Multidimensional Poverty and Disability: Analysis of 52 countries using the global MPI

1. Introduction

People with disabilities account for 16 per cent of the global population (World Health Organization (WHO), 2022); it is expected that the prevalence of disability will increase over time, given the demographic changes that most countries are facing, and the prevalence is expected to be higher in Low and Middle-Income Countries (LMICs) where conflict, lack of access to health services and the limited provision of social protection and support services create that persons with health conditions face higher barriers to access health services, as well as education and employment (World Health Organization and The World Bank, 2011).

Although the number of studies analysing the levels of poverty and deprivation of persons with disabilities has increased in the last decade (Banks et al., 2017), there is limited evidence at the global level of the levels of monetary or multidimensional poverty among persons with disabilities.

The number of studies analysing multidimensional poverty for persons with disabilities in low-middle-income counties (LMICs) has increased in the last decade (Pinilla-Roncancio and Alkire, 2021; Pinilla-Roncancio et al., 2020a; Banks et al., 2017), especially after the Convention on the Rights of Persons with Disabilities (CRPDs) and the Agenda 2030. The foundational documents of both CRPDs and the Agenda 2030 mention the importance of having disaggregated data on disability, and flag the need to measure the levels of poverty of persons with disabilities. The CRPDs call for inclusion and guaranteeing the rights of persons with different disabilities in all areas of human life (United Nations, 2007). The Sustainable Development Goals Agenda (Agenda 2030) calls for recognising that groups in society are usually excluded and left behind (United Nations, 2015). Therefore, it becomes fundamental to design and implement actions to deliberately include vulnerable groups, including persons with disabilities. To do so, it is necessary to know not only whether persons with disabilities are poorer than others but also which deprivations they experience, indicator by indicator.

1.1 Why are persons with disabilities poor?

Persons with disabilities and their families face social and economic barriers to participating in society (World Health Organization and The World Bank, 2011; Mitra and Yap, 2021). In general, persons with disabilities around the globe have lower levels of education and lower participation in the labour market. They demand more health services but face higher costs and barriers to accessing healthcare when needed, and they usually present lower levels of social and political participation. In most LMICs, persons with disabilities are relatively invisible. A large number of countries do not mention persons with disabilities in their national policies aiming to guarantee access to basic services, or persons with disabilities who do have access face barriers that limit their enjoyment of services and the fulfilment of their capabilities.

From a capability approach, persons with disabilities face an earning and a conversion handicap. Indeed, persons with disabilities are more likely to earn less income (earning handicap) as a result of their lower levels of education and the social exclusion they face. In addition, persons with disabilities need to consume disability-specific items; thus, their consumption of other items which might increase their well-being is limited (conversion handicap) (Sen, 2009). Both types of handicaps are related to the extra costs associated with living with a disability. On the one hand, persons with disabilities face higher barriers to participate in the labour market. Therefore, the average household income is expected to be lower than that of households without members with disabilities of similar characteristics. On the other hand, persons with disabilities and their households need to cover the extra costs associated with disabilities, which directly affect their consumption and generate a reduction in the consumption of non-disability-related items to compensate for the acquisition of disability-related items such as a wheelchair and rehabilitation, among others.

Persons with disabilities and their families also face indirect costs and opportunity costs, which are associated with the reduction in the number of household members working and the need to provide care and support to the person with disability. All these individual and household characteristics create that persons with disabilities are considered one of the poorest groups (Mont et al., 2022).

The evidence regarding the levels of poverty of persons with disabilities has shown that, in most cases, no significant differences are found between the levels of income poverty of persons with and without disabilities (Banks et al., 2017). This is given because, in most cases, income or consumption measures do not capture how persons with disabilities and their families compensate to cover their basic needs and the costs of disability-related items. This creates a reduction in the well-being and living standard of the household and individual, but that is not observed in the reduction of food consumption.

In the case of multidimensional poverty measures, the evidence has shown that persons with disabilities present higher levels of poverty and deprivation in aspects related to education, health and employment (Pinilla-Roncancio and Alkire, 2021; Mitra and Yap, 2021). However, there are no significant differences in access to basic services such as water, sanitation or electricity, in part because those services mostly cover households with and without members with disabilities. Nevertheless, it is not well known whether having access to a clean water source or an improved sanitation service guarantees that persons with disabilities use these services, given that, in most cases, aspects regarding accessibility are not considered (Pinilla-Roncancio et al., 2020b).

Multidimensional poverty measures computed at the individual level have shown that persons with disabilities present important disadvantages and, therefore, higher levels of deprivation and poverty than persons without disabilities, even in the same household (Pinilla-Roncancio et al., 2020b; Banks et al., 2021). Indeed, persons with disabilities present higher deprivations in education, employment and participation. If aspects regarding accessibility are included in the measure, the deprivation that persons with disabilities face is higher than for persons without disabilities in the same household.

In addition, persons with severe disabilities face higher levels of multidimensional poverty and deprivation. According to Mitra and Yap (2021) the levels of poverty of persons with severe disability (using the Washington Group Short Set of questions) are higher than for persons with moderate disabilities, and the ones of this last group are higher than for persons with mild disabilities. The magnitude of the difference varies per country, but the results are consistent across levels of economic development. Thus, persons with higher levels of severity of their disability are more likely to be poor and face higher levels of deprivation.

Finally, the evidence reveals that persons with disabilities living in countries with higher levels of development show higher levels of multidimensional poverty than families in which no one experiences a disability (Groce and Kett, 2013). In most cases, this is because of the lack of access to education, health and employment as well as the lack of protection and guarantee of the right to social and economic participation and the higher levels of social and economic discrimination that persons with disabilities face.

At the global level, earlier, some of us disaggregated the global multidimensional poverty index (global MPI) by disability status (Pinilla-Roncancio and Alkire, 2021). This study could not use a comparable measure of disability, given data limitations. Still, it revealed that households with members with disabilities face a higher incidence of multidimensional poverty in five of the 11 countries. A critical finding of this study was that in countries with higher levels of multidimensional poverty (e.g., Uganda), persons with disabilities and their families were not significantly poorer than persons without disabilities and their families. However, in countries where levels of poverty were lower than 5 per cent, persons with disabilities and their families were significantly poorer than other households, revealing the existence of a disability poverty gap.

2. Methodology

This study uses data from 52 countries with information on disability and computes the levels of multidimensional poverty of households with and without members with disabilities. We used the global MPI as the main indicator of poverty measured (see Table 1). The global MPI uses ten indicators and three dimensions (health, education, and living standards). It applies nested weights and uses a poverty line of 33.33 per cent. Thus, a person is considered poor if s/he lives in a household deprived in one or more dimensions of poverty or in weighted indicators the sum of which is one-third or more.

Table 1: Dimensions, Variables, Indicators, Cutoffs and Weights of the MPI

Source: Based on (Alkire et al., 2023).¹ Children under 5 years (60 months and younger) are considered undernourished if their z-score of either height-for-age (stunting) or weight-for-age (underweight) is below minus two standard deviations from the median of the reference population. Children 5-19 years (61-228 months) are identified as deprived if their age-specific BMI cutoff is below minus two standard deviations. Adults aged 20 to 70 years (229-840 months) are considered undernourished if their Body Mass Index (BMI) is below 18.5 m/kg².² The child mortality indicator of the global MPI is based on birth history data provided by mothers aged 15 to 49. In most surveys, men have provided information on child mortality as well, but this lacks the date of birth and death of the child. Hence, the indicator is constructed solely from mothers. However, if the data from the mother are missing, and if the male in the household reported no child mortality, then we identify no child mortality in the household.³ If all individuals in the household are in an age group where they should have formally completed 6 or more years of schooling, but none have this achievement, then the household is deprived. However, if any individuals aged 10 years and older reported 6 years or more of schooling, the household is not deprived.⁴ Data source for the age children start compulsory primary school: DHS or MICS survey reports; and http://data.uis.unesco.org/⁵ If the survey report uses other definitions of solid fuel, we follow the survey report.⁶ A household is considered non-deprived in sanitation if it has some type of flush toilet or latrine, or ventilated improved pit or composting toilet, provided that they are not shared. If the survey report uses other definitions of improved sanitation, we follow the survey report.⁷ A household is considered non-deprived in drinking water if the water source is any of the following types: piped water, public tap, borehole or pump, protected well, protected spring, or rainwater. It must also be within a 30-minute walk, round trip. If the survey report uses other definitions of improved drinking water, we follow the survey report.⁸ A small number of countries do not collect data on electricity because of 100% coverage. In such cases, we identify all households in the country as non-deprived in electricity.⁹ Deprived if floor is made of natural materials or if dwelling has no roof or walls or if either the roof or walls are constructed using natural or rudimentary materials. The definition of natural and rudimentary materials follows the classification used in country specific DHS or MICS questionnaires.

Of the 52 countries, 39 estimations were based on the Multiple Indicator Cluster Survey (MICS), which used the child functioning disability module for children 2 to 17 years older, developed by the Washington Group and validated in different contexts. In 15 countries, MICS also included information on disability for women and men of reproductive age. In addition, 12 Demographic and Health Surveys (DHS) included the Washington Group Short Set of questions for all household members. In these cases, we compute disability following the suggestions made by the WG, where a person with disabilities is identified as someone who reported facing severe difficulty or cannot do at least one of the six domains. We computed, in this case, disability for persons five years or older (Table 2). Finally, we aggregated the information on disability at the household level and identified households with and without members with disabilities. When we had information for children and adults, the information was not combined. Instead, the households were analysed independently in each group (households with children with disabilities and households with adults with disabilities).

Table 2: Number of countries and their survey types per region.

Using the global MPI, we disaggregated the measure by disability status at the household level. We analysed and compared the incidence, intensity, MPI, censored headcount ratios and percentage contributions between households with and without members with disabilities.

3. Results and Discussion

The results of the analysis show that households with members with disabilities (adults or children) face significantly higher levels of multidimensional poverty in 21 of the 52 countries. In total, 15 countries have households with children with disabilities where the levels of multidimensional poverty are higher compared to households without children with disabilities, and six countries have households with adults with disabilities with higher levels of multidimensional poverty compared to households without adults with disabilities. The intensity of poverty was significantly higher in ten countries.

When we analysed the censored headcount ratios of households with adult members with disabilities, we found that depending on the country, households with members with disabilities face higher levels of deprivation in years of schooling and are multidimensionally poor compared to households without members with disabilities. In countries such as Haiti, households with adults with disabilities face significantly higher levels of deprivation in all indicators included in the MPI.

When we grouped countries by region, we identified that countries in Africa face the largest differences between households with and without children with disabilities. The indicator with the largest contribution to the MPI in most of the countries was nutrition, revealing that the censored headcount ratio (percentage of people deprived of nutrition and multidimensionally poor) in nutrition was higher for households with children with disabilities compared to households without children with disabilities.

4. Discussion and conclusions

Persons with disabilities and their families face high levels of deprivation and multidimensional poverty around the world. The global MPI covers over 100 countries and 6.1 million people in developing regions. Of those, we found that 1.3 billion correspond to people living in households with persons with disabilities. Persons with disabilities and their families are more likely to be multidimensionally poor in all regions of the world. In addition, households with children with disabilities face higher levels of poverty and deprivation in 15 countries. They are more likely to be multidimensionally poor and deprived of nutrition indicators. In the case of households with adults with disabilities, depending on the country, households with members with disabilities are more likely to face higher deprivations in school attendance and other indicators in the health, education and living standard dimensions.

Although global levels of multidimensional poverty have reduced over time, the findings of this research show that persons with disabilities have been left behind in development. Indeed, in most countries, this group presents higher levels of multidimensional poverty and deprivation, and even in counties with high levels of poverty, persons with disabilities are part of the poorest groups. This is a common finding across the distribution of levels of poverty and development, revealing that policies implemented to reduce deprivation have not reached persons with disabilities.

Children with disabilities and their families face higher levels of deprivation in nutrition. According to Rotenberg et al. (2024), children with disabilities face higher levels of undernutrition and are more likely to be stunted compared to children without disabilities. Therefore, it is important to analyse if children with disabilities are the ones creating the deprivation and in which cases children with disabilities are deprived of nutrition and also live in households where other children are not deprived in this indicator.

This is the first study that computes the levels of multidimensional poverty of households with children and adults with disabilities around the globe. In the last decade, the number of household surveys, including comparable questions on disability, has increased (Mitra and Yap, 2021). This increase has been mainly due to including the child functioning module for children 2 to 17 in MICSs. In addition, DHS has included the WG-SSQ as one of the optional modules, which has also contributed to the increase of sources of information, including questions on disability in LMICs. However, there are still important data concerns and limitations regarding how to measure disability. Indeed, of the 110 countries included in the global MPI, only 52 have included questions on disabilities. While numerous, these countries only cover 1.3 billion persons, corresponding to 21 per cent of the total population covered by the global MPI. It is essential to highlight that multidimensional poverty better captures the deprivations faced by persons with disabilities and their families and should complement monetary poverty measures. According to Pinilla-Roncancio (forthcoming), multidimensional poverty measures better capture the deprivations of persons with disabilities, and it is a better option for this group’s measurement of poverty. It is important to continue disaggregating multidimensional poverty measures, such as the global MPI by disability status, and to tailor multidimensional poverty measures by disability.

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[1] School of Medicine, Universidad de los Andes. E-mail: mv.pinilla@uniandes.edu.co

[2] Oxford Poverty and Human Development Initiative.

[3] Sustainable Development Goals Centre, Universidad de los Andes.