Vulnerable Children

Earlier this week I stumbled upon a blog (1) that questioned if building orphanages could actually be enabling the impoverished to give up their children, i.e. “child abandonment.” Many orphans today are “poverty orphans,” that is one or both parents may still be living, but they cannot afford to care for their child/children. For many people, I think the idea of donating money or supplies to orphanages is an appealing way to help others. While I don’t doubt generally good intentions, it seems as though few people have stopped to rigorously assess how and by what means the very real issue of orphans and vulnerable children should be addressed. 

Sub-Saharan Africa is often a focus in discussions about orphans due to the myriad of ways HIV/AIDS contributes to vulnerability. Contributors to a book called “A Generation At Risk (2)” pointed out that although institutional care is still found to a large degree in these countries (and often supported by Western NGO donors), the Western world generally does not favor congregate care. Instead, family and/or community-based alternatives are promoted. Now, family-based solutions such as foster care are not perfect and can open doors for abuse or exploitation; however institutions like orphanages are not immune to such problems either and have the added stress of caring for great numbers of children at once. Many times orphanages in developing countries are overwhelmed by demand and struggle to provide food, safe water and sanitary conditions to their residents. 

Even if facilities are adequate,  researchers are finding out more and more about how profoundly parental attachment impacts child development. In 2012, Time magazine wrote an article discussing the results of several studies researching this issue (3). One study conducted in Romania found that compared to children placed in an orphanage, children placed in foster care had less distress, increased attentional skills and less incidence of mental illness (4). The article also cited a study that suggests not only do emotional problems arise in children without parental involvement, but lack of attachment may actually alter hormones in the body and impair development.

This being said, there are situations where institutionally-based care is the best option based on the circumstances. But as public health professionals, we should be looking to remedy the root cause of the problem, which is invariably more complex and involves system-wide changes to promote economic development, access to education and health care, food security, etc. I personally support the model of child sponsorship as an “in-between” step towards full community mobilization. Many organizations (such as World Vision (5)) match donors with specific children to continue their education, provide meals and develop a network of support. Children who are supported in this way remain with their families and the aid goes to help them utilize community resources. I think more of these types of systemic approaches are needed to prevent the underlying circumstances that ultimately lead to vulnerable children. What do you think?

(1) http://www.theveryworstmissionary.com/2013/10/would-jesus-be-cool-with-keeping-poor.html 

(2) Foster, G., Levine, C. & Williamson, J. (2005). A Generation At Risk: The Global Impact of HIV/AIDS on Orphans and Vulnerable Children. Cambridge University Press

(3) http://healthland.time.com/2012/05/24/the-measure-of-a-mothers-love-how-early-deprivation-derails-child-development/#ixzz1w4pqbIKw

(4) Ghera, M., Marshall, P., Fox, N., Zeanah, C., Nelson, C., Smyke, A. & Guthrie, D. (2009).

The effects of foster care intervention on socially deprived institutionalized children's attention and positive affect: results from the BEIP study. Journal of Child Psychology and Psychiatry, 50(3).

(5) http://www.worldvision.org/about-us/how-we-work