Chapter 1. Introduction and Background

“[W]e cannot fulfill both the moral and the economic imperatives of development unless we universalize the opportunities we help to create. [We] will work to mainstream disability perspectives throughout the programs and policies of State and USAID, respectively.”—Quadrennial Diplomacy and Development Review, Leading Through Civilian Power, U.S. Department of State and USAID (December 2010).

The Situation of People with Disabilities in Developing Countries

The World Report on Disability, released in 2011 by the World Health Organization and the World Bank, reveals that more than one billion people, 15 percent of the world’s population, have a disability.[1] The report discloses that the global population of people with disabilities is higher than previously estimated, and that the population is continuing to grow.[2]

The experience of disability for people living in developing countries is more profound than for those in developed countries. As the World Report on Disability notes, disability disproportionately affects vulnerable populations:

Results from the World Health Survey indicate a higher disability prevalence in lower income countries than in higher income countries. People from the poorest wealth quintile, women, and older people also have a higher prevalence of disability. People who have a low income, are out of work, or have low educational qualifications are at an increased risk of disability.[3]

Furthermore, studies estimate that only 2 percent of people with disabilities in developing countries have access to rehabilitation and appropriate basic services.[4] Research suggests that only 2 to 3 percent of children with disabilities attend schools in developing countries.[5] Poverty and social exclusion lead to multiple disadvantages and forms of discrimination in other spheres, including employment, housing, and participation in community life.[6] The barriers that limit the participation of people with disabilities also preclude their participation in development-planning decisions that could advance their inclusion in society.[7]

The situation of people with disabilities in developing countries underscores the critical need to ensure that foreign assistance programming is directed toward advancing disability rights and eliminating barriers to inclusion for people with disabilities. The importance of ensuring the participation of people with disabilities in foreign assistance programming has been further exposed by the increased attention to the human rights of people with disabilities and the prevalence of disability discrimination worldwide,[8] prompted in part by the adoption of the Convention on the Rights of Persons with Disabilities[9] by the United Nations in 2006. The failure to reach this significant population in foreign assistance programming impacts a large segment of society in developing countries and is beginning to emerge as a major concern among numerous bilateral and multilateral development agencies around the world.[10]

The Role of the United States

The United States has an important role to play in improving the situation of people with disabilities throughout the world. The United States contributes substantial funding to foreign assistance and has in place the legal framework to ensure that people with disabilities can both access and benefit from such assistance. American disability rights laws provide essential guidance for U.S. Government agencies in implementing foreign assistance programs that are inclusive and accessible to people with disabilities. Further, it is the stated policy of USAID to make development, stability, and humanitarian assistance efforts accessible to all.[11] The United States is a signatory to the Convention on the Rights of Persons with Disabilities (CRPD), and significantly, the CRPD requires that international development programs be inclusive of people with disabilities.[12] As the world’s largest bilateral development donor[13] and a world leader in domestic disability rights law and policy, the United States should ensure that taxpayer dollars support foreign assistance programs that are inclusive of and accessible to people with disabilities.

In 2010 the U.S. Department of State (DOS) released the Quadrennial Diplomacy and Development Review (QDDR),[14] modeled on the Quadrennial Defense Review (QDR).[15] The QDDR focuses on four components of reform for both DOS and USAID:

  1. Adapt international diplomacy to new threats and opportunities;
  2. Transform development assistance to deliver results and reestablish USAID as the world’s premier development agency;
  3. Improve the ability of the United States to operate in fragile states and help stop conflicts before they happen; and
  4. Improve approaches to planning, procurement, and personnel.

Significantly, the inaugural QDDR articulates the future diplomatic and development goals of DOS and USAID, underscores the importance of including people with disabilities, and commits to disability inclusion in both the programs and policies of DOS and USAID.[16] The reform agenda set forth in the QDDR clearly presents both an opportunity as well as a challenge for disability inclusion in the work of DOS and USAID.

Purpose and Structure of Report

The purpose of this report is to assess the implementation of disability inclusion in U.S. Government-funded overseas facilities, programs, and employment opportunities. In particular, the report analyzes how U.S. federal disability law and policy applies to U.S. foreign assistance work and reviews the application of disability inclusion in three specific areas of U.S. foreign assistance: (1) accessibility of U.S.-funded overseas construction and infrastructure projects; (2) access to and inclusion of people with disabilities in U.S.-funded international development programs; and (3) employment opportunities for people with disabilities. The report also reviews the relevance of international development provisions under the CRPD, of which the United States is a signatory and may ratify in the future. Given the ratification of the CRPD in more than 100 countries around the world, including many countries where the U.S. Government is a major donor of foreign assistance, the CRPD provisions on disability inclusive development assume particular significance.

The report focuses on the work of USAID, DOS, and the U.S. Department of Defense (DOD), as they contribute the bulk of U.S. funding overseas. However, many of the recommendations here are equally relevant for other U.S. Government agencies that fund programs overseas.

Following the introduction, the report is divided into nine chapters. Chapter 2 lays out the research methodology used in the study. Chapter 3 considers U.S. federal disability rights laws and their application to federal foreign assistance programming. Chapter 4 provides an analysis of disability-inclusive development within the context of international disability rights standards, including the CRPD. Chapter 5 reviews the USAID Disability Policy and how it is currently being implemented in development programs. Chapter 6 provides an overview of selected sectors of USAID’s development programming, as well as an analysis of how accessible and inclusive those sectors are to people with disabilities. Chapter 7 focuses on DOS and reviews its Country Human Rights Reports as well as embassy accessibility and cultural exchange programs. Chapter 8 reviews laws and policies used by DOD in overseas building and infrastructure efforts. The report concludes by setting forth recommendations that will secure continued U.S. leadership in inclusive development.


[1] World Health Organization [hereafter WHO] and the World Bank [hereafter WB], Summary: World Report on Disability, 7–8 (2011).

[2] Id. at 7.

[3] WHO and WB, supra note 1, at 8.

[4] See Leandro Despouy, Human Rights and Disabled Persons (Study Series 6), Centre for Human Rights, Geneva, and United Nations, New York (1993).

[5] See S. Peters, “Education for All: Including Children with Disabilities,” Education Notes (August 2003). See also D. Filmer, “Disability, Poverty and Schooling in Developing Countries: Results from 14 Household Surveys,” 22 WB Econ. Rev. 141–63 (2008).

[6] UN Secretary-General, UN, Social Development: Questions Relating to the World Social Situation and to Youth, Aging, Disabled Persons and the Family, Implementation of the World Programme of Action Concerning Disabled Persons and the United Nations Decade of Disabled Persons, paragraph 5, address before the General Assembly (September 11, 1992), UN Document A/CONF.47/415.

[7] See Jen Betts and Jonathan Flower, “Towards a Level Playing Field: A Call to Make Development Programs More Inclusive,” in All Things Being Equal 7 (World Vision, Autumn 2001). See also Jonathan Flower, Mid-term Evaluation of CBR Programme in Mandalay and Rangoon, report written for World Vision and DFID, UK, 2001.

[8] Human rights violations against people with disabilities, many of an egregious nature, are persistent, ongoing, and take many forms. See, for example, Disability Rights International [hereafter DRI] (formerly Mental Disability Rights International), Human Rights and Mental Health: Mexico, 13–41 (2000); DRI, Children in Russia’s Institutions: Human Rights and Opportunities for Reform, 10–23 (1999); Mental Disability Advocacy Center [hereafter MDAC], Cage Beds: Inhuman and Degrading Treatment or Punishment in Four EU Accession Countries, 36–41 (2003), files/English_Cage%20Beds.pdf; DRI, Behind Closed Doors: Human Rights Abuses in the Psychiatric Facilities, Orphanages and Rehabilitation Centers of Turkey, 24–25 (2005),; DRI, Torture Not Treatment: Electric Shock and Long-Term Restraint in the United States on Children and Adults with Disabilities at the Judge Rotenberg Center, 1–3, 12–13 (2010),; Human Rights Watch, As If We Weren’t Human (August 26, 2010), 2010/08/26/if-we-weren-t-human; DRI, Abandoned and Disappeared: Mexico’s Segregation and Abuse of Children and Adults with Disabilities (2010),

[9] Convention on the Rights of Persons with Disabilities [hereafter CRPD], GA Res 61/106, UN Doc A/RES/61/106 (December 13, 2006).

[10] See Janet E. Lord et al., World Bank, Disability and International Cooperation and Development: A Review of Policies and Practices (Social Protection Discussion Paper No. 1003, May 2010), Publications-Reports/Disability_and_Intl_Cooperation.pdf; see also Michael Ashley Stein, Charlotte McClain-Nhlapo, and Janet E. Lord, Disability Rights, the MDGs and Inclusive Development in Millennium Development Goals and Human Rights: Past, Present and Future (Malcolm Langford et al., eds., 2011).

[11] See U.S. Agency for International Development [hereafter USAID], “Disability Initiatives,”

[12] Id.

[13] Development aid rose in 2009 and most donors will meet 2010 aid targets, Organisation for Economic Co-operation and Development [hereafter OECD], April 14, 2010,,3343,en_2649_34447_44981579_1_1_1_374 13,00.html; OECD iLibrary, Development aid: Net official development assistance (ODA),

[14] U.S. Department of State [hereafter DOS] and USAID, Quadrennial Diplomacy and Development Review: Leading through Civilian Power [hereafter QDDR] (December 2010),

[15] Department of Defense [hereafter DOD], Quadrennial Defense Review Report [hereafter QDR] (February 2010), %2029jan10%201600.PDF.

[16] DOS and USAID, supra note 14.

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