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Behind the walls of institutions around the world are millions of children with their own dreams, aspirations and futures. All of them are bound by a system of child care which violates their rights and fails society.
Here is what you need to know about institutions like orphanages and how children end up there in the first place.
What causes a child to end up in an institution?
There are a number of factors that can lead to a child’s separation from their family. This includes poverty, family violence, labour migration, and poor access to education, health, or other community-based services.1,2,3 When there are insufficient services and supports to help overcome these drivers, and a lack of family-based care alternatives, the ‘solution’ is often to place the child into an institution.
What can a child experience once institutionalised?
Institutions are often closed environments, lacking in thorough safeguarding policies and practices, putting children at risk of neglect, physical or sexual abuse, violation of fundamental human rights, trafficking for sex or labour, exploitation through orphanage tourism, and medical experimentation.4,5 The prevalence of physical and sexual abuse in residential care is higher than in other forms of care, even in countries where residential care is better resourced with smaller numbers of children per facility.6,7
Children with disabilities are at even greater risk of abuse and neglect, including chemical and mechanical restraint, electroshock therapy, and routine hysterectomies.8,9,10,11
Children can experience harm even in institutions which appear modern and well-resourced. It is not enough to provide a child with basic health, nutrition, and sanitation needs. They also need individualised and responsive care from a dependable adult in order to thrive – care that institutions, by their very nature, are unable to provide.12,13
How does this impact a child who has experienced institutionalisation?
Institutionalisation is harmful across many areas of a child’s development, especially their physical growth, cognition, attention, socioemotional development, mental health and ability to form attachments.14 Extensive research has shown the negative impact of institutionalisation on children’s social functioning; for example, the higher risk of attachment disorders can cause them to be socially withdrawn and emotionally inhibited, or socially disinhibited and more likely to violate boundaries, when interacting with others.15
Babies and young children in particular fail to develop as they should, due to the lack of one-to-one parental interaction. Studies have shown that children who remain in institutions beyond the age of six months can face developmental delays,16 and institutionalisation is likely to have an especially profound impact on children between 6 and 24 months of age.17,18
Institutionalisation is also particularly harmful to children with disabilities, who often need close and regular adult interaction to help them develop and reach their full potential.19 Tragically, children with disabilities may be left in their beds for long periods without human contact or stimulation, which can result in negative physical and psychological damage, and even death.20
What happens to a child after they leave an institution?
The longer a child remains in institutional care, the greater the negative impact on their well-being, and the harder it becomes for them to recover.21 Conversely, the earlier in life a child is removed from institutional care, the more likely they are to recover, and the fuller their recovery is likely to be.22
If a child is able to leave an institution to be placed with family or foster care, there is a chance for significant recovery in their development in areas like growth and cognition.23 Even children who have experienced severe deprivation in an institution can develop secure relationships with their new adoptive or foster families.24 However, some negative impacts, such as those on attention, can be long-lasting, and substantial long-term impairment can continue for the most seriously affected children.25
The long-term impact can severely limit children’s future life chances, and young people leaving institutions often continue to face significant challenges as they move into adulthood.26 The structured routines and lack of opportunities to exercise choice in institutions do not prepare them well for independent living, and they may lack the social skills and networks they need to live successfully in a community.27 They are likely to be used to following instructions without question and are less aware of their rights—making them vulnerable to exploitation and abuse.28
When children do not form secure attachments in childhood – a significant risk for institutionalised children – the impact can be devastating and may last a lifetime.29,30 It can lead children to substance abuse, homelessness, early pregnancy and intergenerational parenting difficulties.31 Institutional care leavers are at increased risk of suicide, as well as falling into sex work, and they are more likely to become involved in criminal activity, which institutions are ineffective in preventing.32,33,34 This not only has a negative impact on the adult who had once experienced an institution, but also creates significant social and economic costs to society.35,36
Behind the walls of institutions around the world are millions of children with their own dreams, aspirations and futures. All of them are bound by a system of child care which violates their rights and fails society.
Here is what you need to know about institutions like orphanages and how children end up there in the first place.
What causes a child to end up in an institution?
There are a number of factors that can lead to a child’s separation from their family. This includes poverty, family violence, labour migration, and poor access to education, health, or other community-based services.1,2,3 When there are insufficient services and supports to help overcome these drivers, and a lack of family-based care alternatives, the ‘solution’ is often to place the child into an institution.
What can a child experience once institutionalised?
Institutions are often closed environments, lacking in thorough safeguarding policies and practices, putting children at risk of neglect, physical or sexual abuse, violation of fundamental human rights, trafficking for sex or labour, exploitation through orphanage tourism, and medical experimentation.4,5 The prevalence of physical and sexual abuse in residential care is higher than in other forms of care, even in countries where residential care is better resourced with smaller numbers of children per facility.6,7
Children with disabilities are at even greater risk of abuse and neglect, including chemical and mechanical restraint, electroshock therapy, and routine hysterectomies.8,9,10,11
Children can experience harm even in institutions which appear modern and well-resourced. It is not enough to provide a child with basic health, nutrition, and sanitation needs. They also need individualised and responsive care from a dependable adult in order to thrive – care that institutions, by their very nature, are unable to provide.12,13
How does this impact a child who has experienced institutionalisation?
Institutionalisation is harmful across many areas of a child’s development, especially their physical growth, cognition, attention, socioemotional development, mental health and ability to form attachments.14 Extensive research has shown the negative impact of institutionalisation on children’s social functioning; for example, the higher risk of attachment disorders can cause them to be socially withdrawn and emotionally inhibited, or socially disinhibited and more likely to violate boundaries, when interacting with others.15
Babies and young children in particular fail to develop as they should, due to the lack of one-to-one parental interaction. Studies have shown that children who remain in institutions beyond the age of six months can face developmental delays,16 and institutionalisation is likely to have an especially profound impact on children between 6 and 24 months of age.17,18
Institutionalisation is also particularly harmful to children with disabilities, who often need close and regular adult interaction to help them develop and reach their full potential.19 Tragically, children with disabilities may be left in their beds for long periods without human contact or stimulation, which can result in negative physical and psychological damage, and even death.20
What happens to a child after they leave an institution?
The longer a child remains in institutional care, the greater the negative impact on their well-being, and the harder it becomes for them to recover.21 Conversely, the earlier in life a child is removed from institutional care, the more likely they are to recover, and the fuller their recovery is likely to be.22
If a child is able to leave an institution to be placed with family or foster care, there is a chance for significant recovery in their development in areas like growth and cognition.23 Even children who have experienced severe deprivation in an institution can develop secure relationships with their new adoptive or foster families.24 However, some negative impacts, such as those on attention, can be long-lasting, and substantial long-term impairment can continue for the most seriously affected children.25
The long-term impact can severely limit children’s future life chances, and young people leaving institutions often continue to face significant challenges as they move into adulthood.26 The structured routines and lack of opportunities to exercise choice in institutions do not prepare them well for independent living, and they may lack the social skills and networks they need to live successfully in a community.27 They are likely to be used to following instructions without question and are less aware of their rights—making them vulnerable to exploitation and abuse.28
When children do not form secure attachments in childhood – a significant risk for institutionalised children – the impact can be devastating and may last a lifetime.29,30 It can lead children to substance abuse, homelessness, early pregnancy and intergenerational parenting difficulties.31 Institutional care leavers are at increased risk of suicide, as well as falling into sex work, and they are more likely to become involved in criminal activity, which institutions are ineffective in preventing.32,33,34 This not only has a negative impact on the adult who had once experienced an institution, but also creates significant social and economic costs to society.35,36
1. Goldman, P.S., Bakermans-Kranenburg, M.J., Bradford, B. (2020). Institutionalisation and deinstitutionalisation of children 2: policy and practice recommendations for global, national, and local actors. Lancet Child & Adolescent Health. 4(8): 606–633.
2. Berens, A.E. & Nelson, C.A. (2015). The science of early adversity: is there a role for large institutions in the care of vulnerable children? Lancet. 386:388–398.
3. Eurochild (2014). Deinstitutionalisation and quality alternative care for children in Europe: lessons learned and the way forward working paper.
4. van IJzendoorn, M.H., Bakermans-Kranenburg, M.J., Duschinsky, R. et al. (2020). Institutionalisation and deinstitutionalisation of children 1: a systematic and integrative review of evidence regarding effects on development. The Lancet Psychiatry. 7: 703-20. https://www.thelancet.com/pdfs/journals/lanpsy/PIIS2215-0366(19)30399-2.pdf [accessed 3 Jun 2021].
5. Behal, N., Cusworth, L., Wade, J. et al. (2014). Keeping Children Safe: Allegations Concerning the Abuse or Neglect of Children in Care. http://www.york.ac.uk/inst/spru/research/pdf/Abuseincare.pdf [accessed 2 May 2018].
6. Ibid.
7. Euser, S., Alink, L.R., Tharner, A., et al. (2013). The prevalence of child sexual abuse in out-of-home care: a comparison between abuse in residential and in foster care. Child Maltreatment. 18(4): 221-31.
8. Milovanovic, et al. (2013). The Hidden and Forgotten: Segregation and Neglect of Children and Adults with Disabilities in Serbia. Mental Disability Rights international, Belgrade. http://www.mdri-s.org/wp-content/uploads/2013/10/the-hidden-and-forgotten-2013-12-17.pdf [accessed 23 Jul 2021].
9. UNICEF (2007). Promoting the Rights of Children with Disabilities. Innocenti Digest 13. UNICEF. www.unicef-irc.org/publications/pdf/digest13-disability.pdf [accessed 28 May 2018].
10. EveryChild and Better Care Network (2012). Enabling reform. Why supporting children with disabilities must be at the heart of successful child care reform. New York: Better Care Network. http://bettercarenetwork.org/sites/default/files/Enabling%20Reform%20-%20Why%20Supporting%20Children%20with%20Disabilities%20Must%20Be%20at%20the%20Heart%20of%20Successful%20Child%20Care%20Reform_0.pdf [accessed 20 Oct 2016].
11. Ahern, L. & Rosenthal, E. (2006). Hidden Suffering: Romania’s Segregation and Abuse of Infants and Children with Disabilities. Mental Disability Rights International, Washington D.C. http://www.driadvocacy.org/wp-content/uploads/romania-May-9-final_with-photos.pdf [accessed 23 Jul 2021].
12. Berens, A. & Nelson, C. (2015). The science of adversity: Is there a role for large institutions in the care of vulnerable children? The Lancet. 386(9991): 388-398.
13. Yousafzai, A.K. (2020). If not now, then when? The importance of intervening early to provide family-based environments for all children. The Lancet Child & Adolescent Health. 4(8): 563-565.
14. van IJzendoorn, M.H., Bakermans-Kranenburg, M.J., Duschinsky, R. et al. op.cit.
15. Milovanovic, Šimoković, L. & Marković, M. et al. (2013). The Hidden and Forgotten: Segregation and Neglect of Children and Adults with Disabilities in Serbia. Mental Disability Rights International, Belgrade. http://www.mdri-s.org/wp-content/uploads/2013/10/the-hidden-and-forgotten-2013-12-17.pdf [accessed 23 Jul 2021].
16. Berens, A.E. & Nelson, C.A. op. cit.
17. Zeanah, C.H., Humphreys, K.L., Fox, N.A. et al. (2017). Alternatives for Abandoned Children: Insights from the Bucharest Early Intervention Project. Current Opinion in Psychology. 15:182-188. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5607636/ [accessed20 Jul 2021].
18. van IJzendoorn, M.H., Bakermans-Kranenburg, M.J., Duschinsky, R. et al. op.cit.
19. EveryChild and Better Care Network (2012). Enabling reform. Why supporting children with disabilities must be at the heart of successful child care reform. New York: Better Care Network. http://bettercarenetwork.org/sites/default/files/Enabling%20Reform%20-%20Why%20Supporting%20Children%20with%20Disabilities%20Must%20Be%20at%20the%20Heart%20of%20Successful%20Child%20Care%20Reform_0.pdf [accessed 20 Oct 2016].
20. Pinheiro, P.S. (2006). Report of the independent expert for the United Nations study on violence against children. New York: UN General Assembly, p188. https://documents-dds-ny.un.org/doc/UNDOC/GEN/N06/491/05/PDF/N0649105.pdf?OpenElement [accessed 31 Jul 2018].
21. van IJzendoorn, M.H., Bakermans-Kranenburg, M.J., Duschinsky, R. et al. op.cit.
22. Ibid.
23. Ibid.
24. Ibid.
25. Ibid.
26. Csáky, C. (2014). Why Care Matters: The importance of adequate care for children and society. Family for Every Child. https://www.familyforeverychild.org/why-care-matters?locale=en [accessed 23 Jul 2021].
27. Csáky, C. (2009). op. cit.
28. Csáky, C. (2009). op. cit.
29. van IJzendoorn, M.H., Bakermans-Kranenburg, M.J., Duschinsky, R. et al. op.cit.
30. Rees, C. (2007). Childhood attachment. British Journal of General Practice. 57(544): 920–922. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2169321/ [accessed 8 Jul 2021].
31. Ibid.
32. Pashkina, N. (2001) Sotsial’noe obespechenie, 11:42-45. Cited in: Holm-Hansen J, Kristofersen LB, Myrvold, T.M. eds. Orphans in Russia. Oslo, Norwegian Institute for Urban and Regional Research (NIBR-rapport 2003:1).
33. Lindquist, M.J., & Santavirta, T. (2012). Does Placing Children in Out-of-Home Care Increase their Adult Criminality? Swedish Institute for Social Research. Stockholm, Sweden.
34. Coy, M. (2008) Young women, local authority care and selling sex: findings from research. British Journal of Social Work. 38.7: 1408-1424.
35. Congressional Coalition on Adoption Institute [CCAI] (2011). The Way Forward Project Report. p29 http://www.law.harvard.edu/faculty/bartholet/The%20Way%20Forward%20Project%20Report.pdf [accessed 8 Mar 2016].
36. Csáky, C. (2009). op. cit.
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