#alternativecare

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In the course of my research work for the ‘world list’ it has become clear to me that the reasons why children end up in alternative care, and particularly in institutions, are surprisingly similar across many countries. It also became apparent that there is a big difference between why children in high income countries are in alternative care and why children in other countries are in alternative care.  

Earlier this month I promised  a blog  on the reasons why children end up in institutions, why they are abandoned. Here is that blog.

In non-high income countries, overwhelmingly the main reasons why children end up being separated from their parents – with or without the parents’ consent – and placed in alternative care – most often in institutions – are poverty, lack of access to education, and disability.

Here is a bit from How to Help, Not Harm, which illustrates what tends to happen: “Parents do not look for a way to get rid of their child, they look for a way to help their child, to save their child. The problem occurs when while looking for help, they find none. When there are no services available or affordable that allow them to provide their child with what she needs. When for a while it seems like there is no answer and nothing can be done, and then… a solution presents itself. And it is that solution, which presents itself at that moment of desperation when no other solution can be found, that makes everything so much worse. […]The solution to hand your child over to an ‘orphanage’ where she will have her belly full all the time, getting several meals a day, thinking that now she will be able to grow up strong and healthy. Believing the doctor or community elder who says, against everything your instincts tell you, that your handicapped child will be better off and happier in a children’s home. Not wanting to let go of your child, even though she has special needs, but loving her so much that you give her up so that she will be able to survive and get the most out of life, in a children’s home.”

Almost all parents want to take care of their own children. They are okay with that being hard, they are okay with making sacrifices. However, what they want even more than taking care of their own children, is for their children to have good lives. If circumstances make it impossible for parents to take care of their children, they are willing to make the sacrifice of giving them up for what they believe is the best interest of the child.

This means that when healthcare is inaccessible or unaffordable, the parents of a child with a serious illness or disability may feel forced to give up the child in the hope that it will save her life. When educational facilities are unaffordable, not available or refuse to accept a child with a disability or with a marginalised ethnic or religious background, parents may feel their child will only be able to escape their desperate circumstances by getting an education and the only way for the child to get an education is to put her in an institution. The parent who worries that their child might die of starvation or cold, believes that they are doing a good thing by handing their child over to an institution.

These are decisions made out of desperation and love. They are decisions that should be completely unnecessary. In a later blog, we will look more closely at the cost of institutionalisation, but I can already disclose here, that if the money put into institutional care was invested into social security and community support service projects instead, people would not need to face these kinds of decisions.

This is illustrated by the contrast of reasons for entering alternative care between high-income countries and other countries. In high-income countries the main reasons for being taken into alternative care (which almost always means family-based care) are children removed from their families because of situations of serious neglect or abuse, and older children with severe behavioural problems who form a danger to themselves or their surroundings. In other words, children are only separated from their families for their protection.

It is rather heart wrenching to realise that although many, many children in non-high-income countries end up in alternative care, and the majority of them in institutions, extremely few of them were separated from their parents for their own safety. So aside from the large group of children in institutions who should not be there at all, these countries also are home to a group of children who are still with their parents, but are not safe there.

There will always be a small group of children who need alternative care because they are not safe in their own family. However, a lot can be done to work with the family first to ensure that it becomes a safe place for the child to be. And if this is not possible, an assessment needs to be made to weigh off whether the inevitable trauma that is caused by taking a child away from her parents is less than the trauma that would be caused by leaving the child with her parents.

It is time to start providing parents with the support that will enable them to take care of their own children, as most of them could dearly love to do. As well as to make sure that children who are genuinely not safe with their parents, are given the protection they need in alternative, family-based settings.