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Duke-UNC Study Finds Institutions Are No Less Safe for Orphans than Family Care

September 08, 2015

Orphans living in families are at least as vulnerable to sexual and physical abuse and other traumas as orphans living in institutions, a new study finds.

The research, which analyzed longitudinal data from 2,235 orphans from five low- and middle-income countries participating in the Positive Outcomes for Orphans (POFO) study, challenges the commonly held perception that institutional care puts children at higher risk for experience of trauma than family-based care.

The POFO study, based at the Duke Global Health Institute (DGHI) and carried out in Cambodia, Ethiopia, India, Kenya and Tanzania, is led by principal investigator Kathryn Whetten, global health and public policy professor and director of the Center for Health Policy and Inequalities Research.

Christine Gray, epidemiology doctoral student at the University of North Carolina (UNC) Gillings School of Global Public Health, is lead author of the article, published in Global Health: Science and Practice

“We found that the incidence of traumatic events is high in both institutions and families,” Gray said. “The most commonly experienced trauma was physical or sexual abuse—and that was higher among children placed in families.”

Annual incidence of physical or sexual abuse was 13 percent among orphans in institutional care, and 19 percent among orphans in families.

The new study provides a counterpoint to a recent review published in The Lancet, which strongly advocated against institutional care for orphans and vulnerable children. 

In contrast, Gray and her colleagues recommend a nuanced approach, which is in line with other recent research indicating that institutions may, in fact, play an essential role in providing care to the world’s orphaned and vulnerable children.

“Our findings suggest that eliminating institutional care may be removing a viable—and in some cases protective—placement option for vulnerable children,” Whetten said. “We need to use all of the available evidence to identify support services and appropriate care for children, rather than applying sweeping policies that may have unintended consequences, including a rise in street children and child-headed households.”

Co-authors of the current study include DGHI professors Jan Ostermann and Nathan Thielman, CHPIR researcher Rachel Whetten, Duke psychology and pediatrics professor Karen O’Donnell and Brian Pence, associate professor of epidemiology at the UNC Gillings School.
 
In a commentary published in the same edition of the journal, Paula Braitstein argues that specific circumstances determine whether institutions or extended families are better suited to care for orphans and that regardless of the setting, improving the quality of care should be the ultimate priority—views that align with the findings and recommendations of the POFO research team.

This article was adapted from the original press release published by the UNC Gillings School.

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Orphanage Cots

We need to use all of the available evidence to identify support services and appropriate care for children, rather than applying sweeping policies that may have unintended consequences, including a rise in street children and child-headed households.

Kathryn Whetten, director of the Center for Health Policy and Inequalities Research

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