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 tom.price@crs.org

• 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.

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