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Despite disability being a serious problem in post-conflict regions, to date studies still remain rare. In contrast, recent reports are recognising the importance of disability-inclusive development policy worldwide. Prof. Takasaki’s study aimed to bridge these topics while also filling a gap in systematic empirical studies on disabilities in developing countries. To do so, he turned his eye towards the country with the highest prevalence of amputees in the world, Cambodia, a landscape littered by landmines many of which still remain to this day.
As a key factor, employment plays a crucial role in empowerment and inclusion in society. As reported by the OECD, labour market programs for PWDs can potentially promote their economic inclusion, thus leading to empowerment, reduction of stigma and social inclusion.
Researchers consider stigma to be a social construct, not an attribute of individuals. It is defined as a significantly discrediting attribute that lowers the status of an individual or group in the eyes of society. It can be a dynamic process in which “elements of labelling, stereotyping, separation, status loss and discrimination occur together in a power situation that allows them.” Stigma associated with chronic health conditions has been well studied, emphasising its importance for overall well-being in society.
To examine these factors, Prof. Takasaki designed and conducted a field experiment on vocational training for adults with limb amputation or paralysis in heavily mined areas of rural Cambodia. A small scale vocational training program was run by a local nongovernmental organization (NGO) called the Cambodian War Amputees Rehabilitation Society (CWARS). The training was exclusively for PWDs, with stays of up to one year. His study divided a sample of surveyed PWDs into a treatment group (invited to participate in the program) or a control group (not invited to participate). The baseline sample covered 681 PWDs eligible for the program who resided in 305 communities, situated in 65 communes of 8 districts. Among PWDs in the baseline sample, 14% were hand amputees, 62% were leg amputees and 26% had limb paralysis.
The study considered both economic and psychological outcomes from the training. An indicator variable was defined for economic outcomes based on salaried employment, day labour and nonfarming family enterprise. Monthly earnings were also examined as another outcome.
In considering psychological outcomes, categories of stigma that apply to physical disabilities were considered: (1) perceived stigma, consisting of negative feelings or attitudes about stigmatized people in the community, (2) enacted stigma, consisting of actual experiences of discrimination that result from stigma and (3) self-stigma (or internalized stigma), whereby stigmatized people view themselves as deserving of poor treatment.
Household surveys were also conducted among PWDs addressing self-stigma and experiences of discrimination. In a self-report, similar behaviour may have been perceived as discriminatory by some but not by others. The survey questions aimed to measure two categories of indicators: (1) self-stigma, including shame, guilt, and self-blame that PWDs felt because of their disability and (2) experienced discrimination, including indicators of discrimination experienced by PWDs because of their disability.
The results of the study showed that while PWDs assigned to the treatment group experienced greatly increased employment and earnings, they also reported increased discrimination and self-stigmatization. Subjective well-being and perceptions of empowerment were unaltered.
The positive economic impact saw a 26% increase in monthly earnings (about 4.6 USD). This was greater than previous reports for training programs for nondisabled people in developing countries, but similar to results among youth in Uganda and ex-combatants with disabilities in Rwanda. One caveat was that the employment rate among trainees remained low and household income did not increase, instead tending to shift from farming to nonfarming activities. An increase in earnings per hour implied that productivity had improved.
The negative psychological impact was seen in increased discrimination reported by 31% of PWDs who underwent training, as well as signs of persisting self-stigma including feelings of shame among 63% of participants. These counteracting positive economic and negative psychological impacts may have led to no statistically significant change in perceived well-being and empowerment. The results indicate that vocational training can promote PWDs’ economic inclusion but also create negative psychological side effects.
Prof. Takasaki sheds light on the possible mechanisms for these outcomes. Increased economic inclusion may have resulted from the acquisition of skills and networking for employment. The six-month vocational training was intensive and high-quality, designed to advance skills in local labour markets. Skill acquisition was listed as the main benefit obtained from training in 84% of survey responses. At the same time, the program created opportunities to strengthen social networks for trainees. In developing countries, job opportunities are typically learnt through social networks with friends and relatives, placing PWDs at a disadvantage. Reported benefit from networking was also two times more common among trainees who found successful employment than those who did not (45% vs. 21%).
Psychological impact may have resulted from intensive interactions with disabled peers at the training centre which strengthened self-identification as disabled, leading to negative self-stereotyping and self-stigmatization. This possibility is favoured over other effects such as disappointment from trainees who did not find jobs at the end of the program, which could lead to perception of discrimination, as the results were not dependent on salaried employment.
The study contributes crucial evidence towards the strong economic impacts of vocational training among people with war-afflicted disabilities. In addition, it adds insight into the effects of negative self-stereotyping and the overall impact on subjective well-being. Prof. Takasaki concludes that high-quality intensive vocational training is promising for PWDs, but must crucially be combined with effective psychological support. He suggests that negative self-stereotyping may be alleviated by integrated training with nondisabled people. The implications of his study provide an important guide to future disability-inclusive development policy as well as a call for greater empirical studies to better understand these impacts. Such efforts may help to one day unplant the seeds sown by war and their disastrous lingering effects on our society.
Editor: Clement Ng
Illustration: Designed by Freepik
Related link
Impacts of vocational training for persons with disabilities: Experimental evidence from Cambodia
Journal of Development Economics Volume 169, June 2024, 103277
