Three-year change in the wellbeing of orphaned and separated children in institutional and family-based care settings in five low- and middle-income countries

BACKGROUND

With more than 2 million children living in group homes, or "institutions", worldwide, the extent to which institution-based caregiving negatively affects development and wellbeing is a central question for international policymakers.

METHODS

A two-stage random sampling methodology identified community representative samples of 1,357 institution-dwelling orphaned and separated children (OSC) and 1,480 family-dwelling OSC aged 6-12 from 5 low and middle income countries. Data were collected from children and their primary caregivers. Survey-analytic techniques and linear mixed effects models describe child wellbeing collected at baseline and at 36 months, including physical and emotional health, growth, cognitive development and memory, and the variation in outcomes between children, care settings, and study sites.

FINDINGS

At 36-month follow-up, institution-dwelling OSC had statistically significantly higher height-for-age Z-scores and better caregiver-reported physical health; family-dwelling OSC had fewer caregiver-reported emotional difficulties. There were no statistically significant differences between the two groups on other measures. At both baseline and follow-up, the magnitude of the differences between the institution- and family-dwelling groups was small. Relatively little variation in outcomes was attributable to differences between sites (11-27% of total variation) or care settings within sites (8-14%), with most variation attributable to differences between children within settings (60-75%). The percent of variation in outcomes attributable to the care setting type, institution- versus family-based care, ranged from 0-4% at baseline, 0-3% at 36-month follow-up, and 0-4% for changes between baseline and 36 months.

INTERPRETATION

These findings contradict the hypothesis that group home placement universally adversely affects child wellbeing. Without substantial improvements in and support for family settings, the removal of institutions, broadly defined, would not significantly improve child wellbeing and could worsen outcomes of children who are moved from a setting where they are doing relatively well to a more deprived setting.

‘A future not of riches but of comfort’: The emigration of pauper children from Bristol to Canada, 1870–1915

This article examines the emigration of orphan and deserted children from Bristol to Canada in the late nineteenth and early twentieth centuries. This emigration was organised and financed by the local Boards of Guardians and, as such, raises important questions about the way in which state agencies cared for dependent children. The emigration of Poor Law children is explored in relation to debates about childcare, poverty, racial degeneration and imperialism. Of particular interest is the role played by women in promoting child emigration and the article considers the women's contribution to discourse and practice, both locally and nationally. The dynamics of emigration are analysed by using both British and Canadian sources and the tensions associated with pauper emigration are examined in some detail.