SPECIAL NOTE | July 2023
Children and Their Families
Six Months After Pakistan’s Floods
Lauren Dahlin, Juan D. Barón
From June to August 2022, heavy monsoon rains
KEY TAKEAWAYS
caused severe flooding in nearly one-third of
By February 2023, six months after the Pakistan. By February 2023, flood waters have
floods, economic activity, and health
receded in most areas, allowing for rebuilding to
and education indicators are improving
for most households in flood-affected begin after widespread losses.
areas. However, there continue to be
substantial challenges for households in Based on satellite imagery, the United Nations Office for the
areas that were completely flooded. Coordination of Humanitarian Affairs reports that 1.8 million
→ In completely-flooded areas, a quarter people lived near stagnant flood waters in February 2023,
of households have returned home after down from 4.5 million in January (OCHA 2023C). At the onset
living in temporary shelters. However, of the floods, an estimated 33 million people lived close to
one-third of households in these flooded areas (UNOSAT 2022). The Pakistan Post Disaster Needs
areas continue to reside in temporary Assessment estimates that economic losses from floods exceed
shelters. 15 billion USD (Government of Pakistan et al. 2022).
→ Continued areas of concern for families Using a new round of household phone survey data, this
in flooded areas include child mental note documents the progress and pain points in rebuilding
health, food insecurity, and travel human capital in Pakistan after the floods, building upon the
disruptions. For example, families in findings from the first-round survey. Results from the first-
flooded areas were 50 percent more round survey show the floods’ widespread direct and indirect
likely to be worried they would run out
impacts (Barón et al., 2022). Direct impacts included the losses
of food than those in un-flooded areas.
of homes, incomes, crops, and livestock. Indirect impacts
→ In flood-affected areas, most schools included losing access to transportation, health, and education
are reopening. Six months after the services. Children and families were particularly impacted, with
floods, the share of households in an estimated one million out of school due to flooding and at
flooded areas reporting their children’s risk of not returning.
schools were not operating fell from
18 percent to 9 percent. However, only Both rounds of the survey focus on the impacts of the floods
about 40 percent of children have on children and families. Each survey round sampled two
returned to school in these areas. cohorts of 4,000 families with children ages 3 to 17. The first
survey was administered in late September 2022, and the
→ Yet, the children still out of school second began roughly six months later, in February 2023. The
are less likely to return. Parents who
surveys were designed to be nationally representative. (See
said their children were unlikely to
the final section of this note for more on the methodology and
return to school said the travel time
caveats about the interpretation of results.)
increase due to flooding was their top
concern.
ACKNOWLEDGMENTS | For this note, the team benefitted from comments by
Freya Perry, May Bend, Toby Linden, Keiko Inoue, and other colleagues from the
Education Global Practice at the World Bank. This note was made possible by generous
funding from the United Kingdom’s Foreign, Commonwealth & Development Office
(FCDO), through the Data and Research in Education (DARE) project. Juan D. Barón
(jbaron@worldbank.org) and Lauren Dahlin are, respectively, Senior Economist and
Consultant at the Education Global Pratice of the World Bank.
Specifically, this note focuses on
groups who may be left behind as
others recover.
The second-round phone survey
reveals that households in areas
most hit by flooding are the least Households in areas
recovered. By some indicators of most hit by flooding
recovery, such as time spent in are the least recovered.
temporary shelters, all households
appeared to recover at similar
rates, regardless of their wealth or
education levels. However, by other
indicators, such as child work due to The note also examines indicators
flooding, less-educated households of recovery of particular relevance
need to catch up to their more- to children. For example, prior
educated counterparts. These research has shown that even
findings suggest that policymakers when adults are given substantial
could ensure relief reaches the compensation following natural
areas hardest hit by flooding and disasters and fully recover
target at-risk groups in specific economically, such as the 2005
intervention areas. earthquake in Pakistan, children
may continue to incur physical
EQUITABLE IMPACT and educational deficits well
beyond the impact of school
Findings suggest that closures (Andrabi, Daniels, and Das
policymakers could ensure 2021). As such, this note reports
relief reaches the areas on both typical indicators of
educational recovery, such as time
hardest hit by flooding
out of school, and more holistic
and target at-risk groups indicators of well-being, like child
in specific intervention mental health, which will continue
areas. to impact the educational and
economic outcomes of children in
Pakistan for years to come.
SPECIAL NOTE | Children and their Families Six Months After Pakistan’s Floods | July 2023 2
I. Economic impacts on families with children
six months after the floods
The floods disproportionately impacted some provinces (Figure 1)
and poorer households. While households in much of the country
are recovering economically, families in severely-impacted areas
continue to struggle, with many still residing in temporary shelters.
The first-round phone survey showed that certain Figure 1. The provinces of Balochistan and Sindh
provinces experienced more flooding than others. had the highest share of survey respondents from
Poorer and less-educated families were more likely flooded areas.
to live in flooded areas, but families with higher
socio-economic status were also impacted (Barón et Households reporting flooding by province
al., 2022). The provinces of Balochistan, Sindh, and KP
each had at least half of all families living in flooded
areas. To better understand the impact of the floods
on affected families, the second-round survey
included more respondents from these areas (we
stratified to guarantee that 50 percent of the sample
came from partially- or completely-flooded areas
at the time of the initial floods). In the second round
survey, half of the households from Balochistan, and
40 percent of households from Sindh, reported that
their area remained completely inundated.
Evidence from the second-round survey suggests
that families are recovering from the loss of
income, particularly in less-flooded areas. In the Despite evidence of income recovery, about a third
first-round survey (September 2022), two-thirds of families still expect their children will need
of families in flood-affected areas reported partial to work due to the economic conditions caused
or complete income loss. Six months later, just 8 by the floods. In the round 1 and round 2 surveys,
percent of families reported partial or complete respondents were asked, “Do you envision your child
income loss. Families from completely-flooded areas will need to work in the future due to the economic
were 31 percent more likely to have lost their primary difficulty caused by the floods?” One month after the
means of earning a living, compared to somewhat floods, 28 percent of families believed their children
flooded areas. As areas that were hit less severely would need to work. Six months later, 33 percent of
recover, families from completely-flooded areas are families held this expectation. The interpretation of
at risk of being left behind. these numbers is complex as this could compound
the additional impacts of overall economic
conditions in the country, including high inflation and
economic slowdown.
Percent of
respondents in
40% flooded areas
who reported
losing their
homes
SPECIAL NOTE | Children and their Families Six Months After Pakistan’s Floods | July 2023 3
Families where the primary breadwinner had less was 1.7 times higher in completely-flooded areas
than a secondary education (class 10 or higher) relative to somewhat-flooded areas.
were more likely to expect their children would
In addition to losing household goods, nearly 40
need to work. Moreover, the gap in expectation of
percent of households in completely-flooded areas
work based on household education level grew larger
lost their houses. However, rebuilding occurs, and
six months after the floods, compared with one
many families in these areas have left temporary
month after the floods, as shown in Figure 2.
shelters. More than half of families in completely-
This reflects family responses to economic hardship
flooded areas lived in a temporary shelter following
documented by Khan and Hussain (2022); many
the floods. Approximately 43 percent of families
parents who lost income due to the floods withdrew
in completely-flooded areas had left temporary
children from school and put them to work. Girls are
shelters by February 2023. The average time spent in
particularly vulnerable to being compelled to work
a temporary shelter was five weeks.
or marry after climate disasters (Chuang et al. 2023).
It is worth nothing that even among more-educated Yet, many poor families in completely-flooded
households there is no decline in the proportion areas still reside in temporary shelters. As shown
who expect their children will need to work. in the literature, disasters have a greater impact
on poorer families (Hallegatte et al. 2020; Kousky
Figure 2. Six months after the floods, families from 2016). Figure 3 displays this discrepancy between
less educated households were more likely to the rich and poor in their likelihood of residing in
believe their children would need to work due to a temporary shelter and continued residence six
the economic difficulty caused by the floods. months later. Poorer families (in the bottom half of
households by assets) were 30 percent more likely
Less than high school education than wealthier families (in the top half by assets) to
High school or higher live in temporary shelters and nearly three times as
likely to still reside in a temporary shelter six months
after the floods.
Figure 3. Poorer families in completely flooded
areas were more likely to live in temporary shelters
following the floods and continue residing in
shelters six months later.
Households living in temporary shelters
Poorest half
of households
Asset losses are contributing to the poor economic Richest half
outlook in flooded areas. New evidence suggests of households
household assets will be difficult to recover, given
the magnitude of losses. A new question in the
second round about the value of losses to household
goods and other assets provides additional insight
into the magnitude of the losses. About 23 percent
of respondents from flooded areas reported a
loss of household goods or other assets. The self-
reported average value of lost household goods
was approximately 2,479 USD, 1.4 times the average
annual income in Pakistan.1 The value of lost assets
1 Estimate derived using household income provided in the Pakistan
Economic Survey 2021-22 (Government of Pakistan, Finance
Division, 2022)
SPECIAL NOTE | Children and their Families Six Months After Pakistan’s Floods | July 2023 4
II. Barriers to education and continued impacts on families
There is strong global evidence that disasters negatively impact education and
have potentially cumulative and long-lasting effects (Baez, de la Fuente and
Santos 2010). The immediate direct effect on education can be found in the
destruction of schools or reduced access to them due to the destruction of
other critical infrastructure (e.g., roads, bridges). When instruction is disrupted,
quality suffers and children’s human capital accumulation opportunities are
reduced, in both the immediate and long term (Andrabi, et al. 2021;
Husted, et al. 2022).
Figure 4. More parents reported their child felt
A. Child Mental Health sad or became quiet six months after the floods
than one month after.
The mental health of children in flood-affected areas
seems to be getting worse. Prior research has shown
that natural disasters profoundly impact child mental
health, including sleep disturbances and depression
(Kousky 2016). In the second-round survey, a larger share
of parents reported that after the floods their child felt
sad regularly (42 percent) or that their child had become
more quiet (28 percent) relative to parents in the first
round (37 percent and 19 percent, respectively) (Figure 4).
1 month post-floods
Policy interventions to address 6 months post-floods
child mental health
In a recent literature review of interventions that could Additionally, 20 percent of parents nationwide
help to address the child mental health crisis in Pakistan, reported that their child seemed anxious, nervous, or
Cheema et al. (2023) recommend three interventions. The
worried daily or weekly. Twenty percent also reported
first two interventions could be implemented relatively
cheaply using existing school personnel. that their child seemed sad daily or weekly. The second-
round survey asked parents about the frequency of
1. Psychological First Aid (PFA) – Several models of PFA
have been developed for use after natural disasters (see sadness and anxiety in their child as part of a nine-
Wang et al. 2021). For example, the National Child Stress question module on child disability. These questions
Network (NTSN) has adopted a PFA model specifically were derived from the UNICEF/Washington Group
for training school personnel to address the needs Module on Child Functioning (UNICEF 2022B). The overall
of children after disasters (NTSN 2014). Its eight core
principles include stabilizing distressed individuals and
rate of child disability in the survey population was
providing information about stress reactions and coping 30 percent,2 significantly higher than the estimated 11
strategies to reduce distress. percent for the Southeast Asia region found by UNICEF
(2022A) using the same survey questions. The high rate
2. Play and art therapies – Play and art therapies can
help children to express their emotions after natural of disability in our survey is driven, at least in part, by
disasters. Case studies in Pakistan concluded that the high rate of poor mental health in children in both
drawing improved children’s mental health, even flooded and unflooded areas.
if teachers were not formally trained in art therapy
(Ahmed and Siddiqi 2006).
3. Telepsychiatry services – Phone or video conferencing 2 This disability rate excludes children who may have a disability solely
can provide psychological evaluations and therapy to based on their difficulty getting dressed. Thirty-four percent of
children and teenagers. parents reported that their child needed help getting dressed daily.
Additional research is required to assess the reliability and validity of
this instrument for assessing disability when using phone surveys.
SPECIAL NOTE | Children and their Families Six Months After Pakistan’s Floods | July 2023 5
Figure 5. Concern over running out of food has
increased for families, particularly in flooded B. Food Insecurity
areas.
Compounded by inflation, food insecurity is more
severe six months after the floods. As shown in
Not flooded area
Figure 5, before the floods, households in flooded
Flooded area
areas had a similar level of concern about food
insecurity to households not in flooded areas (30
percent vs. 32 percent). After the floods, 75 percent
of respondents in flooded areas were worried their
household would run out of food. In areas unaffected
by the floods, the share of households worried about
food security increased to 52 percent. Inflation has
contributed to food insecurity. In rural areas, food
inflation has increased to 45 percent (OCHA 2023C).
The United Nations estimates that 1.1 million people
are at risk of sliding from acute food and livelihood
crisis (IPC3) situations to humanitarian emergency
(IPC4) food security situations (OCHA 2023B).
Malnutrition can harm children’s development
and learning ability. Children who are hungry and
Figure 6. For the 16 percent of households with undernourished have trouble focusing, have problems
disrupted commutes, almost half report their with attention and memory, and get sick more often,
commute time increased by more than one hour. leading to missed school days (UNICEF 2019). In
Punjab, malnourished 6-8 graders perform worse in
school and have lower attendance and understanding
A. Increase in
than their well-nourished peers (Shabbir et al.
commute time for
2019). Malnutrition is especially harmful during the
daily trips among
critical first two years of a child’s life. It can cause
households whose
stunted growth and permanent damage to cognitive
commutes are
processes that can’t be fixed with proper nutrition
still disrupted
later, leading to long-term effects on their ability to
0– 15 mins learn and achieve their potential (Hioui 2019).
15–30 mins
30–45 mins
45 mins–1 hr C. Travel Disruptions
More than 1 hr
Although travel disruptions have lessened
significantly in flooded areas, the disruption is
significant for households whose commutes to
work and school remain disrupted. About 16 percent
B. Time for travel of households report that their commutes remain
services to return disrupted. Nearly half of these households with
to normal disrupted commutes report that their commute time
has increased by more than one hour (Figure 6A).
0–3 days Additionally, more than one third of respondents
4–7 days reported it took four or more weeks for transportation
1–2 weeks services to return to normal (Figure 6B). As discussed
2–4 weeks in the next section, these disruptions impacted
4+ weeks children’s ability to return to school following the
Still disrupted floods and continue to impact families whose children
are out of school.
SPECIAL NOTE | Children and their Families Six Months After Pakistan’s Floods | July 2023 6
III. Children’s education in recovery
Six months after the floods, many children have returned to
school. Yet, children whose education is still disrupted are at
risk of falling severely behind their peers.
Schools are reopening. The share of households Figure 7. Children from rich and poor families spent
in flooded areas reporting their children’s schools a similar amount of time out of school.
were not operating fell from 18 percent to 9 percent.
Among households that reported schools had closed Time to return to school Poorest 25%
and reopened, the average time school was out of by household asset quartile Richest 25%
session was seven weeks.
100
There were few differences in weeks out of
school based on observed household and child 80
characteristics such as household wealth, education
level, and gender of the child. As shown in Figure 7, 60
the number of weeks for children to return to school More than half (56%) returned by week 5
was similar among rich and poor households. The 40
severity of the flooding was a major determinant
of time out of school, with children in completely 20
flooded areas spending three more weeks out of
school than children in somewhat flooded areas.
0
0 5 10 15 20
Though many children have returned to school,
Weeks after flood
those who are still out of school six months
Poorest 25% Richest 25%
after the floods are unlikely to return. The share
of unenrolled children in flood-affected areas in Figure 8. Parents of children who were still out of
surveyed families fell from 3.2 percent in September school six months after the floods were much less
2022 to 1.9 percent in February 2023, indicating that likely to report that their children were likely to
about 40 percent of unenrolled children returned to return compared to one month after the floods.
school. In the first round of the survey, 52 percent Likelihood of child returning to school by survey round
of households with children out of school reported
that their children were extremely likely to return.
Extremely likely
In round 2, just 20 percent were extremely likely to
Very likely
return, reflecting that children who can have already
Somewhat likely
returned to school (see Figure 8). Among households
Not very likely
where schools remained closed six months after the
Not at all likely
floods, 92 percent still needed to learn when school
would resume operation.
FLOOD DAMAGES AFFECT MILLIONS
The Pakistan Post-Disaster Needs
Assessment reported that over 6,000
schools were fully damaged by
the floods, and nearly 11,000 schools
Round 1 Round 2
were partially damaged, impacting (1 month (6 months
over 2.6 million enrolled children post-floods) post-floods)
(Government of Pakistan et al., 2022).
SPECIAL NOTE | Children and their Families Six Months After Pakistan’s Floods | July 2023 7
In the survey sample, there are no difference Learning recovery remains challenging even among
between boys and girls across different outcomes. schools that are operating normally. Mazari et al.
Unfortunately, the phone surveys did not have (2023) interviewed flood-affected parents, teachers,
a large enough sample size of households with and other key stakeholders in flood-affected areas.
out-of-school children to accurately measure Teachers interviewed felt they had yet to receive
differences between the share of boys and girls out official guidance on curricular adjustments, as
of school. There are also challenges in using phone they had received after Covid-19 school closures.
surveys to reach families of our of school children. Teachers were often tasked with responsibilities after
However, findings from the Pakistan Social and the floods in addition to managing their classrooms,
Living Standards Measurement (PSLM) have shown such as delivering a new curriculum or collecting
that girls are disproportionally represented among data for the national census.
out-of-school children. For example, in 2019 and
2020, 54 percent of out-of-school children were
girls compared to 46 percent of boys, with an even
greater difference in the share of girls versus boys in Using mobile phones to help address
rural areas (Pak Alliance for Maths and Science 2021). challenges in education
Due to lower enrollment rates, 37 percent of children
(Mazari et al. 2023)
in flooded schools were girls and 63 percent were
boys (Pakistan Education Sector Group, EiE, 2022).
Mazari et al. (2023) interviewed flood-affected
The most common reasons for children being parents, teachers, and other key stakeholders in
unlikely to return were the increase in travel time flood-affected areas. They suggest that technology
due to flooding (22 percent), the cost of schooling has the potential to at least partially address some
(18 percent), and the child needing to work due to of the challenges that prevent access to learning:
economic difficulty caused by flooding (18 percent).
In the first-round survey, the cost of schooling was 1. Returns to school can be improved through
the most frequently cited reason. The increase in digital peer networks (over mobile phones)
travel time and cost of schooling are likely related that can provide psychosocial support while
since increased travel time increases the overall cost providing information on options for learning
of sending children to school. In the communities and relief.
hardest hit by the floods, children can return to 2. Flexible learning environments, like temporary
school once travel infrastructure is rebuilt and learning centers or community-based learning
children have access to safe commutes to school. environments, can be enhanced through
The use of schools as temporary shelters in flooded multimodal EdTech approaches.
areas may also continue to impact the quality and 3. Mobile phones can support remedial learning
quantity of education children receive. Nearly 30 by delivering formative assessments and
percent of respondents in the second-round survey educational content for some children.
reported that schools were temporary shelters for
flood victims after the floods, compared to 17 percent The authors recommend that Pakistan invest in
in the first round. Twenty-six percent reported schools a more holistic strategy that identifies appropriate
are currently in use as temporary shelters. Among multimodal teaching and learning content for
households that reported schools were no longer emergencies while acknowledging the challenges
used as temporary shelters, the average time schools of using cellular technology.
were used as a shelter was five weeks.
Improving ease of travel and
developing safe school commute plans
for children in the hardest hit areas will
help more children return to school.
SPECIAL NOTE | Children and their Families Six Months After Pakistan’s Floods | July 2023 8
IV. Flood relief and health impacts
At the International Conference on Climate Resistant Pakistan
hosted by the U.N. in Geneva in January, multilateral and bilateral
organiations pledged over 10 billion USD for reconstruction and
relief activities (Nabi 2023). The Government of Pakistan has also
created and prioritized interventions through its Resilient Recovery,
Rehabilitation, and Reconstruction Framework (4RF) (Government
of Pakistan 2022). Yet, awareness of relief activities has remained
low six months after the floods.
Awareness of flood relief activities has changed Table 1. Awareness of flood relief activities could have
little in the six months since the floods. In the first been higher across relief activity types.
round of the survey, 80 percent of respondents
from flooded areas reported no relief activities Flood-Affected
for flood victims. In the second round, 82 percent Relief Type
Households
Reporting
reported no relief activities. Nevertheless, the
(Percentage)
United Nations Office for the Coordination of
Raw food distribution 12.7
Humanitarian Affairs (OCHA) estimates that seven
million people, roughly 21 percent of people in Clothing 4.4
flood-affected areas, have received aid (OCHA Distribution of cooked/prepared foods 4.3
2023B). This close correspondence between the Medicine 4.1
OCHA percentage receiving aid (21 percent) and the
Tents 2.7
percentage reporting flood relief activities in our
surveys suggests that families who are aware receive Potable water 1.6
aid. Raw food distribution had the highest level of Shelter 1.4
awareness; 13 percent of flood-affected households Seed distribution 0.5
reported raw food distribution to victims in their area Productive assets such as livestock 0.4
(Table 1).
Temporary learning centers 0.1
Although awareness and receipt of relief activities
were low, one quarter of respondents from flooded Figure 9. Fewer households reported outbreaks of
areas received cash transfers from the Benazir mosquito-borne diseases six months after the floods
Income Support Programme (BISP). Starting in 2007, compared to one month after.
the government of Pakistan began providing BISP
funds to the neediest families who are identified 1 month post-floods
using a poverty scorecard (Government of Pakistan 6 months post-floods
2023). About 22 percent of respondents in flooded
areas reported receiving BISP in the second-round
survey, compared to 18 percent of respondents in
areas unaffected by the floods.
Additionally, interventions around mosquito-borne
seemed to have worked. As shown in Figure 9,
disease outbreaks have remained relatively stable,
with the incidence of dengue decreasing significantly.
The reduction in stagnant flood waters where
mosquitoes breed and early diagnosis at over 4,000 Suspected malaria cases in camps fell from 38,000
medical camps has helped to decrease the incidence cases in October 2022 to 5,000 cases in December
of mosquito-borne diseases (Vohra et al. 2023). 2022 (OCHA 2023A).
SPECIAL NOTE | Children and their Families Six Months After Pakistan’s Floods | July 2023 9
IN SUMMARY
In summary, by February 2023, six months
after the floods, economic activity, health,
and education indicators are improving
for most households in flood-affected areas.
However, there continue
to be substantial challenges for
children in households in areas
that were complety-flooded
and where destruction was
widespread.
SPECIAL NOTE | Children and their Families Six Months After Pakistan’s Floods | July 2023 10
Methodology
The data used in this note come from a nationally representative phone
survey designed by the World Bank and implemented by Gallup Pakistan.
Data collection was carried out in February 2023.
4,000
The survey was carried out using random digit
dialing (RDD) of mobile phones using all four
telecom providers with active numbers across
Pakistan. Approximately 93 percent of households
have access to a mobile phone (Government of
Pakistan 2021). Despite the high-penetration rate
of mobile phones, lower-income households
are overrepresented in the remaining 7 percent Completed surveys in the study
of those who do not have access to mobile
technology. This likely means that in many cases,
the results presented show an underestimation of The survey’s target population was parents or
the true impacts of the floods on families and their caregivers of children ages 3 to 17. If more than one
children in Pakistan. child lived in the household, one child was randomly
selected as the subject of inquiry. The gender of
Each random number was called to survey
the child stratified the sample. The survey also
households until a call was answered (with
oversampled households that reported any impact
a maximum of three attempts). Calls were
of floods, aiming for a sample of at least 1,000
placed at different times on different days of the
households that suffered the effects of floods in their
week to maximize the response rate. Once an
area. In addition, the survey collected information
individual was contacted on his or her mobile
on the education status of children, food security,
phone, consent was obtained, a screening
child work, health, environment, and household
questionnaire was administered, and a unique
composition. A limited set of sociodemographic
study identification number was generated for
characteristics was also collected, including parents’
the respondent. Next, interviewers entered data
education, assets, gender, family composition, rural,
into a tablet with Survey CTO software that had
urban, district, and province.
the preloaded questionnaire with automatic
skipping patterns (Computer Assisted Telephone The survey randomly called 40,375 numbers,
Interviewing, CATI). reaching 18,083 individuals who answered the
phone, of which 5,449 agreed to the interview,
In the sample: 1,449 with incomplete surveys, and 4,000 that
(unweighted) have a complete survey. The survey was carried out
66%
rural
34%
urban
using random digit dialing (RDD) of mobile phones
using all four telecom providers with active numbers
across Pakistan, except that 345 respondents from
flood-affected areas in the first-round survey also
participated in the second round. To better capture
the aggregate impact, weights are created using
quintiles from province, rural/urban, gender and
education of household head. All graphs in this note
show weighted statistics.
15%
female
85%
male
SPECIAL NOTE | Children and their Families Six Months After Pakistan’s Floods | July 2023 11
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First Aid for Schools (PFA-S) Field Operations Guide
publication/cd3e54af-1391-565b-b1f7-cf3b2e4abf26
IN THIS NOTE | Source for all data graphics: Authors’ estimates based on phone survey. Photography: Insiya Syed. Graphic design: Elizabeth Salud.
© 2023 International Bank for Reconstruction and Development / The World Bank
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