Children, Orphanages, and Families:: A Summary of Research To Help Guide Faith-Based Action

Children,
Orphanages,
and Families:
A SUMMARY OF RESEARCH TO
HELP GUIDE FAITH-BASED ACTION
THE FAITH TO ACTION INITIATIVE, 2014

This Summary of Research is offered to churches, faith-based organizations, and individuals of faith seeking
evidence-based information about the best ways to care for orphans and children separated from parental
care. Whether directly providing care in our own communities or partnering with groups overseas to support
orphan care ministries and programs, Christians around the world are rising to the Biblical call to respond to the
needs of the orphaned and vulnerable. Globally, the need is great and there is no “one right answer” for every
situation. There is, however, a growing body of research and evidence-based “lessons learned” to help guide
this faith-inspired work.
TABLE OF CONTENTS
Introduction pages 1 – 2
Orphans and Children in Orphanages: pages 3 – 6

Global Estimates and Key Facts
Orphaned and Vulnerable Children Worldwide
Reasons for Placement in Orphanages
The Importance of Family Care and pages 7 – 11

the Need for a Range of Options
Children’s Well-being and Development are Best Supported in Families
A Continuum of Family-based Care Options
Care in Emergencies
Orphanages: Key Challenges and the Impact on Children pages 12 – 15
Lack of Individualized Care Has Long-Term Consequences
Early and Long-Term Placement In Institutional Care

Has the Most Severe Effects
Risks of Institutional Care on Later Life
Strengthening Family Care and Preventing pages 16 – 17

Placement in Orphanages
The Role of Government and Country Policy
Faith-Based Responses to Orphans and Vulnerable Children
Striving for the Best Interests of Children: Concluding Remarks pages 18 – 19
Glossary of Terms pages 20 – 21
References pages 22 – 28
Introduction
This resource aims to provide a concise overview of a range of studies
and findings that can inform approaches to caring for children who, through
orphanhood, abandonment, or other causes, have been separated from parental
care. Included are current global estimates and key facts about orphans and children
living in orphanages; an introduction to the range of care options, called the
continuum of care; significant findings that demonstrate the importance of family-
based care and the limitations of orphanages; and interventions that strengthen
family care and help prevent placement in orphanages. A robust evidence base
supports the contents of this document.
Research studies over many years in a wide range of cultures and contexts
have consistently demonstrated the positive impact family care has on children’s
growth and development. It has also illustrated the harmful effects that living outside
family care can have on children. This resource highlights the importance of
effective interventions to strengthen families, preventing unnecessary separation.
For example, providing material and educational support to children in families
reduces the likelihood of being placed in orphanages to access food, shelter, and
school. When children are separated from their parents due to death or other causes,
priority can still be placed on ensuring they are cared for within families. Family-
based interventions include reunification and — when this is no longer possible or
in the child’s best interests — placement in extended family care (kinship care),
foster care, or adoption.
The purpose of this document is not to argue that residential care for orphans
and vulnerable children is never needed. Many churches have established or
funded orphanages as a way to serve children in need. For children in emergency
situations and with no other means of support, high-quality residential care can
provide transitional, rehabilitative, or interim special-needs care. As a primary or
long-term solution, however, orphanages cannot replace the loving care of family
and too often fail to meet the social, emotional, cognitive, and developmental
needs of children and youth. Formal residential care varies in type and quality,
from higher quality smaller orphanages based on a “family-style” model, offering
more individualized care, to large-scale institutions. The detrimental effects of
orphanages are increased when children are placed at an early age and/or for long
periods of time, and especially within institutions with large numbers of children and
few caregivers. Global discussions, research, and policy demonstrate that although
higher quality residential care is a recognized option on the overall continuum, the
benefits of family care must be more widely recognized and supported.
THE FAITH TO ACTION INITIATIVE, 2014 CHILDREN, ORPHANAGES, AND FAMILIES: A SUMMARY OF RESEARCH TO HELP GUIDE FAITH-BASED ACTION | 1
The evidence base on the topics addressed in this paper is extensive and the
issues are complex. This guide strives to summarize key overall findings, while also
providing examples within specific countries or regions, to further illustrate some
of the general points. A glossary of key terms and list of citations can be found at
the end of this paper. A companion annotated bibliography of published working
papers, meta-analysis, original research papers, and select interagency discussion
papers will enable the reader to delve deeper into specific topics highlighted
within this document. The aim is to provide a foundation that informs and supports
churches, faith-based organizations (FBOs), and people of faith to anchor their
outreach and programming within existing evidence.
2 | THE FAITH TO ACTION INITIATIVE, 2014 CHILDREN, ORPHANAGES, AND FAMILIES: A SUMMARY OF RESEARCH TO HELP GUIDE FAITH-BASED ACTION

Orphans and Children in Orphanages:
GLOBAL ESTIMATES AND KEY FACTS
Orphaned and Vulnerable Children Worldwide

An orphan is defined as a child that has lost one or both parents. The loss of one
parent classifies a child as a “single orphan” and the loss of both parents as a “double
orphan.”1 In many cases an “orphan” may still live with primary or extended family.
Globally, it is estimated that there are approximately 153 million children who have
lost a mother or a father; 17.8 million of them have lost both parents.2
The most frequent causes of separation of children from parental care include
poverty, lack of access to basic services, abuse, neglect, disease, disabilities, and
emergencies. Looking at each of these factors of vulnerability in detail is beyond
the scope of this paper, but additional information can be found in many of the
referenced documents.
Cambodia saw a 75% UNICEF estimates that at least 2.2 million children in the world live in orphanages.
increase during the
Orphanages in this case include all types of residential care, from small (15 or
five-year period from
2005 to 2010.5 fewer children) to large-scale institutions. This number is considered by many to
be a significant underestimate, given that many orphanages around the world are
unregistered and the children living within them are not officially counted.3
Studies and anecdotal reports regarding orphanages in various countries have

shown that the majority are still large in scale. For example, in Rwanda, 28 out of 30
orphanages were found to have between 16 and 566 children in care.4
Unfortunately the number of children living in orphanages appears to be rising. This

increase contradicts global guidance and the stated policies of many governments
directing the scaling down of orphanage care, and in some parts of the world the rise
is growing unchecked.
Cambodia saw a 75% increase in the number of orphanages to 269 orphanages

housing 11,945 children during the five-year period from 2005 to 2010.5 Recent
studies on residential care in sub-Saharan Africa have shown substantial increases in
the number of orphanages and children in care. In Uganda, for example, the number
of orphanages went from 30 in late 1992 to an estimated 800 in 2013. 6,7 More than
95% of the facilities were not appropriately licensed by the government to operate,
and were therefore operating in violation of national child protection laws.8
In Ghana, despite a concerted effort aimed at decreasing the use of orphanages and
increasing family-based options, the number of orphanages has increased since 2006,
from 99 to 114. The number of children documented as living in those orphanages has
grown from 3,388 in 2006 to 4,432 in 2012.9
Poverty, not lack of Reasons for Placement in Orphanages

caregivers, is often
cited as the reason
The vast majority of children in residential care globally are not double orphans.10
for placing children Depending on the region, upwards of 50-90% of children living in orphanages have
in orphanages. 13
at least one living parent.11 In Eastern Europe and Central Asia, for example, a 2012
situation analysis found that 95-98% of children below three years of age in formal
care were not orphans.12 They had parents who for one reason or another felt they
could not care for them. A study of orphanages in Ghana found that between 80-90%
of the children in care had families that, with some support, would be able to care
for them.13
Poverty, not lack of caregivers, is often cited as the reason for placing children in
orphanages.14 Parents and other caregivers struggling to provide for their children
may feel compelled to use orphanages to address an immediate problem. In many
regions where material poverty is prevalent, evidence demonstrates the “pull factor”
of residential care as the means of meeting such basic needs as food, access to
education, and other services for children.15
A recent study on abandonment of children in Europe found that, in more than 90%
of cases, poverty and homelessness were the reasons for child abandonment (and
subsequent placement in orphanages).16 In parts of Africa and Asia, poverty combined
with the accompanying inability to provide education (supplies, transport, clothing, etc.)
or parental illness is a driving force for families to place a child in residential care.17 A
recent Cambodian study found the main reason why parents placed children in care
was to access education, although the same study found that many orphanages
claiming to offer education in-house instead sent children to the local public school.18
A study of orphanages in Ethiopia found that the most commonly noted reasons for
children being placed in orphanages were parental HIV and AIDS status or other chronic
illness and poverty.19 Chronic diseases such as AIDS and lack of adequate medical
treatment are frequently correlated with poverty. A recently published study of Rwandan
orphanages found that poverty, together with death of a parent or abandonment by a
parent, was the reason for placement in an orphanage in 40% of all cases.20 There were
similar findings from a study of orphanages in Malawi.21

Parents and community members may be under the impression that an orphanage
is beneficial to a child because it fulfills some of his or her basic needs, without
realizing the detrimental effects it can have on a child’s social, emotional, and
cognitive development.22 In some regions, teachers, missionaries, and orphanage
staff have actively encouraged or solicited parents and families to place their children
in formal residential care. In Malawi, for example, over 50% of institutions reported
directly recruiting in this way.23 For many concerned, it may seem like this is the
fastest way to provide a child living in poverty with basic material support. However,
investing in programs that provide these needs for children living in family care is
more cost-effective and reduces the likelihood of orphanage placement. There is
also anecdotal evidence that where orphanages do not exist, families and community
members are more likely to initiate or seek other ways to care for orphans and
vulnerable children within families.24
In many contexts Another significant reason that children are placed in orphanages is because of
around the world,
disability. In Central and Eastern Europe and the Commonwealth of Independent
children with
disabilities are States, one-third of children in residential care are there because of disability.25 In
placed in orphanages many contexts around the world, children with disabilities are placed in orphanages
because families
don’t have access because families don’t have access to appropriate support services.26 Children with
to appropriate disabilities may also be abandoned, at birth or later, as a result of cultural beliefs
support services.26
and persistent discrimination.27
Abuse and chronic neglect by parents or other caregivers are also reasons for
placement of children in residential care, especially in the face of alcohol and drug
abuse or in cases of untreated mental illness.28 Here children may be placed in
residential care after being removed from their families via external intervention,
after being abandoned, or after running away and living on the street. The stress
associated with single parenthood, family breakdown, or parental illness, when
coupled with lack of access to a reliable social support system, medical care, or
services such as day care, can also increase the risk of loss of parental care.29
Children may enter residential care after being separated from their families
during natural disasters. In emergencies such as these, parents may also place
their children in an orphanage after the disaster so their immediate needs for
food, shelter, or medical care are met. When proper procedures are in place,
children can be reunited with families after rehabilitative or emergency care has
been provided. However, this is not always the case: sometimes children remain
separated from their families permanently or for a long time.30
Review procedures or decision-making processes are often absent when it comes to

determining whether orphanage placement is absolutely necessary and appropriate
Gatekeeping for the child in question.31 This review process is called gatekeeping. Gatekeeping
mechanisms should
is a critical factor in any alternative care system, but is still undeveloped in most parts
determine that there
are no viable family- of the world, especially in Africa.
care options available
for the child prior to
placing him or her in
Gatekeeping can occur within the orphanage, led by managers and social work
an orphanage. staff under the supervision of local authorities. It can also be a statutory function
of a government body mandated with child welfare and protection with community
participation. Ideally, both of these methodologies should be in place to ensure
proper assessment and review by the responsible authorities. In Rwanda, pilot
projects have established Child Care Networks at the community level that
involve community leaders and social workers in the decision-making processes.32
Gatekeeping mechanisms should determine that there are no viable family-care
options available for the child prior to placing him or her in an orphanage. When
placement does occur, it should be temporary and/or rehabilitative in nature, with
every effort being made to transition the child to family care.

The Importance of Family Care
and the Need for a Range of Options
Children’s Well-being and Development are Best Supported in Families
A robust body of evidence shows that nurturing family environments are associated
with positive outcomes for children’s development.33,34 A family is able to provide a
child with love, a sense of belonging, and a lifelong connection to a community of
people. Within families, children learn and participate in family and cultural traditions,
have a sense of shared history, and learn important social skills that help them
engage and interact as family and community members later in life.35
Research shows Research over the last 30 years has demonstrated that positive interaction
that the quality of between a child and parent or other primary caregiver significantly impacts the
material components
of care…is not
development of the brain. Children seek interaction with adults, especially in
nearly as important the early years between birth and 3 years of age.36 They babble, search for eye
as consistent and contact, and listen for the voices of their parents. The absence of this kind of warm,
responsive child-
caregiver interaction,
responsive, and reciprocal relationship between a child and an adult can result in
especially in the damage to brain development.37
early years.
In seminal studies, children raised in biological, foster, and adoptive families

demonstrate better physical, intellectual, and developmental outcomes as
compared to children living in institutional care.38,39 Even in small scale orphanages
there can still be negative consequences to children’s development. For example,
in a series of longitudinal studies of children in orphanages in Britain, high quality
food, shelter, and medical attention were provided to children in care. There was a
positive child to caregiver ratio (i.e., one caregiver charged with a small number of
children); however, children experienced multiple caregivers.40 Despite the higher
quality of care provided, children were found to have identifiable negative effects
on their social development. Research shows that the quality of material components
of care (i.e., food and infrastructure) is not nearly as important as consistent and
responsive child-caregiver interaction, especially in the early years.41
While minimal or inconsistent caregiver interaction is found in many orphanages,

it is also important to recognize that neglect may occur in homes. Therefore,
programs that help “at risk” families to better care for children and that address
some of the underlying causes of parental or caregiver stress are critical. Investing
in these kinds of programs, such as early childhood development centers, parenting
support groups, livelihood support, and services that mitigate the negative impacts
of poverty, have been shown to have long-lasting gains benefitting not only children
and families, but also communities and entire nations.42
A Continuum of Family-based Care Options
Good practice dictates having a full range of care options available for children
in need, with priority placed on care within families. Family strengthening and
prevention of unnecessary separation matter greatly. Once a child has been
separated from parental care, the spectrum of family care options includes
reunification, relative (kinship) care, foster care, guardianship, and adoption.
According to international guidance and best practice, children and youth should
participate in the decisions regarding their care, according to their evolving
capacities.43 Whenever possible, siblings should be placed together so these
important family ties are not broken.44
• Reunification: This is the process of transitioning a child back to his or

her family of origin. For children outside of parental care, including children
in orphanages, foster care, or living on the street, reunification should be
considered the best option if it is deemed safe and appropriate for the child.45
Reunification is a process, made up of many different steps, and is not a one-time
event.46 Preparation of the child and the family, facilitating access to appropriate
services and support, and ongoing monitoring are important elements of any
reunification process. Past efforts in several countries have illustrated the necessity
of considering all reasons why the child was initially separated from the family,
addressing those before, during, and after the reunification process.47
Retrak, an organization working with street children in Ethiopia, Malawi, and Uganda,
has developed Standard Operating Procedures (SOPs) for reunification of street children
with their families. The SOPs include key definitions, guidance, and tools for each step of
the reunification process. The steps have been adapted over time and are flexible so as
to meet the unique needs of each child. Retrak successfully reintegrated more than
600 street children into families between 2009-2011.48
An organization in Uganda that provides temporary shelter and care to abandoned

infants (newborn to two years) uses a number of techniques to trace parents or relatives
of abandoned children, including radio announcements, posters in the community
where the child was found, and photos in local newspapers. When social workers
are successful in finding the immediate family or relatives, a thorough assessment
is conducted. A case plan is developed, together with the parent or relative, which
includes required social services or economic support, counseling, and a schedule for
visits prior to final placement to encourage attachment between the child and caregiver.
Once the baby is reunited with the family, the social worker makes follow-up visits for a
period of one to three years to ensure that the placement is going well and the child is
safe and well cared for. 49

• Relative or Kinship Care: In most countries, care with relatives, also called
kinship care, is the most common form of care for orphans and children separated
from parental care. This is frequently informal in nature but is a long-standing
and culturally acceptable mode of care for children.50 Care by relatives offers
the benefits of a family environment and supports the continuation of important
familial, communal, and cultural ties. Extended family plays a significant role in
both temporary and permanent orphan care, but unfortunately receives little
attention and support. Building upon existing cultural traditions of extended family
care, including better monitoring and targeted support is also a cost-effective
way to ensure family care for a large population of children no longer living
with parents.51,52
Studies from Africa show that, even in the face of HIV and AIDS, upwards
of 80-90% of children outside of parental care are still living in kinship
arrangements.53 One study illustrated that approximately 95% of children
directly affected by AIDS (i.e., having one or both parents who are living with
or have died from the disease) continue to live with their extended family.54
Grandmothers play a particularly important caregiving role, with approximately
81% of double orphans in Zimbabwe living in this type of care arrangement.55
Similarly, in Moldova, where parental migration for labor purposes leaves
children in the care of others, 91% of children for whom both parents had
migrated were left in the care of grandparents.56
Several studies have shown that some children placed in kinship care may face
bias, exclusion, or discrimination from caregivers and community members or
may be at risk of neglect, abuse, or exploitation.57, 58 A growing body of evidence
suggests that the closer the biological ties of the child and caregiver, the more
secure and less discriminated against the child feels, with care by grandparents
or older siblings reporting the best findings.59
Whether children are reunified with parents who have placed them in an
orphanage, or are placed in an alternative family-care setting such as kinship care,
there will often be the need for continuing support from communities and local
officials to ensure that children are protected and that caregivers have access to
the appropriate material and social support.60
• Foster Care: Full-time care, provided by a non-related family, known as foster

care, varies widely throughout the world. It is a growing alternative to residential
care. Formal foster care is typically authorized and arranged by an administrative
or judicial authority, which also provides oversight to ensure the best interests of
the child are being met. Many countries have a history of informal fostering, such
as when a child is placed in the care of a trusted neighbor or community member.
This type of care has many of the same benefits and risks of kinship care noted
above. Foster care can be temporary arrangement, or in some cases, permanent.
Processes and procedures should be established to ensure that children and
caregivers receive necessary support and access to services.
In the Republic of Moldova, a five-year national child care reform process has
resulted in the establishment of 660 formal foster caregivers helping to prevent
children from going into orphanages, and providing family-based options for
children leaving orphanages through deinstitutionalization.61 In South Africa,
more than 50,000 children are living in formal foster care, approximately two
and a half times the number of children registered in orphanages.62 After the
genocide in Rwanda, formal fostering was established, allowing an estimated
1,200 children to be cared for in a family setting rather than in an orphanage
or on the streets.63
• Adoption: For children who have no possibility of remaining with parents or

relatives, adoption can provide a permanent family. Research has demonstrated
that an adoptive family environment can support improved developmental
outcomes for children, especially those coming from orphanages.64 Statistics
compiled by the United Nations show that 85% of all adoptions are domestic,
numbering approximately 220,000 per year.65 Most of these formal domestic
adoptions occur in middle- and upper-income countries like the United States,
although “customary adoption,” though rarely recorded formally, is known to
be common in middle- and low-income contexts.
Formal domestic adoption, although still in very nascent stages, is gaining

momentum in countries in Latin America and Africa. In one region of Ethiopia,
a government study found that 724 formal domestic adoptions occurred
in a single year.66 In Uganda, government and child welfare organizations
are supporting a campaign to help promote domestic adoption as a viable
option.67 The campaign is promoting formal processes as well as increased
openness around domestic adoption. This is a new concept where traditionally
adoption was done informally. As a result, more than 40 domestic adoptions
in Uganda have occurred in the past two years as part of a pilot project
implemented by the Ugandan government and an NGO.68

In situations where a child is determined to be legally free for adoption and has no
viable permanent family-care options available in their home country, intercountry
adoption provides children the opportunity to have a permanent family. In 2010,
roughly 29,000 intercountry adoptions occurred worldwide, but this number has
been decreasing.69 Many efforts have been made to ensure that strong policies
and procedures and appropriate government oversight are in place to ensure
that intercountry adoptions are occurring in alignment with international norms
and standards.
In emergency contexts, Care in Emergencies

evidence has shown In emergency contexts, evidence has shown that family tracing and reunification
that family tracing and
reunification and family-
and family-based alternatives are much more effective responses than placement
based alternatives are of children in orphanages.70 Rescuing children from emergencies by removing them
much more effective from their communities or their country runs the risk of psychologically harming
responses than placement
children, and significantly inhibits the possibility of eventual reunification, which is
of children in orphanages.
always the highest priority in emergency settings.71 Experiences from emergency
settings such as Haiti and Rwanda show that most separated children have extended
family, neighbors, or community members that are willing to care for them if they can
be identified.72, 73 After the tsunami in Indonesia, 80% of children were reunited with
family members within six months after the disaster using family tracing
and identification.74
To mitigate the unnecessary separation of children from their families during an

emergency, prevention is vitally important. In areas that are prone to natural disasters
like hurricanes, mudslides, or other calamities, communities must designate safe
places and ensure that local plans are in place for how to care for any children that
might become separated.75
Orphanages:
KEY CHALLENGES AND THE IMPACT ON CHILDREN
At a minimum, every Evidence and best practice clearly demonstrate that the better models of residential
child in an orphanage
should have an
care offer small, “family-style” environments with qualified and consistent caregiving.
individualized case Such care is a recognized option within the continuum of alternative care for children
plan that minimizes
the time spent
when family care is not available or possible. However, even high quality residential
in an orphanage care cannot replace families, and it is recommended that it be used primarily for
and facilitates
eventual integration
temporary or rehabilitative purposes, with every effort made to transition children
into a family. back into family care. Large institutions with high child-to-caregiver ratios and a lack
of individualized or developmentally appropriate care have the most negative and
often life-long consequences for children. These are not recognized as a viable or
recommended option for children’s care.
Residential care is used too often as a “first resort” response without consideration
for or investment in family care options. Too frequently, children are placed in care,
without proper planning, and ultimately lose connection with parents, extended
family, and community, without any hope of reintegration. When orphanages provide
limited opportunities for interaction between children and their families, they hinder
reunification.76
Orphanages whose operation supports long-term over temporary care inhibits

reintegration. At a minimum, every child in an orphanage should have an
individualized case plan that minimizes the time spent in an orphanage and facilitates
eventual integration into a family. In too many instances this is not the case. In Malawi,
for example, only 9% of more than 6,000 children in care had a case plan and only
one-third of these children reported being visited by a relative.77 In Ethiopia, only
one-third of all orphanages reported having case plans.78
A study of orphanages in Guatemala found that approximately one-third of

the children living in them had a judicial decree stating that their placement
was permanent. This was in direct violation of the country’s Children’s Law,
which states that orphanage placement could only be temporary.79 A study
of orphanages in Rwanda also illustrated how a temporary solution for children
often becomes permanent. Approximately 30% of all Rwandan children in
orphanages have been in care more than ten years, and 13.6% of children
(452 children) spent more than 15 years in an orphanage — essentially their
entire childhoods.80

Lack of Individualized Care Has Long-Term Consequences
Evidence demonstrates that compared to a nurturing family environment, most
orphanage settings, particularly for infants and young children, do not support a
child’s proper development.81 In many instances, placement in orphanages may
produce long-term and sometimes permanent effects on children’s brains and their
physical, intellectual, and social-emotional development.82 Children raised in large-
scale orphanages often have pervasive growth problems, including stunting (severe
growth delay), and impairments in fine and gross motor skills and coordination.83, 84, 85
The larger the orphanage, the less likely it is that children receive care from a
consistent caregiver focusing on the child’s individualized needs. Typically, children
will be group-fed on a schedule rather than on demand, diapers will be changed
on a schedule rather than as needed, and less attention will be paid to a child’s
individual growth, social, and emotional development. Poor quality care and a lack
of individualized stimulation can lead not only to health and development problems,
but to isolation and lack of identity (the core sense of self that is developed through
close relationships).
Recent studies of orphanages in Ethiopia and Rwanda included findings on

caregiver-to-child ratios. In the Ethiopian study, three orphanages reported that
they had administrative personnel but did not have any caregivers on staff.86 The
others were within a range that includes .33 to 125 children per caregiver.87 In
Rwanda, the study found that the average ratio was one caregiver to 13 children.88
Evidence from Research from Romania has shown that the chronic neglect associated with larger
Eastern Europe shows
scale orphanages can weaken and disrupt the developing brain structure and
that more children
leave large-scale
functioning, impeding language acquisition and creating problems in mental
orphanages with health and chronic physical disease.89 Here neglect is defined as “warehouse-like
disabilities than enter conditions with many children, few caregivers, and no individualized adult-child
them, suggesting
relationships that are reliably responsive and where only basic survival needs may
that orphanage care
can actually cause be met.”90 Evidence from Eastern Europe shows that more children leave large-scale
disability in children.91 orphanages with disabilities than enter them, suggesting that orphanage care can
actually cause disability in children.91
While abuse and neglect is documented in many settings, including families, research
has shown that children are more likely to be abused in orphanages. A global study
on violence against children found that children living in orphanages were some of
the most vulnerable to violence, abuse and exploitation.92 Many orphanages utilize
volunteers to augment caregiving functions or to fill a human resource gap. This
constant flow of short-term volunteers exposes children to repeated departures and
can increase the risk of potential abuse and exploitation.93 These practices, although
often well intentioned, can be detrimental to children’s social and emotional
development and result in attachment issues in the long term.
Early and Long-Term Placement in Institutional Care

Has the Most Severe Effects
Negative effects associated with orphanages are more severe the longer that
a child remains in large-scale residential care, and are most critical in younger
children, especially those under three years of age.94 The first three years of life
are a “sensitive period” when a child requires intimate emotional and physical
contact.95, 96 If this is not present, there is a high risk that development will be
significantly impaired.
Failing to place a child in family-based care before the age of six months can have
devastating consequences.97 The Guidelines for the Alternative Care of Children
currently suggest that, in general, children under three should be cared for in a family
setting: In accordance with the predominant opinion of experts, alternative care for
young children, especially those under three, should be provided in family-based
settings. Exceptions to this principle may be warranted in order to prevent separation
of siblings and in cases where the placement is of an emergency nature or is for
predetermined and very limited duration, with planned family reintegration or other
appropriate long-term care solutions as its outcome.98
Risks of Institutional Care on Later Life

When children are in families, they do not “age out” of care. They remain connected
to their parents, siblings, and community and have a social support network. This is
rarely the case with children living in orphanages. When children reach a certain age,
usually 18, they must leave the orphanage. These youth (care leavers) are frequently
unprepared for independent life. This can result in unemployment, homelessness,
conflict with the law, sexual exploitation, and poor parenting, requiring increased
expenses associated with health, education, and legal services that may result in
longer-term costs to society.99

Ethiopian youth who had left care said that they felt that their orphanage would
“be their home forever” and were not prepared for independent living outside
it.100 They require support and training in practical life skills, such as how to
manage money, find a job, or rent a house, skills typically learned when living
in a family.101 Additionally, care leavers report feelings of depression, isolation,
and hopelessness. One study of children leaving orphanage care found that
there is a chronic lack of attention given to this population, leaving them with
feelings of isolation that was compared to “living on an island without service
to promote integration into society.”102
Examples of deinstitutionalization efforts have shown that a minimum package of

support is needed for successful transition. This is true for children being reintegrated
into families and for older care leavers who are transitioning to independent living
situations. Support should include material or financial assistance to the family or youth,
as well as a preparation period to ensure that the child and the family are ready for
reunification or that the youth is helped to be self-supporting in the community.103
Trained social workers should facilitate a process that addresses the psychosocial
needs of children and youth before, during, and after the process, an essential
component of reunification and leaving residential care that is often overlooked.104
Strengthening Family Care and Preventing
Placement in Orphanages
Evidence demonstrates that children thrive best in a family. Experience shows
that in the absence of interventions and services to strengthen the care of children
within families, orphanages can proliferate and “pull” children from families for
the wrong reasons. Parents and communities may see orphanages as a solution to
difficult circumstances. Local governments and communities might also see this as a
quicker and easier fix rather than investing time, human, and financial resources into
strengthening families and addressing the root causes that place families at risk of
separation. Orphanages are too frequently promoted as offering more, in a material
sense, than some families are able to provide, without recognizing the vital role that
emotional and social relationships play in a child’s development. It is the latter that is
found within a family setting.
It is essential that factors contributing to the loss of parental care are reduced
and fewer children are placed in orphanages. Communities can be mobilized and
strengthened in ways that lead to a stronger safety net for parents, families, and
their children. For example, increasing the number and support of community-based
social workers that can identify, assess, and refer vulnerable children and families to
appropriate services is critical.105Additionally, research has shown that a combination
of access to basic services, together with economic support, is fundamental to
helping families stay together.106
Findings The Role of Government and Country Policy

consistently show
International guidance recognizes the importance of a family environment and the
that most parents,
when presented government’s role in providing support that enables families to care for and protect
with some support children and fulfill their rights.107 They recommend committing resources to family
from the community,
government, and/or strengthening efforts to prevent family separation.108
social services, would
resoundingly choose
to keep their children
In most instances, children are placed in orphanages by family members that feel
at home.108 desperate and in need of support. Children are placed in orphanages due to the
lack of access to social services such as education, health care, day care facilities,
or specialized services for children with disabilities. Findings consistently show that
most parents, when presented with some support from the community, government,
and/or social services, would resoundingly choose to keep their children at
home.109 Studies conducted in multiple contexts have also demonstrated the cost-
effectiveness of preventing separation and supporting family-based alternatives
over orphanages.110

Research has proven the long-term benefits of investing in children as compared
to investments made later in life.111 Investing in efforts that support families and
children, such as early childhood education programs, reduces stress on parents and
helps increase the likelihood that children will develop into healthy and productive
members of society later in life.112
Churches and other Faith-Based Responses to Orphans and Vulnerable Children

faith-based initiatives
Faith-based organizations have historically played and continue to play an important
are often the first to
identify and respond role in the provision of care and support to the poor and the vulnerable. Churches
to children and and other faith-based initiatives are often the first to identify and respond to children
families in need.
and families in need. Pastors often have the trust of their community members and
can speak and act with authority, helping to mobilize and lead local responses. In
many HIV-affected communities throughout Africa and around the world, faith-based
groups have provided support ranging from food and shelter to home-based care
and spiritual counseling. Many of these initiatives are small, but the impact they have
upon strengthening families is significant.113
Research in Zimbabwe found that local faith-based initiatives were providing

a significant amount of help that was derived from the community itself,
demonstrating the resiliency of communities and the innate sustainability
of such actions.114 Faith-based communities in Rwanda have been actively
engaged in promoting deinstitutionalization by emphasizing the importance
of family in weekly sermons and community outreach.115 Acknowledging the
central role that faith plays in Rwandan communities, religious leaders have
been recognized players in the national care reform effort.
Striving for the Best Interests of Children:
CONCLUDING REMARKS
Recent internationally endorsed guidance suggests that a range of alternative care

options, primarily family-based, must exist in order to respond to children’s individual
needs and circumstances.116, 117 This continuum of care, including both prevention
and response services, is at the core of any child welfare system. The process of
decreasing reliance on orphanages, ensuring quality of care, and providing a range
of care options with an emphasis on family care, requires significant investment of
human and financial resources, and public support.118, 119, 120 This process requires
time, and also conviction.121 Churches, faith-based organizations, and people of faith
play an important role in supporting the needs of the orphaned and the vulnerable
across the continuum of care.
In summary, key points supported by the evidence include:
• The term “orphan” is often a misnomer. Most children who have lost a mother
or father still have a living parent or other family members who are willing to care
for them. However, many children have been separated or are at risk of being
separated from family care for a range of reasons. Globally, it is estimated that
well over 2 million children are living in orphanages.
• Poverty is a primary reason that children are placed in orphanages. Too often,
parents and relatives place children in orphanages in order to provide them with
food, shelter, and an education. Other causes include: lack of access to health care
and/or social services; abandonment, abuse, and neglect; the loss of parents; and
disability status. Each of these factors, when coupled with poverty, increases the
risk of a child being placed in an orphanage.
• Strengthening families and addressing children’s basic needs while enabling

them to remain within family care is critical. Studies show that when parents
and relatives are presented with the option of support or social services to avoid
placing their children in an orphanage, most would unequivocally choose to keep
their children at home. Supporting family-based options is also shown to be more
cost-effective than orphanages.
• A robust body of evidence over the last 30 years demonstrates that families
provide the best environment for a child’s development. Children’s cognitive,
social, and emotional development are supported when they are loved and
protected, have a sense of belonging, and learn the life skills that are integral to
growing up within a family.

• Children living in orphanages are at greater risk for long-term negative impact
on their social, emotional, and cognitive development. This is especially true
for children under three years of age and for children living in large institutions
for long periods of time. While higher quality residential care (small numbers
of children living “family-style” with consistent, well-trained caregivers) can help
minimize these impacts, research shows that children growing up within families
fare better in the long term than children raised in orphanages.
• Good practice dictates having a full range of care options available for children
in need, with emphasis on care within families. This facilitates the possibility of
identifying the best care option to meet each child’s unique needs. The continuum
of care includes prevention/family strengthening, family reunification, kinship care,
adoption, and foster care, as well as smaller, “family-style” high quality residential care.
• Whether in family care or in orphanages, all vulnerable children need to be

protected from abuse, neglect, and the deprivation of their basic needs. While
the evidence demonstrates that children are more likely to be abused or neglected
in institutional care, it is important to support the well-being and protection of
children in all settings.
• Ensuring that all children are well cared for, ideally within a family, takes
the active involvement of and collaboration between government, non-
governmental organizations, local communities, the faith-based community,
families and caregivers, as well as children and youth. There is a role for each
of these groups and a need for collaboration and a shared understanding of what
is best for children.
Glossary of Terms
• Alternative care: Includes formal and informal care of children outside of parental
care.122 Alternative care includes kinship care, foster care, supervised independent
living, and residential care.
• Attachment: Attachment is an emotional bond to another person. Psychologist

John Bowlby was the first attachment theorist, describing attachment as a “lasting
psychological connectedness between human beings.” Primary caregivers
(generally parents) who are available and responsive to an infant’s needs allow
the child to develop a sense of security that has a large impact on his/her ability
to navigate the world of social relationships as an adult.
• Care leaver: A child who is exiting a care placement. This is typically used to refer
to children who are leaving orphanages, either through reintegration, placement
in an alternative family environment, or for independent living.
• Community-based Care: Refers to both the direct caring role assumed by the
leadership or members of a community and the supportive role community-based
organizations play in assisting direct caregivers.123
• Continuum of Care: A Continuum of Care describes a range of services and

placement options for children beginning with family preservation (i.e., remaining
with biological parent(s)) through to placement in residential care centers/facilities.
Other care options included within this continuum are kinship care, temporary
foster family care, long- term foster care, domestic adoption, monitored child
headed households, and small group homes, intercountry adoption, and as noted,
high-quality residential care (including orphanages). A continuum should represent
a wide range of options so that the necessary and appropriate placement can be
determined based on every child’s best interest.
• Informal/Formal Care: 1) Informal care is defined as “…any private arrangement

provided in a family environment, whereby the child is looked after on an ongoing
or indefinite basis by relatives or friends (informal kinship care) or by others in
their individual capacity, at the initiative of the child, his/her parents or other
person without this arrangement having been ordered by an administrative or
judicial authority or a duly accredited body;”124 2) Formal care is defined as “…all
care provided in a family environment which has been ordered by a competent
administrative body or judicial authority, and all care provided in a residential
environment, including in private facilities, whether or not as a result
of administrative or judicial measures.”125

• Foster care: Situations whereby children are placed by a competent authority
for the purposes of alternative care in the domestic environment of a family other
than children’s own family, one that has been selected, qualified, approved, and
supervised for providing such care.126
• Institution: Residential care settings where children are looked after in any public
or private facility, staffed by paid carers or volunteers working pre-determined
hours/shifts, and based on collective living arrangements, with a large capacity.
• Kinship care: “Family-based care within the child’s extended family or with close
friends of the family known to the child, whether formal or informal in nature.”127
• NGO: Non-governmental organization.
• Orphan: A child that has lost one or both parents. The loss of one parent classifies
a child as a “single orphan” and the loss of both parents as a “double orphan.”128
An “orphan” may still live with primary or extended family.
• Orphanage: An orphanage is a type of residential care (see definition below) and

is most often thought of as “institutional care” (see definition above).
• OVC: Orphans and vulnerable children.
• Reintegration: “Return to the [child’s] family,”129 which could include kinship

care or parental care and often involves return to communities of origin. It is
important to see reintegration as a process, which can begin from the moment
a child becomes separated from families or parents, and last until they have
returned to communities.
• Residential Care: “Care provided in any non family-based group setting, such as
places of safety for emergency care, transit centers in emergency situations, and
all other short and long-term residential care facilities including group homes.”130
Residential care is the umbrella that encompasses institutional care such as
orphanages and its basic characteristic is that it is a living arrangement/facility
where salaried staff or volunteers ensure care for children living there.
1
Retrieved from http://www.unicef.org/media/media_45279.html
2
United States Government. Fifth Annual Report to Congress on PL 109-95. World’s Vulnerable Children
(2010). Retrievable at: http://pdf.usaid.gov/pdf_docs/PDACU307.pdf
3
Pinheiro, P. (2006). World Report on Violence Against Children. Geneva. United Nations. Op cit.
4
Ministry of Gender and Family Promotion, Republic of Rwanda (MIGEPROF) and Hope and Homes
for Children (2012). National Survey of Institutions for Children in Rwanda. Retrievable at:
http://bettercarenetwork.org/BCN/details.asp?id=31605&themeID=1001&topicID=1011, p. 10
5
Ministry of Social Affairs, Veterans and Youth Rehabilitation (2011). With the best of intentions.
A study of attitudes towards residential care in Cambodia.
Retrievable at: http://www.unicef.org/eapro/Study_Attitudes_towards_RC.pdf
6
Boothby, N., Wessells, M., Williamson, J. et al (2012). What are the most effective early response
strategies and interventions to assess and address the immediate needs of children outside of family
care? Child Abuse & Neglect 36 (2012) 711–721
7
“Uganda’s Official Alternative Care Framework. Situation Analysis and Response.” Presentation by Mark
Riley. 04 December 2013. Children without Appropriate Care in Uganda Workshop. Kampala, Uganda.
8
Ibid.
9
Idris Abdallah, Child Protection Specialist at the UNICEF Ghana Country Office, personal
correspondence, December 2013.
10
United Nations General Assembly (2009) Guidelines for the Alternative Care of Children, A/Res/64/142.
United Nations, New York, 2010. Retrieved from: http://bettercarenetwork.org/docs/Guidelines-
English.pdf
11
Williamson, J. & Greenberg A.(2010). Families, Not Orphanages, Better Care Network Working Paper.
Retrieved from: http://bettercarenetwork.org/BCN/details.asp?id=23328&themeID=1003&topic
ID=1023
12
UNICEF (2012). Fact Sheet. Retrieved 04 December 2013 from http://www.unicef.org/ceecis/
FACTSHEET-SofiaConference_20112012final.pdf
13
Frimpong-Manso, K. (2013). From walls to homes: Child care reform and deinstitutionalisation in
Ghana. International Journal of Social Welfare. http://dx.doi.org/10.1111/ijsw.12073; Ghana Business
News (GBN), “Social Welfare Department Defines Conditions for Placing Children in Orphanages,”
March 15, 2013, http://www.ghanabusinessnews.com/2013/03/15/social-welfare-department-defines-
conditions-for-placing-children-in-orphanages/. Article is referencing the DSW 2006-2007 study,
supported by OrphanAid Africa.
14
Bilson, A. & Cox, P. (2007). Caring about Poverty. Journal of Children and Poverty, 13(1), pp. 37-49.
Retrieved from: http://www.bettercarenetwork.org/BCN/details.asp?id=20556&themeID=1002&topic
ID=1017
15
Ministry of Gender and Family Promotion, Republic of Rwanda (MIGEPROF) and Hope and Homes for
Children (2012). Op cit.
16
The University of Nottingham (2012). Child Abandonment and its Prevention in Europe. The European
Commission’s Daphne Programme. Retrieved from: http://www.bettercarenetwork.org/BCN/details.asp
?id=30091&themeID=1001&topicID=1006
17
Ibid.; Family Health International, Children’s Investment Fund, & UNICEF (2010). Improving
Care Options for Children Through Understanding Institutional Child Care and Factors Driving
Institutionalization.Family Health International. Retrievable at: www.fhi.org/en/CountryProfiles/Ethiopia/
res_eth_institutional_care.htm
18
Ministry of Social Affairs, Veterans and Youth Rehabilitation (2011). Op cit.
19
Family Health International, Children’s Investment Fund, & UNICEF (2010). Op cit.

20
Children (2012). Op cit.Retrieved 15 November 2013 from http://bettercarenetwork.org/BCN/details.
asp?id=31605&themeID=1001&topicID=1011
21
Ministry of Gender, Children and Community Development & UNICEF (2013). All Children Count. A
baseline study of children in institutional care in Malawi. Retrieved from: http://www.crin.org/en/library/
publications/all-children-count-baseline-study-children-institutional-care-malawi
22
Ministry of Gender, Children and Community Development & UNICEF (2013). Op cit.; Ministry of Social
Affairs, Veterans and Youth Rehabilitation (2011). Op cit.
23
Ministry of Gender, Children and Community Development & UNICEF (2013). Op cit.
24
Abebe, T., & Aase, A., (2007). Children, AIDS and the Politics of Orphan Care in Ethiopia: The Extended
Family Revisited. Social Science & Medicine 64 (07), pp. 2058–2069.
25
UNICEF Regional Office for CEE/CIS (2010). At Home or In a Home? Formal Care and Adoption of
Children in Eastern Europe and Central Asia. Retrieved from: http://www.bettercarenetwork.org/BCN/
details.asp?id=25427&themeID=1002&topicID=1017
26
Ibid.
27
UNICEF (2013). State of the World’s Children. New York. Retrieved from: http://www.unicef.org/sowc/
28
UNICEF Regional Office for CEE/CIS (2010). Op cit.
29
Ibid.
30
Wedge, J., on behalf of the interagency Group on Reintegration (2013). Reaching for Home Global
learning on family reintegration in low and middle income countries; Legesse, Z.K. and Bunkers, K.M.
on behalf of Retrak (2012). Deinstitutionalization of Street Children in Addis Ababa. Retrievable at:
www.retrak.org/uploaded/Retrak%20Research%20Report%20Deinstitutionalisation%20in%20
Ethiopia%20March%202012%20light.pdf
31
Bilson, A. & Harwin, J. (2003) Gatekeeping Services for Vulnerable Children and Families in the
Changing Minds, Policies and Lives. UNICEF/World Bank. Florence: UNICEF Innocenti Research Centre;
Bilson A. (2010). The development of Gate-Keeping functions in Central and Eastern Europe and the
CIS: Lessons from Bulgaria, Kazakhstan and Ukraine. Geneva: UNICEF; Bilson, A. & Carter, R. (2008).
Strategy development for the reform of the state care system for children deprived of parental care
living in state care institutions. UNICEF; Bilson, A. & Larkins, C. (2013). Providing alternatives to infant
institutionalisation in Bulgaria: How gatekeeping can beneﬁt from a social development orientation.
School of Social Work, University of Central Lancashire, Preston.
32
Bunkers, K., on behalf of Better Care Network and UNICEF (in draft). Key informant interviews. Child
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33
Richter L, Foster G, Sherr L. (2006). Where the heart is: Meeting the psychosocial needs of young
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young_children_in_the_context_of_HIV_AIDS
34
Smyke, A. T., Koga, S. F., Johnson, D. E., Fox, N. A., Marshall, P. J., Nelson, C. A., Zeanah, C.H., & Group,
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35
Groark, C. J., & McCall, R. B. (2011). Improving institutions: Can we? Should we? How? International
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36
National Scientific Council on the Developing Child. (2012). The Science of Neglect: The Persistent
Absence of Responsive Care Disrupts the Developing Brain: Working Paper 12. Retrieved from:
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Environment, Caregivers, and Children in Three Central American Orphanages. Infant Mental Health
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37
National Scientific Council on the Developing Child. (2012). Op cit.
38
Van IJzendoorn, M. H., Bakermans-Kranenburg, M. J., & Juffer, F. (2007). Plasticity of growth in height,
weight and head circumference: Meta-analytic evidence of massive catch-up of children's physical
growth after adoption. Journal of Developmental and Behavioral Pediatrics, 28, pp. 334-343. Abstract
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Height,_Weight,_and_Head.12.aspx
39
B. C. (2007). The caregiving context in institution-reared and family- reared infants and toddlers in
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40
Hodges, J., Tizard, B. (1989).IQ and behavioural adjustment of ex-institutional adolescents. Journal
of Child Psychology and Psychiatry. 30(1):53-75. Retrievable at: http://www.ncbi.nlm.nih.gov/
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41
Ibid.; Tizard, B. & Tizard, J. (1971). Social development of two year old children in residential nurseries.
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10162.
43
Cantwell, N., Davidson, J., Elsley, S., Milligan, I., Quinn, N. (2012). Op cit.; Groza, V., Bunkers, K., &
Gamer, G. (2011). Ideal components and current characteristics of alternative care options for children
outside of parental care. In R. B. McCall, M. H. van IJzendoorn, F. Juffer, C. J. Groark, and V. K. Groza
(Eds.), Children without permanent parents: Research, practice, and policy. Monographs of the Society
for Research in Child Development, 76(4), pp. 163–189. Abstract Retrieved from:
http://onlinelibrary.wiley.com/doi/10.1111/mono.2011.76.issue-4/issuetoc
44
Cantwell, N., Davidson, J., Elsley, S., Milligan, I., Quinn, N. (2012). Moving Forward: Implementing the
Guidelines for the Alternative Care of Children. UK: Centre for Excellence for Looked After Children in
Scotland. Retrievable at: www.alternativecareguidelines.org
45
United Nations Convention on the Rights of the Child, Resolution 44/25, November 20, 1989, United
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46
Ibid.
47
Terre des Hommes Foundation and Hope for Himalayan Kids Nepal (2011). Ten Steps Forward
to Deinstitutionalisation. Building communities to support children’s rights. Retrieved from: http://
resourcecentre.savethechildren.se/library/10-steps-forward-desinstitutionalisation-building-
communities-support-childrens-rights
48
Retrak (2012). Standard Operating Procedures. Family Reintegration. Retrievable from: http://www.
retrak.org/newsDetail.aspx?uid=258
49
Walakira, E; Ochen, E., Bukuluki, P. and Allan, S. (2014). Residential Care for Abandoned Children and
their Integration into a Family-based setting in Uganda: Lessons for Policy and Programming. Infant
Mental Health Journal. DOI: 10.1002/imhj.21432. For more information about the organization, see
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50
Roby, J. (2011) Children in Informal Alternative Care. Discussion paper. UNICEF, New York. Retrieved
from: http://www.bettercarenetwork.org/BCN/details.asp?id=25477&themeID=1002&topicID=1013
Abebe, T. & Aase, A. (2007). Children, AIDS and the politics of orphan care in Ethiopia: The extended
family revisited Social Science & Medicine 6: 2058–2069
51
Williamson, J, & Greenberg, A. (2010). Families, not orphanages. (Better Care Network, working paper).
Retrieved from http://www.crin.org/docs/Families%20Not%20Orphanages.pdf

52
Roby, J (2011). Op cit.
53
Lombe, M. & Ochombo, A. (2008). Sub-Saharan African’s orphan crisis: Challenges and opportunities.
International Social Work, 51, 682-698; Madhavan, S. (2004). Fosterage patterns in the age of AIDS:
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54
Hosegood, V. (2008). Demographic Evidence of Family and Household Changes in Response to the
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JLICA Learning Group. Retrieved from: http://www.bettercarenetwork.org/BCN/details.asp?id=19617&
themeID=1004&topicID=1025
55
Beegle, K., Filmer, D. Stokes, A., and Tiererova, L. (2010). Orphanhood and the Living
Arrangements of Children in Sub-Saharan Africa. World Development, p. 1727-1746. doi:10.1016/j.
worlddev.2010.06.015
56
Roby, J. (2011). Op cit.
57
Ibid.
58
Roby, J., Shaw, S., & George, L. (2013). Perceived food and labor equity and school attendance among
Ugandan children living in kin care. International Journal of Social Welfare. Retrievable at: DOI:
10.1111/ijsw.12051
59
Ibid.; Case, A., Paxson, C., & Ableidinger, J. (2004). Orphans in Africa: Parental death, poverty, and
school enrollment. Demography, 41(3), 483–508. Retrieved from http://www.jstor.org/stable/1515189
60
Hosegood, V. (2008). Op cit.
61
USAID, Capacity Plus, PEPFAR, Better Care Network, and the Global Social Service Workforce Alliance.
“Deinstitutionalizing the Alternative Care System for Children-Implications for the social service
workforce with learning from Rwanda and Moldova.” Webinar presentation 05 December 2013.
62
Parry-Williams, J and Dunn, A (2009) Family and Kinship Care Presentation given at the International
conference on family-based care for Children, Nairobi as cited in EveryChild (2011). Fostering better
care: Improving foster care provision around the world.
63
Doná, G (2001) The Rwandan Experience of Fostering Separated Children, Save the Children.
Retrievable from: http://resourcecentre.savethechildren.se/sites/default/files/documents/1461.pdf
64
Johnson, D. E. (2002). Adoption and the effect on children’s development’, Early Human Development,
68, pp. 39-54; Van IJzendoorn, M. H., & Juffer, F. (2006). The Emanuel Miller Memorial Lecture 2006:
Adoption as intervention. Meta-analytic evidence for massive catch-up and plasticity in physical, socio-
emotional, and cognitive development. Journal of Child Psychology and Psychiatry, 47(12), 1228-1245.
65
United Nations, Department of Economic and Social Affairs, Population Division, ‘Child Adoption,
Trends and Policies’, ST/ESA/SER.A/292, United Nations, New York, p. 88, 2009.
66
Oromia Bureau of Women, Children and Youth Affairs (BoWCYA), (2012). Summary Report on the
Assessment and Verification of Domestic Adoption in Oromia Regional State. Used with permission of
the Oromia BoWCYA as referenced in Groza, V., & Bunkers, K. M.(2014). Adoption Policy and Evidence-
Based Domestic Adoption Practice: A Comparison of Romania, Ukraine, India, Guatemala and Ethiopia.
Infant Mental Health Journal (special issue).
67
http://ugandansadopt.ug/videos/
68
Information received via email from Robert Commons, Executive Director of Child’s I Foundation,
Kampala, Uganda. See also http://ugandansadopt.ug
69
Selman, P. (2012). Global Trends in Intercountry Adoption: 2001-2010. National Council for Adoption,
Adoption Advocate (2012)
70
Save the Children (2010). Misguided Kindness: Making the Right Decisions for Children in
Emergencies. Retrieved from: http://www.bettercarenetwork.org/BCN/details.asp?id=24138&themeID
=1005&topicID=1031
71
Ibid.
72
Ibid.
73
Doná, G (2001) The Rwandan Experience of Fostering Separated Children, Save the Children;
International Rescue Committee (IRC) (2003). Protecting Children and Adolescents Before and After
Conflict. Innovative Approaches and Practices. Family Reunification, Alternative Care and Community
Reintegration of Separated Children in Post-Conflict Rwanda.
74
UNICEF. (2009a). Children and the 2004 Indian Ocean Tsunami: UNICEF’s response in Indonesia
(2005–2008). New York, USA: UNICEF. Retrieved from. http://www.unicef.org/evaluation/files/Children_
and_the_2004_Indian_Ocean_tsunami_Indonesia-Sri_Lanka-Maldives.pdf; UNICEF. (2009). Progress for
children: A report card on child protection. Retrieved from http://www.unicef.org/protection/
75
Save the Children (2010). Op cit.
76
Children (2012). Op cit.; Family Health International, Children’s Investment Fund, & UNICEF (2010).
Op cit.
77
Ministry of Gender, Children and Community Development & UNICEF (2013). Op cit.
78
79
Perez, L.M. (2008) Situation Faced by Institutionalized Children and Adolescents in Shelters in
Guatemala. Guatemala City: USID and Holt International Children Services. Retrieved from http://www.
brandeis.edu/investigate/adoption/docs/GuatemalanInstitutionalizedChildrenReport--June2008.pdf
80
81
The Leiden Conference on the Development and Care of Children without Permanent Parents.
The Development and Care of Institutionally Reared Children (2012). Child Development
Perspective, 6 (2), pp. 174–180. Abstract Retrieved from: http://onlinelibrary.wiley.com/doi/10.1111/
j.17508606.2011.00231.x/abstract
82
Johnson, D. E., & Gunnar, M. R. (2011). IV. Growth Failure in Institutionalized Children. Monographs of
the Society for Research in Child Development, 76:92–126. doi: 10.1111/j.1540-5834.2011.00629.x
Abstract Retrieved from: http://onlinelibrary.wiley.com/doi/10.1111/mono.2011.76.issue-4/issuetoc
83
Johnson, D. E., & Gunnar, M. R. (2011). IV. Growth Failure in Institutionalized Children. Monographs of
the Society for Research in Child Development, 76:92–126. doi: 10.1111/j.1540-5834.2011.00629.x
Abstract Retrieved from: http://onlinelibrary.wiley.com/doi/10.1111/mono.2011.76.issue-4/issuetoc
84
Dobrova-Krol, N. A., Van IJzendoorn, M. H., Bakermans-Kranenburg, M.J., Juffer, F., & Cyr, C. (2008).
Physical growth delays and stress dysregulation in stunted and non-stunted Ukrainian institution-
reared children. Infant Behavior and Development, 31, pp. 539–553. Abstract Retrieved from: www.
sciencedirect.com/science/article/pii/S0163638308000404
85
Levin, A., Zeanah, C., Fox, N. & Nelson, C. (2014). Motor Outcomes in Children Exposed to Early
Psychosocial Deprivation. The Journal of Pediatrics, Vol. 164, No. 1 pp.123-130. www.jpeds.com;
Roeber, B., Gunnar, M. and Pollak, S. (2013). Early Deprivation Impairs the Development of Balance
and Bilateral Coordination. Developmental Psychology, pp: 1-9.
86
Ibid.
87
Ibid.
88
89
B. C. (2007). The caregiving context in institution-reared and family- reared infants and toddlers in
umd.edu/EDHD/faculty/Fox/publications/78.pdf; Nelson, C.Fox, N. & Zeanah, C. (2013). Anguish of the

Abandoned Child. Scientific American.com; van IJzendoorn, M.,et al (2011). Children in Institutional
Care: Delayed Development and Resilience. In R. B. McCall, M. H. van IJzendoorn, F. Juffer, C. J. Groark,
and V. K. Groza (Eds.), Children without permanent parents: Research, practice, and policy. Monographs
of the Society for Research in Child Development, 76(4), pp.8-30.
90
National Scientific Council on the Developing Child. (2012). Op cit.
91
Browne, K. (2009). The Risk of Harm to Young Children in Institutional Care. Better Care Network.
Retrieved 29 November 2013 from http://www.crin.org/docs/the_Risk_of_Harm.pdf
92
Pinheiro, P. (2006). Op cit.
93
Roby, J.L., Rotabi,K.S., & Bunkers, K.M. (2013). Social justice and intercountry adoptions: The role of the
U.S. social work community. Social Work, 58, (4), 293-303; Richter, L. & Normal, A. (2010). AIDS orphan
tourism: A threat to children in residential care. Vulnerable Children and Youth Studies, 5 (3), 217-229;
Ministry of Social Affairs, Veterans and Youth Rehabilitation (2011). Op cit.
94
Browne, K. (2009). Op cit.
95
Bucharest Early Intervention Project (2009) Caring for Orphaned, Abandoned and Maltreated Children.
Retrieved from: http://www.bettercarenetwork.org/BCN/details.asp?id=12323&themeID=1003&topic
ID=1023
96
Perspective, 6 (2), pp. 174–180. Abstract available at: http://onlinelibrary.wiley.com/doi/10.1111/
j.17508606.2011.00231.x/abstract; Bucharest Early Intervention Project (2009) Caring for Orphaned,
Abandoned and Maltreated Children. Available at: http://www.bettercarenetwork.org/BCN/details.
asp?id=12323&themeID=1003&topicID=1023; Nelson, C.Fox, N. & Zeanah, C. (2013). Anguish of the
Abandoned Child. Scientific American.com
97
Browne, K. (2009). Op cit.
98
United Nations General Assembly (2009). Op cit., article 21.
99
Save the Children (2009). Keeping Children out of Harmful Institutions:Why we should be investing in
Family-Based Care.Retrieved from: http://www.bettercarenetwork.org/BCN/details.asp?id=21471&the
meID=1003&topicID=1023
100
101
SOS Children’s Villages (2010). Ageing Out of Care. From care to adulthood in European and Central
Asian societies.
Retrieved 01 December 2013 from http://www.york.ac.uk/inst/spru/pubs/pdf/ageing.pdf
102
Ibid., p. 6
103
Wedge, J., on behalf of the interagency Group on Reintegration (2013). Op cit.
104
Gebru, M. (2003). Impact Study on Jerusalem Association of Children’s Homes (JACH)
De- institutionalization Programs.
Retrieved 15 November 2013 from http://thewayforwardproject.org/resources/
105
The term social worker in this case is used to define anyone with some specific training in child care
and protection with a specific and recognized function related to identification, assessment, support
and monitoring of vulnerable children and families within the community.
106
Greenberg, A.& Sherr, L. (2009): Social welfare and cash transfer meeting, Carmona, Spain. Vulnerable
Children and Youth Studies: An International Interdisciplinary Journal for Research, Policy and Care,
4:S1, 6-9; Greenberg, A. (2009). Strengthening the social welfare sector: Expanding the reach and
effectiveness of cash transfers', Vulnerable Children and Youth Studies, 4: 1, 81 — 85.
107
United Nations General Assembly (2009) Op cit.
108
Cantwell, N., Davidson, J., Elsley, S., Milligan, I., Quinn, N. (2012). Op cit.
109
UNICEF Regional Office for CEE/CIS (S2010). Op cit.; Ministry of Social Affairs, Veterans and Youth
Rehabilitation (2011). Op cit.
110
Williamson, J. & Greenberg, A. (2010). Op cit.; Desmond, C., & Gow, J. (2001). The Cost Effectiveness
of Six Models of Care for Orphans and Vulnerable Children in South Africa, University of Natal,
Durban, South Africa, 2001.
111
Heckman, J. (2011). The economics of inequality. Education Digest, 77(4), pp. 4-11. Retrieved from:
http://actionforchildren.net/up_doc/heckman.pdf
112
Engle, P., Black, M. M., Behrman, J. R., Cabral de Mello, M., Gertler, P. J., Kapiriri, Martorell, R., Eming
Young, M., the International Child Development Steering Group (2007). Strategies to avoid the loss of
developmental potential in more than 200 million children in the developing world. Lancet, 369(415),
pp. 229–242. Retrieved from: www.thelancet.com/journals/lancet/article/PIIS0140-6736(07)60112-3/
fulltext#article_upsell
113
Foster, G., Webster, J., Stephenson, P. (2003). A Study of 19 Christian Community Orphan Initiatives
in Zimbabwe.
114
Ibid.
115
Personal discussions with P.E.A.C.E. Plan, Kigali, Rwanda.
116
United Nations General Assembly (2009) Guidelines for the Alternative Care of Children, A/
Res/64/142. United Nations, New York, 2010. Retrieved from: http://bettercarenetwork.org/docs/
Guidelines-English.pdf
117
Cantwell, N., Davidson, J., Elsley, S., Milligan, I., Quinn, N. (2012). Op cit.
118
Dobrova-Krol, N. A., Van IJzendoorn, M. H., Bakermans-Kranenburg, M.J., Juffer, F., & Cyr, C. (2008).
reared children. Infant Behavior and Development, 31, pp. 539–553. Abstract Retrieved from: www.
sciencedirect.com/science/article/pii/S0163638308000404
119
Perspective, 6 (2), pp. 174–180. Abstract Retrieved from: http://onlinelibrary.wiley.com/doi/10.1111/
j.17508606.2011.00231.x/abstract
120
Fluke, J. D., Goldman, P. S., Shriberg, J., Hillis, S. D., Yun, K., Allison, S., & Light, E. (2012). Systems,
strategies, and interventions for sustainable long-term care and protection of children with a history
of living outside of family care. Child Abuse and Neglect. pp. 722-731. Abstract Retrieved from: http://
bettercarenetwork.org/BCN/details.asp?id=30007&themeID=1001&topicID=1009
121
Dobrova-Krol, N. A., Van IJzendoorn, M. H., Bakermans-Kranenburg, M.J., Juffer, F., & Cyr, C.. (2008).
reared children. Infant Behavior and Development, 31, pp. 539–553. Abstract Retrieved from:
www.sciencedirect.com/science/article/pii/S0163638308000404
122
United Nations General Assembly (2009). Op cit.
123
Roby, J. (2011). Op cit.
124
United Nations General Assembly (2009). Op cit., article 29.
125
Ibid.
126
Ibid., article 29.
127
Ibid.
128
Retrieved from http://www.unicef.org/media/media_45279.html
129
Ibid., article 49.
130
Ibid., article 29.

NOTES
Contributors: Kelley Bunkers, Amanda Cox, Sarah Gesiriech, and Kerry Olson
This guide is produced by the Faith to Action Initiative, with support from the Oak Foundation and the Better Care Network. The
Faith to Action Initiative serves as a resource for Christian groups, churches, and individuals seeking to respond to the needs of
orphans and vulnerable children. Through our publications, website, and workshops, we offer practical tools and resources and
up-to-date information on key strategies and research to help guide action. The Better Care Network facilitates active information
exchange and collaboration on the issue of children without adequate family care, and advocates for technically sound policy
and programmatic action on global, regional, and national levels.
For more information and updated resources, please visit: www.faithtoaction.org and www.bettercarenetwork.org

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Children,

THE FAITH TO ACTION INITIATIVE, 2014

Orphans and Children in Orphanages:  pages 3 – 6

Orphaned and Vulnerable Children Worldwide

Reasons for Placement in Orphanages

The Importance of Family Care and pages 7 – 11

Children’s Well-being and Development are Best Supported in Families

A Continuum of Family-based Care Options

Orphanages: Key Challenges and the Impact on Children pages 12 – 15

Lack of Individualized Care Has Long-Term Consequences

Early and Long-Term Placement In Institutional Care

Risks of Institutional Care on Later Life

Strengthening Family Care and Preventing pages 16 – 17

The Role of Government and Country Policy

Faith-Based Responses to Orphans and Vulnerable Children

Striving for the Best Interests of Children: Concluding Remarks pages 18 – 19

Glossary of Terms  pages 20 – 21

Orphaned and Vulnerable Children Worldwide

Studies and anecdotal reports regarding orphanages in various countries have

Unfortunately the number of children living in orphanages appears to be rising. This

Cambodia saw a 75% increase in the number of orphanages to 269 orphanages

Poverty, not lack of Reasons for Placement in Orphanages

Review procedures or decision-making processes are often absent when it comes to

In seminal studies, children raised in biological, foster, and adoptive families

While minimal or inconsistent caregiver interaction is found in many orphanages,

• Reunification: This is the process of transitioning a child back to his or

An organization in Uganda that provides temporary shelter and care to abandoned

• Foster Care: Full-time care, provided by a non-related family, known as foster

• Adoption: For children who have no possibility of remaining with parents or

Formal domestic adoption, although still in very nascent stages, is gaining

In emergency contexts, Care in Emergencies

To mitigate the unnecessary separation of children from their families during an

Orphanages whose operation supports long-term over temporary care inhibits

A study of orphanages in Guatemala found that approximately one-third of

Recent studies of orphanages in Ethiopia and Rwanda included findings on

Early and Long-Term Placement in Institutional Care

Risks of Institutional Care on Later Life

Examples of deinstitutionalization efforts have shown that a minimum package of

Findings The Role of Government and Country Policy

Churches and other Faith-Based Responses to Orphans and Vulnerable Children

Research in Zimbabwe found that local faith-based initiatives were providing

Recent internationally endorsed guidance suggests that a range of alternative care

In summary, key points supported by the evidence include:

• Strengthening families and addressing children’s basic needs while enabling

• Whether in family care or in orphanages, all vulnerable children need to be

• Attachment: Attachment is an emotional bond to another person. Psychologist

• Continuum of Care: A Continuum of Care describes a range of services and

• Informal/Formal Care: 1) Informal care is defined as “…any private arrangement

• NGO: Non-governmental organization.

• Orphanage: An orphanage is a type of residential care (see definition below) and

• OVC: Orphans and vulnerable children.

• Reintegration: “Return to the [child’s] family,”129 which could include kinship

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THE FAITH TO ACTION INITIATIVE, 2014

Orphans and Children in Orphanages: pages 3 – 6

The Importance of Family Care and pages 7 – 11

Children’s Well-being and Development are Best Supported in Families

Orphanages: Key Challenges and the Impact on Children pages 12 – 15

Lack of Individualized Care Has Long-Term Consequences

Strengthening Family Care and Preventing pages 16 – 17

Striving for the Best Interests of Children: Concluding Remarks pages 18 – 19

Glossary of Terms pages 20 – 21

• Reunification: This is the process of transitioning a child back to his or

• Foster Care: Full-time care, provided by a non-related family, known as foster

• Adoption: For children who have no possibility of remaining with parents or

• Strengthening families and addressing children’s basic needs while enabling

• Whether in family care or in orphanages, all vulnerable children need to be