Conceptualisation and analysis of disability

their non-disabled peers 26 compared to 52 percent. Not attending school at present means that for the future, disabled children further minimize their already slim chances to find decent work on the labour market. For secondary school middle and high school combined, the corresponding rates indicate even smaller chances to attend school for disabled children 17 percent compared to 45 percent for non-disabled children, although the effect is primarily with boys. Table 8.10 Disability, by sex, and by cause of disability Cause of disability Sex Male Female Both sexes Thousands Percentage Thousands Percentage Thousands Percentage Traffic accident 7 3 3 1 10 2 Work accident 16 6 8 4 24 5 Other accident 17 6 10 5 27 6 Mines, explosives 24 9 4 2 28 6 Conflicts, war 25 10 7 3 32 7 Illness 78 30 82 41 160 35 Old age 83 32 84 41 167 36 Drugs 2 1 2 Other 9 4 5 2 14 3 Total 260 100 202 100 462 100 Table 8.11 Net-attendance rates of the school-age population, by sex, school age, and by disability status Disability status, school attendance Sex, school age Boys Girls Both sexes Primary age 7-12 Secondary age 13-18 Primary age 7-12 Secondary age 13-18 Primary age 7-12 Secondary age 13-18 Not disabled 61 56 42 32 52 45 Disabled 30 19 20 14 26 17 Total 61 56 42 32 52 44 The ratio of net primary attendance rates between disabled and non-disabled children is similar for girls and boys, although the level of attendance for the former is significantly lower. This suggests that there is no gender dimension in the probability of sending disabled children to primary school. In similar vein, Figure 8.6 shows that disabled persons are significantly less active on the labour market. The labour force participation rate for disabled men is around half that of the non-disabled, and for women it is even as low as around one- third. Moreover, among the disabled people who are currently active, a higher percentage is unemployed than among the non-disabled population as shown by the unemployment rates for the respective groups. Health 89 Health 90 Figure 8.6 Labour force participation rates and unemployment rates, by disability status, sex

8.6 Conclusions

For various health indicators, the NRVA provided new information to assess the health status in the population and the performance of the health sector of Afghanistan. To the extent that methodological similarities allow, trends can be established by comparing the present results with the findings of the MICS 2003, NDSA 2005, NRVA 2005 and AHS 2006. The overall conclusion of this assessment is that many health indicators are improving, but remain well below desirable levels, and are often abysmal in comparison to levels in other countries. The build-up of health infrastructure and access to health services, especially in rural areas, are badly needed. It is, therefore, not surprising to find that improvement of health facilities invariantly ranks among the top priorities for community development, regardless of gender perspective. Presently, of the large rural majority seeking affordable public health care only about half 54 percent can reach a facility within one hour walking. In remote areas, where motorized transport is required to reach health centers, transport costs play an additional role as barrier to health care access. Women are in a particularly disadvantaged position since they usually cannot travel alone, which doubles out-of-pocket expenditure on transportation. In addition, lack of female staff – only 29 percent of nearest health posts has a female community health worker – feeds the resistance to health center visits by women in need of medical assistance, probably especially if it concerns reproductive health. These factors contribute to the low use of family planning 23 percent overall, 15 percent using modern contraceptive methods, antenatal care 36 percent and skilled birth attendance 24 percent, and denies many women life-saving emergency obstetric care. Early pregnancies, closely spaced births 53 percent of reported birth intervals less than 24 months and bearing many children a TFR of 6.3 further make women pay a high price for giving new life. For almost all indicators, the figures underline the substantial differences that exist between rural, urban and Kuchi populations. Whereas the NRVA analysis paints a harsh reality, it also discovers some hopeful signs of improvement. Section 3.3.2 reported that for successive younger cohorts the share of women marrying before age 20 declined and section