A/HRC/34/58 including for basic day-to-day activities such as getting up, bathing, dressing and eating. 3 The sustained ageing of the global population, particularly in high-income countries, has also had a substantial impact on the demand for disability-related support, as older persons tend to be overrepresented in the disability community.4 Other sociopolitical factors such as conflict and migration increase the demand for support, as support networks tend to fall apart in such situations. 18. Despite the rising demand, the support needs of most persons with disabilities worldwide are not being met. Evidence indicates that in most developed and developing countries, the majority of persons with disabilities have limited access to support services. 5 There is a shortage of community support services for persons with disabilities who require personal assistance. In many countries, only 5-15 per cent of those in need of assistive devices and technologies are able to obtain them. 6 Deaf and deafblind persons frequently face difficulties in accessing trained interpreters, particularly in rural or isolated communities. Persons with psychosocial and intellectual disabilities are overrepresented among the homeless because of the lack of support for living in the community and for decision-making. Furthermore, general public services in such areas as education and employment do not envision support measures to ensure the full participation of persons with disabilities. While all persons with disabilities face challenges in accessing support, those with high support needs are disproportionately affected by the lack of appropriate services. 19. Regretfully, there is little public and political interest or attention to the support needs of persons with disabilities. In many countries, support is not included in national legislation and policies and, when available, it is an underfunded residual service with scarce provision that does not match people’s needs.7 Moreover, whereas there are some forms of formal support for persons with disabilities in many high-income countries, this is not the case in many low- and middle-income countries. Consequently, the majority of persons with disabilities have to rely on informal forms of support, primarily from their families and personal networks. 20. Support is a normal part of community life, with families serving as the first source of support for everyone. For many persons with disabilities, family support serves as a bridge to access other assistance needed to fully enjoy their human rights. However, when no other options are available and families are the sole source of support, the autonomy of persons with disabilities and their family members is reduced. Those being supported have no choice or control over the assistance they require to pursue their life plans, and questions of overprotection and conflict of interest commonly arise. Families — especially the poorest — are also under significant pressure as unpaid familial support also affects social relationships, income levels and the general well-being of the household. Women and girls are disproportionately affected, as in practice they are the main providers of support within the household, reducing their freedom and choices to pursue their own life plans. 21. The absence of appropriate support systems increases the risk of segregation and institutionalization. When families do not get the necessary support, there is great pressure to place their family member with a disability in an institution. In addition, service providers in many countries continue to claim that institutions are the best way to support persons with disabilities. Thus, the only way a family can get any support for accessing basic services is by placing their family member in an institution. Both institutionalization 3 4 5 6 7 6 World Health Organization (WHO) and World Bank, World Report on Disability 2011, p. 29. Ibid., pp. 34-35. Ibid., pp. 139-140. See who.int/disabilities/technology/activities/en/. WHO and World Bank, World Report on Disability 2011, pp. 144-147.