Why Institutions Matter: Empirical Data from Five Low- and Middle-Income Countries Indicate the Critical Role of Institutions for Orphans



Millions of children orphaned by or separated from their parents are particularly vulnerable to maltreatment. Preventing and mitigating the effects of maltreatment requires understanding the context in which maltreatment occurs. A vastly disproportionate number of the world’s orphans live in South Asia and sub-Saharan Africa, where poverty, civil unrest, and economic insecurity compromise the capacity of family-based care. While studies of children in select destitute orphanages have demonstrated the effects of severe early deprivation, they do not represent the heterogeneity of institution-based care in general or the heterogeneity of institution-based care in low- and middle-income countries (LMICs) specifically. Furthermore, the only large-scale, multi-country study designed to compare average experiences in both institution-based and family-based care indicates the prevalence, and incidence of maltreatment is similar in both types of care. Increasing advocacy for global deinstitutionalization is inconsistent with emerging evidence about institution-based care as compared to family-based care. Furthermore, such sweeping action would remove a critical safety net for many orphans. Long-term positive outcomes are much more likely to come from improved understanding of the essential elements of quality caregiving in all settings, caregiver training and support, and innovative models of orphan care.


Orphans Institutions Context LMICs Care options Heterogeneity Prevalence Incidence 


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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Department of EpidemiologyUniversity of North Carolina at Chapel Hill, Gillings School of Global Public HealthChapel HillUSA
  2. 2.Duke Global Health InstituteDurhamUSA
  3. 3.Public Policy and Global HealthDurhamUSA

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