AMERICAN ACADEMY OF DEVELOPMENTAL MEDICINE & DENTISTRY
Differences Between Women and Men with Disabilities
Disabilities BY H. BARRY WALDMAN, DDS, MPH, PHD, RICK RADER, MD, FAAIDD, FAADMD, DHL (HON) AND STEVEN P. PERLMAN, DDS, MSCD, DHL (HON)
"Attitudinal barriers confronting (women) with disabilities are constructed out of myths and stereotypes, many of which harken back to the superstitions of ancient history that regarded the disabled as evil, possessed by the devil, or being punished for past evils." 1 (Note: These ancient evil perceptions were to some degree associated with the fact that healthy women would periodically experience unexplained vaginal bleeding with no symptoms of illness.)
There is a well-known expression "men are from Mars; women are from Venus." It was promoted to describe the distinct differences in the emotions, perspective, outlook and behavior of males and females. While there are several moving parts in the contrasts, there is one that has not been widely considered as a major divider, and that is a disabling condition. The question of how disabilities, abilities, ableism, inclusion and personhood can bring men and women together or serve to promote confusion, misunderstanding and separatism is worth examining.
WORLDWIDE
"For far too long, women and girls with disabilities have been invisible, both to the advocates of women's rights and of disability rights, and this has increased their vulnerability. Women and girls with disabilities… are likely to experience the 'double discrimination,' which includes the gender-based violence, abuse and marginalization. As a result, women with disabilities often must confront additional disadvantages even in comparison to men with disabilities and the women without disabilities." 2 (UN Report)
GENDER AND DISABILITY
The 2011 World Report on Disability indicates that the female disability prevalence rate is 19.2 percent, whereas it is 12 percent for men.
• The global literacy rate is as low as three per cent for all adults with disabilities, and one per cent for women with disabilities.
• Although all persons with disabilities face barriers to employment, men with disabilities have been found to be almost twice as likely to be employed as women with disabilities.
• Women and girls with disabilities experience higher rates of gender-based violence, sexual abuse, neglect, maltreatment and exploitation than women and girls without disabilities and are three times more likely to experience gender-based violence compared to non-disabled women. 2,3
CONTRIBUTING FACTORS
Actions and initiatives often do not give adequate attention to the gender gap in disability. For example:
• Double discrimination faced by women and girls with disabilities are often compounded by other factors such as being minorities, indigenous people, refugees, persons living with HIV and AIDS and as older people.
• Women and girls with disabilities are discriminated differently from men, i.e.: women are at higher risk of sexual violence, forced sterilization and forced abortion.
• Lack of empowerment and capacity development of women and girls with disabilities, limits their future leadership and participation in the decision making in political, economic and social spheres.
As a result of aging and longer life expectancy of women, the number of women with disabilities is likely to be become higher in many populations than the number of men with disabilities. Many older women who are disabled may lack access to services/support. 2,3
In all countries, they face significantly more difficulties – in both public and private sectors – in attaining the social determinants of health, such as adequate housing, health, education, vocational training and employment. They also experience inequality in hiring, promotion rates and pay for equal work, access to training and retraining, credit and other productive resources, and rarely participate in economic decision making.
CONTRIBUTING FACTORS
About 36 million women in the U.S. have disabilities – and the number is rapidly growing. About 44% of those aged 65 years or older are living with a disability. The most common cause of disability for women is arthritis or rheumatism. 4
The percentage of the disability population that is male is lower in metropolitan counties (47.5%) and higher in micropolitan (49.8%) and noncore counties (50.7%). However, for women, the percentage of the disability population is higher in metropolitan (52.5%) and lower in micropolitan (50.2%) and noncore counties (49.3%). 5
About 1 in 4 of all women have experienced contact sexual violence, physical violence, and/or stalking by an intimate partner during their lifetime. Research also has shown that women with a disability are more likely to experience intimate partner violence (IPV) than those without a disability. Women with a disability were significantly more likely to report experiencing each form of IPV measures which included rape, sexual violence, stalking, psychological aggression, and control of reproductive or sexual health. 6
In 2006, disability-associated health care expenditures accounted for 26.7% of all health care expenditures for adults residing in the United States and totaled $397.8 billion, with state expenditures ranging from $598 million in Wyoming to $40.1 billion in New York. Of the national total:
• Medicare paid $118.9 billion.
• Medicaid paid $161.1 billion.
• Non-public sources paid $117.8 billion.
In part, the magnitude of disability-associated health care expenditures stemmed from the high prevalence of disability among the adult population, with 18.2% of all adults reporting a limitation in some way in at least one activity because of physical, mental, or emotional problems. 7
WOMAN'S WORK: In all countries, women experience inequality in hiring, promotion rates and pay for equal work, access to training and retraining, credit and other productive resources, and rarely participate in economic decision making.
"Women with disabilities have historically been neglected by those concerned with issues of disability as well as the feminist movement. It is only within the last decade that serious attempts have been made to identify and understand the forces shaping their lives. These attempts have mainly focused on understanding how being female and having a disability interacts and how women with disabilities view their experiences."
According to a Bureau of Statistics report, the unemployment rate among women with disabilities is 9.4%, whereas it is 4% for those without disabilities. That means women with disabilities are more than twice as likely to be unemployed than are their nondisabled counterparts. (Note: The group with the next highest rate is Black Americans, at 6.8%.) The Bureau also shows that only 28% of women with disabilities were employed in 2018, compared to 68.6% of women without disabilities. Meanwhile, 31.7% of men with disabilities were employed. 9
WE KNOW THE NUMBERS, WHAT'S NEXT?
"Unwittingly or not, mainstream feminists have long been excluding their disabled sisters in their activism. Often times this is due to the lack of empathy or awareness. Non-disabled feminists are too frequently unaware of their own privilege and ableism when it comes to the intersection of feminism and disability. Financial freedom is ultimately one of the critical components for a woman, or anyone, to live independently. It is often the driving force for someone to get out of an abusive relationship, for example. This is all the reasons why feminist movements must include women with disabilities." 9
REALITIES TO BE ADDRESSED – AN EXTENDED SERIES OF STEPS MUST BE INCLUDED
SERIES OF STEPS MUST BE INCLUDED Gender Violence: Women with disabilities experience high rates of violence, both at the hands of family members and of personal assistants.
Access to Justice: Access to justice for any historically marginalized group is essential in order to address wrongs and seek remedies. Access to Rehabilitation Services: Services that do exist are very often inaccessible or unavailable to women and girls. Access to Essential Health Care: Women and girls with and without disabilities also face major barriers related to their right to basic health care.
Right to Sexual and Reproductive Health Care: Women with mental and physical disabilities must fight to participate in decisions about their health care.10 One area of women's health that has not received enough attention is the oral-systemic relationship which includes specific women's issues, such as: menstruation, pregnancy, menopausal osteoporosis, and oral contraception. 11 Right to Marry and Form a Family: Women with disabilities also face limitations on their rights to marry and have a family. Education and Literacy: Disability discrimination combined with cultural and gender discrimination sometimes keeps women and girls with disabilities out of school. Workplace Discrimination: Often, the labor market does not adequately accommodate women with disabilities. Not being able to fulfill job requirements or that reasonable accommodation will be extensive and costly. Adequate Standard of Living: When women are most valued for their productive and reproductive capacities, women with a disability face even greater discrimination. Women with disabilities: Must take on leadership roles. 10
IF NOT BY YOU, THEN WHO? •
AMERICAN ACADEMY OF DEVELOPMENTAL MEDICINE AND DENTISTRY
The American Academy of Developmental Medicine and Dentistry (AADMD) was organized in 2002 to provide a forum for healthcare professionals who provide clinical care to people with neurodevelopmental disorders and intellectual disabilities (ND/ID). The mission of the organization is to improve the quality and assure the parity of healthcare for individuals with neurodevelopmental disorders and intellectual disabilities throughout the lifespan.
ABOUT THE AUTHORS:
H. Barry Waldman, DDS, MPH, PhD is a SUNY Distinguished Teaching Professor, Department of General Dentistry, Stony Brook University, NY. E-mail: h.waldman@stonybrook.edu. Rick Rader, MD, DHL (Hon) is the Director of the Morton J. Kent Habilitation Center, Orange Groove, Chattanooga, TN; Senior VP Public Policy, American Academy of Developmental Medicine and Dentistry; Adjunct Professor, Human Development, University of Tennessee-Chattanooga. He is Exceptional Parent Magazine's Editor in Chief. Steven P. Perlman, DDS, MScD, DHL (Hon) is the Global Clinical Director and founder, Special Olympics, Special Smiles; and Clinical Professor of Pediatric Dentistry, The Boston University Goldman School of Dental Medicine.
References
1. Miles SE, Signore C. Eliminating inequities for women with disabilities: agenda for health and wellness. American Psychological Association. 2016.
2. United Nations. Addressing gender equality in the context of disability. Available from: Protect Against COVID-19. A safe and effective vaccine to protect against COVID-19 is now available. Learn how you can get a COVID-19 vaccine. cdc.gov/coronavirus/vaccines un.org/development/desa/disabilities/issues/women-and-girls-with- disabilities.html#:~:text=The%20Convention%20on%20the%20Rights,exploitation%20(see%20footnote%206). Accessed January 6, 2021.
3. United Nations. International norms and standard relating to disability: rights of women with disabilities. Available from: un.org/esa/socdev/enable/comp504.htm Accessed January 6, 2021.
4. CDC. Disability and Health Information for Women with Disabilities. Available from: cdc.gov/ncbddd/disabilityandhealth/women.htmlAccessed January 6, 2021.
5. Rates of disabilities by gender -Disability in America Series. Available from: Rtc.ruralinstitude.umt.edu Access January 6, 2021.
6. Breiding MJ, Armour BS. The association between disability and intimate partner violence in the United States. Annals Epidemiology, 2015 Jun;25(6):455-7.
7. CDC. Disability and Health: Healthcare cost data. Available from: cdc.gov/ncbddd/disabilityandhealth/data-highlights.html Accessed January 6, 2021.
8. Traustadottir R. (revised by) Harris, P. Women with disabilities: issues, resources, connections revised. Available from: independentliving.org/docs3/chp1997.html#anchor Accessed December 6, 2021.
9. Kim S. Why no one talks about the high unemployment rate among women with disabilities. Available from: forbes.com/sites/sarahkim/2019/02/20/women-with-disabilities-unemploy-ment/?sh=af92bdd58a12 Accessed January 6, 2021.
10. Convention on the Rights of Persons with Disabilities. Available from: hrlibrary.umn.edu/edumat/hreduseries/HR-YES/chap-16.html Accessed January 6, 2021. 11. Seckman CH. Women's health. RDH, 2014; 12:60-63.