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RESEARCH BRIEF
Poverty and a child’s disability push many
children with living parents needlessly into
orphanage care. Photo by David Snyder/CRS
Finding FamiliesTHE STATE OF RESIDENTIAL CARE FOR CHILDREN AND
IMPLICATIONS FOR HUMAN DEVELOPMENT
“It has been more than 80 years since researchers in child psychology first documented developmental delays among children separated from family environments and placed in orphanages or other institutions.” 1
Despite decades of rigorous research in a wide array
of contexts, evidence illustrates that orphanage care
for children (also called residential care) negatively
impacts cognitive, physical, and social development
of children. Effects are intensified the longer a child
is in care and the younger the child is at the time
of placement. In some countries, orphanage care is
experiencing exponential growth despite the evidence
illustrating that it is harmful to children.
This brief is an overview of the literature, from
multiple disciplines, on orphanage care for children.
It also points towards ways forward, underscoring
the need to move away from orphanages as
a first response and instead focus efforts on
prevention of family separation and provision
of family-based and supportive community
environments. In the process, however, it is also
important to note the incredible and inspiring
resiliency of children who, when removed from
orphanages, demonstrate an extraordinary
ability to rebound from early challenges to become
healthy, vibrant young adults.
2
BACKGROUNDUNICEF has estimated at least 8 million children live in
orphanages globally. These numbers are incomplete
and almost certainly underestimate the severity of
the situation, especially given the proliferation of
unregistered orphanages that work outside the law.
• Much of the financing for these orphanages
comes from private, charitable, and even faith-
based organizations.
• An orphanage ‘industry’ perversely incentivizes
the status quo and is linked to the recruitment of
children by orphanages for other reasons than
the well-being of children.
The overwhelming majority of children in orphanages
have at least one parent and are not orphans.
Multiple studies estimate 80-90 percent of children in
orphanages have a parent.
Cheney and Rotabi (2015), who label the phenome-non as the “global orphanage industrial complex,” argue that the presence and growth of orphanages has crowded out public financing for potentially more effective child social services, or has absolved governments of being more proactive in the protection of vulnerable children.2
THE RESEARCHScientists from across disciplines have amassed
results from studies that continually reinforce
findings: orphanage care for children results in
significant cognitive, physical and social harm to the
child:
• Lower IQs and poor learning skills are a function
of duration in residential care as a child.
• Childhood head circumference, height, and
weight are stunted by residential care. Studies
estimate infants/toddlers lose 1 month of
linear growth for every 2-3 months spent in an
institution.3
• Mood and attachment disorders are far more
prevalent among children in residential care than
in adopted or family-based environments.
• Abuse and neglect are prevalent in orphanages,
exacerbating vulnerabilities.
Ultimately, it is at-risk or vulnerable youth—whether
from conflict, poverty, disability, or neglect—who
are more likely to be placed in orphanages, but
whose vulnerability is only further compounded by
orphanage care itself.
EIGHT MILLION CHILDREN
LIVE IN RESIDENTIAL CARE GLOBALLY.
RESILIENCY OF CHILDREN When removed from residential care, children
demonstrate an extraordinary ability to rebound
from early challenges to become healthy,
vibrant young adults.
Photo by Ismail Ferdous for CRS
3
THE STAYING POWER OF ORPHANAGES: Why does orphanage care continue to be the first
response to vulnerable children around the world?
PUSH FACTORS increase vulnerability and push children out of their homes and away from family care.• Poverty is a key push
factor. In some cases, parents send children to institutions so that they can obtain access to basic services such as education.4
• Children with disabilities are frequently misunderstood and stigmatized, or parents may not be able to adequately care for their disabled child, pushing them into residential care where their needs frequently remain unmet.
PULL FACTORS make it easier for parents or caregivers to send children to an orphanage.• Even knowledge of
the presence of an orphanage, especially in resource-scarce contexts where social and rehabilitative services may not be available, can “pull” or recruit children from vulnerable families..
• Some in the medical community encourage orphanage care, particularly where norms and attitudes toward disabilities have been slower to change.
WAYS FORWARD: FAMILY AND COMMUNITY-BASED CARE
The same science that demonstrates the harm posed
to children by orphanage care also presents a ray of
hope: reunification with parents or placing children in
supportive family settings is highly effective at reversing
harm and rehabilitating children into healthy, vibrant
young adults. Children removed from orphanage care
and placed in families at an early age rebound and
“catch-up” to peers, physically and emotionally, over a
few years. It is clear that the way forward is to transition
from orphanages to increased family-based care.
In 2009, the UN General Assembly endorsed the
Guidelines for the Alternative Care of Children5 in
order to encourage reform, increase accountability,
and guide this shift based on recognized best
practices. The guidelines include:
• Whenever possible, prevent new, unnecessary
admissions to orphanage care through the provision
of accessible family support services;
• Establish proper gatekeeping mechanisms;
• Prioritize placement in family-based alternative care
settings (such as kinship, foster, independent living)
if biological parents and extended family are unable
to care for the child;
Reunification with parents or placing children in supportive family settings is highly effective at reversing harm and rehabilitating children into healthy, vibrant young adults.
Photo by Philip Laubner/CRS
Catholic Relief Services 228 W. Lexington Street, Baltimore, MD 21201, USA
For more information, contact [email protected]
• Promote and support safe reintegration of children
currently residing in orphanages;
• Strengthen the oversight, accountability, and quality
of care in all alternative care settings.
WHAT WE CAN DODespite advancements in knowledge, national-level
legislation, and reforms based on the UN Guidelines,
orphanages have continued to proliferate. Transitioning
to family-centered care has proven a significant
obstacle, especially in resource-scarce contexts, but
there are things the global community can do:
• Raise awareness about the harm posed by
orphanage care, increase knowledge about
available alternatives, and review giving practices.
Donors, including faith-based organizations, are
driven by a desire to do well by children worldwide,
however there is a perception that orphanage care
is the best option for children with disabilities or
otherwise separated from a parent. As continuing
financial support is a large factor promoting and
sustaining the orphanage complex, private donors,
charitable and faith-based organizations, and the
general public must be a driving force in creating
systems that reunify children with parents, kin, or
supportive families.
• Focus efforts on supporting the implementation of
progressive legislation and assist with the support
of gatekeeping and social service schemes that
cost-effectively keep children with their families.
There is too often a gulf between passing
legislation and implementation. Movement toward
family or community-based care will require
more than guidelines. It will take evolving social
contracts that acknowledge local contexts, mores,
and norms. Some children will need short-term
residential care. Donors can help by assuring that
their partners are providing the best services
possible—not inadvertently separating children
from families—and are helping transition children
back to family-centered care as quickly as possible.
KEY STRATEGY
“Gatekeeping” is a tactic to provide a suite
of services and resources—such as innovate
grants and cash assistance for caregivers—that
keeps families together and children out of
institutions in the first place. There is no single
model of gatekeeping that works best, but it has
been shown to be implemented differently and
effectively in contexts as different as Moldova,
Rwanda, Brazil, Bulgaria, and Indonesia.6
Notes
1 A.E. Berens & C.A. Nelson, C. A. (2015). “The science of early adversity: is there a role for large institutions in the care of vulnerable children?” The Lancet, p.1 (See: http://faithtoaction.org/wp-content/uploads/2013/09/14TL0649_Berens.pdf)
2 Cheney, K. E., & Rotabi, K. S. (2015). Addicted to Orphans: How the Global Orphan Industrial Complex Jeopardizes Local Child Protection Systems. Conflict, Violence and Peace, 1-19.
3 Johnson, D. (2001). The impact of orphanage rearing on growth and development. In: C. A. Nelson (Ed.), The effects of adversity on neurobehavioral development: Minnesota symposia on child psychology. New York: Erlbaum and Associates.
4 Better Care Network (2017). Violence Against Children and Care in Africa: A Discussion Paper. New York.
5 United Nations. (2009). “Guidelines for the Alternative Care for Children,” A/Res/64/142 (https://www.unicef.org/protection/alternative_care_Guidelines-English.pdf).
6 Better Care Network and UNICEF (2015). Making Decisions for the Better Care of Children: The Role of Gatekeeping in Strengthening Family-Based Care and Reforming Alternative Care Systems. Retrieved from http://www.bettercarenetwork.org/sites/default/files/Making%20Decisions%20for%20the%20Better%20Care%20of%20Children.pdf.
©2017 Catholic Relief Services. All Rights Reserved. 17MK–22602