Who Cares? Child and family perspectives on effective care, who provides it and why it matters

Gillian Mann and Emma de Vise-Lewis - Family for Every Child


The importance of children being well cared for in families is widely recognised in global policies and guidance. There is extensive research demonstrating clearly the importance of a safe and caring family for child wellbeing and development. While there is consensus on the importance of effective care in families for children, there is a lack of discussion and agreement about the precise components of this care. In particular, further exploration is needed to determine which elements of effective care are universal and which are culturally or contextually specific, and to explore who provides this care and the factors that hinder or support it. This report contributes to debates on this important topic by providing perspectives from focus groups with 198 children and 81 adults from Brazil, Colombia, Egypt, Mexico, Russia, Rwanda and Zimbabwe (see Annex for information about these focus groups).

This report demonstrates that there are many commonalities in perspectives on and experiences of care across contexts. The following was consistently found throughout the seven settings where the consultations took place.

  • Effective care for children in families involves meeting children’s material and emotional needs, and providing them with food and shelter, love and affection, support and advice, and a peaceful, safe environment in which to flourish. In the minds of children, material needs do not take precedence over love and guidance.
  • A range of individuals contribute to the care of children and it is rare for this care to be solely provided by parents. Each contributing family member provides specific inputs, meaning that the loss of a mother or grandmother has very different ramifications for child well-being compared to the loss of a father or grandfather.
  • Communities make vital contributions to children’s care.
  • Care is impacted by both structural factors, such as poverty or lack of access to vital services, and relationships within the household and wider community, such as bonds between the carer and the child, or stigma and discrimination, as well as carers’ access to extended family and community support.

There are also important differences in how care is perceived and experienced between the different settings. For example:

  • It is far more common for children to live with one or both parents in some settings than others, and the most common family types differ by country and context.
  • The specific role played by different family members and other actors in children’s care varies and is heavily influenced by prevailing cultural norms. These also change over time and adjust to factors such as women having a greater role in the workplace.
  • The particular structural and relational factors that influence care vary greatly by context with, for example, drug and alcohol abuse and high levels of violence in the community having a far stronger influence on care in some settings than others.

This suggests that while it is possible to identify some common features of effective care and universal strategies to support this care, it is equally important to fully understand and respond to specifics of effective care in each setting.

The findings of this report have numerous implications for both policymakers and practitioners, the most important of which include the following.

1. Improving children’s care is a policy priority. Having the opportunity to grow up safe and protected in a family is of vital importance to children’s well-being and development. This has ramifications for children’s physical and mental health, schooling, and moral guidance, and consequent implications across a range of areas and development targets. Meeting children’s physical and material needs is obviously important for their survival. However, as important is ensuring they have strong emotional well-being, supported by relationships, love and guidance.

2. Interventions to improve care must be holistic. Supporting effective care within families is unlikely to ever involve simple, single sector responses. Improving care requires efforts to build relationships within families and communities, combined with interventions to reduce poverty and improve access to services. Those working in child protection, health, education, social protection and other sectors all have a responsibility to monitor and improve children’s care. Policymakers, programme designers and practitioners must develop a holistic package of support for families that can be individually tailored to meet specific needs.

3. Policymakers and practitioners must recognise that a range of individuals are responsible for children’s care and must target interventions appropriately. For example, efforts to enhance ‘parenting’ cannot just be aimed at mothers and fathers but must also reach siblings and extended family members. Similarly, messaging in areas such as child nutrition, health or safety, will be far more effective if it targets those responsible for feeding and supervising children, which may not always be parents. When working with individual children and families, practitioners must consider wider caring relationships, rather than just focusing on parent and child interactions. Understanding the specific contributions made by each carer and how this varies by context and circumstance is vital for the success of a range of interventions.

4. Care must be a key consideration when seeking to identify and support the most vulnerable groups. Rather than focusing exclusively on orphanhood as a sign of vulnerability, it is important to also examine the existence of wider caring networks. Children who have smaller networks, or who lose key caregivers such as a grandparent, sibling, aunt or uncle, may be particularly vulnerable. As different caregivers provide different types of support, the lack of a particular caregiver in a child’s network can also have an impact on the specific forms of vulnerability that children face.

5. Policies and interventions on care must be context specific. Who cares for children and the factors that affect the quality of care vary by setting; it is important to avoid simply importing solutions from one setting to another. Efforts must be made to fully understand context, to build on strengths within communities, and to develop supports to families that are appropriate to each setting. This includes avoiding importing parenting programmes from higher income countries and applying them without adaptation in lower income contexts.

Read the summary version here.

Read the Spanish version here.