ASSOCIATION BETWEEN POVERTY AND

CONGENITAL PHYSICAL DISABILITY

A survey study in the northern part of Bangladesh

Amzad Hossain

Master’s Thesis

Department of Health and Social Management

Masters program of Health and Business

Faculty of Social Sciences and Business Studies

University of Eastern Finland

November 2018
The UNIVERSITY OF EASTERN FINLAND, Faculty of Social Sciences and Business Studies
Department of Health and Social Management
Hossain A.: Association between poverty and congenital physical Disability- A survey study in
Bangladesh
Master’s thesis: 50 pages, 2 Appendices (5 pages)
Supervisors: Ulla-Mari Kinnunen, Senior Lecturer, Ph.D., RN.
Virpi Jylhä, Senior Lecturer, Ph.D.
December 2018
Key Words: Poverty, Congenital Physical Disability, Quality of life, Empowerment, Holistic
Development.

The aim of this quantitative research was to ascertain the correlation between poverty and
congenital disability and what are the recent trends in addressing this issue and future
recommendations how different steps and supports to address these two issues in a more
productive and holistic way.

A semi-structured questionnaire was developed and pre-tested for attaining relative information
about knowledge, understanding and social stigma about poverty and congenital physical
disability for this study in Bangladesh. This also gave an insight into what were the specific areas
needed to be addressed by the government of Bangladesh, different international and local Non-
government organizations working in the field of Disability of Bangladesh.

There were 53 respondents who took part in the study (All from a very low socio-economic
background and sufferers of congenital physical disability) and SPSS method of data analysis
was used to analyze of the obtained data with different forms of charts (e.g. Bar, Column etc)
were used for visual demonstrate the analyzed data. The analysis showed marked drawbacks in
the present poverty prone society of Bangladesh which plays as a catalyst in the birth of a
physically challenged child. This study also went on to show the prevailing services for reducing
the incidents and vast other steps to be taken to make the initiatives more fruitful and holistic as
far as causing change on a wider range. How the dimension of poverty (regarding health,
education, knowledge, sanitation, and nutrition) impacts on disability (Physical Disability)
related to birth – was the principal focus of this research.
1 INTRODUCTION ................................................................................................................. 3

2 THEORETICAL BACKGROUND ..................................................................................... 6

2.1 Disability (Physical Disability) ............................................................................. 6

2.2 Poverty ................................................................................................................. 18

2.3 Poverty and Disability ........................................................................................ 21

3 LITERATURE REVIEW ................................................................................................... 23

4 AIMS AND OBJECTIVES OF THE STUDY .................................................................. 28

5 METHODOLOGY .............................................................................................................. 30

6 RESULTS ............................................................................................................................. 32

7 DISCUSSION ....................................................................................................................... 45

7.1 Validity and reliability of the study ................................................................... 45

7.2 Discussion of the study findings ......................................................................... 46

7.3 Strengths and weaknesses of the study ............................................................. 48

7.4 The Implication for Future Research, Policy and Practice ............................. 48

8 CONCLUSION .................................................................................................................... 50

9 REFERENCES .................................................................................................................... 52

10 APPENDICES ...................................................................................................................... 57

Appendix A: Questionnaire ........................................................................................... 57

Appendix B: Consent form ............................................................................................ 61

FIGURES

Figure 1: International classification of functioning (WHO 2001) ................................................ 6

Figure 2: Causes for disability/impairment (UNESCO 1995) ...................................................... 16

Figure 3: Poverty and Disability cycle (DFID 2000).................................................................... 22

Figure 4: Correlation between Chronic poverty and disability (Chronic Poverty and
Disability, Rebecca Yeo, August 2001) ........................................................................................ 27

Figure 5: Correlation between Chronic poverty and disability. (Chronic Poverty and
Disability, Rebecca Yeo, August 2001) ........................................................................................ 27

Figure 6: Distribution of the respondents by type of physical disability ...................................... 33

Figure 7: Distribution of the respondents by cause of disability .................................................. 35

Figure 8: Distribution of the respondents by the perception of disability related to complications

of pregnancy.................................................................................................................................. 37

Figure 9: Distribution of the respondents by the perception of disability related to lack of

awareness ...................................................................................................................................... 38

Figure 10: Distribution of the respondents by the perception of disability related to inadequate
nutrition during pregnancy ............................................................................................................ 40

Figure 12: Conceptual framework correlating malnutrition and disability (Groce et al, 2014) ... 47

TABLES

Table 1: Disability prevalence study in Bangladesh (Marella 2015) ............................................ 17

Table 2: Distribution of the respondents by Age category ........................................................... 32

Table 3: Distribution of the respondents by level of education .................................................... 32

Table 4: Distribution of the respondents by type of Employment ................................................ 33

Table 5: Distribution of the respondents by homemade materials ............................................... 34

Table 6: Distribution of the respondents by Monthly family income ........................................... 34

Table 7: Distribution of the respondents by Perception about the cause of disability .................. 35

Table 8: Distribution of the respondents by the perception of disability-related with poverty .... 36

Table 9: Distribution of the respondents by the perception of disability related to lack of health
services .......................................................................................................................................... 36

Table 10: Distribution of the respondents by the perception of disability related to complication
during pregnancy .......................................................................................................................... 37

Table 11: Distribution of the respondents by the perception of disability related to lack of
awareness ...................................................................................................................................... 38

Table 12: Distribution of the respondents by the perception of disability related to inadequate
nutrition during pregnancy ............................................................................................................ 39

Table 13: Distribution of the respondents by the perception of disability related to suffering from
fever during pregnancy ................................................................................................................. 40

Table 14: Distribution of the respondents by the most common mode of treatment .................... 40

Table 15: Distribution of the respondents by the nearest availability of health services ............. 41

Table 16: Distribution of the respondents by available mode of transportation ........................... 41

Table 17: Distribution of the respondents by the provision of safe drinking water ..................... 41

Table 18: Distribution of the respondents by the provision of sanitary latrine ............................ 42

Table 19: Distribution of the respondents by awareness program on disability in the community
....................................................................................................................................................... 42

Table 20: Distribution of the respondents by Government and social welfare activity in the
community .................................................................................................................................... 43

Table 21: Distribution of the respondents by disability based NGO activity ............................... 43

Table 22: Distribution of the respondents by marital status and stigma/taboo/cultural beliefs
regarding various health issues present in the society .................................................................. 43

Table 23: Distribution of the respondents by the association between adequate nutrition during
pregnancy and lack of health services (χ2 test) ............................................................................. 44

Table 24: Distribution of the respondents by the association between poverty and type of
physical disability (χ2 test) ............................................................................................................ 44
1 INTRODUCTION

The term “Low income” is often used to define poverty by World Health Organization (WHO)
veterans. Poverty is manifested as denial in welfare and renders many magnitudes, such as poor
income and the incapability to purchase basic belongings and essential services for existence
with minimal health and societal dignity. Poverty also consists of physical well-being
deprivation, less edification, underprivileged reach to hygienic sanitation and pure drinking
water, insufficient physical sanctuary, lack of expression of opinion and inadequate capacity and
lack of resources for the betterment of an individual’s life. (World Bank 2004)

"Disability both causes poverty and worsens poverty. People with disabilities often find it
difficult to get work and take part in normal activities. In some communities, disability is
viewed as the result of evil, witchcraft or divine punishment. Poor communities often cannot
afford things like a wheelchair that give people with disabilities some independence." (World
Bank 2004)

According to WHO’s international classification of functioning, disability and health (ICF)

in 2001, disability undertones that the disability is a negative co-product between a person’s
disabling health condition and other contextual features (e.g. environment) (WHO 2001)

The number of persons with disabilities in Bangladesh is such high in number in context to the
prevailing economic vulnerability of the nation, paying specific attention to their special need is
understandably a big ask for a poverty prone country like Bangladesh. An overall prevalence of
disability in Bangladesh has been estimated about 10% of the total population of Bangladesh
(WHO-World Bank 2001). Disability is to some extent treatable (Depending upon the mode and
extent of disability) and to an extensive extent, it is preventable, especially those which are
directly linked to poverty. An estimated 1.5 million blind children are residing in Africa and
Asia. According to WHO estimation 50% of children with hearing impairment is also
preventable if taken good care of the mother during pregnancy. (WHO-World Bank 2001)

3
Among the most underprivileged and unprivileged group of people in the world, a person with
disabilities is highly remarkable and considered as the poorest of the poor considering all spheres
of life. According to the estimation of World Bank, a person with disabilities is comprised
almost 15% - 20% in the poverty prone countries of the world and in Bangladesh most of the
person with disabilities are poor or even under the extreme poverty line. The estimation also
shows that 15% of the total population of Bangladesh is suffering from some mode of disability
and most of them live in rural areas. The Dhaka city has the maximum pervasiveness of
disability of 8.2%, subsequently 4.2% in the division of Chittagong, and then 4.3% each in
Khulna and Sylhet division, after that 6.4% Barisal and 6.0% in Rajshahi division. Bangladesh
has extensive poverty all over the country and 17.6% of the total inhabitants are suffering from
various poverty-related problems such as malnutrition, illiteracy, economic instability, poor
health care facility, vulnerable social security, immense lack of empowerment for persons with
disabilities, lack/ total absence of disaster preparedness on a whole. There is another possible
problem in a country with most of the people suffering to earn their daily minimum wedge for
living in poverty and poverty induced disability. The variety of disability and impairments
people experiences is tremendous and they affect people's lives and their surroundings in
different ways. Some people have single impairment; some have multiple; some got impairment
since their birth, whereas some other gets impairment during the phase of their life. It is more
likely that poor people have more chance of attaining disability. Poverty is not just lack of
money; rather it has many other dimensions, such as- poverty abolishes economic, health-related
and social rights (right to health, housing, adequate food, sanitation pure water, and proper
education. A research conducted in Dhaka district shows that 4.9% of people in Dhaka are below
extreme poverty line among 15.7%, which is the estimation of poverty-prone people in Dhaka
city. (WHO-World Bank 2001)

This is a retrospective cohort study of 53 clients who were diagnosed with a congenital physical
disability in the northern part of Bangladesh and the reason for conducting the study in that part
was the immense attribute of poverty and a greater number of persons with physical disability in
that part are comparatively more than any other part of Bangladesh. Many people in Bangladesh
think that disability is a curse or result of a bad deed of either of the parents; they view it as a
reason for embarrassment and social exclusion for the family.

4
Some systemic (Both Government and non-government) interventions have taken place in
Bangladesh to raise awareness and ensuring rights for Persons with disabilities in the society but
those steps are by no means adequate to resurrect the prevailing widespread exclusion which
imposes a heavy effect on the socio-economic deterioration. Disabled Women among Persons
with disabilities are even more helpless to social discernment and abandonment. Poor people are
more exposed to disability due to lack of education, resource, health service, knowledge, poor
maternal health, malnutrition and so on.

Figuring out the relation of poverty with congenital physical disability is the main objective of
this research and it follows quantitative approach to ascertain the desired result which is to find
survey of target beneficiaries through specific questionnaire, who or a member of whose family
has encountered congenital physical disability and his/her/their family is amongst the extreme
poverty group in Bangladesh.

5
2 THEORETICAL BACKGROUND

2.1 Disability (Physical Disability)

Throughout the world, disability represents different physical, intellectual, functional and
psychosocial limitations. Some of these impairments or disabilities are permanent and some
others are temporary. On the other hand, the social model in this regard states that the
impairments of the disabled persons are not accommodated and becomes a reason for their social
exclusion. This model also deals with omission, domination, marginalization, and discrimination
to accuse and remove the obstacles produced by so-called hegemonic social and cultural
institution, which forces persons with disabilities towards more vulnerability and exclusion. This
social model of disability became distinctive in the year 1980 and was reinforced by different
movements and redefined human rights model (Handicap International - CBM 2006).

In order to explain human being’s functioning related limitations (Physical disability), ICF
(International Classification of Functioning) also uses the term *Impairment* along with the
world *Disability*! ICF was designed to have a scientific basis for understanding and explaining
different health and functioning related issues among different health discipline. (WHO 2004)

Figure 1: International classification of functioning (WHO 2001)

In the year 1996, The Ministry of Social Welfare and The National Forum of Organizations
Working with the Disabled (NFOWD, Bangladesh) jointly instigated draft paper on different
6
factors comprising disability and it became rectified and took shape of The Disability Welfare
Act in April 2001.

The paper has defined and classified disabled persons in three different ways are as follows:

1. Persons with congenital physical disability are usually referred to those individuals
who got debilitated physically due to any disease/infection while being in their
mother’s womb, victim of birth accident, inadequate nutrition of mother or the baby,
maltreatment by the uneducated traditional village doctor/religious healers, either
from birth or as a result of mother’s sickness.
2. Persons with physical disabilities are also defined as those persons who have an
absence of their one or both limbs (Congenitally), partial or full sensation loss of any
part of the body, physical deformity (Congenital), lack or loss of physical equilibrium
because of neuro-disequilibrium (Developmental or birth accident)
3. Persons with multiple/mixed physical disorder are denoted as People suffering from
more than one type of abnormality or in-capacitance from birth. (The Disability
Welfare Act 2001)

WHO standard jargon currently used, denotes a precise discrepancy between impairment
(psychological), disability (personal) and handicap (social)

1. An impairment refers to the absence or loss or aberration of the psychosomatic,

biological or structural entity or function;

2. A disability refers to the restraint or deficiency of capability to do something referred to

as normal for a human being.

3. A handicap refers to the shortcoming of a person that hinders him from participating or
acting actively as a social being due to his/her disability or impairment.
All through history, the conception of disability has rested on make-belief ideas and societal
stigma and prejudice. The consequence of these stereotyped imaginations and substantial
7
accomplishment by the typical social order and organization for the persons with disabilities has
been the result of continual negligence and depravity. These negligence blocks are created
among persons with disabilities, from normal social, monetary and dogmatic deprivation and
segregation in the society, surrounding the community, and educational intuition and last but not
the least, even in their own families. Moreover, persons with disabilities face widespread
obstacles to accessing services concerning education, employment, health, transportation, and
information as well. The outcome of these societal barriers induces worst possible effect upon
their health and socioeconomic condition. (WHO 2004)

The term Global Burden of Disease (GBD) denotes the fact that prevalence of disability and
accordingly need of rehab services, preventive measures needed in an area specific way and
identifying underlying facts causing disability. The disability-adjusted life years (DALY) is
another indicator to estimate years lost due to premature death or years lived with disability.
(Murray 1994)

Disability does not necessarily impact the individual alone but on the whole the
entire community person with disability surrounded with. The effect of exclusion of persons with
disability from participating actively in the betterment of the community is quite high and the
after effect has to be carried out by the society in the long run, particularly in terms of the burden
of care embraced to it. Vivid effects of exclusion have its effect on the total productivity as well
as on the individual's productivity and potential as a whole. From the estimation of UN, 25% of
the total population of a country is one way or another adversely affected by some sort of
disability. (Leandro & Despouy 1993)

There are three components in terms of direct and indirect cost of disability as described by UN
and they are:
1. The direct cost of rehabilitation and other health services, including the cost of traveling
to access those services.

8
 2. Those who are in direct contact with the person with a disability but not affected by it
(Caregivers; amount of time they have to spend for the care of the person with a
disability)
3. The loss of opportunity cost resulted from the in-capacitance to work like a normal
human being to lead an economically viable and productive life. (S. Erb & B. Hariss-
White 1999)

According to a research regarding the state of Persons with disabilities in India 'Merely
32million people were reported to be disable in the year 1991 and the collective number of
people in the end found to be affected indirectly due to those persons with disabilities were not
less than four to five times, a mammoth number of 130 million or more! ' (IBID 1991) An earlier
study done in the year 1989 conventionally estimates that the collective cost of blindness to
Indian national economy, together with the lowest sustenance allowance for blind people, getting
as high as 6 billion every year. (WHO fact sheet 1997)

An analysis of several survey data from Tanzania goes to show that a single household with only
one person with disability in the family have a mean consumption lower than 60% of the average
(and a headcount of 20% greater than average), guiding the author to end up with the conclusive
statement that this might be the hidden cause among all other causes of poverty in Africa.
(Howard White 1999)

Though to be dealt with attention, a gauge that it recently been used widely to enumerate the
burden of disease in a country or specific area is DALY (Disability Adjusted Life Year). This
quantifies healthy life years lost due to early mortality, with those lost as a result of disability or
morbidity. According to estimation by the World Bank, prolong disabilities were a predominant
cause for DALY lost worldwide in the year 1990 to an alarming amount of more than a third
(34%). (World Development Report 1993)

The effect direct cost of disability is more often than not unequally observed in the economy.
The burden of care is often descended on the family members of the person with a disability,
more commonly the mother or other relatives residing in that very family. Caring for a child with

9
disability imposes extra workload on the mother of a family living in the extreme poverty as she
has to manage extra time from her daily hectic schedule to provide care for the child with
disability who is fully dependent on her and thus it takes full tall on her, struggling to ensure
living for the entire family, every single day. The burden of are also imposed often on other
siblings of the family, especially the girls, which in turn causes her to compromise her education
and remain at home to take care of her disabled brother or sister or another relative of the family
with some sort of disability. The beneficiary effect of reduction in disability and morbidity to the
entire economy is huge and hence ensures increased efficiency, better working opportunity and
enabling oneself to a better paying job and longer paying lives. (S. Miles 1999)

The UN, through social policy and development, promotes monitors and evaluates their
implemented rules and program (regional, national and international) for persons with disabilities
worldwide. They are also responsible to do write-ups and statistical information regarding
factors affecting Persons with disabilities life and extend substantial support to government and
NGO’s through different projects and defined activities. (UNESCO 1960)

The UN general assembly adopted in the year 1993, on ensuring equal rights for Persons with
disabilities has been a milestone for shaping and reforming agendas worldwide, reinforcing the
idea and implementing methods for the betterment of Persons with disabilities . In the year
2001, UN general assembly formulated a committee in an ad hoc basis to promote and preserve
the rights and dignity of Persons with disabilities, ensuring holistic development and reduce
discrimination and promote empowerment. (UN General assembly 2004)

ESCAP provides assistance to the government and self-help groups to generate comprehensive,
hinder free and right focused social infrastructure for Persons with disabilities by ensuring their
participation in the holistic developmental process, with the help of a full-time Disability advisor
(resource person from Asian Development Bank) supporting the role. The support is ensured in
the form of operational activities, encouraging networking and collaboration with government
bodies, identification and replicating good practice and advisory service holistic betterment of
Persons with disabilities . (ESCAP 2015)

10
The work of ILO is based on their unique approach (same opportunity, same importance,
nondiscrimination, and bringing everyone in the mainstream development), along with
encouraging and ensuring proper implication of law and justice on the basis of internationally
standardized human and labor rights. ILO program for Persons with disabilities is aimed at
ensuring the participation of Persons with disabilities in the present job market by providing
them with needed skills, training, knowledge and employability through advocacy, network
building with different training centers (Both government and non-government), guidance,
policy advisory meetings with government sectors, technical advisory service and cooperating
activities. (ILO & Disability 2015)

The WHO, through its integrated work on ICF and implementation of CBR strategy in its
disability and Rehabilitation program, works to improve the quality of life and obtain economic
solvency by mainstreaming in holistic development activities by ensuring equal opportunities
and a hindrance free surroundings for Persons with disabilities . The WHO disability and
rehabilitation team provides support to its member states in developing plans and proper
implementation strategy for persons with disabilities in collaboration with other UN agencies and
international NGO's working in that region, in terms of medical care, rehabilitation, support
service, and skill enhancement training. (World report on disability 2011)

UNDP is a worldwide acting development organization with a focus to induce a change in the
holistic social structure, improving the knowledge base, an experience-oriented implementation
plan for specific regions and plans for proper resource providence and allocation for the
betterment of Persons with disabilities and ensure their empowerment and social inclusion.
UNDP's network links and coordinates global and national programs to achieve MDG
(Millennium Development Goal) with special emphasis on reduction of poverty, good
governance, crisis mitigation, emergency response, energy, and environmental safety, ICT
development and safety and HIV/AIDS. Persons with disabilities are treated as the main focus
for all these areas of work of UNDP. (UNDP 2015)

UNESCO focuses on promotion and implementation of bringing children with disabilities under
the umbrella of inclusive education regardless their physical, mental, emotional, linguistic,

11
intellectual shortcomings, as this has been observed as one of the most effective ways to
eliminate the discriminatory attitude of the children and society, as well as promoting an
inclusive and barrier-free society for all. (UN 2006)

DCG’s are right based and policy rectifying organizations with members from more than 168
countries formally established in Singapore in the year 1982and working closely with UN and its
agencies. There are well established national and community-based DPO's (Disabled Peoples
Organization) who are actively engaged in policy dialogue with local and national policymakers
to ensure rights for persons with disabilities. Bangladesh Protibandhi Kallyan Somity (BPKS) is
one of the protagonists in addressing initiatives and movements of Persons with Disabilities in
the mainstreaming development approach and policy advocacy. (BPKS 1996)

The World Bank disability and related programs and research wing work to find the core issues
affecting the lives of persons with disabilities by formulating cross-sectional working groups in
six regions through developing work plans and facilitating coordination between working
groups. The expanded strategy of WB Disability and development team concentrates on building
a partnership with other development agencies working in the region, as well as multilateral,
bilateral and non-government agencies in holistic mainstreaming and avoid duplication of
efforts. WB's other relevant country-specific development agenda include PRSPs (Poverty
Reduction Strategy Papers). Presently there are 49 interim PRSPs and 40 full PRSPs for
countries like Bangladesh, Cambodia, central Asia republics, LAO PDR, Mongolia, Pakistan, Sri
Lanka, Vietnam and so on. Donors working in those areas are using these PRSPs as their guiding
tool for coordinating and supporting priority development initiatives, monitoring and reduce
duplication of poverty analysis. (World Bank 2018)

The integrated correlation between disability, poverty, and health are assumed to be not only
having a strong inter-linkage considering the fact that the number of Persons with disabilities has
risen up to 1 billion in the past decade or so, comprising 15% of the total population of the entire
country (World Bank 2011). Persons with disabilities are amongst underprivileged and
marginalized in the societal arena and they are entitled as protagonist among the poorest of the
poor. Studies conducted by The Asian Development Bank (ADB) shows about one-fourth of the
12
population in the Asia Pacific region is suffering from some variety of disability. (Asian
Development Bank 2002)

The pervasiveness of disability is believed to be quite high in Bangladesh predominantly due to

over density of population in a small area, prevailing poverty, illiteracy, lack of awareness of
causes for congenital disability and means of preventing them and last but not the least, lack of
medical and health care services. According to the Bangladesh Population and Housing census
2011, the estimation of persons with disabilities ranges from 1.4 percent to 9 percent amongst the
entire population. Organizations like Action aid Bangladesh and SARPV (Social Assistance and
Rehabilitation for the Physically Vulnerable) has some sample studies and came up with figures
like 8.8% of the total population being affected by some sort of disability.

Bangladesh Protibondhi Kallyan Samity has estimated about 7.8% and Action Aid Bangladesh
recorded 14.04% people suffering from some sort of physical or mental impairment in their
another study. The main reason for the rural poor people being the ultimate sufferers of disability
and its consequences are a lack or total absence of knowledge about the cause and after effects of
disability, being superimposed by social taboo and absence of needed pre and postnatal care in or
near to their area of residence. An individual bearing disability from his/her childhood faces
most amount of marginalization and exclusion from the society and have significantly fewer
chances of availing health care, mainstream education and inclusion in the long
run, leading to extreme poverty and gradually increasing the burden of care as he/she grows
older and disability remains undertreated/untreated (Trani et al. 2010, Groce et al 2011). This
extreme condition induced exclusion from the society does not affect only the PWD but also the
entire family as a whole.

According to UNCRPD (United Nation Convention on the Rights of Persons with Disabilities),
access to appropriate rehabilitation/habilitation service for Persons with disabilities is more a
rightful ask, but despite Bangladesh ratifies the convention, very less has been ensured (Despite
the extensive plans were been taken) in this regard due to overspread poverty and lack of fund in
the country. Rehabilitation services are now provided by 70 rehabilitation centers established
nationwide controlled by Ministry of Social Welfare (MOSW), Bangladesh and some non-

13
Government organization (With the help of donors like EU, DFID, LCD, LFTW and so on) in
the last 5 years. Some other services entitled to persons with disabilities from the Social welfare
ministry of Bangladesh are as follows:

1. Training (empowerment) and rehabilitation (Physical and social) of a female with a

disability
2. Certificate and Identity Card (personal, VGD, VGF) for persons with disabilities; so that
they can avail different support and allotments entitled only to them and some other fake
people can't benefit from these supports.
3. Registration of self-help groups of persons with disabilities and thus empowering them to
ask for their entitlements and right in a defined group, rather than being alone and
powerless.
4. Financial assistance for students with disabilities
5. Financial assistance for persons with disabilities
6. Small business start-up loans for persons with disabilities (Ministry of Social Welfare of
Bangladesh 2018)

The international community is determined to an approved set of development goals, aimed at a

gradual reduction in global poverty by speeding up the wheels of economy and empowerment of
persons of disabilities by including them in the mainstream development process. This
increase in attention towards issues regarding Persons with disabilities is predominantly seen in
prescribed guidelines and programs of mutual institutions. (DFID 2000)

New ingenuities within UN to comprise Persons with disabilities in all prevailing and upcoming
Millennium Development Goals (MDGs) goes to emphasis on the fact that no nation can prosper
or holistic development can never be achieved if there is prevailing poverty and in this
connection poverty can't be alleviated keeping a large portion of the population out of the active
development process. This inactive portion of the population will mount on the economic burden
and hinder/slow down the development process. Thus the importance of community-based
rehabilitation emerged as a prime need for sustainable change in the health and holistic wellbeing
of persons with disabilities (WHO 2010). This will result in the inactive portion of the population

14
converting from a burden to asset and to alleviate poverty and in the process alleviate societal
and financial radicalization for Persons with disabilities (WHO - World Bank 2011). Eliminating
poverty is by no means achievable without taking the rightful agenda and precise necessity of
persons with disability into account. "Poverty prone Persons with disabilities are overwhelmed
by a brutal sequence of poverty and disability, each being a consequential reason for each other".
(DFID 2000)

Disability has been continually addressed in the poverty reduction strategy plans (PRSPs)
whereas very little could be done to obtain a substantial and sustainable effect in regard to reduce
both of it. A recent study review was done by World Bank on 33 PRSPs and 11 PRSP final
reports. The obtained outcome was 73% of the PRSPs predicts that Persons with disabilities are
amongst the poorest whereas 37% exceptionally said that the intent of strategy regarding the
Persons with disabilities are to bring this disadvantaged group in the mainstream development
process and 23% revealed the exclusion stigma being the prime most cause for Persons with
disabilities to be debarred away from conventional development process. It is important to
mention that Bangladesh included persons with disabilities in their PRSP from the year
2011 (Handicap International 2011)

In Bangladesh, Government, international development agencies and international financial

institutions have made extensive changes to their rotundity as well as issued specific strategies
and plans regarding steps to be undertaken for the betterment of Persons with disabilities.
Almost all institution both inside the country and working worldwide are having their
contribution in the disability sector of Bangladesh, posing more importance on the social model
of disability (As a mode of preventive measures of disability) alongside the physical model (For
curative initiative regarding the prevailing disability situation in Bangladesh). In a study
propagated by UNESCO in the year 1995 on the overall situation of disability in the world,
shows that disability or impairment is caused due to congenital disease 20%, malnutrition of the
pregnant mother 20%, infectious disease 11% which are more closely related with poverty and
poverty induced congenital disability. (UNESCO 1995)

15
 Figure 2: Causes for disability/impairment (UNESCO 1995)

According to an estimation of WHO, about 10 million people in Bangladesh are suffering from
some form of disability but there are very inadequate data to validate this hugely important
economically and socially overwhelming assumption. Here are some of the very few study
findings in a tabulated form:

16
Table 1: Disability prevalence study in Bangladesh (Marella 2015)

Authors Study Sample Ages Disability measures Prevalence

Bangladesh Census 2010 National All ages Questionnaire on 1.4 %
Bureau of census different modes of
Statistics disabilities.
Titumur and Disability in 13,025 All ages Questionnaire on 5.6 %
Hossain Bangladesh: individuals. different modes of
Prevalence, disabilities
Knowledge,
attitude and
Practices,
2004.
Mitra and World Health 5,931 18 year Questions on the basis 22.0 %
Sambamoorti Survey 2002– households s and of Vision, Mobility,
2004 and 5,549 above concentration or
individuals remembrance, and
self-hygiene.
World report World Health 5,931 18 year 16 questions on pain, 31.9 %
on Disability Survey 2002– households s and sleep, self-hygiene,
2004 and 5,549 above vision, cognition,
individuals affect, interpersonal
relationships,
mobility, and energy
Bangladesh Household 12,240 All ages Questionnaire on the 9.1 %
Bureau of Income and households basis of Vision,
Statistics Expenditure hearing, Mobility and
Survey 2010 climbing, cognition or
concentration, self-
hygiene, and Inter-
personal

17
 communication)
Cherry et al. Gonoshasthay 43417 60 year 12 questions based on 26.0 %
a Kendra individuals s and Vision, hearing,
survey 2010 from 600 above mobility, cognition,
villages. self-hygiene, and
communication.
Marella et al. Rapid 2315 18 year 15 questions based on 8.9 %
(current Assessment of individuals in s and WG questions: vision,
study) Disability Bogra, above hearing, mobility,
Survey 2010 Bangladesh. communication, gross
and fine motor,
cognition, appearance,
and psychological
distress.

2.2 Poverty

Economist around the world has always seen or measured poverty on the basis of the low level
of income compared with the lowest wedge of per capita income for the country as well as low
level of consumption of wealth available for them in the given society. Social policy architects
and welfare economists contemplate poverty as those entities whose daily wedge is below an
identified survival level widely referred to as poverty margin. Nevertheless, steps like those are
often unsuccessful to draw a distinct difference between revenue and living in a poverty prone
society. Two of the most outdated measures for poverty (ratio of the headcount and the income
discrepancy ratio) have been criticized by Amartya Sen as according to his research these two
steps are unable to ascertain the income distribution among poor into consideration. Moreover,
they tend to cause further degradation of the situation of people who are already poor. Other
authors came up with the study output that poverty can never be seen from one single point of
measure, whereas it has multidimensional factors to comprise it as a whole like a resource
18
availability and consumption, housing, average living cycle, edification, attainment of public
goods must be taken into contemplation. On the whole, people who find it extremely difficult to
meet their basic survival needs in their day to day life are known or referred to as extremely
poor. The World Bank measurement for extreme poverty indicator denotes when the income per
day for an individual is equal or less than 1$(USD). (Sen 1983)

According to DESA (United Nations Department of Economic and Social Affairs), poverty is
more than lack of earnings and resourceful possessions to guarantee a continual source of
livelihood. Its indicators include hunger and malnutrition, restricted or no admittance to basic
education and other basic amenities needed to live a minimal healthy life, social discrimination,
and exclusion, as well as the lack of social participation for an individual in the decision making
phase. Poverty is not merely a matter of in-capacitance of meeting basic survival needs. It is on
the whole a syndromic compilation of structural imbalance, manifested in all spheres of human
existence. So on collective note poverty denotes radicalization, isolation and other monetary,
dogmatic, communal and ethnic dimensions of withdrawal, marginalization, vulnerable situation
and at the very end resulting exclusion from the societal system.

According to Dube and Charowa (2005), poverty origins from no or lack of access to basic set-
up or amenities and it is reinforced by peoples lack of admittance to cultivable land, money for
business startups, expertise to enhance their prevailing capacity, institutions to upgrade their
knowledge, productive assets and minimal resource needed to ensure sustainable growth and
livelihood.

Nobel prize winner Amartya Sen stated very significantly that poverty is a standard at which one
is incapable of "attaining satisfactory contribution in shared actions and be free from civic
disgrace induced by disappointment in satisfying conventions". (Sen A 1983)

The concept of poverty according to the Human Rights Commissions report can be described in
three distinctive ways (CHRI Millennium Report). The first and the most expressive
definition drawn from the rest as poverty is an undesired situation in which there is absence or
lack of essential facilities resulting from inadequate or absence of income. There is an invisible

19
or expressed benchmark for an individual's minimum level of income and standard of living in
every societal accepted system. Those unmet individuals who are below that benchmark level are
recommended as poor or marginalized in the society. The second definition of poverty is
grounded with regard to basic or fundamental needs. Incapability to access or meet basic human
needs (Food, clothing, dwelling, education, and health) for existence is poverty or to remain
deprived or excluded such need for a short or long term is poverty. The third way of expressing
poverty is in regard to the lack or absence of opportunities, which is a paradigm shift from the
traditional basis of defining poverty only on the regard to fundamental need and income. It
denotes the fact that individuals, despite having good health and capacity to overcome the
poverty barrier, are somewhat deprived due to lack of sustainable opportunity in the society they
belong. This implicit absence of opportunity pushes them in the regime of unemployment further
resulting in inadequate income hence obtaining the in-capacitance to meet basic human needs.
Here the urge has been shifted from the individual to the prevailing societal situation which
compels or decides the fate of people lacking opportunity that fails to insulate him from the
insecurity and further pushing him in the poverty black hole. (CHRI Millennium Report 2001)

A part of the entire population whether it is individual, families or a group of people are referred
as poor when they lack the resource to afford the diet needed to live a minimal healthy life,
participation his hampered in the societal activities for being marginalized, having the dwelling
condition and facilities that are habitual, or at least extensively reinvigorated, or permitted, in the
social order of their belongingness. (Townsend 1979)

The empirical observation of this research is to find a correlation between poverty and congenital
disability and several factors that have been discussed till now are predominantly responsible to
cause it. Economically vulnerable people in society are known to be struggling to meet basic
health care needs, hygiene, proper food, and sanitation causing a vulnerable environment for the
newborn to be born. Moreover, they do not have the money to reach for proper health care
facilities during pregnancy and eventually compelled to deliver the child through illiterate
village doctors/ nurses/ religious healers, leading to congenital disability in most of the cases
found for children born with a disability. (DFID 2000)

20
2.3 Poverty and Disability

WHO has brought a totally new and realistic concept for ICFD (International Classification of
Functioning and Disability, the Beta-2 version of ICIDH-2) to address disability from a refined
point of view. The utmost purpose of International Classification of Impairments, Disabilities,
and Handicaps-2 (ICIDH-2) classification is to provide a customary definition and framework
for analyzing human functioning as an integral component of health (WHO 2011). The
categorization bears information regarding three main modes of the human body which is:
Physical, Individual and societal; and corresponds a number of combines a list of biological
factors, as they have superimposed effect on all the factors mentioned earlier. (WHO 1980)

This mentioned paper is only predominantly discussing chronic and long-term functional
limitations. So, for the people suffering from chronic impairments which may or may not affect
his/her natural way of living and some of which if corrected may not necessarily hinder his/her
Activities of Daily Living (The Economist 1999). Disability is a relevant term, which is
normally interpreted as a barrier or hindrance in doing/performing anyone to his/her part as a
social being. But at the same time what is disabling for someone and posing a hindrance for
him/her in performing as an active social being, for others it might not be the case and he/she can
be an active part of the society with the same amount of disability. For example, various modes
of psychosocial and psychological conditions may hinder an individual to act as an active social
being whereas it can be unrecognized/ not that effective to exclude someone from acting as a
social being. In some countries, infertility has been seen as physical shortcomings for a female
and society/surrounding poses psychological stress on females whereas it's not the case in
western culture. A physical condition as COPD or allergic rhinitis can be a disabling condition
for farmers in a village but not that disabling for someone working in the office-based city
condition etc. (Howard White 1999)

In order to observe disability to the core, an in-depth measure of both the affected individual and
estimation of the surrounding determining factors has to be done along with the prevailing social
background. A study on disability insurance by National Institute on Disability and
Rehabilitation Research (Washington D.C 1996) denotes the fact that, disability insurance

21
variation is linked with the various incentives embedded in the disability insurance programs.
The study shows that a higher proportion of disabling households in rural India was found to be
below the poverty line that had very minimal aggregate of assets, small or no land in their name
and greater debt in comparison to households which has no disabled member residing there. A
study in Sierra Leon went on to show that disable people were not considered as poor as they
were provided with adequate support networks and proper labor contracts. (Elwan Ann 1999)

Figure 3: Poverty and Disability cycle (DFID 2000)

The integral reason to understand the correlation between poverty and disability is to have a deep
understanding of the economic implication of inclusion and exclusion on the societal, country-
based and on the whole global. Poverty and disability are predominantly related to a cyclic order,
each having a huge impact on the other outcome. This cyclic correlation has a
strong theoretical basis to support its formation as the conditions associated with lack of access
to health care, pure drinking water, hygiene and sanitation, poor nutrition, below par living
condition, lack of basic education superimposes the causes for neonate disability. These
obstacles and difficulties faced by persons with disabilities are preventable and to some extent
lowered by proper planning which will bring them from exclusion to inclusion otherwise the
disadvantages associated with disabilities can prevail in the long run affecting all spheres of
society alongside the individual him/herself. (DFID 2000)
22
3 LITERATURE REVIEW

The main origin and effect of disability is poverty. The association between poverty and
disability can be easily diagnosed and distinguished. This link between poverty and disability is
manually resistant and Persons with disabilities and their families represent a significant number
of the poverty prone part of the society in Bangladesh. Poor people in the whole world are more
likely to have the disability in their whole lifetime than those who are financially solvent. The
portion of persons with disabilities within underdeveloped and poverty prone nations is
considerably higher than that found in the richer or developed countries. (DFID 2000)

As it has been observed that disability might be caused due to interlinked reasons, in a country
where there is a widespread disability, poverty can also be a by-product of that higher percentage
of disability in the society (Rao 1990). The causes are inadequate nutrition/undernourishment,
less access to preventive medical care, persons with disabilities giving birth to newborn,
exposure to high-risk environments responsible for congenital disability for the child, poor
sanitation facilities, illiteracy, lack of health awareness programs for pregnant women in the
poverty prone areas etc. A synchronized deprivation is the effect of the coherent relationship
between poverty (related to economic solvency), weakness (social disability) and physical
disability (Described by the medical model of disability). This syndrome is made of
Philosophical fortification, penalizing experience and psychological extermination (the severe
lack of consequential correspondence in behavioral development); a cognitive and vocal
improvement and stimulus deprivation which collectively affect the involvement of lower
income groups in the societal and economic scenario on the whole. Poverty and disability are
interconnected. The new UNCRPD (UN Convention on the Rights of persons with disabilities)
has shown a distinctive association between poverty and disability. (UNCRPD 2006).

Many authors like Elwan (1999), Zimmer (2008), Parnes (2009) argued that the source and effect
of disability is poverty. The mechanisms of these relations are now more or less known to all.
Anam and Bari conducted a study in 1999 among street children with disability in Dhaka city
and found that- 63.33% of the street children with disabilities have no education, 38% of those
street children have disabilities or impairments caused by congenital and birth-related problems,

23
57.5% and 32.5% of their mother had received treatment from traditional and religious healers
respectively during their sickness in pregnancy. Titumir and Hossain (2005) conducted a study
on the Cause of Disability, found that the majority of the people blamed the lack of birth-related
pre and postnatal health care as the predominant reason for disability. As most of the people
under poverty line can't afford a healthy and hygienic atmosphere for their delivery (In case of
the post-delivery situation) and more often than not the secondary complications arising post-
delivery situation are a cause for congenital disability. Some also convict a congenitally defected
child as a result of his/her parents' sins.

A survey conducted on "Disability and Poverty in Developing Countries" in the year 2011 by
Mitra, Posarac and Vick using data from respondents of 15 developing countries found that
disability was vividly related to higher poverty prone areas, as well as regions with a high
percentage of illiteracy rates, lower wages, and a higher percentage of social taboo and disbelief .
A study conducted by Tareque Begum and Saito (2014) on “Inequality and Disability in
Bangladesh” went on to show that an incline in disability was observed across affluence groups;
entities from middle or rich families are been observed to have fewer persons with disabilities
than those living in poor families. A study conducted on 267 children in Turkana and Kenya on
"Childhood Disability and Malnutrition". The study shows 67% of the cause of disability is
congenital, 13% is for illness, 6% is for birth-related problems and 5% in for birth trauma. Only
15% of the children with disabilities received treatment (Though it varies from place to place
inside a specific region or country). Obstacles of receiving treatments were 34% for lack of
awareness, 33% for lack of money, 18% for lack of perceived need and 4% for lack of proper
transportation (CBM - Kenya Red cross 2013). A research conducted in the year 2000 by Durkin
M.S, Khan N.Z on “Prenatal and Postnatal Risk Factors for Mental Retardation among Children
in Bangladesh” and found that cognitive disability related to social, economic factors and
malnutrition especially the maternal iodine deficiency (Durkin M. S; Khan N. Z, 2000).
ICDDRB and UNICEF conducted a study in the year 2011-2012, which showed that the brain
development of a baby is severely affected by the spectacular act. During pregnancy, deficiency
in folic acid may cause spinal defects and cleft palate. In Bangladesh, iodine deficiency is found
among 40% of school-aged children, which causes curable intellectual disability and impaired
psychomotor development in those children. (ICDDRB - UNICEF 2011-2012)

24
Disabled children are discriminated in their own families, society and workplace, which is the
foundation of the highest desecration of rights of Persons with disabilities in Bangladesh. Many
people in Bangladesh believe that being disabled is a curse and a penalty for evil deeds, which
also effects right to get proper care, medical services, education etc. In Bangladesh, malnutrition
of mothers and children, various diseases, accidents and unprofessional (untrained village
midwives) delivery and inborn condition are some of the crucial reasons for disabilities. There
are some good health services for disabled children, but most of those are less generalized and
often available only in urban areas. So they are more likely to serve a few numbers of children,
especially more affluent groups. There is some accessible Community-based rehabilitation
(CBR) programs, support by non-governmental agencies (mostly funded by developed
countries), but they have limited geographic coverage and insufficient resource to provide
immediate treatment to the disabled children (UNICEF 2014). According to Situation
Assessment and Analysis of Children and Women in Bangladesh, stated in the year 2009 that
"The principal cause for disability among newborn are primarily maternal complications,
complications during delivery, lack of hygiene, accidents and malnutrition while the baby in
their mother's womb" (UNICEF 2009). Another study was conducted by Priya K. Malone,
Elisabeth R Despres and others in 2010 on "Perception of Disability among mothers of children
with disability in Bangladesh: Implications for rehabilitation service delivery". This study states
that- the seniors of a family strongly believe in the traditional explanation that restricts the
disabled person of that family to get appropriate treatment. (Maloni K & Despres R 2010)

In developing countries, estimation states that only 2% of Persons with disabilities are having the
right to use to rehabilitative service and other health-related basic services (Despouy 1993).
Malnourishment and micronutrient deficits continue to hinder the full mental and physical
growth of millions of children in Bangladesh. Children with restricted congenital growth among
children aging fewer than 5 are reported to be 54 % among the poorest groups (UNICEF 2009).
The full mental and physical development of millions of children in Bangladesh is greatly
hampered due to malnutrition and micronutrient deficiencies which are predominantly caused by
poverty. Growth anomalies or stunting among children less than 5 years of age has been reported
to be 54% in the poorest group in Bangladesh. Other reasons for disability among newborn in
Bangladesh has been reported as being associated to absent/ inadequate and/or inaccessibility to

25
basic health care facilities, inadequate/mal-nutrition, insufficient supply of safe drinking water
and hygienic sanitation and birth accidents. Poverty, discriminatory beliefs/behaviors are the
core reasons for these limitations (UNICEF 2009). A study named "Poverty and Blindness: A
survey of the literature" performed by Sight savers international (SSI) has shown a precise
correlation between poverty and visual impairment. The review inflects a strong picture how
multiple dimensions of poverty influences the pre and post congenital life of an inborn and how
this, in turn, influences an impact on visual capacity and eventually causing partial or complete
loss of vision (SSI 2006). An estimation performed by The International Disability and
Development Consortium reveals that 98% of children with disabilities are deprived of any
formal education (IDDC 1999). At least 40 million children with disabilities according to the
World Bank are devoid of receiving any formal education and thus their exclusion from
obtaining necessary knowledge that is mandatory for employment, compels them to be
economically and psychosocially dependent on others. A contemporary study on the education of
children with disabilities by UNESCO goes to show that only 1-2% of children with disabilities
are able to obtain some form of education despite their limitations caused by their congenital
disability induced by poverty and its way to alarming in present situation and forcing them to be
dependent on others all the time.

A research titled "Educating Children in Difficult Circumstances: Children with Disabilities"

performed by CSID (Centre for Services and Information on Disability, Bangladesh) in the year
2002 goes to show that only a mere 11% of children with disabilities from their birth, are capable
of receiving some sort of formal education and the prime most reason being their congenital
disability and poverty. Reports go to show that those families having children with disability are
amongst the most disadvantaged, neglected and marginalized when it comes to education and
receiving basic services related to health and well-being. Out of 1.4 million children with
disabilities who belong to the age group of primary school, only 4% had access to basic
education where there is no disability service in those areas and the majority of the children
were suffering from mild to moderate physical impairments. (CSID 2002). Rebecca in her study
regarding "Chronic poverty and Disability" has brought about the compelling relationship
between poverty and disability which reveals that being poor vividly increases the chances for
giving birth of disabled children, as the overwhelming effect of immense inadequacy of

26
nutritional food, sanitation, basic and specialized (Maternal) health service, hygienic shelter,
basic education and economic solvency. Furthermore, due to immense poverty, her pregnant
mother is often compelled to work in the most hazardous atmosphere, increasing the risk for her
own self as well as the baby in her womb. All these factors collectively contribute to illness,
injury and congenitally deformed child. (Yeo R 2001)

Figure 4: Correlation between Chronic poverty and disability (Chronic Poverty and
Disability, Rebecca Yeo, August 2001)

Figure 5: Correlation between Chronic poverty and disability. (Chronic Poverty and
Disability, Rebecca Yeo, August 2001)
27
4 AIMS AND OBJECTIVES OF THE STUDY

The principal focus of the research is to figure out the relation of poverty with the congenital
physical disability is the main objective of this research. How different dimension of poverty
(regarding income status, health, education, nutrition, hygiene, and sanitation etc) impacts on
physical disability related to birth is the principal focus of this research.

Research question

- How the different dimension of poverty impacts on physical disability related to

birth (Congenital physical Disability)?
- How can be the amount of congenital physical disability reduced?

Bangladesh being a poor third-world country where even a healthy individual finds it hard to
afford basic needs for living (Food, clothing, shelter, education and health) for himself/ herself,
the situation of persons with disabilities is beggars’ description. Different government, non-
government and international organization have worked over a long period of time to improve
the situation and most of the initiatives have been according to the therapeutic model of
rehabilitation (Providing therapeutic and assistive device support for the persons with
disabilities). But different studies and researches have shown the need for the Social model of
rehabilitation being far more effective (As it addresses most of the social problems which are
responsible for the birth of disable child and hence reducing those problems will in turn reduces
the amount of disable child births and induces more effective way to encounter disability related
problems in the society) in the present scenario.

Working for five long years very closely with different Government, Non-government
organizations (NGOs) and international donors like European Union (EU, Light for the world
(Netherlands), DFID-LCD (UK), AusAID (Australia) and so on, who are providing and donating
a healthy amount of support to improve the overall situation of persons with disabilities in
Bangladesh. So far the rehabilitation support of these organizations have been more concentrated
into the therapeutic and assistive device support, whereas in my view there should be more

28
concentration in the economic empowerment of persons with disabilities and their families,
better nutritional support during pregnancy (Both through increasing awareness about proper
nutrition during pregnancy and providing basic nutritional support), improving sanitation and
more social awareness to eradicate the social stigma and taboo hovering around disability. The
reason why the social model of rehabilitation will be more effective in the present scenario is, the
social model more or less intervenes before the disability actually takes place and interventions
(Awareness) in the stage of pregnancy or future mothers will actually reduce the amount of birth
of disable (Physical disability) children on a whole. The overall aim of the research is to
ascertain the impact of lack of different dimensions of basic life needs in the most poverty prone
region of Bangladesh (Northern Region) and how these results is causing poverty and in turn
how this poverty can induce the birth of the physically disabled child in Bangladesh.

29
5 METHODOLOGY

This is a questionnaire (Semi-structured and close-ended) survey-based quantitative research

conducted from May 2018 to October 2018. The study was carried out within the northern part
of Bangladesh where the prevalence of poverty and congenital physical disability is greater than
others parts of Bangladesh among poor families, having a disabled family member (congenital
physical disability). Only the persons who have members in their family with the congenital
physical disability were included in the study. Any other persons with disabilities, who were not
suffering from disability from their birth, were excluded from the study. For data collection,
simple random sampling was used. The study sample has been taken 53.

An interview schedule was developed to collect data from the respondent. Interview schedule
had Semi-structured closed-ended questions. The developed interview schedule was tested prior
to implementation, to assess sensitiveness and appropriateness in ascertaining the relevant
information and to facilitate the desired outcome of the study. Pre-testing of the questionnaire
took place in Centre for Disability in Development, Savar campus where they provide service
to people with disability coming from different parts of Bangladesh and only
persons with congenital disability (In case if the persons with congenital physical disability is
unable to communicate, I interviewed her/his attendant) was chosen for the pre-testing. The
respondents were contacted personally and the desired information according to
the questionnaire has been collected with due accuracy and confidentiality after explaining the
objective to the respondents and getting their approval to participate in the study.
The questionnaire was first prepared in English and then translated to Bengali for the
convenience of the respondents. After data collection was over, the questionnaires were re-
checked for any incompleteness, any need for correction and internal consistency to exclude
any irrelevant data/information. Data management included computerization of data through
data coding and editing in SPSS. The editing portion involved verification of information for
consistency, relevance and any disproportion in data input. Ethical clearance has been obtained
from all the respondents on an individual basis. A written consent form stating the objective of
the study as well as the confidentiality issues was read and signed by the respondents before
them taking part in the study. The study was designed and carried out keeping the cultural and

30
religious sensitivity of the respondents in mind and they were dealt with utter respect and
empathy. As the study population, belong to only the northern part of Bangladesh, the end result
have the limitation of generalization on the whole and hence might not be depicting the situation
on the whole for overall physically disabled population of Bangladesh.

31
6 RESULTS

This was a retrospective cohort study of 53 clients who were diagnosed with the congenital
physical disability in the northern part of Bangladesh to find out the association between poverty
and congenital physical Disability. A semi-structured, pre-tested, modified, interviewer
administrated questionnaires were used to collect the information. All the data were entered and
analyzed by using Statistical Packages for Social Science (SPSS) software version 16.0
(Chicago).

Table 2: Distribution of the respondents by Age category

Age category (in Years) Frequency Percentage

1-5 12 22.6

6-10 25 47.2

11-15 16 30.2

Mean ± SD 8.57±3.920

Table 2 reveals that majority of the respondents (47.2%) were in the age group 6-10 years
followed by 30.2% and 22.6% were 11-15 years and 1-5 years respectively.

Table 3: Distribution of the respondents by level of education

Level of education Frequency Percentage

None 38 71.7

Primary 1 1.9

Junior school 8 15.1

Matriculation 6 11.3

Total 53 100.0

32
Table 3 explores that 71.7% of the respondents did not have any institutional education among
them only 15.1% had junior level education, 11.3% had matriculation and only 1.9% had
primary level education.

Table 4: Distribution of the respondents by type of Employment

Employment status Frequency Percentage

Non-employed 48 90.6

Employed 5 9.4

Total 53 100.0

It is shown by Table 4 that only 9.4% of the respondents were employed.

35

30

25

20

15

10

0
Diplegic Hemiplegic Athetoid Mixed

Figure 6: Distribution of the respondents by type of physical disability

Figure no 6 shows that majority of the respondents (60.4%) had mixed type of physical disability
followed by 32.1%, 5.7%, and 1.9% had athletic, diplegic and hemiplegic respectively.

33
Table 5: Distribution of the respondents by homemade materials

Homemade materials Frequency Percentage

Bamboo 7 13.2

Mud 27 50.9

Tin 13 24.5

Brick 6 11.3

Total 53 100.0

Table 5 explores that half of the respondents homemade by mud and rest of the 24.5% made by
tin, 13.2% by bamboo and 11.35 by brick.

Table 6: Distribution of the respondents by Monthly family income

Monthly family income Frequency Percent

Between 2000-4000 BDT 12 22.6

Between 5000-10000 BDT 35 66.0

10000 and above 6 11.3

Total 53 100.0

Table 6 shows that 66.0 % of the respondents monthly family income was between 5000-10000
BDT followed by 22.6% and 11.3% was between 2000-4000 and 10000 & above respectively.

34
Table 7: Distribution of the respondents by Perception about the cause of disability

Perception about the cause of disability Frequency Percent

Medically informed reasons 6 11.3

Supernatural causes 20 37.7

Bad Deeds 14 26.4

Black magic 1 1.9

Curse 12 22.6

Total 53 100.0

Table 7 explores that 37.7% of the respondents' perception about the cause of disability was
supernatural causes, 26.4% was bad deeds, 22.6% was the curse, 11.3% was medically informed
reasons and only 1.9% said black magic.

40

35

30

25

20
Frequency
15 Percentage

10

0
Medically Supernatural Bad deeds Black magic Curse
informed causes
reasons

Figure 7: Distribution of the respondents by cause of disability

35
Figure no 7: explores that 37.7% of the respondents' Perception about the cause of disability was
supernatural causes, 26.4% was bad deeds, 22.6% was the curse, 11.3% was medically informed
reasons and only 1.9% said black magic.

Table 8: Distribution of the respondents by the perception of disability-related with poverty

Relation with poverty Frequency Percent

Strongly disagree 2 3.8

Disagree 1 1.9

Strongly agree 50 94.3

Total 53 100.0

Table 8 shows that majority of the respondents (94.3%) had a perception of disability-related
with poverty, 3.8% strongly disagree and only 1.9% disagrees with it

Table 9: Distribution of the respondents by the perception of disability related to lack of health
services

Related to the lack of health services Frequency Percent

Agree 24 45.3

Strongly agree 29 54.7

Total 53 100.0

Table 9 explores that 54.7% of the respondents strongly agreed on the perception of disability
related to lack of health services and 45.3% agreed on it.

36
Table 10: Distribution of the respondents by the perception of disability related to complication
during pregnancy

Related to complications of pregnancy Frequency Percent

Neither agree nor disagree 20 37.7

Agree 32 60.4

Strongly agree 1 1.9

Total 53 100.0

Table 10 shows that 60.4 % of the respondents agree regarding the perception of disability
related to complications of pregnancy, 37.7 % neither agree nor disagree and 1.9% strongly
agrees on it.

70

60

50

40
Frequency
30
Percentage

20

10

0
Neither agree nor Agree Strongly agree
disagree

Figure 8: Distribution of the respondents by the perception of disability related to complications

of pregnancy

Figure no 8 shows that 60 % of the respondents agree regarding the perception of disability
related to complications of pregnancy, 37 % neither agree nor disagree and 1% strongly agree on
it.

37
Table 11: Distribution of the respondents by the perception of disability related to lack of
awareness

Disability related to lack of awareness Frequency Percent

Neither agree nor disagree 19 35.8

Agree 2 3.8

Strongly agree 20 37.7

Do not know 12 22.6

Total 53 100.0

Table 11 shows that 37.7 % of the respondents strongly agree regarding the perception of
disability related to lack of awareness followed by 35.8 %,22.6 %, and 3.8% were neither agree
nor disagree, do not know, and agree respectively.

40

35

30

25

20 Frequency

15 Percentage

10

0
Neither agree nor Agree Strongly agree Do not know
disagree

Figure 9: Distribution of the respondents by the perception of disability related to lack of

awareness

38
Figure no 9 shows that 37.7 % of the respondents strongly agree regarding the perception of
disability related to lack of awareness followed by 35.8 %,22.6 %, and 3.8% were neither agree
nor disagree, do not know, and agree respectively.

Table 12: Distribution of the respondents by the perception of disability related to inadequate
nutrition during pregnancy

Inadequate nutrition during pregnancy Frequency Percent

Strongly disagree 7 13.2

Neither agree nor disagree 32 60.4

Agree 6 11.3

Strongly agree 2 3.8

Do not know 6 11.3

Total 53 100.0

Table 12 reveals that 60.4 % of the respondents neither agree nor disagree regarding the
perception of disability related to inadequate nutrition during pregnancy, followed by 13.2%,
11.3%, and 3.8% were strongly disagree, agree, do not know and strongly agree respectively.

70

60

50

40
Frequency
30
Percent
20

10

0
Strongly Neither agree Agree Strongly agree Do not know
disagree nor disagree

39
 Figure 10: Distribution of the respondents by the perception of disability related to inadequate
nutrition during pregnancy

Figure no 10 reveals that 60.4 % of the respondents neither agree nor disagree regarding the
perception of disability related to inadequate nutrition during pregnancy, followed by 13.2%,
11.3%, and 3.8% were strongly disagree, agree, do not know and strongly agree respectively.

Table 13: Distribution of the respondents by the perception of disability related to suffering from
fever during pregnancy

Suffer from fever during pregnancy Frequency Percent

No 30 56.6

Yes 23 43.4

Total 53 100.0

Table 13 explores that 43.4 % of the respondents had the perception of disability related to
suffering from fever during pregnancy and the majority of them didn't have it.

Table 14: Distribution of the respondents by the most common mode of treatment

The most common mode of treatment Frequency Percent

Government hospital 2 3.8

Non-Government hospital 6 11.3

Paramedics 7 13.2

Traditional healers 6 11.3

Religious healer 32 60.4

Total 53 100.0

Table 14 reveals that 60.4 % of the respondents treated by the religious healer, followed by
13.2%, 11.3%, and 3.8% were treated by paramedics, traditional healer, non-Government
hospital and government hospital respectivel

40
Table 15: Distribution of the respondents by the nearest availability of health services

Nearest availability of health services Frequency Percent

Within 500 meters 6 11.3

Within half km and 11.3% was within 5oo meters. half km 7 13.2

1-2 km 30 56.6

More than 2 km 10 18.9

Total 53 100.0

Table 15 explores that 56.6 % of the respondents nearest availability of health services was 1-2
km, 18.9% was more than 2 km, 13.2% was within 500 meters

Table 16: Distribution of the respondents by available mode of transportation

Available mode of transportation Frequency Percent

By foot 1 1.9

Rickshaw 8 15.1

Van 30 56.6

Battery operated three wheelers 14 26.4

Total 53 100.0

Table 16 explores that majority of the respondents (56.6%) had van facilities, 26.4% had battery
operated three wheelers, 15.1% had rickshaw and 1.9% traveled by foot.

Table 17: Distribution of the respondents by the provision of safe drinking water

Provision of safe drinking water Frequency Percent

No 15 28.3

Yes 38 71.7

Total 53 100.0

41
Table 17 reveals that 71.7% of the respondents had the provision of safe drinking water and the
rest of them didn't have it.

Table 18: Distribution of the respondents by the provision of sanitary latrine

Provision of sanitary latrine Frequency Percent

No 24 45.3

Yes 29 54.7

Total 53 100.0

Table 18 shows that 54.7% of the respondents had the provision of sanitary latrine and rest of
them didn't have it.

Table 19: Distribution of the respondents by awareness program on disability in the community

Awareness program on disability in the community Frequency Percent

No 13 24.5

Yes 40 75.5

Total 53 100.0

Table 19 explores that 75.5 % of the respondents had an awareness program on disability in the
community

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Table 20: Distribution of the respondents by Government and social welfare activity in the
community

Government and social welfare activity in the community Frequency Percent

No 43 81.1

Yes 10 18.9

Total 53 100.0

In table 20, it has been shown that only 18.9% of the respondents had government and social
welfare activity in the community and the rest of them didn't have it.

Table 21: Distribution of the respondents by disability based NGO activity

Disability based NGO activity Frequency Percent

No 9 17.0

Yes 44 83.0

Total 53 100.0

Table 21 shows that 83 % of the respondents had disability based NGO activities and rest of
them didn’t have it.

Table 22: Distribution of the respondents by marital status and stigma/taboo/cultural beliefs
regarding various health issues present in the society

Marital status & stigma/taboo/cultural beliefs regarding various health

issues present in the society Frequency Percent

Never married 53 100.0

Yes 53 100.0

Total 53 100.0

43
Table 22 explores that 100 % of the respondents were never married and all of them had
stigma/taboo/cultural beliefs regarding various health issues present in the society.

Table 23: Distribution of the respondents by the association between adequate nutrition during
pregnancy and lack of health services (χ2 test)

Adequate nutrition during pregnancy Lack of health services

strongly agree P value

Strongly disagree 6 1

Neither agree nor disagree 18 14

Agree 0 6 0.001

Strongly agree 0 2

Do not know 0 6

Table 23 shows that there is a highly significant association between adequate nutrition during
pregnancy and lack of health services (p =0.001, applicable for both the compared scenarios)

Table 24: Distribution of the respondents by the association between poverty and type of
physical disability (χ2 test)

Relation with poverty

Type of physical disability
strongly disagree disagree strongly agree P value

Diplegic 1 1 1

Hemiplegic 0 0 1
0.001
Athetoid 1 0 16

Mixed 0 0 32

Table 24 shows that there is a highly significant association between poverty and type of
physical disability (p =0.001, applicable for both the compared scenarios)

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7 DISCUSSION

7.1 Validity and reliability of the study

Almost all of the respondents and their family members are from the most poverty prone areas of
Bangladesh and hence they are deprived of formal education and alongside knowledge about
causes of disability and aftereffect of disability on the family and society, on the whole, are
pretty much unknown to them. With the prevailing lack of education and overwhelming social
taboo, people are unaware of proper health care and hence they are dependent on unconventional
health care in society and as a result confronting various conditions. It has been observed poor
people are quite dependent and apprehended about various cultural beliefs and only consult with
various cultural or religious healers in case of their health condition, despite the presence of
proper health care services near to them.

Despite some NGO’s have started social awareness programs in some areas to inform the poor
people about different health conditions that might arise if proper care is not taken of the
pregnant mother and observation says that village people are a bit reluctant to attend and follow
their direction. The study has shown a marked number of respondents are totally unaware of the
proper care and diet for a pregnant mother and that also being a vital cause for congenital
physical disability. Respondents were eager to take part in the questionnaire survey and almost
all of them agreed to the statement that poverty is responsible for congenital physical disability
(100%) but when asked if they can explain why they think like that, most of they were unable to
explain. The respondents were mostly eager to attain some rehabilitation help for their own
self/their disable child but a strong need for awareness has been found for proper behavior and
proper care towards the pregnant mother, which will decrease the birth of children with disability
to an extent, because it’s always best to intervene beforehand in a way so that the situation
(Physical disability) do not occur. so the proper networking with the government rehabilitation
service centers and as well as the non government offices providing rehab service in the
community has to understand the need of social awareness programs and take necessary steps to
arrange such programs in the rural community often and make them aware of the different ways

45
to take care of the pregnant mother and how this, in turn, will reduce the chance of the birth of
physically disabling child.

The family members of a disabled child were in such a dilemma and expressed their emotion like
we do not have the provision of sanitary water and safe latrine, in this situation how can/could
we ensure the healthy surrounding for a pregnant mother? As shown in the physical structure of
the household of the clients, it’s quite evident that most of the houses are below standard for a
healthy life leading and unhealthy surrounding (absence of sanitary latrine and pure during water
in case of most of the respondents). People are too much dependent on the unskilled village
nurses and religious healers than taking the pregnant mother to the nearby health center. Some
prevailing rituals are like these kinds of disability occurs due to any bad deed of the mother/ any
of the parents and hence the mother/ family of the disabled child has to undergo extreme social
isolation and are treated as bad people of the society. The situation of the family of children with
the disability is beggars’ description.

7.2 Discussion of the study findings

Studies have shown that households with disable person have fewer assets in comparison to other
poor households (Mitra S 2012). This research also showed evidence of households with disable
person is among the poorest of the poor. They have the lowest socio-economic condition as well
as the housing infrastructure in the society, making them vulnerable to societal exclusion and
withdraw from social participation. There has been evidence of malnutrition leading to disability
(Groce et al, 2014) according to different studies.

46
 Figure 11: Conceptual framework correlating malnutrition and disability (Groce et al, 2014)

This very study also showing that there is immense lack of knowledge and awareness regarding
nutritional food intake during pregnancy and this is reinforced by lack of pure drinking water and
unhealthy sanitation (Poor living condition) for the persons with disabilities. These contextual
factors lead to various health issues for the pregnant mother in the poverty prone society and in
turn increasing the possibilities of giving birth to children with disability (Physical disability).

Mitra S has mentioned about how different social stigma and taboo associated with cultural
context might make the health condition even more beggar’s description for pregnant mother and
resulting in giving birth of a disable child (Mitra S, 2012). Unavailability of proper health care in
the close vicinity of the poor social households and the scarcity of reaching there on time also
makes it susceptible for giving birth to disable children (Neonate hypoxia causing birth to
children with cerebral palsy with extreme physical limitations), which is also an alarming finding
of my study.

47
7.3 Strengths and weaknesses of the study

According to the current knowledge, the need for community-based rehabilitation (Social model)
is more important in assuring sustaining effect on personal and social life than community-based
rehabilitation (Therapeutic model). To ascertain the effect of the social model of rehabilitation in
peoples life, this retrospective study was done to ascertain what all places need to be addressed
to ensure the reduction in childbirth accidents (During childbirth) as well as creating awareness
in the proper care of the pregnant mother. Most of the funding from European Union going to
Bangladesh to run different pilot projects for the betterment of persons with disabilities has been
concentrating on the rehabilitation of the disable people and very little has been done in finding
out what are the hind causes for this disability percentage to be this high (10%) in a poor country
like Bangladesh and creating awareness among the people in regard to those reasons, so that
people are aware of the fact why disability is happening and what should be done to bypass this
phenomenon.

The main weakness of the research was lack of generalization of the result obtained and also the
fact that the recommendations made at the end of the research might not be convenient for other
parts of Bangladesh to replicate, taking into consideration the overall situation of the survey
areas.

7.4 The Implication for Future Research, Policy and Practice

1 The government of Bangladesh, Multi and bi-lateral donors, international community has to
understand the correlation between nutritional food intake and disability and thus ensure
supplement of proper nutritional food to the pregnant mother to avoid giving birth to disable
(Physical) children.
2 WHO induced Severe Acute Malnutrition (SAM) guide should be followed by national and
international correspondents which directly or indirectly increase the susceptibility of giving
birth to disable child.

48
3 Severe need for ensuring nutritious food support to pregnant and breastfeeding mothers (In
rural outskirts) to reduce the susceptibility of giving birth to disable child.
4 The inclusion of separate chapters containing ways and stories about "How to create a
disability friendly environment in the society" in the primary education books can be done.
5 Organizing different rural drama and songs on how to take care of pregnant mother and how
that can lead to the birth of a healthy child can be an entertaining way of making people
aware about the need of care during pregnancy, present scenario of disability in our country
and also the correct attitude towards persons with disability.
6 Printing and distributing leaflets and pamphlets about the need of care during pregnancy,
present scenario of disability in our country and also the correct attitude towards persons with
disability.
7 Rights for Persons with Disability have to be ensured and practiced and those people with
disability hiding behind the house corner should be informed and made empowered so that
they convert from a burden to an asset to the country.
8 If the awareness program can be carried out in the survey area, there can be a list made of
pregnant mothers (Specially those having a physically disable child in the family) and follow
them up in regard to their delivery of child and research what was the prevailing ratio of
physically disable childbirth in that area and how many children has born with physical
disability after different initiative of awareness has been carried out in those areas.
9 More health care facilities (Especially pre and post natal) trough trained health care
professionals need to be availed for poor people of the marginalized lot of the society.
10 More practical steps needs to be taken and carried out to get rid of pregnancy related social
stigma and taboo in the society and thus creating a crucial environment for healthy pre and
post natal care of the pregnant mother and increasing the chance of giving birth to healthy
child.

49
8 CONCLUSION

Results of this study were obtained by using questionnaire which was constructed with the help
of literature reviews of previous studies in the same field. Piloting was conducted before the
actual data collection survey in order to improve the questionnaire's aim, content, and logistics.
One thing which is necessary to mention here is that family of a disable child is considered as a
taboo in South Asian societies so this can be a reason that why respondents (or family member of
the client answering on behalf of the client) of this study were reluctant to disclose their disable
child in the society (Often they are kept inside the house) and some are so afraid of the social
exclusion that they do not even say outside that they have a disabled child in their family. But
during the survey, they were told and assured about the confidentiality of their information and
hence they were free to express their views. However, the identity of the participants was kept
anonymous in the questionnaire so that respondents (or family member of the client answering
on behalf of the client) of this study can disclose their information without any hesitation, to
attain the maximum reliable results of this study. Though results of this study cannot be validated
to other parts of the country as the social condition and economic criteria’s are a determining
factor for this study and it is not all the same everywhere in Bangladesh. So this study cannot
represent the holistic knowledge, attitude, and attributes regarding the correlation between
poverty and congenital physical disability as a whole in entire Bangladesh.

Disability and poverty are intricately linked as both a cause and consequence of each other and
physical disability being the majority in those overall incidents. Unfortunately, due to lack of
data and the difficulty of addressing the additional costs of disability, few estimates exist of the
impact of disability on poverty – especially taking into account Sen's capability approach would
argue for a separate poverty line for households with disabled members. Applying the Zaidi and
Burchardt approach to collect data from Bosnia and Vietnam that allows for a consumption-
based measure of poverty and a functional measure of disability reveals that ignoring the issue of
disability significantly understates both poverty and the impact of the disability. Bangladesh is
one of the poorest courtiers in the south Asia where ensuring basic life needs for persons without
the disability is a challenge, taking special steps for reducing the birth of disabled children is an,
even more, tougher ask. But if the government and the non government sector realize how

50
disability and poverty go hand in hand and signify the effects of suffering of the country as a
whole, they will take all the necessary steps as soon as possible with highest attention to reduce
the rate of congenital birth of physically disable child and thus contribute in the overall
betterment of the country, with the help of the international disability organizations mentioned
above.

51
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10 APPENDICES

Appendix A: Questionnaire

1. Age:
2. Sex:
3. Education level: None Primary Junior high Matriculation Tertiary
4. Type of physical disability: Quadriplegic
Diplegic
Hemiplegic
Dystonic /Athetoid /Ataxic
Mixed

5. Employment history of the client: Employed Unemployed

6. Marital status: Married

Live in
Widowed
Divorced
Separated
Single (never married)

7. House made of Wood Bamboo Mud Tin Brick Homeless

8. Monthly income of the family (1 euro = 100 BDT): Less than BDT2000
Between BDT2000-4000
Between BDT5000-10000
10000 and above (Approx.)

57
9. Causative perception about disability in the family:

Medically informed reasons

Due to supernatural causes

Bad deeds/ Karma

Possessions

Black magic

Curse

Others:…………………………………………………………………………(State)

10. Do you think disability is related to poverty?

1) Strongly disagree 2) Disagree 3) Neither agree nor disagree 4) Agree
5) Strongly agree 6) Do not know

11. Do you think is it related to the lack of health services?

1) Strongly disagree 2) Disagree 3) Neither agree nor disagree 4) Agree

5) Strongly agree 6) Do not know

12. Do you think is it related to knowledge (pregnancy-related)?

1) Strongly disagree 2) Disagree 3) Neither agree nor disagree 4) Agree

5) Strongly agree 6) Do not know

13. Do you think is it related to a lack of awareness?

1) Strongly disagree 2) Disagree 3) Neither agree nor disagree 4) Agree

5) Strongly agree 6) Do not know

14. Do you have/ had an idea about minimum adequacy of nutritional diet during pregnancy?

1) Strongly disagree 2) Disagree 3) Neither agree nor disagree 4) Agree

5) Strongly agree 6) Do not know

58
15. Did your mother suffer from any strong fever/ other diseases during her pregnancy?

1) Yes 2) No 3) Do not know

16. The most common mode of treatment available/ accessible in the client's community:
Government hospital/ health care service
Non Government hospital care service
Paramedics
Ayurveda
Homeopath
Traditional healers(Folk healers)
Religious healers
Others:…………………………………………………………………………(State)

17. Nearest availability of Government or non-government health service:

Within 500 meters
Between 500meters – half kilometers
Between 1-2 kilometers
More than 2 kilometers

18. Available mode of transportation to the nearest health service:

Walking
Rickshaw
Van
Battery operated 3 wheelers
Other: ………………………………………………………………………… (State)

19. Provision of safe drinking water: Yes No

20. Provision of sanitary latrine: Yes No

21. Awareness program on disability in the community: Yes No

59
22. Government and social welfare activity in the community:
Yes No Do not know

23. Disability based non-government Organization (NGO) activity in the community:

Yes No Do not know

24. Does stigma/taboo/cultural beliefs regarding various health issues present in society?
Yes No Do not know

Thank YOU for your participation

60
Appendix B: Consent form
LETTER OF CONSENT

August ........., 2018

(2 Pages)

Dear Mr/Ms........................................................................

I am delighted and grateful to you as you have agreed to attend my thesis study (Association
between Poverty and Congenital Physical Disability) as a respondent and in order to facilitate
and support your contribution, I kindly ask you to provide your approval of participation by
signing this consent form. It is meant to ensure that we have your approval to include/share your
information's (name, gender, age, country of origin and other disability-related information's
shared by you as an answer of the questions asked to you by the interviewer) to be used in any
disability-related studies.

Please do not hesitate to contact me, Amzad Hossain, with any questions or concerns (Directly in
my email or through Mr. Liton Paul- The Interviewer). My details are as follows:

AMZAD Hossain
UNIVERSITY OF EASTERN FINLAND
Faculty of Social Sciences and Business Studies
Department of Business
MDP in Health and Business
Cell+Viber+Whatsapp: +358469337707

61
 How to fill out the consent form:

1. Please fill out all the information in English (write-in CAPITALS) with the help of the
interviewer.
2. Please make sure that any questions or concerns have been answered by the interviewer
before you sign it.

3. Please include your mailing address if you would like to receive copies of the final
Thesis report.

Contributor details

Last name First name Middle name

Gender Date of Birth Age (on 1

(female/male) August 2018)

Mailing Address

City Province Postal Code

Phone Number Mobile Country

Number

Email address

62
Copyright release form for original works of art

For the purposes of promoting health and reduce disable childbirths, I hereby grant Mr. Amzad
Hossain the right to reproduce, display and disseminate the shared information's (By me and my
family members) worldwide and in perpetuity, in any traditional or electronic media format, and
therefore I do grant permission for this copyright use:

__________________________________________

Date and Signature/Finger Print

63