Executive Summary
We demonstrate that the overuse of institutional care is far more widespread than official statistics suggest; it remains a very serious problem, with damaging effects on children’s development. Many attempts at reform have been well meaning but misguided, and there is a serious danger that many view the overthrow of the communist system as sufficient evidence of reform in the region. These problems have far-reaching consequences: each generation of damaged children is likely to turn into a generation of damaged adults, perpetuating the problems far into the future.
Although most of the evidence in this report is based on Central and Eastern Europe and the former Soviet Union, it is very important to stress that the problem of children in large residential institutions is not confined to that region. The escalating growth in HIV/AIDS in recent years, as well as the many ongoing violent conflicts in the world, has meant that there are many more children in the world without parents. For example, it is calculated that Ethiopia alone had an estimated 989,000 children orphaned by AIDS in 2001, a figure which will have increased to over two million by 2010 (UNICEF 2003). With such numbers, it is hardly surprising that governments cannot cope, and are susceptible to suggestions that orphanages are the answer. If there is only one lesson to be drawn from this report, it is that the rest of the world must learn from the mistakes made in CEE and FSU, and avoid creating more large-scale orphanages.
Our research highlights a number of important revelations, which are explored in detail in this report. In summary, we conclude that:
1. The rate of children entering institutional care has risen, despite the fact that actual numbers have decreased, due to declining birth rates. Over the past 15 years, there has been a small decline (about 13%) in the absolute number of children in institutional care in the region. However, over the same period, the child population, like the population overall, has fallen by a slightly higher amount. This means that the proportion of the child population in institutions has actually risen by about 3%. Consequently, the position, far from having improved since the collapse of the communist system, has actually worsened.
2. The number of children in institutional care is significantly higher than the official statistics indicate. Largely, as a result of a combination of poor official record keeping and inconsistently applied classification methods, official statistics are unreliable and significantly understate the true numbers in care. Wherever full surveys have been carried out, the numbers of children counted have been considerably higher than hitherto recognised. Using a variety of sources (including some full surveys and country reports to the 2003 Stockholm Conference on institutional care), EveryChild estimates that the official figure of around 715,000 children in institutions is incorrect, and that the true figure is at least 1.3 million, and possibly much higher.
3. Orphanages remain in CEE and FSU, and their use is increasing in other parts of the world. Most children’s homes in Western Europe have been phased out, but in CEE and FSU they remain. The presence of so many large residential institutions in the region, coupled with a lack of alternatives, fuels their continued use. Evidence is accumulating that some governments and NGOs are responding to the crisis of children orphaned by HIV/AIDS by accommodating children in orphanages. Most children orphaned by HIV/AIDS are cared for by extended family and community. But anecdotal evidence suggests that extended family support is weakened to breaking point by poverty, and that is why children orphaned by HIV/AIDS may find themselves in residential institutions.
4. The last 15 years of economic reform in the region have been disastrous for children and families living in poverty. The great hopes that were expressed when the communist systems collapsed at the beginning of the 1990s have largely been dashed by subsequent experience. Although some of the former communist states have achieved the kind of personal freedoms that people dreamed of, many others, particularly Russia, Belarus and the Central Asian republics, have relapsed into authoritarian rule (although recent political reforms in Georgia, Ukraine and Kyrgyzstan give grounds for optimism). Furthermore, the neo-liberal ideology that was imposed from the outset (with its large-scale privatisations, removal of price controls and decimation of previous welfare safety nets) produced a devasting economic collapse. Even now, many countries in the region are struggling to reach pre-collapse economic levels.
5. Children are in care for largely social reasons – but poverty plays a significant part. The conventional view over the last decade has been that poverty is the reason why families in the region leave their children in institutions. However, EveryChild’s research suggests that this is only part of the problem. After all, many families are poor, but not all of them utilise institutional care. We believe that although poverty is a significant underlying factor in the decision, the precipitating factors are social ones linked to family breakdown under the pressure of economic and other circumstances, such as single parenthood and unemployment.
6. The conditions in institutions are almost always terrible. There is abundant evidence of poor conditions in institutions, from in-country literature, independent reports and our own experience: poorly-trained staff present in inadequate numbers; badly-maintained premises with poor (or sometimes non-existent) heating and sanitation; inadequate dietary provisions; and for children with disabilities there is an almost total lack of rehabilitation methods. Largely this is due to the economic collapse in the region, but constraints resulting from the prevailing ideology and poor organisation and corruption have also played their part.
7. Institutions are almost always harmful for children’s development. Since the 1940s and the pioneering work of Goldfarb and Bowlby, the damaging effects of large-scale residential institutions on the development of children have been clear. These include delays in cognitive, social and motor development and physical growth, substandard healthcare, and frequent abuse by both staff and older inmates. Young adults who have spent a large part of their childhood in orphanages are over-represented among the unemployed and the homeless, as well as those who have been in jail, been sexually exploited or abused substances. There are, of course, some children who, for a variety of reasons, cannot live in a family. For them, some kind of institutional care may be better than living on the streets. However, these children are relatively few in number.
8. Family-based care is better for children than institutional care and significantly cheaper for the state. The evidence shows that care in family-type settings (the child’s natural or extended family, foster care or adoption), is immeasurably better than life in even a wellorganised institution for almost all children. The individual, one-to-one love and attention that only parents (whether birth, foster or adoptive) can give, is extremely powerful and cannot be bettered by institutional care in promoting the development of children.
Furthermore, there is a huge body of evidence, not just from CEE and FSU but from a wide range of countries, that institutional care is very much more expensive than family-based alternatives. EveryChild’s assessment of the evidence indicates that on average, institutional care is twice as expensive as the most costly alternative: community residential/small group homes; three to five times as expensive as foster care (depending on whether it is provided professionally or voluntarily); and around eight times more expensive than providing social services-type support to vulnerable families.
These cost differences are highly significant. Although the transitional costs associated with moving from one system to another may well increase during the period of change, it is clear that the argument, “We understand that familytype care is better but we cannot afford it” is a false one.
The full version of this report is available here.
