CHAPTER 2: SCREEN READING SOFTWARE (SCREEN READERS)

1. Screen Readers Landscape

Screen readers are software programmes for people with vision impairment and/or learning disabilities that convert screen content into a format that is accessible to the individual, such as braille, speech, or both.37 Screen readers use text-to-speech synthesiser software that converts the screen elements into speech. A refreshable braille display – a hardware device that displays a braille representation of the text – can additionally be combined with a screen reader to make the digital ecosystem even more accessible.38

Screen readers can be used on laptops, desktop computers, tablets and smart feature phones and smartphones. On laptops and desktop computers, users navigate the content with keyboard commands, either stepping

from object to object or by jumping between different types of components, like headings or links. On smartphones, screen reader users move their finger on the screen, either swiping left and right to move to the next or previous item (swipe navigation) or getting what is under their finger read to them (touch navigation).

Globally, estimates show that at least 1 billion people are blind or have a vision impairment.39 Many are not provided with equal opportunities. For example, in Rwanda in 2012, 56% of working-age people with a severe visual impairment were employed, compared to 71% of the national population, and 41% of those with severe visual impairment had never attended school, compared to 20% of the national population. 40

With screen readers, people with visual impairment can both consume content, such as educational content, and create it through productivity software such as the Microsoft Office Suite. Screen readers can contribute to the participation of people with vison impairment in society and to the realisation of their human rights as defined in the United Nations Convention on the Rights of Persons with Disabilities.

LMIC governments have progressively transitioned their services to digital content, which is often inaccessible to people with disabilities and leads to their exclusion from accessing it. People with disabilities need equal access to government websites or applications so that they too can receive key information and use digital public services as full members of society. This would allow people with disabilities to take further steps towards living independent lives and fully benefitting from their rights regarding health, social benefits, or employment. Some initiatives exist in HICs and LMICs to promote equal access of people with disabilities to employment (see Case Study 3).

Different models of screen readers exist. Many smartphones, laptops, or desktop computers have some form of screen reader built into the operating system as an accessibility feature, but these often offer fewer features than stand-alone screen readers. Stand-alone screen reader software ranges from open source and free to commercial and paid subscription software. Each screen reader is compatible with specific operating systems and their performance varies with different software and websites. Table 3 presents popular screen readers across those three categories.

TABLE 3 – EXAMPLES OF POPULAR SCREEN READERS BY CATEGORY

Built-in software	Voiceover Operating system: Apple Device: computer and mobile Price:free Features:Audio screen reader; swipe and flick-through; double-tap; select icon and buttons with voice commands Languages availability: 40+	Talkback Operating system: Android Device: mobile only Price: free Features: Audio screen reader; swipe and flick-through; double-tap; select icon and buttons with voice command; activate with different gestures Language availability: 50+	Narrator Operating system: Microsoft Device: computer only Price: free Features: Audio screen reader; pick and read sentence; verbosity level adjustment; scan mode; narrator key Language availability: 10+	Orca Operating system: Linux Device: computer only Price: free Features: Screen reader (braille/speech); magnifier with auto-focus; different voice types Language availability: 10+
Open source software	NVDA Operating system:Windows Device: computer only Price: free Features: Speech synthesiser in 50 languages; textual formatting report; braille-display enabled; optional audible mouse tracker Language availability: 50+	Chrome Vox Operating system: web-based, comes pre-installed on Google Chrome Device: computer and mobile Price: free Features: web-based extension for Chrome – audio screen reader for content displayed on the web (HTML5; CSS; Javascript) Language availability: 50+	-	-
Commercial software	JAWS Operating system: Windows Device: computer only Price: USD 90 (home version, up to 3 computers) Features: Screen reader with built-in DAISY player; skim reader; text analyser; pearl camera (print-to-speech add on) Language availability: 30+	Supernova Operating system: Windows Device: computer only Price: USD 1,195 (upfront cost) + USD 240 (guaranteed lifetime updates) Features: intelligent reader and magnifier; scan and read paper (print-to-speech); natural voice reading Language availability: 40+	Cobra Operating system: Windows Device: computer only Price: USD 849 (upfront cost) Features: Screen reader (voice and braille); magnifier up to 32x; edge smoothing and extra-large mouse pointer Language availability: 10+	ZoomText Fusion Operating system: Windows Device: computer only Price: USD 160 (home version, up to 3 computers) Features: Screen magnification and visual enhancement; all features of JAWS available Language availability: 30+

A few years ago, commercial software such as JAWS and SuperNova were the most widely used screen readers worldwide.45 Open source software like NVDA offered lower quality and fewer features. 46 In recent years, open source screen readers have addressed most of their limitations and are now recognised as being of equal quality in terms of:

• FEATURES PARITY: important parameters in the quality of screen readers include the number of tasks that can be performed and user-friendliness of the software. Examples include user-friendliness to install and navigate the software, or ability to perform tasks in word processing, spreadsheet, presentation, e-mail, web browsing, video-conferencing, or PDF applications. Initial versions of NVDA could perform fewer tasks compared to commercial screen readers like JAWS. Over the past few years, experts note that NVDA’s features have gradually become as good as or even better than JAWS for some tasks related to web browsing or working with spreadsheets.
• MAINTENANCE OF THE CODE: sustainability of small-scale open source software has been a concern as the maintenance of its code is often left to the associated software development community. There is however little to no concern among developers and users that NVDA will stop being maintained. While open source, NVDA is organised as a company and sells customised NVDA packages at nominal prices to support operations.

A survey run by WebAIM across various regions showed that NVDA became the most common primary computer screen reader in 2018 ahead of JAWS (see Figure 3).47 This trend is reflected for example in the National Association for the Blind, Delhi moving from JAWS to NVDA as the recommended screen reader five years ago. Users commonly use several screen readers, depending on the type of task they are performing: 73% use more than one screen reader, with 41% using three or more different screen readers. Each screen reader has differentiating features and no all-in-one solution exists.

FIGURE 3 – SHARE OF NVDA, JAWS AND VOICEOVER AS PRIMARY SCREEN READERS OVER TIME, 2009-2019 48

Commercial screen readers remain the preferred choice for many employers as they offer more customisation options and support for specific applications, as reported by WebAIM.49 For example, if a person with vision impairment is hired by a banking company, JAWS will provide support to customise the screen reader to the banking application, unlike open source screen readers. Some governments have decided to support the employability and employment of people with disabilities by supporting the distribution of commercial screen readers (see Case Study 4).

Open source screen readers often do not have the financial leverage to purchase licences to use commercial adjacent technologies such as a text-to-speech synthesiser or braille refreshable display. For example, NVDA uses the open source speech synthesiser eSpeak, which has a lower voice quality than Eloquence, a popular speech synthesiser used by commercial screen readers such as JAWS. Experts consider the quality of eSpeak nonetheless sufficient for the everyday usage of a screen reader (but not for example to read an entire book) and is adapted to LMIC and low-resource settings, especially due to the number of languages supported (see next section).

Open source and built-in solutions have made access to quality screen readers more equitable. High price remains a barrier to accessing commercial screen readers, such as JAWS, limiting access to certain software. However, key barriers to access remain that are common to all screen readers:

• LIMITED LANGUAGE COMPATIBILITY: Text-to-speech synthesisers, which are developed separately, need to be available in the local language of the content being accessed. Many text-to-speech synthesisers are only available in English or other European languages. Limited language compatibility is particularly important as a barrier in regions with multiple languages and dialects, such as India or Sub-Saharan Africa.51 Open source text-to-speech synthesisers often offer better local solutions as they can be adapted by volunteers all over the world: for example, eSpeak is the only text-to-speech synthesiser offering a Punjabi version.52 Universities also carry out projects to develop text-to-speech synthesisers in local languages, but these initiatives are research-focused and often lack the capabilities to develop a product that can be deployed at scale.
• LACK OF AWARENESS AND USER TRAINING: In LMICs, health providers, care-givers, and people with disabilities themselves have low awareness of the existence and benefits of screen readers. People with disabilities may find it difficult to select a screen reader and other digital AT adapted to their disability without the help of a health professional or peers. Users then need training to use various screen readers across a variety of tasks and applications, and to use adjacent technologies such as refreshable braille displays. Software options like JAWS or VoiceOver offer keyboard shortcut options that users need to familiarise themselves and gain comfort with to take full advantage of the product. The National Association for the Blind, Delhi estimates that a young adult with no previous experience requires around 120 hours of training to become efficient at using a screen reader and adjacent technologies. The number of trainers and training centres in LMICs is limited and often managed by NGOs. Distance learning through video conferencing platforms like Zoom is emerging as a potential solution for training people with disabilities in using screen readers and other digital AT.

Accessibility of websites can be measured against a set of international guidelines: the Web Content Accessibility Guidelines version 2.0 (WCAG 2.0). These guidelines provide success criteria and associated requirements to ensure that web-based content can be accessed by people with disabilities.53 However, these guidelines are not binding unless transposed and enforced by national legislation. The ITU and G3ict Model ICT Accessibility Policy Report and Accessibility Policy Toolkit (e-accessibilitytoolkit.org) provide a model web accessibility policy that governments can adopt. Legislation around web accessibility varies across countries:

• UNITED STATES: The US has the most advanced regulation of accessibility. Section 508 of the Rehabilitation Act and the Electronic and Information Technology Standards promulgated by the US Access Board requires all mainstream IT procured by the US federal government, including websites, to have certain accessibility features (www.section508.gov/). This legislation has positively impacted non-federal areas, with many private sector websites – such as e-commerce platforms – complying with accessibility standards.
• EUROPEAN UNION: the EU recently adopted the Web Accessibility Directive, which requires public websites and applications to meet European accessibility standards. The directive will become binding once transposed and implemented into national legislation. In addition, EN 301 549 by CEN/CENELEC/ETSI (2014) sets out accessibility requirements for public procurement of ICT products and services in Europe (www.cencenelec.eu/standards/Topics/Accessibility/Pages/eAccessibility.aspx).
• LMICs: LMICs typically do not have legislation around accessibility, or it is rarely enforced where it does exist. A 2017 study on the accessibility of government websites in Sub-Saharan Africa found that none of the 217 government websites examined adhered to WCAG 2.0 guidelines54 Among upper-middle income countries, Mexico is a notable exception as it has been active in promoting accessibility guidelines and best practices in both the public and private sector (see Case Study 5).

Web developers have little incentive to develop accessible websites, such as e-commerce platforms, government basic services, or banking platforms. They are often not aware that people with a disability or a functional limitation may use such platforms or do not consider people with disabilities as a consumer segment. Beyond awareness, it takes time, cost, and effort to create and maintain/update an accessible website or application. Web developers need to invest time to understand accessibility guidelines, or they need to outsource the work to competent organisations. To alleviate those challenges, some NGOs offer trainings to web developers around accessibility (see Case Study 5).

Access to print content is also an important issue for people with visual impairment and/or learning disabilities. To tackle this, the Digital Accessible Information System (DAISY) consortium has created technical standards for accessible books. The DAISY standards apply to digital talking books which offer a flexible reading experience for people who are ‘print disabled’, offering a significantly enhanced reading experience.56 For example, users can search, place bookmarks, navigate line by line, or regulate the speaking speed. 57 Books in DAISY format have been adopted by large accessible libraries such as the Japanese Association of Libraries for the Blind, the US National Library Service for the Blind and Print Disabled, the South African Library for the Blind or the Bibliotheca Alexandrina in Egypt. 58, 59

2. Screen Reader Access Challenges

Demand
Awareness	People with disabilities, caregivers, social service, and health providers: low awareness of the existence, use cases, and importance of screen readers to improve the economic, social, and health well-being of people with disabilities. There is low awareness of the availability and benefits of various digital AT, and people may find it difficult to select products or software adapted to their disability. Policymakers and web developers:low awareness of the benefits and importance of providing accessible content. For example, web developers often do not realise that people with disabilities can use online platforms and they additionally lack knowledge around the accessibility standards when developing a website or an application.
Training	People with disabilities: there is usually an important learning curve for using a screen reader and other digital AT. Users often need to be trained on how to use a screen reader across a variety of tasks. Training in digital AT might be crucial for people with disabilities to be able to find employment. Training is limited in LMICs and is typically delivered by peer networks and NGOs. Web developers: developing a website or application that is accessible may add significant time, cost, and effort to the project. Web developers are not typically trained in digital accessibility and need to invest time to understand accessibility guidelines. Websites that are not inclusive from their initial development must adapt content to meet guidelines at a later date, which is a significant follow-on investment.
Price (for commercial products)	Commercial screen readers are preferred by companies or users in employment as they offer more customisation options. However, commercial screen readers require a significant investment and lead to high out-of-pocket costs as they are not typically covered by any benefit packages. For example, versions of JAWS are available at USD 90 per year, which remains unaffordable to many people with disabilities in LMICs. This cost may also discourage companies from hiring people with disabilities.

Supply
Access to device	To use a screen reader, you first need access to a smartphone, laptop, or desktop computer. See Chapter I for barriers to access to mobile phones and mobile internet.
Accessible content	The vast majority of content available on the internet is not fully accessible to persons with disabilities or other functional limitations. This includes critical information provided on government websites and applications that prevent people with disabilities from benefiting from their rights regarding health, social benefits, or employment.
Product Profile	Screen readers use text-to-speech synthesisers that are mainly available in English and other European languages. People with disabilities cannot use a screen reader that is not available in the local language of the content visited. This issue is common across various digital AT.

Enablers
Policy	Most LMIC governments do not have legislation around accessibility. Where they do exist, accessibility guidelines around government websites are often voluntary and rarely enforced if mandatory.

3. Proposed Interventions to Increase Access to Screen Readers

Strategic Objective 1: Adopt accessibility standards on public government websites and apps

Rationale	Government websites and applications contain critical information and offer digital public services for people with disabilities to benefit from their rights regarding health, employment, information, social benefits, etc. Government leadership on accessibility can positively impact the actions of the private sector, as has been observed in the US.
Proposed Interventions	Support LMIC governments to adopt and implement accessibility standards for government websites. Advocate to LMIC governments to adopt the WCAG 2.0 and provide a mechanism for people with disabilities to report content that is not accessible.

Strategic Objective 2: Develop text-to-speech synthesisers in local languages

Rationale	Screen readers use text-to-speech synthesisers that are mainly available in European languages. People with disabilities cannot use a screen reader that is not available in the local language of the content visited. Initiatives to develop text-to-speech synthesisers in local languages exist, but lack the capabilities to develop a product that can be deployed at scale.
Proposed Interventions	Support developers or start-ups interested in developing text-to-speech software in local languages, e.g. by promoting partnerships with national institutions and innovation funds. Advocate for government incentives such as tax reductions, awards, or prizes for innovators working on localised digital AT solutions.

Strategic Objective 3: Establish (sub-)national programmes to enable price agreements with commercial screen reader suppliers

Rationale	Commercial screen readers such as JAWS are preferred by companies or users in employment as they offer more customisation options, but they are more expensive. Access to commercial screen readers at reduced cost can support the employability of people with severe visual impairment or other functional limitations.
Proposed Interventions	Work with LMIC governments and commercial screen reader suppliers to explore a pricing agreement, leveraging best practices from Colombia. LMIC governments to distribute commercial screen readers at discounted prices or for free to people with disabilities looking for employment or to companies employing people with disabilities.

Strategic Objective 4: Train people with disabilities in digital AT

Rationale	There is an important learning curve for using a screen reader and other digital AT and how to use a screen reader across a variety of tasks. Training is typically provided by NGOs in LMICs.
Proposed Interventions	Provide training programmes and services to teachers, health workers, and other social service providers in how to use digital AT, including screen readers.