet teachers wh
have disabiities.
Icusive educati requires a exibe apprach t
sch rgaizati, curricuum devepmet ad
pupi assessmet. Such exibiity wud aw r
the devepmet a mre icusive pedaggy,
shitig the cus rm teacher-cetred t chid-
cetred t embrace diverse earig styes.
Teachers te have iadequate supprt i the
cassrm, ad they eed t be abe t ca
speciaist hep r istace, with Braie r
cmputer-based istructi whe the eeds
their studets with disabiities are beyd their
expertise. Such speciaists are i shrt suppy,
especiay i such w-icme areas as sub-
Sahara Arica. This presets a pprtuity r
apprpriate supprt rm prviders iacia
ad techica assistace rm the iteratia
t the ca eve.
Icusive educati as eeds t draw up
resurces rm utside the cassrm. Parets
have the ptetia t ctribute i may ways,
rm prvidig accessibe trasprt t raisig
awareess t iaisig with the heath ad scia
sectrs t btai equipmet, supprt ad grats.
The mst uderused resurce i schs ad
cmmuities a ver the wrd is the chidre
themseves. Athugh the imprtace chid
agecy ad chid participati is we dcu-
meted, they sit ucmrtaby withi existig
structures ad systems educati. Ivvig
chidre with disabiities i decisis ca be
particuary chaegig, t east because
igraied thikig ad behaviur that perceives
them as passive victims.
I participatry research, chidre requety
highight the imprtace a cea evirmet
ad hygieic tiets; r chidre with disabiities,
privacy ad accessibiity are paramut. Chidre
with disabiities ca ad must guide ad evau-
ate erts t advace accessibiity ad icusi.
Ater a, wh better t uderstad the meas
ad impact excusi?
Aspiratis r icusive educati are mre ike-
y t be reaized i gvermets ad their part-
ers are cear abut wh is t d what ad hw,
ad t whm they are expected t reprt. Where
picies ai t be impemeted, the prbem
may be e ucear madates. I Bagadesh,
r exampe, mst aspects the educati
chidre with disabiities are maaged by the
Miistry Scia Weare rather tha that
Educati. T make icusive educati a reaity,
Miistries Educati shud be ecuraged t
take respsibiity r a chidre sch age.
Crdiati with parters ad stakehders ca
pay a strg supprtig re i this prcess.
Excusi deies chidre with disabiities the ie-
g beeits educati: a better jb, scia ad
ecmic security, ad pprtuities r u par-
ticipati i sciety. I ctrast, ivestmet i the
educati chidre with disabiities ca ctrib-
ute t their uture eectiveess as members the
abur rce. Ideed, a perss ptetia icme
ca icrease by as much as 10 per cet with each
additia year schig.
Furthermre, basic readig ad writig skis as
imprve heath: A chid br t a mther wh ca
read is 50 per cet mre ikey t survive past the
age 5, ad wer matera educati has bee
iked t higher rates stutig amg chidre
i urba sums i Keya, Rma settemets i
Serbia, ad i Cambdia.
Educati is bth a useu istrumet ad a right.
As stated i the CRC, it prmtes the devep-
met the chids persaity, taets ad me-
ta ad physica abiities t their uest ptetia.
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ExEcutivE Summary 11
A yug by with abiism reads Braie at sch i the
tw Mshi, Uited Repubic Tazaia.
UnICEF/HQ2008-1786/Pirzzi
ESSEnTIAlS oF PRoTECTIon
Chidre with disabiities are amg the mst
vuerabe members sciety. They stad t
beeit the mst rm measures t cut them,
prtect them agaist abuse ad guaratee them
access t justice.
I scieties where they are stigmatized ad their
amiies expsed t scia r ecmic excusi,
may chidre with disabiities are t eve abe t
btai a idetity dcumet. This is a viati
these chidres huma rights ad a udameta
barrier t their participati i sciety. It ca sea
their ivisibiity ad icrease their vuerabiity t
the may rms expitati that resut rm t
havig a icia idetity.
States parties t the CRPD have the cear biga-
ti t guaratee eective ega prtecti r
chidre with disabiities. T chage discrimiatry
scia rms, States eed t make sure existig
aws are erced ad that chidre with disabii-
ties are irmed abut their right t prtecti
rm discrimiati, ad hw t exercise this
right. The pricipe reasabe accmmdati
dictates that ecessary ad apprpriate adapta-
tis be made s that chidre with disabiities ca
ejy their rights a equa basis with thers.
Reegatig them t separate systems wud be
iapprpriate; equity thrugh icusi is the ga.
Discrimiati agaist ad excusi chidre
with disabiities reders them disprprtiatey
vuerabe t viece, egect ad abuse. Sme
rms viece are speciic t chidre with
disabiities. It may be perpetrated i the guise
treatmet r behaviur mdiicati, r exampe,
usig eectric shcks r drugs. Girs with disabii-
ties i may cutries are subject t rced steri-
izati r abrti.
I may cutries, chidre with disabiities c-
tiue t be paced i istitutis. It is rare r these
aciities t prvide the idividua atteti that
chidre eed t devep t their u capacity. The
educatia, medica ad rehabiitative care they
receive i such paces is te isuiciet, wig
t either w stadards r iadequate mitrig.
Separatig chidre with disabiities rm their
amiies is a viati their right t be cared r
by their parets uess this is deemed by a cm-
petet authrity t be i the idividua chids best
iterests. I immediate amiy is uabe t care r
a chid, the CRPD bigates State parties t prvide
aterative care withi the exteded amiy r cm-
muity, r istace i a ster amiy.
Where cutries have sught t retur istituti-
aized chidre t their amiies ad cmmuities,
chidre with disabiities have bee amg the ast
t be reeased. Such was the case, r exampe,
i Serbia, athugh the reaizati that rerms
had bypassed chidre with disabiities i the past
decade has sice added vigur t such erts (see
chart, page 12).
A States respsibiity t prtect the rights a
chidre uder its jurisdicti as exteds t chi-
dre with disabiities wh are i ctact with the
aw whether as victims, witesses, suspects r
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THE STATE OF THE WORLDS CHILDREN 2013: Children with Disabilities12
Violence against children with disabilitiesChidre with disabiities are three t ur times mre ikey t be victims viece. Research teams at
liverp Jh Mres Uiversity ad the Wrd Heath orgaizati have cducted a systematic review ad
meta-aaysis existig studies viece agaist chidre with disabiities. The review csidered 17 studies
rm high-icme cutries, i the absece high-quaity studies rm w- ad midde-icme cutries.
Estimates risk idicated that chidre with disabiities were at sigiicaty higher risk experiecig
viece tha peers withut disabiities: 3.7 times mre ikey r cmbied measures viece, 3.6 times
r physica viece ad 2.9 times r sexua viece. Chidre with meta r iteectua disabiities were
ud t be 4.6 times mre ikey t be victims sexua viece tha peers withut disabiities.
Why are chidre with disabiities at greater risk viece? Severa expaatis have bee put rward:First, carig r a chid with a disabiity ca put extra strai caregivers, icreasig the risk abuse. Secd,
sigiicat umbers chidre with disabiities are sti paced i residetia care, a majr risk actr r sexua
ad physica abuse. Fiay, impairmets aectig cmmuicati reder sme chidre particuary vuerabe,
as they may t be abe t discse abusive experieces.
A chidre with disabiities shud be viewed as a high-risk grup i which it is critica t idetiy viece. They
may beeit rm itervetis such as hme visits ad traiig i paretig skis that have prve eective
i prevetig viece r mitigatig its csequeces amg chidre withut disabiities.
Under Serbias welfare reforms, children withdisabilities were released from institutions at a
slower rate than children without disabilities.
Children and youth (026 years old)
with disabilities in institutions
Children and youth (026 years old)
without disabilities in institutions
100% 100%
91%
79%
63%
83%
49%
37%
2000 2005 2008 2011 2000 2005 2008 2011
37%decrease
63%decrease
Source: Repubica Istitute r Scia Prtecti, Serbia.
Sampe sizes: Chidre ad yuth (026 years d) with disabiities: 2,020 i
2000, 1,280 i 2011. Chidre ad yuth (026 years d) withut disabiities:
1,534 i 2000, 574 i 2011.
Last to benefit cvicts. Speciic measures ca hep: Chidre cabe iterviewed i the apprpriate siged r spke
aguages; a pressias ivved i the admi-
istrati justice, rm aw ercemet icers
t judges, ca be traied t wrk with chidre
wh have disabiities; ad reguatis ad prt-
cs ca be estabished t esure equa treatmet
chidre with disabiities.
Furthermre, it is imprtat t devep aterative
sutis t rma judicia prceedigs, takig it
accut the rage chidres idividua capaci-
ties. Chidre with disabiities shud as t be
paced i reguar juveie deteti aciities; rather,
they shud be prvided apprpriate treatmet t
address the issues that ed them t cmmit a crime.
Such treatmet shud be carried ut i apprpriate
aciities with adequatey traied sta, with huma
rights ad ega saeguards uy respected.
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ExEcutivE Summary 13
Vijay, 12, survived a admie expsi ad has ge
t becme a mie risk educatr i Sri laka.
UnICEF/Sri laka/2012/Tuadar
HUMAnITARIAn RESPonSE
Humaitaria crises, such as thse stemmig
rm warare r atura disasters, pse particu-
ar risks r chidre with disabiities. Icusive
humaitaria respse is urgety eeded
ad easibe.
Armed cict is a majr cause disabiity
amg chidre, whm it aects i direct ad
idirect ways. Chidre sustai physica ijuries
rm attack, artiery ire ad admie expsis
icudig ater cicts have eded; they as
suer psychgica eects rm these ijuries r
rm witessig traumatic evets. Idirect eects
icude iesses utreated whe heath services
break dw ad mautriti that deveps whe
d becmes scarce. Chidre may as be sepa-
rated rm their amiies, their hmes ad their
schs, smetimes r years.
Simiar deprivatis ca esue as a resut
atura disasters, which particuary as thse
reated t cimate chage icrease i severity ad
requecy are expected t aect ever greater
umbers chidre ad aduts i cmig years.
Chidre with disabiities ace particuar cha-
eges i emergecies. They may be excuded
rm r uabe t access maistream supprt
services ad assistace prgrammes, such as
heath services r d distributi, because
physica barriers psed by iaccessibe buidigs
r egative attitudes. They may be rgtte i
the estabishmet targeted services ad dis-
regarded i eary warig systems, which te
d t take it accut the cmmuicati ad
mbiity requiremets thse with disabiities.
Disabiity-icusive humaitaria acti is
irmed by ad gruded i:
A rights-based apprach. Artice 11 the
CRPD speciicay cas duty bearers t take
a ecessary measures t prtect perss with
disabiities i emergecies.
A icusive apprach that recgizes that
i additi t their disabiity-speciic eeds,
chidre with disabiities have the same eeds
as ther chidre, ad that as addresses the
barriers, physica ad therwise, that impede
their participati i reguar prgrammes.
Esurig accessibiity ad uiversa desig
irastructure ad irmati.
Prmtig idepedet ivig ad participa-
ti i a aspects ie r chidre with
disabiities.
Itegratig age, geder ad diversity aware-
ess, with specia atteti t the discrimia-
ti aced by girs ad wme with disabiities.
This apprach cas r histic ad icusive pr-
grammes, rather tha just isated prjects ad
picies targetig disabiities. Key itervetis
icude:
Imprvig data ad assessmets i rder t
have a evidece base r the distict eeds
ad pririties chidre with disabiities.
Makig maistream humaitaria services
accessibe r chidre with disabiities ad
ivvig them i paig ad desig.
Desigig speciaized services r chidre
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THE STATE OF THE WORLDS CHILDREN 2013: Children with Disabilities14
Risk, resilience and inclusive humanitarian action
Chidre with disabiities ad their amiies ace particuar chaeges i emergecies. They may have t cted
with ew evirmeta barriers such as capsed ramps; damaged r st assistive devices; ad the ss such
services as sig aguage iterpreters r visitig urses.
I amiy members die, there may be e et wh kws hw t care r a chid with a physica disabiity r
wh ca cmmuicate with a chid with a sesry impairmet. Feeig amiies may eave behid chidre wh
are uabe t wak r are i rai heath r they may abad a chid ut ear that they wi be reused asyum
i ather cutry that excudes pepe with disabiities. Istitutis ad residetia schs may cse r be
abaded by sta, eavig the chidre i their charge withut care.
I armed cict, chidre with disabiities, especiay thse with earig disabiities, may be pressed it service
as ighters, cks r prters, because they are csidered t be ess vauabe r ess ikey t resist tha chidre
withut disabiities. Prgrammes aimed at the reitegrati chid ex-cmbatats might t serve the eeds
chidre with disabiities, wh therere remai margiaized ad excuded, te havig t beg, as has bee the
case i liberia ad Sierra lee.
Chidre with disabiities shud be give the pprtuity t take part i the paig ad impemetati
disaster risk reducti ad peace-buidig strategies as we as i disaster respse ad recvery prcesses. This
has begu t happe as demstrated by erts i Pakista ad Haiti.
Disabiity is beig maistreamed it such emergecy guideies as the Sphere Prjects Humanitarian Charter and
Minimum Standards in Humanitarian Response. Such prgress shud be exteded t such areas as chid utriti
ad prtecti, ad the extet t which chidre with disabiities are icuded i humaitaria respse must be
audited t mitr ad imprve resuts.
with disabiities ad esurig that recvery
ad reitegrati prcesses ster we-beig,
heath, se-respect ad digity.
Takig measures t prevet ijuries ad abuse
ad prmte accessibiity.
Parterig with cmmuity, regia ad
atia actrs, icudig disabed perss
rgaizatis, t chaege discrimiatry atti-
tudes ad perceptis ad prmte equity.
Prmtig participati chidre with disabi-
ities by csutig them ad creatig pprtu-
ities r their vices t be heard.
Parties t cict have a bigati t prtect
chidre rm the eects armed viece ad
t prvide them with access t apprpriate heath
ad psychscia care t aid their recvery ad
reitegrati. The Cmmittee the Rights the
Chid has recmmeded that States parties t
the Cveti add expicit reerece t chidre
with disabiities as part their brader cmmit-
met t t recruit chidre it armed rces.
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ExEcutivE Summary 15
Explosive remnants of war
Expsive remats war (ERW) ad ati-perse admies represet a sigiicat ctributig
actr t chid disabiity. Such istrumets as the 1997 Mie Ba Treaty have heped t reduce the
vera umber pepe kied r ijured by these weaps, but the percetage chidre amg
tta casuaties has icreased.
Auay sice 2005, chidre have accuted r apprximatey 2030 per cet casuaties, ad there have
bee at east 1,000 chid casuaties each year sice mitrig bega i 1999. I 2010, chidre accuted r
55 per cet a civiia deaths, makig them the civiia grup r whm admies ad ERW are mst deady.
I sme the wrds mst mie-aected cutries, such as Aghaista ad Cambdia, the percetage
casuaties represeted by chidre is eve higher (see chart).
Sice 2008, bys have made up the sige argest casuaty grup, accutig r abut ha a civiia
casuaties; that year, they represeted 73 per cet chid casuaties. I may ctamiated cutries, bys
are mre ikey tha girs t cme acrss mies r ERW because they are mre ivved i utdr activities
0%
20%
40%
60%
80%
100%
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Afghanistan
Cambodia
Colombia
90%
70%
50%
30%
10%
Child casualties in the most affected countries*Percentage of children among civilian casualties (19992011)
* The three States parties t the Mie Ba Treaty with the highest aua casuaty rates.
Source: ladmie ad Custer Muiti Mitr.
(continued on p. 16)
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THE STATE OF THE WORLDS CHILDREN 2013: Children with Disabilities16
such as herdig ivestck, gatherig wd r d, r cectig scrap meta. They are as mre ikey tha girs
t tamper with ay devices they id.
Chidre i geera are mre ikey t deiberatey hade expsive devices tha aduts, te ukwigy,
ut curisity r mistakig them r tys. We-paed risk educati is therere especiay imprtat r
chidre.
Mre tha e third a bast survivrs require amputati; the percetage ca be expected t be higher r
chidre, give their smaer size. Chidres physica rehabiitati is mre cmpex tha that aduts: Because
their bes grw aster tha their st tissue, they may eed severa re-amputatis. Prstheses must be adjustedr repaced as they grw.
The psychgica csequeces a ERW r admie bast are te devastatig r a chids devepmet.
They ca icude eeigs guit, ss se-esteem, phbias ad ears, seep disrders ad a iabiity t speak.
I et utreated, chidre may devep g-term meta disrders.
The scia ad ecmic reitegrati eeds chid survivrs as vary csideraby rm thse aduts. I
may cutries, chid survivrs are rced t cut shrt their educati wig t the time eeded r recvery r
the iacia burde that rehabiitati paces their amiies. They may be physicay uabe t wak t sch
ad ack access t aterative trasprtati; cassrms may t be accessibe, ad teachers may t be traied
t csider their eeds. Access t ree educati r chidre with disabiities as a resut admie r ERW
ijuries is ecessary bth t prmte a sese rmacy i their ives ad t reitegrate them with their peer
grup ad aw them t uy participate i sciety.
Few victim assistace prgrammes address age- ad geder-speciic ccers. I a 2009 survey mre
tha 1,600 survivrs rm 25 aected cutries cducted by Hadicap Iteratia, amst tw thirds
respdets reprted that services r chidre were ever r amst ever adapted t their speciic
eeds r age.
As chidre accut r a icreasig percetage the tta civiia casuaties rm ERW ad admies, it
is essetia t impemet speciic picy ad prgrammatic recmmedatis that meet their eeds. These
shud icude measures t disaggregate data casuaties by age ad geder; t trai heath ad educati
pressias t csider the eeds chid survivrs; ad t bster victim assistace, vera, as a key piar
respse t the impact ERW, with guideies that speciicay pertai t chidre.
(continued from p. 15)
Explosive remnants of war
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ExEcutivE Summary 17
A heath wrker assesses a by at the Ataua Sciety
r Dea Chidre, State Paestie. The rgaizati
ers educati ad vcatia traiig, ree heathcare, psychscia services ad jb pacemet.
UnICEF/HQ2008-0159/Davey
MEASURInG CHIlD DISABIlITY
A sciety cat be equitabe uess a chidre
are icuded, ad chidre with disabiities ca-
t be icuded uess sud data cecti ad
aaysis reder them visibe.
Measurig chid disabiity presets a uique set
chaeges. Because chidre devep ad
ear t perrm basic tasks at dieret speeds, it
ca be diicut t assess ucti ad distiguish
sigiicat imitatis rm variatis i rma
devepmet. The varyig ature ad severity
disabiities, tgether with the eed t appy
age-speciic deiitis ad measures, urther
cmpicate data cecti erts.
I additi, the pr quaity data chid
disabiity stems, i sme cases, rm a imited
uderstadig what disabiity is i chidre,
ad i ther cases, rm stigma r isuiciet
ivestmet i imprvig measuremet. The ack
evidece that resuts rm such diicuties
hiders the devepmet gd picies ad
the deivery vita services.
Whie there is geera agreemet that deiitis
disabiity shud icrprate bth medica ad
scia determiats, the measuremet disabi-
ity is sti predmiaty medica, with a cus
speciic physica ad meta impairmets.
oe ramewrk r csiderig heath ad dis-
abiity withi a brader ctext scia barriers
is the Iteratia Cassiicati Fuctiig,
Disabiity ad Heath (ICF), deveped by the
Wrd Heath orgaizati. This cassiicati
regards disabiity i tw mai ways: as a mat-
ter the bdys structure ad uctis, ad i
terms the perss activity ad participati.
Disabiity, as deied by the ICF, is a rdiary
part huma existece every pers ca
experiece sme degree it. The ICF deiiti
as recgizes that uctiig ad disabiity
ccur i ctext, ad therere it is meaigu
t assess t y bdiy but as scieta ad
evirmeta actrs.
Derived rm the ICF, the Iteratia
Cassiicati Fuctiig, Disabiity ad
Heath r Chidre ad Yuth (ICF-CY) takes a
step twards icrpratig the scia dimesi
by capturig t y the impairmet but as its
eect chidres uctiig ad participati
i their evirmet. It cvers ur mai areas:
bdy structures (e.g., rgas, imbs), bdy uc-
tis (e.g., isteig, rememberig), imitatis
activity (e.g., wakig, dressig) ad restric-
tis participati (e.g., payig with ther
chidre, perrmig simpe chres).
Data disabiity shud be iterpreted i c-
text. Prevaece estimates are a ucti bth
icidece ad surviva. Where chid mrtaity
rates are high, w reprted disabiity prevaece
may be the csequece w surviva rates r
yug chidre with disabiities r it may reect
the aiure t cut chidre wh ive i istitu-
tis, are hidde away by amiies, r ive ad
wrk the streets.
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THE STATE OF THE WORLDS CHILDREN 2013: Children with Disabilities18
Lessons learned
Sice 1995, UnICEF has supprted mre tha 100 w- ad midde-icme cutries i cductig Mutipe
Idicatr Custer Surveys (MICS) t track prgress i chidres ad wmes we-beig. Sice 20002001, sme
these surveys have icuded a mdue desiged t scree chid disabiity, ad this irmati is w beig buit
up t desig a imprved measuremet t.
The stadard disabiity mdue used i MICS betwee 2000 ad 2010 is the Te Questis Scree (TQ), which was
deveped i 1984 ad reects hw disabiity was uderstd at the time. The prcess starts by askig the primary
caregivers chidre aged 29 years r a persa assessmet the physica ad meta devepmet ad
uctiig the chidre i their care; respses are either psitive r egative, with rm r uaces.
The vaidity the TQ apprach has bee widey tested, but the resuts must be iterpreted with cauti. The TQ is
a screeig t ad requires w-up medica ad devepmeta assessmet i rder t yied a reiabe estimate
the umber chidre i a give ppuati wh have disabiities. Few cutries have had the budgets rcapacity t cduct the secd-stage ciica assessmet t vaidate resuts, ad they have bee urther hampered
by the ack a stadardized methdgy r cductig that assessmet.
Appyig the TQ durig the 20052006 MICS yieded a wide rage resuts acrss participatig cutries. The
percetage chidre screeig psitive r disabiity raged rm 3 per cet i Uzbekista t 48 per cet i the
Cetra Arica Repubic. It is t cear whether this variace reected true diereces amg the ppuatis
samped r additia actrs. Fr istace, the w reprted rate i Uzbekista may have reected a arge
ppuati chidre with disabiities ivig i istitutis, which are t subject t husehd surveys.
Cuture as pays a imprtat re. The iter-
pretati what may be csidered rma
uctiig varies acrss ctexts ad iueces
measuremet utcmes. The attaimet cer-
tai miestes may t y vary amg chi-
dre, but dier as by cuture, as chidre may
be ecuraged t experimet with ew activities
at dieret stages devepmet. Reerece va-
ues must therere be set with csiderati
ca circumstaces ad uderstadig.
Fr these reass, assessmet ts deveped
i high-icme cutries, such as the Wechser
Iteigece Scae r Chidre, cat be idis-
crimiatey appied i ther cutries r cm-
muities. Frames reerece may vary, ad
survey ts may ai t suiciety capture ca
custms, cutura uderstadig, aguages
ad expressis.
Furthermre, the speciic bjectives the data c-
ecti are ikey t iuece the deiiti what
cstitutes disabiity, the questis asked ad the
resutig igures. Fr istace, the criteria used t
deie eigibiity r a disabiity beeit are ikey
t be mre restrictive tha criteria r a survey
cducted t idetiy a perss with a uctia
imitati, yiedig dramaticay dieret umbers.
May chidre are idetiied as havig a disabiity
whe they cme it ctact with educati r
heath-care systems. But i w-icme cu-
tries r cmmuities, sch ad ciic sta may
t be abe t rutiey recgize r register the
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ExEcutivE Summary 19
From screening to assessment
Chid disabiity measuremet experts agree that screeig erts must be wed by i-depth assessmets.
Experieces i Bhuta, Cambdia ad the rmer Yugsav Repubic Macedia prvide imprtat esss
r the measuremet chid disabiity ad adaptati methdgy t ca ctext. They as testiy t the
trasrmative pwer data cecti.
The cmpsiti the cre assessmet team ad the type ts used were adapted t ca capacity. At the time
the study, bth Bhuta ad Cambdia aced a shrtage quaiied assessrs. I Cambdia, mbie assessmet
teams were empyed ad a hearig speciaist was brught i rm abrad, whie i Bhuta emphasis was put
traiig mid-eve pressias.
The assessmets demstrated that ts such as questiaires ad tests must be cay vaidated ad cuturay
apprpriate. Careu atteti must be paid t aguage r istace, i idig apprpriate iguistic equivaets
r the ccepts impairmet ad disabiity.
With assessmet cmes the ptetia r immediate iterveti. I Cambdia, r exampe, sme chidre
wh screeed psitive r hearig impairmet were ud t have ear iectis r a buid-up ear wax.
oce idetiied, these cditis were easiy treated ad mre serius secdary iectis ad ger-term
impairmets preveted.
Assessmet ca as aid awareess-raisig ad spark chage eve whie the prcesses cectig ad aaysigdata are sti uder way. Whe assessmets i Bhuta shwed a higher icidece mid cgitive disabiities
amg chidre rm prer husehds ad with ess educated mthers, the gvermet decided t cus
eary chidhd devepmet ad chidcare services i rura areas, where icme ad educati eves are wer.
A strategy r iterveti beha chidre idetiied as havig a disabiity shud be icrprated i the
assessmet rm the eariest stages paig. Such a strategy shud icude a mappig the avaiabe
services, the devepmet reerra prtcs ad the preparati irmative materias r amiies
hw t adjust chidres surrudigs t ehace uctiig ad participati i hme ad cmmuity ie.
presece chidre with disabiities. The resut-
ig paucity irmati chidre with dis-
abiities i w-icme cutries has ctributed
t a misccepti that disabiity des t merit
gba pririty.
Geera data cecti istrumets such as
cesus r husehd surveys are ikey t
uderestimate the umber chidre with dis-
abiities, particuary i the surveys d t ask
speciicay abut them. Targeted husehd
surveys that d s have prduced mre accu-
rate resuts tha thse that ask abut disabiity
i geera, withut reerece t chidre. Mre
umerus ad detaied questis the subject
ted t prduce higher prevaece rates.
T accuratey reprt chid disabiity, the chice
questis must be taired t a chids age i
rder t reect the devepmeta stages ad
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THE STATE OF THE WORLDS CHILDREN 2013: Children with Disabilities20
evvig capacities chidre. Give the cm-
pexity devepmeta prcesses durig the
irst tw years ie, it ca be diicut t disti-
guish disabiity rm variatis i rma deve-
pmet withut speciaized ts r assessmet.
May data cecti istrumets are based
sey the respses parets, wh may t
have kwedge the speciic bechmarks used
t evauate chidre at each stage devep-
met. Parets may reprt diicuties that stem
rm temprary cditis, such as ear iec-
tis, ad they may as verk certai sigs,
r hesitate t reprt them because a ack
acceptace r stigma surrudig disabiity i
their cuture.
Erts t measure chid disabiity represet a
pprtuity t ik assessmet with iterveti
strategies. Thugh eary iterveti is critica,
capacity ad resurces r w-up assessmet
ad supprt r chidre wh scree psitive r
disabiity are te scarce.
A way forward
UnICEF, i partership with the Washigt Grup Disabiity Statistics ad a brad array stakehders, is
hdig csutatis t imprve the methdgy used t measure chid disabiity i Mutipe Idicatr Custer
Surveys ad ther data cecti erts, i rder t prduce atiay cmparabe igures ad prmte the
harmizati data chid uctiig ad disabiity iteratiay.
The screeig t uder devepmet cvers chidre aged 217 years ad uses a ratig scae t assess speech
ad aguage, hearig, visi, earig (cgiti ad iteectua devepmet), mbiity ad mtr skis,emtis, ad behaviurs; it as icudes aspects chidres abiity t participate i a rage activities ad
scia iteractis. As i devepmet is a stadardized vera methdgy r a mre i-depth assessmet
disabiity i chidre, with data cecti prtcs, assessmet ts ad a ramewrk aaysis.
Recgizig that speciaists may be i shrt suppy i sme areas, a tkit is beig desiged t eabe teachers,
cmmuity wrkers ad ther traied pressias t admiister the ew methdgy. This wi serve t
stregthe ca capacity t idetiy ad assess chidre with disabiities wh are at risk scia excusi
ad reduced participati.
Data that capture the type ad severity chidres
disabiities as we as the barriers t chidres
uctiig ad cmmuity participati, whe
cmbied with reevat sci-ecmic idicatrs,
hep t irm decisis abut hw t acate
resurces, eimiate barriers, desig ad prvide
services, ad meaiguy evauate such iter-
vetis. Fr istace, data ca be used t map
whether icme, geder r mirity status aects
access t educati r immuizati r chidre
with disabiities. Reguar mitrig makes it
pssibe t assess whether iitiatives desiged
t beeit chidre are meetig their gas.
There is a cear eed t harmize chid disabiity
measuremet i rder t prduce estimates that
are reiabe, vaid ad iteratiay cmparabe.
Hwever, the currety ragmeted state chid
disabiity data cecti is excuse t deer
meaigu acti twards icusi; as ew data
ad aayses emerge, they wi preset pprtui-
ties t adapt existig ad paed prgrammes
r chidre with disabiities ad their amiies.
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ExEcutivE Summary 21
As the atis the wrd have repeatedy
airmed their cmmitmet t buidig mre
icusive scieties, the situati may chidre
with disabiities ad their amiies has imprved.
But prgress has varied acrss cutries, ad t
may chidre with disabiities ctiue t ace
barriers t their participati i the civic, scia ad
cutura aairs their cmmuities. Reaizig the
prmise equity thrugh icusi wi require
acti i umerus areas ad by may actrs.
Ratify and implement the
ConventionsAs 2013 bega, 127 cutries ad the Eurpea
Ui had ratiied the CRPD ad 193 had ratiied
the CRC, thereby shwig a cmmitmet t a
their citizes.
Ratiicati ae wi t be eugh; hurig
cmmitmets i practice wi require t y
diiget ercemet but as rigrus mitrig,
accutabiity ad adaptati. The prcess wi
require ert the part atia gver-
mets, ca authrities, empyers, disabed
pepes rgaizatis ad parets assciatis.
Iteratia rgaizatis ad drs ca
aig their assistace with these iteratia
istrumets.
Fight discrimination
Discrimiati ies at the rt may the
chaeges crted by chidre with disabiities
ad their amiies. Airmatis equa rights ad
-discrimiati i aw ad picy eed t be
cmpemeted by erts t ehace awareess
disabiity amg the geera pubic, startig with
thse wh prvide essetia services r chidre i
such ieds as heath, educati ad prtecti.
States parties t the CRPD ad the Uited natis
ad its agecies have cmmitted themseves t
cductig awareess-raisig campaigs, ad
they are as required t prvide irmati t
chidre ad their amiies hw t prevet ad
reprt expitati, viece ad abuse.
Iteratia agecies ad their gvermet ad
cmmuity parters ca hep vercme prejudice
by prvidig icias ad pubic servats with a
deeper uderstadig the rights, capacities ad
chaeges chidre with disabiities. Parets
rgaizatis ca pay a pivta re ad shud
be reirced s that chidre with disabiities are
vaued, cherished ad supprted by their amiies
ad cmmuities.
Discrimiati the gruds disabiity is a
rm ppressi. The estabishmet a cear,
ega etitemet t prtecti rm discrimiati
is vita i reducig the vuerabiity chidre with
disabiities. Where egisati baig discrimia-
ti des t exist, disabed pepes rgaizatis
ad civi sciety as a whe wi ctiue t have a
crucia re t pay i pressig r such aws.
nguye, wh has autism, atteds a cass specifcay taired
t his eeds at the Da nag Icusive Educati Resurce
Cetre i Viet nam. Such cetres were set up t hep chidre
prepare r admissi t icusive maistream schs.
UnICEF/Viet nam/2012/Bisi
An AGEnDA FoR ACTIon
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THE STATE OF THE WORLDS CHILDREN 2013: Children with Disabilities22
Convention on the Rights of Persons with Disabilities andOptional Protocol: Signatures and ratifications
155COUNTRIES HAVE
SIGNED THE
CONVENTION*
128
COUNTRIES HAVE
RATIFIED THE
CONVENTION*
91
COUNTRIES HAVE
SIGNED THE
PROTOCOL
76
COUNTRIES HAVE
RATIFIED THE
PROTOCOL
27
COUNTRIES HAVE
NOT SIGNED
Dismantle barriers to inclusion
A chidres evirmets schs, heath acii-
ties, pubic trasprt ad s ca be buit t
aciitate access ad ecurage the participati
chidre with disabiities agside their peers.
Whe chidre iteract ad uderstad each
ther acrss eves abiity, they a beeit.
Uiversa desig which prmtes usabiity
by a pepe t the greatest extet pssibe
shud be appied t the cstructi a
pubic ad private irastructure, as we as t
the devepmet icusive sch curricua,
vcatia traiig prgrammes, ad chid
prtecti aws, picies ad services.
Gvermets have the decisive re t pay i
itrducig ad impemetig the egisative,
admiistrative ad educatia measures eces-
sary t prtect chidre with disabiities rm a
*Icudes the Eurpea Ui.
Source: Un Eabe; Uited natis Treaty Cecti. Fr tes terms used, see p. 25.
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
AzerbaijanBahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia (Plurinational State of)
Bosnia and Herzegovina
Botswana
Brazil
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
CanadaCape Verde
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cte dIvoire
Croatia
Cuba
Cyprus
Czech Republic
Democratic Peoples
Republic of Korea
Democratic Republic
of the Congo
DenmarkDjibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia
Georgia
Germany
Ghana
Greece
GrenadaGuatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
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Ratified ConventionSigned Convention Signed Protocol Ratified Protocol Not signed
rms expitati, viece ad abuse. It is
t apprpriate t create separate systems r
chidre with disabiities the ga must be icu-
sive, high-quaity prtecti mechaisms suitabe
ad accessibe t a chidre.
oe such mechaism is birth registrati, a
essetia eemet prtecti. Erts t register
chidre with disabiities ad thereby reder
them visibe deserve pririty.
End institutionalization
Istitutis are pr substitutes r a urturig
hme ie, eve i they are we ru ad mitred.
Immediate measures t reduce verreiace
them cud icude a mratrium ew admis-
sis. This shud be accmpaied by the prm-
ti ad icreased supprt r amiy-based
care ad cmmuity-based rehabiitati. Makig
pubic services, schs ad heath systems
EXECUTIVE SUMMARY 23
Indonesia
Iran (Islamic Republic of)
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
KazakhstanKenya
Kiribati
Kuwait
Kyrgyzstan
Lao Peoples
Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
LithuaniaLuxembourg
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia (Federated States of)
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
NamibiaNauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norway
Oman
Pakistan
Palau
PanamaPapua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Republic of Korea
Republic of Moldova
Romania
Russian Federation
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the
Grenadines
Samoa
San Marino
Sao Tome and PrincipeSaudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Sudan
SpainSri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Tajikistan
Thailand
The former Yugoslav Republic
of Macedonia
Timor-Leste
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
TuvaluUganda
Ukraine
United Arab Emirates
United Kingdom
United Republic of Tanzania
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela (Bolivarian
Republic of)
Viet Nam
YemenZambia
Zimbabwe
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THE STATE OF THE WORLDS CHILDREN 2013: Children with Disabilities24
accessibe ad respsive t the eeds chidre
with disabiities ad their amiies wi reduce the
pressure t sed chidre away i the irst pace.
Support families
Disabiity i the amiy is te assciated with
higher csts ivig ad st pprtuities t
ear icme, ad thus may icrease the risk
becmig r remaiig pr. Pverty makes it
harder r chidre t btai eeded services
ad assistive techgy.
Scia picies shud take it accut the m-
etary ad time csts assciated with disabiity.
These ca be set with scia grats, subsidies
r trasprtati r udig r persa assis-
tats r respite care. Cash beeits are easier t
admiister, mre exibe at meetig particuar
eeds, ad as respect the decisi-makig rights
parets ad chidre. Existig cash traser
prgrammes ca be adapted s that amiies car-
ig r chidre with disabiities are t excuded
r ered isuiciet supprt.
Move beyond minimum standards
Existig supprts ad services shud be ctiu-
ay assessed with a view t achievig the best
pssibe quaity t just meetig miimum
stadards. Atteti eeds t cus servig
the idividua chid as we as trasrmig etire
systems ad scieties.
I this prcess evauati, the imprtace
participati by chidre with disabiities ad
their amiies cat be verstated. Chidre ad
yug pepe with disabiities are amg the mst
authritative surces irmati what they
eed ad whether their eeds are beig met.
Coordinate services to supportthe child
The eects disabiity cut acrss sectrs, requir-
ig crdiated services t address the u rage
chaeges acig chidre with disabiities
ad their amiies. A crdiated prgramme
eary iterveti acrss the heath, educati ad
weare sectrs wud hep t prmte the eary
idetiicati ad maagemet chidhd dis-
abiities. Earier itervetis have bee shw
t ead t arger gais i uctia capacity, ad
remvig barriers earier i ie esses the cm-
pudig eect the mutipe barriers aced by
chidre with disabiities.
Imprvemets i abiity wi have greater impact i
sch systems are wiig ad abe t accept chi-
dre with disabiities ad meet their eeds, whie
icusive sch-t-wrk prgrammes as we as
ecmy-wide erts t prmte the empymet
pepe with disabiities wi make acquirig a
educati mre meaigu r them.
Chidre with ad withut disabiities participate i
sch estivities i Bagadesh.
UnICEF/BAnA2007-00655/Siddique
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ExEcutivE Summary 25
Involve children with disabilities inmaking decisions
Chidre ad adescets with disabiities beg
at the cetre erts t buid icusive scieties
t just as beeiciaries, but as agets chage.
They are uiquey quaiied t prvide irmati
whether their eeds are beig met.
States parties t the CRC ad CRPD have
airmed the right chidre with disabiities t
express their views matters ccerig them
ad t be csuted whe egisati ad picies
ccerig them are deveped ad impemet-
ed. T that ed, decisi-makers wi eed t
cmmuicate i ways ad usig meas that are
easiy accessed ad used by chidre ad yug
pepe with disabiities.
The right t be heard appies t a chidre.
A chid wh is abe t express herse r himse
is much ess ikey t be abused r expited.
Participati is especiay imprtat r such mar-
giaized grups as chidre wh ive i istitutis.
Global promise, local test
I rder t ui the prmises the CRPD ad the
CRC, iteratia agecies ad drs ad their
atia ad ca parters ca icude chidre
with disabiities i the bjectives, targets ad
mitrig a devepmet prgrammes.
Reiabe ad bjective data are imprtat t assist
i paig ad resurce acati ad t pace
chidre with disabiities mre ceary the
devepmet ageda. T give impetus t the ec-
essary statistica wrk, iteratia drs ca
prmte a ccerted gba research ageda
disabiity. I the meatime, prgrammes ad bud-
gets ca be desiged t aw r mdiicatis as
additia irmati is made avaiabe.
The utimate pr a gba ad atia erts
wi be ca, the test beig whether every chid
with a disabiity ejys her r his rights icudig
access t services, supprt ad pprtuities
a par with ther chidre, eve i the mst remte
settigs ad the mst deprived circumstaces.
Conventions, optional protocols, signatures and ratifications
A Convention is a rma, mutiatera agreemet betwee may States parties.
A Optional Protocol t a Cveti is a ega istrumet iteded t suppemet the rigia agreemet by
estabishig additia rights r bigatis. Such a prtc is ptia i the sese that States parties t a
Cveti are t autmaticay bud by its prvisis, but must ratiy it idepedety. Thus, a State may
be party t a Cveti but t t its optia Prtcs.
I mst cases, a State becmes party t a Cveti by wig tw steps: sigature ad ratiicati.
By signing a Convention, a State idicates its iteti t take steps t examie the Cveti ad its
cmpatibiity with dmestic aw. A sigature des t create a ega bigati t be bud by a Cvetis
prvisis, but it idicates that a State wi t take actis that wud udermie the purpse the Cveti.
Ratification is the ccrete acti by which a State agrees t be egay bud by the terms a Cveti. The
prcedure varies accrdig t each cutrys particuar egisative structure. I sme cases, a state wi accede t a
Cveti r optia Prtc. Essetiay, accession is ike ratiyig withut irst havig t sig.
More detailed definitions are available at.
The Convention on the Rights of Persons with Disabilities is available at .
The Optional Protocol is available at.
7/28/2019 UNICEF State of the Worlds Children _Focus Children With Disabilities_SOWC-Rapporten 2013
28/28
Somewhere, a child is being told he cannot play because he
cannot walk, or another that she cannot learn because she cannot
see. That boy deserves a chance to play. And we all benefit when
that girl, and all children, can read, learn and contribute.
The path forward will be challenging. But children do not accept
unnecessary limits. Neither should we.
Anthony Lake
Executive Directr, UnICEF
Cover photograph:
Schoolchildren queue to enter their classroom in this 2007 photograph
from the Syrian Arab Republic. UNICEF/HQ2007-0745/Noorani
Design by Prographics, Inc.
United Nations Childrens Fund
3 United Nations Plaza
New York, NY 10017
www.unicef.org/sowc2013
United Nations Childrens Fund (UNICEF)May 2013
To read this report online,
scan this QR code or go to
www.unicef.org/sowc2013
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