Orphanhood, Poverty and the Care Dilemma: Review of Global Policy Trends

The care and protection of children experiencing orphanhood presents a major child-care policy challenge. This paper draws on a review of the literature to document divergent conceptualizations of orphanhood, how the hurdles for the care of orphans reflect wider issues of poverty and inequality, as well as the ways in which different care interventions (familial, institutional, community-based and rights-based) might be appropriated for children in need. It is argued that the map of contemporary orphanhood overlaps with the contours of global poverty, inequality, age-based deprivations and marginalization. An example of a ‘globalised’ model of orphan care, namely SOS Children’s Villages, is presented and its implications for policy are examined. The paper highlights the significance of fighting poverty and enhancing the care-giving capabilities of extended families in the care and protection of children from a rights-based perspective. It suggests that external interventions should primarily address the structural causes of poverty and marginality, rather than amplifying inequalities through the selective support of orphans in economically vulnerable communities.

Children without parents are not only among the most vulnerable members of society – their care and protection also presents a major child-care policy challenge. To date, finding the necessary resources to protect orphans has become a priority for the international aid community (Ennew 2005). This is reflected in ‘rights-based approaches’ to child welfare underpinned by the United Nations Convention on the Rights of the Child (UNCRC).  [1] Among other things, the UNCRC establishes standards for the fulfillment of the well-being of children without parental care. Different articles of the Convention also stipulate the provision, protection and participation of orphans and other vulnerable children in similar circumstances. These include Article 9 (on children’s right to continued contact with parents when in the care of the state); Article 10 (on family reunification if children and parents become separated by national borders); Article 20 (on the state’s responsibilities and alternative forms of care for children separated from their parents); Article 21 (on adoption); and Article 25 (on the need for periodic reviews of placements for children without parents in institutional or alternative care).

Although rights-based approaches tend to be powerful at present, they are not the only framework for the care and protection of orphans. Throughout history, different actors of development (the state, the family, charitable organizations, NGOs) have been promoting different strategies of care for orphans and vulnerable children. These strategies not only change with time, but also are dynamic according to what one might call the ‘language of development’. This paper explores the policy implications of problematic constructions of ‘global orphans’ and the challenges of their care in the contexts of deepening poverty and social inequality. It argues that policy interventions for orphans and other vulnerable children mirror globalised ideals of proper childhood that shape the discourses of care. The paper first discusses the social history of orphanhood and the ways in which orphans are viewed variably in different societies. Secondly, it explores how orphanhood is associated with victimhood, innocence, vulnerability and dependence, and examines a wide range of care interventions for orphans, including family care, institutional care, community-based care and rights-based care. Drawing on an example of a ‘globalised’ model of institutional care, namely SOS children’s villages, the paper finally examines broad challenges of poverty and marginalization facing children in low-resource countries and suggests some policy options to ensure the well-being of children in need from a rights-based perspective.

Although orphanhood is not a new phenomenon, ensuring the care and protection of parentless children depends to a large extent on the relative development of governance structures, the availability of resources, the attitudes of different stakeholders and the social construction of orphanhood. The latter varies across space and with time, as well as with the ways in which society perceives what childhood ought to be. In her valuable contribution entitled Prisoners of childhood: orphans and economic dependency, Judith Ennew (2005) argues that, throughout Western history, orphans have played a pivotal role in two domains – mythology and social welfare provision. These relate to and have been transformed with the culture, politics and economics of development, as well as the ideology of nation states, for which children fulfil multiple narrative, social, economic, cultural and political roles (see Table 1). Although the definitions may vary, Ennew points out that orphans are parentless children who are socially and materially dependent on the wider society for their safe passage through childhood. In modernity and post-modernity, orphans have been necessary to the social construction of the world of the nation state, which is based on the image of (nuclear) family units. Since, by living outside ‘the family’, orphans challenge the necessities of patriarchy, their vulnerability and dependence are emphasized as the rationale for their institutionalization and other forms of control (Ennew 2003, 6; see also Liu and Zhu 2009). If they live outside families or adult care, they threaten the consensus that the family is necessary. Likewise the strategies for the care of orphans bears witness to distinctive shifts in discourses of development, and, as I will show later on, in what the international aid community believes is in the children’s ‘best interests’. In what follows, I will discuss conceptualizations of social and biological orphanhood, and how contemporary understandings of the category ‘orphan’ are different from how orphanhood has been perceived in history.

Orphan(-hood) is a generic categorization used mainly to describe a parental status, as well as the socio-economic condition of children who have lost one or both parents due to various causes. Although these causes are far too numerous to list, it is generally (and simply) possible to classify orphaned children into ‘AIDS orphans’ and ‘non-AIDS orphans’. The latter consist of children who have been orphaned due to famine, malaria, war etc. Within these general classifications, special categories of vulnerable children are the subject of attention within what Ennew (2003, 5) calls is the ‘Donor-Media Complex’. These include ‘AIDS orphans’ in Africa and ‘street children’ in Latin America, as well as historically specific groups such as ‘Biafra babies’ of the 1960s and the ‘Romanian orphans’ of the early 1990s. The Donor-Media complex has also produced the construction of orphanhood as a crisis-childhood: a ‘ticking time-bomb’, ‘silent crises’, ‘lost generation’, ‘robbed childhood’, and ‘childhood in the sun’ (Abebe and Aase 2007). Such constructions not only amplify children’s vulnerability, but are also largely orchestrated by the rhetoric of disability (in the social sense) which, in its own turn, undermines the complex ways in which orphans muster the resources and develop the capabilities they need to cope with their marginalization.

Although the most usual global definition of ‘orphan’ in international social work is a child with two deceased biological parents, this is by no means universal. Different societies have different conceptions about orphans, and understanding orphanhood – both biological and social – as a phenomenon and mode of life of children is culture-specific. In the context of AIDS, UNAIDS (2004) has for long defined an orphan as ‘a child under the age of 15 years who has lost its mother to HIV/AIDS’. However, such a definition based on a global model of childhood – focusing on chronological age and the biological status of the parents – is problematic on many accounts. Orphan children do not cease to have needs upon reaching the key age of 15, nor do they necessarily become socially and economically independent of their care-givers. Although many children may take on the responsibility of heading a household when their parents are deceased (Ayieko 2000), this responsibility is dynamic, depending on whether the children have acquired social maturity or not, the presence or absence of adult co-residents and other members of the extended family system, etc. (Abebe and Aase 2007). Furthermore, the plight of maternal orphanhood does not necessarily entail a more desperate situation than that of paternal orphanhood (Whiteside and Sunter 2000). Although the mother is crucial to the direct child-care process, children suffer economic difficulties on losing their fathers and, as a result, their well-being is severely compromised (Chirwa 2002; Abebe 2005).

Table 1: Source: Ennew 2003, 8.

Central to the social construction of orphanhood are the ideas of ‘care’, and ‘dependency’. The absence of a carer, acute poverty and economic marginality are often important in local definitions of who orphans are in Ethiopia (Messing 1985), Malawi (Chirwa 2002), Tanzania (Ahmed 1999 in Ennew 2005) South Africa (Bray 2003), Russia (Schmidt 2009), Brazil (Garcia and Fernandez 2009), and China (Liu and Zhu, 2009). As Meintjes and Giese (2006) point out, in Xhosa (South Africa), the term inkedama includes the verbal root kedama, which means ‘to be cast away, deserted, orphaned, to become downcast’:

“The term ‘orphan’ is thus only applicable to a child who has no parent and no ‘substitute’ caregiver, putting more emphasis on the social than the biological aspects of parenting. Therefore, the labelling of a child in this way is not only stigmatizing of the child, but a direct insult to those participants in the social network providing care and support to the child…the global preoccupation with the category of ‘orphans’ centres analytical attention on absence of parents, and loses sight of their presence.” (Meintjes and Giese 2006, 411-423)

Orphanhood is linked neither with mere parental loss nor with inability of patriarchal families to provide care for the children per se. As the above citation reveals, it refers to children who no longer live under the protection of their families and who have fallen outside the traditional social safety net. Although often they are not taken into account in the policies of international organisations, differences between maternal, paternal and double orphans, the capabilities of extended families and adult co-residents, and the children’s own agency lead to important variations in children’s living circumstances. In some traditional Thai societies, where maternal uncles play a crucial role in the lives of children, orphanhood and orphan care-giving practices are not only defined by the maternal lineage, but also deaths of such relatives can have greater consequences than paternal deaths (Ennew 2005). The social and policy implications of defining orphans from a patrilineal angle in societies where the dominant social structure is matrilineal are enormous. Equally intriguing is the question of how the notion of orphanhood is constructed by international organizations that advocate the UNCRC, where children are defined as subjects less than 18 years of age, whereas orphans, a supposedly more vulnerable social group, are ironically categorized as parentless children less than 15 years of age. These highlight the fact that orphanhood is a social and cultural phenomenon in much the same way as the notion of childhood, which is shown to be an economic and social construct that can have no universal validity. It should also be recognized as neither a given nor a consistent social category, but rather as a dynamic process marked by diversity that can take on different characteristics over space and time. As Chirwa (2002, 42) lucidly sums it up, orphanhood is a social category and/or status, and a situational and/or structural condition that can either be heightened and highlighted or suppressed, depending on the material and social conditions of the wider society of which orphans are a part.

A fundamental feature of contemporary orphanhood is that it is encapsulated in a time warp. I have argued elsewhere that for many children orphanhood due to AIDS is experienced more as a gradual process than an event (Abebe 2005). Children become orphans and disadvantaged long before their parents actually die, as the ‘time lag’ between the infection and death of adults progressively reduces their capacity to be productive and provide care for their children. During this period, child-parent relationships may be altered drastically, often characterized by children caring for their parents during the latter’s terminal illnesses.

The African continent is home to 14 million such orphans, a figure which it is estimated will increase to 50 million by 2015 (UNAIDS 2007). However, the lives of the vast majority of children who are indirectly affected by the devastation caused by the epidemic are often overlooked. Robson (2004) shows that households in Zimbabwe often rely on extended family networks, and that young girls are often sent to the city to care for sick relatives, even if this means at the expense of their schooling. Likewise, in their study of the social consequences of HIV/AIDS, Ansell and Van Blerk (2004) document that coping with AIDS takes place at the expense of children’s migration in order to improve family livelihoods. The repercussions of the epidemic also include household labour shortages, losses of income and savings due to adult morbidity and mortality, increasing numbers of dependents, the burden of caring for the sick etc. (Barnett and Whiteside 2006).

Notwithstanding the fact that orphanhood is associated with varying degrees of vulnerability, the living circumstances and well-being of children who are marginalized by poverty in many low-resource communities are equally critical. Recent studies document how the consequences of being an orphan on child’s well-being, schooling and health and leisure depend partly on economic resources and partly on how the culture treats children outside their maternal homes (Foster and Germann 2002; Verhoef 2005; Abebe and Aase 2007). Also, orphaned children receive different levels of treatment and degrees of exclusion and inclusion in their host families (Chirwa 2002; Nyambedha et al. 2002; Oleke et al. 2006). It is not possible to maintain facile generalisations about their well-being, simply because we know little about their perspectives of orphanhood. The available research from countries with high levels of orphaned children shows only mixed results. While some studies have shown that sexual abuse (Pridmore and Yates 2005) and social discrimination (Cluver et al. 2008) against orphans are common, and that orphans are at a higher risk of contracting HIV and other sexually transmitted infections (Nyamukapa and Gregson 2005); nationally representative samples provide only limited convincing evidence that there are significant disparities between orphans and non-orphans in these respects (Bray 2003, Meintjes and Giese 2006).

Much of our knowledge about contemporary orphans is based on cross-sectional studies lacking a control group of non-orphans. A lack of historical research further limits our understanding of how societies and communities in the past have coped with large-scale orphanhood (Madhavan 2004). Methodological weaknesses regarding the lack of control for other possible intervening factors, as well as studies of the status of ‘biological’ orphans as a proxy for all non-orphans, not only limits the scope and application of many research findings, but also make the identification of the ‘orphan effect’ more problematic (Campbell et al. 2008). As a result, the current evidence base provides insufficient knowledge of the underlying causal relationships to allow for generalizable conclusions about the situation of orphans, including those affected by HIV/AIDS. Abebe and Aase (2007) further dispute some of the symptomatic perceptions of orphanhood. They argue that although orphans may be distressed by their new circumstances, which may require them to cater for themselves and/or assume care-giving responsibility for their younger siblings, they have the resilience and agency to cope with the challenges of life following parental death. Inadequate resources, instability and uncertainty are fundamental problems which many children (orphans and non-orphans) living in poverty must deal with. This is documented in a growing body of literature that reveals the impacts of being an orphan as being no different or inseparable from the impacts of poverty, an issue which I will explore in greater depth below.

Although Hunter (1990) suggests that contemporary orphanhood could be held up as a mirror to the AIDS epidemic, the vulnerability of orphans is not solely a reflection of the distribution of the disease. Instead, it is a manifestation of the spatial distribution of economically vulnerable and disadvantaged social groups. The HIV/AIDS pandemic has deep roots in global social and economic inequalities. For example, sub-Saharan Africa, the world’s poorest continent and the one worst-affected by the ravages of the pandemic, is home to only 10% of the world’s population but accounts for more than 90% of global AIDS orphans. On the other hand, in South and South East Asia, Latin America and the Caribbean, where the epidemic began later, there are an estimated 1 million orphans, making up nearly 8% of the total AIDS orphans (UNICEF 2003). In the remainder of the developed world, which is home to 2% of global orphans, the small size of the epidemic combined with the immense resources available for its prevention and treatment have contained the disease, resulting in no perceivable impacts on children (Brown 2004).

A further look at the statistics on the plight of African children also reveals a grim picture of how endemic poverty, child destitution and orphanhood are closely intertwined. During the decade 1990–2000, which witnessed over 100 countries cut mortality rates for children under five years by 20%, the UN Children’s Fund reported that the rate for Africa declined by just 3% overall, and it actually increased in nine African countries (United Nations 2002). The under-five mortality rate for sub-Saharan Africa as a whole of 175 per thousand in 2000 was more than double the world average of 81 per 1000 and nearly 30 times higher than that of children in developed countries. The statistics for another key indicator of well-being for children and their families, maternal mortality, are equally disturbing. Nearly half of the estimated 515,000 women who die annually from pregnancy or childbirth are African. With 1100 deaths per 100,000 births, African women are nearly three times more likely to die than women in South Asia, which has the second highest rates. Chronic malnutrition is widespread in Africa, and the target of a 50% reduction of malnutrition in children is beyond reach. One in three Africans are malnourished and, despite improvements in some countries, the absolute number of hungry children rose during the last decade. The continent has the highest proportion of impoverished children in the world: over 40% of its child population do not attend school, and more than half of its population does not have access to safe drinking water or primary health-care services (United Nations 2002). The prevalence of preventable illnesses is increasing, and structural unemployment has become chronic (Plessis and Conley 2007).

These striking geographical imbalances regarding childhood poverty add interpretations to the global map of orphanhood. They exemplify how the general map of orphanhood and the global map of childhood deprivation overlap. Arguably, the challenges of orphanhood on the larger scale are a replica not only of epidemiology (e.g. the AIDS epidemic alone), but also of complex contours of poverty, inequality, age-based deprivation and marginalization. Many of the hurdles orphans face are indeed poverty-related, such as lack of access to food, education, medical care and sanitation facilities, as well as urbanization-, monetarisation- and globalization-driven social inequalities, all of which impact on the lives of other children as well (Hunter 1990; Therborn 2004; Meintjes and Bray 2006; Abebe 2008).

The economic and political transformations affecting the lives of children are also varied and complex. These include debt, corruption, war, geo-political conflicts, epidemics, unfair trade, structural adjustment programs (SAP), inappropriate policies and ineffective legislation (Bass 2004; Abebe 2007). The macro-economic policy changes imposed by the IMF and the World Bank that forced poor countries to open up their economies in response to the ‘Washington Consensus’ are seen as having devastating impacts on the lives of children even in remote villages (Abebe and Kjorholt 2009). As Jenning argues (1997, in Boyden and Levison 2000), the consequences of SAP are consistent with processes of increasing women’s unpaid work in both the home and the community. And, in general, work that is shifted on to women tends to be shared by children or completely shifted on to children working under women’s supervision. The myriad ways in which SAP has affected the lives and hidden care work of boys and girls is adequately documented (Robson 2004; Skovdal et al. 2009). These studies reveal that children’s marginalization locally cannot be detached from material realities and need to be situated at the heart of the changing global political economy.

What are the policy implications of broad structural and politico-economic constraints in planning interventions for the welfare of disadvantaged children?

Current approaches to dealing with orphanhood emphasize the role of families, communities, institutions and foster homes. Hunter and Williamson (2000) outline different strategies to assist orphans and vulnerable children in the context of poverty. These are: a) to strengthen and support the capacity of families to protect and care for their children; b) to mobilise and strengthen community-based responses; c) to strengthen the capacity of children and young people to meet their own needs; d) to ensure that governments protect the most vulnerable children and provide essential services; and e) to create an enabling environment for poor children and families. Although these strategies are not neatly separate from one another, their implementation in diverse social, economic, cultural and ideological systems reflects the powerful nature of donor-driven development supported by the international aid community. In this section, I will explore four different approaches of orphan care – familial, community-based, institutional and rights-based – whose strategies and rise to prominence reflect the philosophies, premises and specific policies of different actors.

This article has examined different approaches to the care of orphans – family-, community-, institutional-, and rights-based – in the context of poverty and economic marginality. While familial care is old and still predominant, there has been a shift towards institutions based on an erroneous assumption that the extended family system has collapsed. Challenges to institutionalized care arose during the period in which discussions on children’s rights, dignity and freedom were taking place. A new ‘alternative’ model of care emerged with the prominence of theories of empowerment, participation and local governance. Just at the point at which the NGO-driven model was itself being recognized as problematic for having limited impact and for being partial, cost ineffective and not reaching the poorest of the poor, the ‘AIDS orphan crisis’ made all models redundant through the sheer weight of numbers (Ennew 2005). As Ennew points out, nation states and international welfare organizations seem to be constructing a paradigm of community-based care for whole families of orphans. However, in the face of dependency ratios that are socially and economically non-viable, millions of parentless children continue to seek care within the traditional, kinship system of support, despite their poverty and marginalization.

The article highlights the fact that lasting interventions to the challenges of orphanhood should not only be sensitive to the local realities of individual communities, but also must not lose sight of the ‘big picture’. They ought to be grounded in the diversity of orphanhood and the care-giving capacities of kinship systems while paying sufficient attention to orphans’ own testimonies and their experiences of lived orphanhood. Social support programmes should not only be inclusive but they also must support livelihoods, build assets and generate gainful income to lift families out of poverty using a rights-based perspective. In other words, the focus of external interventions should be to fight structural poverty and strengthen the capabilities of families’ resilience to orphanhood, rather than implementing resource-intensive approaches for a limited number of beneficiary orphans. This may appear to mean stepping back from the urgency required to address the needs of vulnerable children, but in fact it is the only effective response.

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Author´s Address:
Dr Tatek Abebe
Norwegian University of Sciences and Technology
Norwegian Centre for Child Research
Pavillion C, NTNU Dragvoll
N-7491 Trondheim
Norway
Tel: ++47 73596247
Email: tatek.abebe@svt.ntnu.no