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Are children with disabilities in school and learning? Evidence from a household survey in rural Pun

Invisibility of children with disabilities in data on educational access and learning is a key policy challenge for tracking progress towards the Sustainable Development Goals. In this article, we report findings from a household survey undertaken in rural Punjab, Pakistan. These data enable us to identify the extent to which children with disabilities are in school and learning the basics in literacy and numeracy. We find that, perhaps contrary to expectations, many of these children in this context are in mainstream (government and private) schools, although their chances of being in school are lower than their peers. We further find that overall levels of literacy and numeracy are low, even more so for children with disabilities. Our findings corroborate recent research from other countries. The paper highlights important lessons for the policy which are of relevance to other low-income contexts.

The Sustainable Development Goals (SDGs) have placed in the spotlight the need for timely, reliable, high-quality data on people with disabilities in order to track progress towards leaving no one behind (United Nations 2006). With respect to education, recent flagship global education reports identify that, not only are some of the most disadvantaged children still not completing primary school, but many of those in school are not learning. These reports highlight, however, that children with disabilities are often missing from the tracking of progress towards these education targets. They, therefore, promote the urgent need to identify approaches for the collection of robust data on their access and learning (UNESCO 2018; World Bank 2018; Education Commission 2016). Literature from Southern contexts (Singal, Lynch, and Taneja-Johansson 2019) has further highlighted the challenges of identifying children with disabilities in large-scale datasets including, for example, due to risks of stigmatisation and under-reporting. Recent advances have been made to tackle these challenges through the development of the Washington Group questions on disability. These questions are increasingly being incorporated in household surveys but have so far rarely been used to identify the education experiences of children with disabilities in low-income contexts. In the limited studies that are available, the evidence indicates that children with disabilities are more likely to be out of school and, for those in school, less likely to have the opportunity to learn compared with their peers. Questions remain on the extent to which disability interacts with other identifiers of disadvantage that hold back access and learning, such as poverty – an issue we seek to address in this paper. Drawing on the use of the Washington Group questions in our household survey in rural areas of the Punjab Province of Pakistan, this article aims to advance evidence with respect to children with disabilities in Southern contexts by showing the extent to which they are in school and learning. Providing lessons for other low-income contexts, it highlights that collecting such data is both feasible, and highly informative for tracking progress towards national and global goals and for setting national education strategies. We begin by outlining key evidence on what is known about educational access and learning of children with disabilities in Southern contexts. This is followed by an overview of the challenges commonly faced in measuring disability, particularly childhood disability, together with recent developments to improve the identification in large-scale surveys. We then outline the approach adopted in our project for data collection and analysis, and present the findings. We conclude by discussing the implications of our findings and methodological considerations of our approach.

Literature review This section reviews key literature on identifying children with disabilities in large-scale datasets, and their educational access and learning in Southern contexts. The section further identifies the policy climate within Pakistan with respect to the education of children with disabilities. Identifying children with disabilities in large-scale datasets Article 31 of the UN Convention on the Rights of Persons with Disabilities (UNCRPD) encourages States to collect appropriate information, including statistical and research data, to enable them to formulate and implement policies to give effect to the Convention. Moreover, the SDGs highlight the need for high-quality, timely and reliable data disaggregated by disability, along with other markers of disadvantage. As Cappa, Petrowski, and Njelesani (2015) note, such data are crucial for identifying where inequities exist across populations, for monitoring and planning both at policy and programme levels, and in providing evidence for advocacy purposes. Until recently, disability has often been absent as a variable in large-scale datasets for a range of reasons. A common argument is that disability is a complex construct with little clarity around how it is conceptualised and, therefore, how to measure it (WHO, 2011). In Uganda, Lwanga-Ntale (2003, 4) notes problems with identifying disability in datasets as, when translated into the local language, the term was commonly used for those with physical impairment, mostly of upper and lower limbs. He noted that in most dialects, there is no single word that translated into the English word ‘disability’. This is similar to the experience in other settings, for example in Hindi (one of the languages used in India), there is no simple and standard translation for the word ‘disability’ (Singal 2010). Previous studies that have aimed to identify people with disabilities have found potential biases in who is included. In rural Tamil Nadu (India), Erb and Harriss-White (2001) found that the self-reported rates of disability were significantly biased towards upper-caste Hindus. They inferred that ‘scheduled caste people have to be more severely disabled than other inhabitants of the caste settlement before they will publicly acknowledge their infirmity’ (16). In some contexts, such discrepancies in reporting can be due to a greater willingness to be identified as having a disability amongst those informed about the possibility of claiming social benefits (Jeffery and Singal 2008). As understandings of disability have evolved and the importance of identifying people with disabilities in datasets increasingly acknowledged as important, common approaches adopted in large-scale surveys and censuses have been criticised. These have often asked about the presence or absence of disability amongst household members. Such an approach is likely to result in under-reporting. Taking Pakistan as an example, the 1998 census asked the question, ‘Do you suffer from any type of disability: physical disability, visual impairment, hearing impairment, mental disability, or overlapping?’ Such questions are likely to result in underreporting as labelling individuals as ‘disabled’ in questions could be stigmatising. In the National Census 2017, a similar question focusing on the presence or absence of disability was incorporated. The question on disability was introduced after much lobbying by disability groups and included under the ‘sex’ column of the census form. Initially, the census form had allotted three codes: ‘1ʹ was for male, ‘2ʹ was for female and ‘3ʹ was for transgender residents. On the orders of the Supreme Court, two additional codes were added to the code sequence: ‘4ʹ for disabled man, ‘5ʹ for disabled woman and ‘6ʹ for a disabled transgender person. The incorporation of a complicated question in mid-cycle of census collection has raised concerns around the reliability of the data gathered. As an alternative to this approach, disability prevalence can also be established through assessment and diagnostic measures undertaken by health professionals. This approach was used in the 2012 Pakistan Alleviation Fund – Disability Evaluation Report, but is more expensive and difficult to undertake on a large scale, given the paucity of trained health professionals. In recognition of the shortcomings of existing approaches, the Washington Group on Disability Statistics was established under the United Nations Statistical Commission to ‘ … Address the urgent need for cross-nationally comparable population based measures of disability.’1 Questions on disability developed by the Washington Group represents the most recent thinking around disability and draw support from the UNCRPD. Here persons with disabilities are defined to ‘include those who have long-term physical, mental, intellectual or sensory impairments which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others’ (UNCRPD 2007, 4).2 Over the years, the Washington Group has developed three sets of questions:

  1. The Washington Group Short Set of Questions on Disability: a short set of questions focused on assessing functioning of adults.

  2. The Extended Set of Questions on Functioning: a long set of questions focused assessing the functioning of adults.

  3. Child Functioning Moule (CFM): (i) for children under 5 years (ii) for children 5 to 17 years.

The questions developed by the Washington Group both are intended to be simple to administer and do not raise concerns of stigmatisation as they do not require respondents to label themselves or others as disabled (Groce and Mont 2017). Furthermore, the questions provide the opportunity for international comparability, and have been developed using a rigorous methodology.3 Recent evidence on access and learning of children with disabilities As also articulated by Mizunoya, Mitra, and Yamasaki (2018), our starting point is that education disadvantage with respect to access and learning for children with disabilities is not inevitable. However, it is frequently claimed that children with disabilities are less likely than their peers to be in school. It is recognised that the extremely limited available reliable data make it difficult to substantiate such claims. Where figures on the proportion of children out of school with disabilities are reported, the origins of these numbers are uncertain (Rose 2019). As noted, a key reason for the lack of reliable data is the limited identification of people, and even more so children, with disabilities in large-scale data sets. Moreover, the evidence that does exist focuses primarily on access to school. While there is growing qualitative evidence to suggest that children with disabilities are more likely to be neglected and excluded from teaching and learning in mainstream classrooms in many Southern contexts (Singal 2019; Urwick and Elliott 2010; Vorapanya and Dunlap 2014), there is more limited quantitative evidence on the learning gains made by children with disabilities in these settings (Singal et al. 2018). A World Bank report by Filmer (2008) is one of the first studies to look more systematically at disability data with respect to education. Analysing data across 14 countries over the period 1992–2005, it showed a common pattern of the relative disadvantage children with disabilities face, although with wide variation. These variations might in part be due to different approaches to identifying disability in the datasets. Given the timing of the datasets precede Education for All and the Millennium Development Goal campaigns which led to a rapid expansion in enrolment, more up-to-date information is now needed to identify if this expansion has benefited children with disabilities (Mizunoya, Mitra, and Yamasaki 2018). The 2011 World Disability Report is perhaps the most comprehensive review, although also dated. Based on data from 2002–2004, it estimated that, across 51 countries responding to their survey, only around 42% of girls with disabilities completed primary school (WHO, 2011). More recently, data on disability from 49 predominantly low- and middle-income countries gathered between 2005 and 2015 has been used to identify patterns in access to schooling (UNESCO Institute for Statistics 2018). It finds that, in 37 countries with data amongst 15- to 29-year-olds, on average 87% of persons without disabilities attended school, compared to 77% of persons with disabilities. While this disability gap is notable, it is perhaps not as wide as often thought, although there are again wide variations across countries (in part due to differences in the way in which disability is identified in datasets). The paper concludes by recommending a need for more comprehensive and comparable data on disability, drawing on the Washington Group set of questions. Beyond these primarily descriptive studies that point to an education access-disability gap, there is a small but growing literature aiming to identify the determinants of school access and attendance for children with disabilities. The most comprehensive of these is an analysis by Mizunoya, Mitra, and Yamasaki (2018) drawing on data collected from 15 countries between 2005–2012. Using the short set of Washington Group questions (designed primarily for adults and so likely to under-estimate prevalence amongst children), the paper identifies that the disability gap in out-of-school rates varies widely across country contexts. Multivariate analysis shows a consistent negative and statistically significant relationship between disability and school attendance. Moreover, their results indicate that the effect of socioeconomic status on the attendance of children with disabilities appears limited. There remains an even greater paucity of data that enables similar analysis for learning. One study in a Southern context draws on data collected in 2008–9 based on a sample of 1,436 children in Darfur, Sudan (Bakhshi, Babulal, and Trani 2018). The research used a 35 item validated disability screening questionnaire to identify children with disabilities, and collected data on children’s ability to read, write and count. It found that disability was not significantly associated with either children’s access or basic learning. This could be due to low levels of learning for all children in such a conflict-affected setting, regardless of whether they have a disability. Another study, drawing on the 2005 India Human Development Survey that included an adaptation of the Washington Group questions along with achievement tests in reading, writing and mathematics (Takeda and Lamichhane 2018), concluded that children with disabilities had significantly lower achievement scores compared with those without disabilities. However, interacting disability with being in school, their analysis showed that once children with disabilities had the opportunity to access education, they were less likely to fall behind. Education for children with disabilities in Pakistan While there is emerging evidence on access and learning for children with disabilities, as the previous section has identified, this is still nascent. For our analysis, we have chosen to focus on Pakistan where education for children with disabilities has become an increasing key policy focus in recent times, in line with the global spotlight more broadly (Singal 2016a). In 2010, the government put in place a Right to Education Act, although strategies are not yet implemented to ensure children facing different forms of disadvantage are able to realise this right (RTE, 2019). Like many countries, Pakistan has experienced rapidly expanding primary school enrolment. However, recent data from Annual Status of Education Reports (ASER) finds wide disparities between richer and poorer states in rural Pakistan and, even within the richest states, poor girls perform worse than their richer counterparts (Alcott and Rose 2015). There is also emerging evidence on both access and learning for children with disabilities from ASER data in the Punjab province in Pakistan. Using the short set of Washington Group questions, 1.2% of the sample are identified as having difficulties in seeing, hearing, walking, caring, understanding or remembering. Based on this sample, a gap in access and learning between children with disabilities and those without is identified (Singal et al. 2018). We build on this emerging evidence by developing a more detailed household survey drawing on the full set of Washington Group CFM questions. Given the diversity of education experience in Pakistan, we selected Central Punjab as it represents a midrange in terms of educational access. Given our interest in identifying the particular challenges that disadvantaged children face, we chose to focus on rural districts .


In this section, we present analysis responding to our two research questions with respect to access and learning for children with disabilities. Before doing so, we begin with prevalence rates for disability in our sample, showing how this differs from other estimates in Pakistan. We also show how these intersect with variables such as gender and household wealth.

Prevalence of disability Our findings estimate that disability prevalence among 8–12 years in our sample is around 11% in rural Central Punjab, Pakistan. This is considerable higher than in other surveys (Table 1). It is, however, more in line with global figures estimated by the WHO. WHO (2011, 53) notes that ‘over a billion people (or about 15% of the world’s population) were estimated to be living with disability’. Importantly, using the CFM, our data enable us to capture difficulties in functionings that might affect children in particular that other surveys could miss.8 Table 1. Prevalence rates of disability in censuses and surveys in Pakistan1. CSVDisplay Table

Household wealth, gender and disability Our data suggests that prevalence rates for disabilities for girls and boys are similar in our sample (Figure 1). However, children with disabilities are more likely to be in poorer households: around 15% of children in the poorest quartile of the sample are reported to face moderate to severe difficulties compared with 7% of those in the richest quartile. It should be noted that this translates into relatively small numbers overall (for example, 24 children from the richest quartile in the sample are reported to have a moderate to severe difficulty), so caution is needed. It is, however, consistent with other studies that similarly show the interconnection between poverty and disability (Mitra, Posorac, and Vick 2012). Figure 1. Intersection of disability with gender and poverty. Source: Teaching Effectively All Children survey. Display full size

Are children with disabilities are in school? If so, what type of school are they attending? Our data identify variations in school enrolment depending on the severity of disabilities. It should be noted that Central Punjab, the area selected for the TEACh survey, has higher levels of enrolment than some of the more disadvantaged areas of the country. For example, according to ASER Pakistan data, Central Punjab has an overall enrolment rate of 90%, compared with 83% in Southern Punjab, or 66% in Sindh. In our sample, the vast majority of 8–12-year olds without disability were in school, with only around 6% out of school (Figure 2). By comparison, almost one-quarter of those identified with moderate to severe disabilities were out of school. With respect to specific functionings, a significant proportion of those facing difficulties in walking are out of school, although the sample size is small: nine out of 15 children reported to have moderate to severe difficulties with walking are out of school. This could suggest the lack of basic adapted facilities in schools, such as ramps, aids and appliances, adapted teaching and learning materials which might prevent these children from accessing schools and the curriculum. However, a larger sample size would be needed for more meaningful analysis. Figure 2. Children out of school by the severity of disability. Source: Teaching Effectively All Children survey. In this context where a reasonable proportion of children are in school, including those with disabilities, it is also notable that some children identified with disabilities are in private schools . The proportion in private schools is higher for boys, suggesting that parents are more likely to be willing to invest in their son’s education whether or not they have a disability. By contrast, a larger proportion of girls, irrespective of their disability status, are likely to be out of school. Even so, the fact that around one quarter of boys and one-fifth of girls with moderate to severe disabilities are found enrolled in private schools deserves further investigation. It should again be noted that the absolute numbers in these categories are very low given the small sample sizes of the sub-categories. Figure 3. Type of school attended by disability and gender. Source: Teaching Effectively All Children survey.

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