The World Orphan Crisis 133,000,000 Orphans Who, Where, Why and What Should We Do?

Dana E. Johnson, M.D., Ph.D. Professor of Pediatrics Divisions of Neonatology and Global Pediatrics University of Minnesota

This presentation is made possible, in part, by the support of the American people through the United States Agency for International Development (USAID). The content of this presentation is the sole responsibility of the author(s) and does not necessarily reflect the views of USAID or the United States Government. The opinions and views expressed by the authors in this document do not necessarily reflect the views and opinions of KPMG.

Who is an “Orphan” • “Children whose mothers and/or fathers have died.” • Single Orphans • Maternal • Paternal

• Double Orphans • Children on the Brink 2004, UNICEF, UNAIDS, USAID

• Age range. < 18 years (UNCRC definition of Childhood)

All children deprived of parental care

Orphans in sub-Saharan Africa, Asia and Latin America/Caribbean 2003

N = 142,000,000

Children on the Brink 2004

Types of Orphans by Region Asia

Latin America Caribbean Sub-Saharan Africa Children on the Brink 2004

Parental Death Disease, War and Natural Disasters

Killed 1/3rd of Europe’s Population (25,000,000) between 1347-52.

Haitian Earthquake 230,000 Deaths, 1/12/10

Abandonment/Infanticide Reasons: • • • • •

Illegitimacy Poverty Inheritance Gender Birth Defects

Incidence: 18th century France 10-40% of recorded births.

What Happens to Orphans • • • • • • •

Permanent Family Kinship Care Foster Care Child-Headed Households Institutional Care Homeless/Street Kids Trafficking • • •

Child Laborers Child Soldiers Sex Industry

Well Being

Exploitation

Development of Foundling Homes/Orphanages Florence: • • •

Santa Maria dan San Gallo-late 13th Century Santa Maria della Scala-1316 Santa Maria degli Innocenti-1445

Randall’s Island Infant Hospital

White House Conference on the Care of Dependent Children January 25 and 26, 1909 • • • • • •

Maintenance of the family and home Preventive work to avoid dependency Home finding (adoption, kinship or foster care) Cottage System Financial solvency and suitable character Oversight • State inspection • Inspection of educational work • Facts and records

• Proper medical care of children

James West

Orphans (estimate in thousands)

Where are the Orphans

The State of the World’s Children, 2007-UNICEF

Minnesota1,300,000 Children 245,000 Orphans

Children on the Brink 2004

Orphans as % of Population < 18 y

Children on the Brink 2004

If orphanages are so detrimental, why do they still exist in many countries? • Inadequate financial and human resources for alternatives. • Lack of political commitment to develop alternatives. • Concern about unemployment in orphanage staff. • Misconceived good intentions. • Appealing to donors • Frank exploitation.

Care for Orphans • • • • • •

Permanent Family Kinship Care Foster Care Child-Headed Households Institutional Care Homeless/Street Kids

Well Being

• Trafficking • Child Laborers • Child Soldiers • Sex Industry

Exploitation

Trafficking for Labor

• 300,000 worldwide • Kidnapped or lured with promises of food, protection, revenge or a better life • Used as combatants, porters, spies, human land-mine detectors, and sexual slaves • 30% female

Sex Trafficking

Bangladesh teens being trafficked to the Gulf States for Prostitution

800,000/year 80% female 50% children “Don’t Sell People”

Trafficking Persons Report, US State Department, 2005

Nepal • One of the poorest countries in the world. • Government is corrupt, broke and in disarray. • Ministry for Women and Children particularly weak and under funded. • Education is free, school supplies and uniforms are not. • Tradition of placing children as laborers.

Trafficking

Child Soldiers

Orphanages and Exploitation “Explosion” in the number of institutions since the beginning of the Maoist insurgency in 1996 (n = 568: 40,000 children) • • • • • •

Orphaned children Evacuation from conflict areas Care for child soldiers Disabilities Education Profit

Almost all operated by NGO’s • • • •

Class A (1%) Above minimal standards Class B (10%) Meet minimal standards Class C (41%) Trying to meet minimal standards Cass D (48%) Far below minimal standard

Orphanages: A fine line between care and exploitation

Trafficking for Adoption

The Appropriate Response?

Traditional vs. Evidence-Based Response

Needs-Based Response Firelight Foundation “From Faith to Action” 1. Focus on the most vulnerable children. 2. Strengthen the capacity of families and communities to care for children. 3. Reduce stigma and discrimination. 4. Support HIV prevention and awareness. 5. Strengthen the ability of caregivers and youth to earn livelihoods. 6. Provide material assistance to those who are too old or ill to work.

Needs-Based Response 7. Ensure access to health care. 8. Provide daycare and other support services to ease burden on caregivers. 9. Support schools and ensure access to education, for girls as well as boys. 10.Support the psychosocial, as well as material needs of children. 11.Engage children and youth in the decisions that affect their lives. 12.Protect children from abuse, gender discrimination and labor exploitation.

Age of Orphans in Sub- Saharan Africa, Asia, and Latin America/Caribbean

Children on the Brink 2004

Care for Orphans: A Developmental Approach Infancy and early childhood (0-5 years) • • • • • • • •

Survival Requires one-to-one Growth trajectory Interaction Development of brain function Sense of trust and belonging Language acquisition Curiosity and interest in experimentation Developing understanding of cause and effect Readiness to learn in a group setting

Care for Infants and Young Children • • • •

Permanent Family Kinship Care Foster Care Child-Headed Households • Institutional Care • Vocational Training

Well Being

Care for Orphans: A Developmental Approach Middle Childhood (6-11 years)

Requires a Family

• Continued physical growth • Developing understanding of rules and responsibility • Developing healthy peer relations and family identity • Developing skills for numeracy and literacy • Increasing ability to express feelings Orphan School • Improving problem-solving skills Attendance 80%

Middle Childhood • • • •

Permanent Family Kinship Care Foster Care Child-Headed Households • Institutional Care • Vocational Training

Well Being

Care for Orphans: A Developmental Approach Adolescence (12-17 years) • • • • • • • •

Requires a Community

Physical and sexual maturation Understanding relationships Challenging rules and testing limits Navigating risk behaviors Developing images of independent self Exploring vocational opportunities Understanding of consequences of actions Identity development and cultural learning

Care for Teens • • • •

Permanent Family Kinship Care Foster Care Child-Headed Households • Institutional Care • Vocational Training

Well Being

Transforming Institutional Care Changing the role of the institution, NOT elimination of the institution Children belong in a family • Preventing institutionalization • Promoting reunification • Promoting adoption

Transforming Care • No change is too small • Change the relationship between caregivers and children • Consistency • Family Environment • Mixed ages

Orphanage Transformation According to Developmental Needs

Orphanage Transformation

Orphanage Transformation • Start Small • Think Big • Focus on Best Interests of the Children