۩ David Brunetti/EveryChild/FSCE, Ethiopia

Why Care Matters:

The importance of adequate
care for children and society
 Contents
Acknowledgments 2

Executive Summary 3

Glossary of Terms 6

1 Introduction 8

2 Who are children without adequate care? 9

3 What impact does inadequate care have on children? 13

4 How does the inadequate care of children impact on wider society? 14

5 What action is needed to improve the care of children? 17

6 Conclusion and recommendations 20

References 22

Acknowledgements
This report was written for Family for Every Child by Corinna Csáky, a consultant. Thanks go to the children
and families whose stories are represented here and for the insights they bring to our work.

2 Why Care Matters: The importance of adequate care for children and society
 Executive Summary
This report reflects the views and collective expertise of 15 national organisations working hands on with
millions of vulnerable children worldwide. These organisations have come together to form Family for
Every Child, an alliance aimed at enabling more children to grow up safe and protected in families and to
access temporary, quality alternative care when needed.

The care of children matters to all of us. It affects Inadequate care impacts both children and wider
how we live; influences our capacity to develop, society. Children without adequate care are less
both as individuals and as a society; and it reflects likely to attend or do well in school, less able to
our aspirations for the kind of world we wish to live access health and other basic services, more likely
in. Global consultations with children show that to engage in anti-social and criminal behaviours,
children themselves consistently prioritise their need and in many cases their physical, emotional and
for better care. cognitive development is compromised. Inadequate
care can also be life-threatening and lead to
“When your parents are with you, you feel happy.
other child protection concerns, such as child
You know that they love you.”
exploitation. Having never experienced adequate
(Girl aged 8-12 in residential care in Russia, cited in
care themselves, some children who have been
Family for Every Child 2013a p.10)1
poorly cared for go on to neglect and abuse their
“My security comes from having everyone I love at own children, creating a vicious cycle of harm.
my side”
The future prospects of children without adequate
(Girl aged 15 from Brazil, cited in Family for Every
care are often severely limited. As adults, they are
Child 2013a p.10)2
often less able to access employment, more likely to
“Everybody wants to go home to live with their experience poverty and more likely to be dependent
parents so they can give you love and attention.” on the state. As such, the care of children underpins
(10-year-old girl living in residential care in Guyana, social and economic progress. Inadequate care can
cited in Family for Every Child p.10)3 hinder efforts towards development targets such
Children have the right to be cared for properly, and as growth, employment, poverty reduction, health,
for their survival and well-being they need physical education and humanitarian preparedness and
and psychological support from parents or carers response. Children without adequate care are also
in a nurturing family environment. Despite this, an important target group for achieving equity in any
millions of children around the world are without sector since they are often the most vulnerable and
this adequate care and this problem is likely to marginalised in society.
escalate further due to factors such as rising rates Supporting children to grow up in a permanent,
of urbanisation and migration, and the conflict and safe and caring family is at the heart of adequate
climate change affecting communities in many care. All children, where possible, should be cared
regions of the world. These girls and boys are in for by their own family. Where this is not possible,
every country: low, high and middle income, fragile adoption, the kafala of the Islamic world or similar
and stable. They are neglected, abused physically, practices should be used to give children a
sexually and psychologically, and deprived of permanent home within a family. Or, where a child
love and affection. They include children living in requires temporary alternative care, this should be
large-scale institutions, on the street or with an family-based or as family-like as possible, and the
employer; girls and boys associated with armed child should be reintegrated back home or placed
forces/groups; children abused in their own home into a permanent, safe and caring family as soon
by parents or other family members, and children as possible. Achieving this requires investment in
who have been forced to marry early. Girls and boys vulnerable families and communities to strengthen
separated from their families in emergencies and their ability to care for their own children, as well
those living with distant relatives are also at greater as in quality, family-based, alternative care. It also
risk of being poorly cared for. means giving children without adequate care a

1. Family for Every Child (2013) My world, my vision. Consultations with children on their priorities for the post-2015 development framework.
London: Family for Every Child, p.10.
2. As above, p.10.
3. As above, p.10.

3 Why Care Matters: The importance of adequate care for children and society
 stronger voice and raising awareness of their needs. businesses, trade unions, multilateral and bilateral
Improving the care of children requires action from agencies, the media, national and international
all parts of society. This is not just a challenge for NGOs, and, not least, children and families
child protection specialists. Rather, it affects the full
themselves. All of these actors have a role to play
spectrum of sectors – from education to health,
from economic planning to humanitarian work. in designing and implementing change and holding
It is a matter for governments, parliamentarians, others to account for improving the care of children.

© Juconi, Mexico

4 Why Care Matters: The importance of adequate care for children and society
 Recommendations 4. Increase the coverage and quality of social
protection in order to strengthen the
1. Build an in-depth understanding of care
capacity of families to care for children.
in each context, and develop locally
appropriate responses. - Provide families/carers of vulnerable children
with a combined package of cash transfers and
- Gain insights into both formal, government-
led care provision, and the care and support broader forms of social support to help enable
offered informally by families and communities. them to care for children properly.

- Build on existing strengths, including the vital - Carefully design social protection for vulnerable
support already offered by extended families. families and children to ensure that it benefits
and does not have a detrimental impact on the
- Explore innovative, promising practice care of children.5
developed by national civil society organisations
for potential replication on a larger scale. 5. Ensure that each country adheres to
the Guidelines for the Alternative Care
- Understand children’s perspectives on
of Children. The following are particularly
adequate and inadequate care.
important.
2. Make the care of children a political and
- Build on strengths within informal care systems
financial priority.
and work to address any discriminatory or
- Allocate sufficient resources to ensure the harmful practices that may exist.
adequate care of all children.
- End the use of institutional care for all children,
- Incorporate the care of children into the post- particularly those less than three years of
2015 development framework through, for age and develop safer alternatives, such as
example, a specific goal and/or target on care.4 more effective support for families to enable
- Make investments in the care of children more reintegration, small group homes and foster
visible, with dedicated lines of accountability. care.
- Regularly collect and monitor data on children - Review and, where necessary, reform national
without adequate care. laws and policies so that they prioritise the care
of children in a safe, caring and permanent
3. Ensure broader development and
family environment.
humanitarian work reinforces the effective
care of children. - Increase and strengthen care structures as
- Make health, education and other basic appropriate to each context (for example,
and life-saving services accessible to poor kinship care, domestic adoption or kafala and/
and marginalised children in their home or foster care) to ensure that children who
communities, and inclusive of children without cannot be cared for by their own parents
adequate care. have a range of quality options in a family
environment.
- Ensure that actors working on child welfare,
health, education, justice, growth, migration, - Improve local, national and international child
poverty reduction, and disaster preparedness protection systems to ensure that inadequate
and response work together to prevent children care is prevented, detected, and addressed.
from being unnecessarily separated from This includes enhancing the capacity and
families. effectiveness of the child welfare workforce.
- Support children without adequate care to - Support children and their families to participate
participate in the design and implementation of in decisions that affect them, including
relevant laws, policies, structures and services. individual care arrangements.

4. An example goal: all children live a life free from all forms of violence, are protected in conflicts, and disasters, and thrive in a safe family
environment. An example target: halve the number of children unnecessarily living outside family care and end the placement of all children in
institutional care (from: BCN et al. (2013) Protect my Future. Why child protection matters in the post 2015 development agenda. Family for
Every Child, London.
5. See Roelen and Shelmerdine 2014 for further recommendations around the design of social protection programmes to ensure that they
enhance the care of children.

5 Why Care Matters: The importance of adequate care for children and society
 Glossary of terms
Adoption: A social and legal protective measure for older, adult siblings, and children living with families
children; a process whereby a child who cannot be who are part of wider kinship networks. Children in
brought up by his or her own parents (due to death, formal foster care are also part of families, although,
or child protection concerns which cannot be whilst this care may be long-term in some settings,
addressed etc.) becomes a member of a new family this care is not generally intended to be permanent
(ISS and IRC 2004). (Family for Every Child 2013b).
Alternative care includes formal and informal Foster care: A form of alternative care (and
care of children outside of parental care (UN therefore by definition a temporary arrangement)
2010a). This includes kinship care, foster care, which may be defined as: “situations whereby
supported independent living and residential care. children are placed by a competent authority for
Residential care includes a range of arrangements the purposes of alternative care in the domestic
including small group homes, children’s villages and environment of a family other than children’s own
institutional care, whereby children are cared for family, that has been selected, qualified, approved
collectively in large groups (see below). and supervised for providing such care” (UN 2010a).
Child abuse: “A deliberate act of ill treatment that Institutional care: Large-scale residential facilities
can harm or is likely to cause harm to a child’s involving children being cared for collectively in large
safety, well-being, dignity and development. Abuse groups. The distinction between institutional care
includes all forms of physical, sexual, psychological and other forms of residential care rests not only
or emotional ill treatment.” (Save the Children, on the size of the facilities, but also on the nature
undated). Simple neglect of a child is also classified and quality of the care provided. Institutional care
as child abuse. involves the use of shift-systems, children generally
Child and early/forced marriage: “Child marriage sleep together in dormitories, their lives are
involves the marriage of anyone below the age governed by set rules and routines, and children are
of 18. It is the marriage of a child to an adult or commonly isolated from wider communities (Family
another child, and may be legally condoned by for Every Child 2013b; UN 2010a).
national laws.” (CRIN 2007). We are particularly Kafala: A variety of means for providing child care
concerned with forced and very early marriage for vulnerable children, recognised under Islamic
(under around the age of 14) where the risks to law, which does not recognise adoption as the
children are greatest. blood bonds between parents and children are seen
Child protection: “Measures and structures to as irreplaceable. This may include providing regular
prevent and respond to abuse, neglect, exploitation financial and other support to children in need in
and violence affecting children” (Save the Children parental, extended family or residential care, or
2010). taking a child to live with a family on a permanent,
legal basis (Cantwell and Jacomy-Vite 2011).
Children are defined as girls and boys under the
age of 18 years.6 Kinship care: “Family-based care within the
child’s extended family or with close friends of
Children outside of parental care: “All children
the family known to the child, whether formal or
not in the overnight care of at least one of their
informal in nature” (UN 2010a Art 29). Kinship care
parents, for whatever reason and under whatever
is both a form of permanent family-based care,
circumstances” (UN 2010a).
and a form of temporary alternative care. There
Families take on many different forms and may are two types of kinship care. Informal kinship
include children living with one or both of their care is any private arrangement provided in a
parents or adoptive parents, children living with family environment, whereby the child is looked
step parents, children living with extended family after on an on-going or indefinite basis by relatives
members, such as grandparents, aunts or uncles or or friends … at the initiative of the child, his/her

6. This is based on Article 1 of the UNCRC (UN 1989). We acknowledge that age is not the way in which many communities
define childhood. For example, in some settings childhood comes to an end when individuals start to do ‘adult’ activities (such
as becoming sexually active) (Inter-Agency Learning Initiative on Community-Based Child Protection Mechanisms 2012). We
believe that it is important to recognise these differing perceptions of childhood in the ways in which we communicate and
work with communities.

6 Why Care Matters: The importance of adequate care for children and society
 parents or another person without this arrangement and designated facility by salaried staff or volunteers
having been ordered by an administrative or judicial (Family for Every Child 2013b).
authority or a duly accredited body (UN 2010a).
Small group homes: Where children are cared for
Formal kinship care is care by extended family
in smaller groups, with usually one or two consistent
or close friends which has been ordered by an
carers responsible for their care. This care is
administrative or judicial authority or duly accredited
body (UN 2010a). This may in some settings include different from foster care in that it takes place
guardianship or foster care (EveryChild and HelpAge outside of the natural ‘domestic environment’ of the
International 2012). family, usually in facilities that have been especially
designed and/or designated for the care of groups
Neglect: “Deliberately, or through carelessness of children (Family for Every Child 2013b).
or negligence, failing to provide for, or secure
for a child, their rights to physical safety and Social protection: “All public and private initiatives
development. Neglect is sometimes called the that provide income or consumption transfers to the
‘passive’ form of abuse in that it relates to the poor, protect the vulnerable against livelihood risks,
failure to carry out some key aspect of the care and and enhance the social status and rights of the
protection of children which results in significant marginalised; with the overall objective of reducing
impairment of the child’s health or development the economic and social vulnerability of poor,
including a failure to thrive emotionally and socially” vulnerable and marginalised groups” (Devereux and
(Save the Children, undated, p.3). Sabates-Wheeler 2004).

Residential care: “Care provided in any non Supervised independent living: “Settings where
family-based group setting, such as places of safety children and young persons, in a small group, are
for emergency care, transit centres in emergency encouraged and enabled to acquire the necessary
situations, and all other short and long-term competencies for autonomy in society through
residential care facilities including group homes”(UN appropriate contact with, and access to, support
2010a). Care is provided in a specially designed workers” (Cantwell 2010).

7 Why Care Matters: The importance of adequate care for children and society
 1. Introduction
This report explains why the care of children This report is aimed at anyone striving for economic
underpins the achievement of several fundamental or social progress. It is as relevant to governments
rights as well as broader development and and parliamentarians as it is to businesses, trade
humanitarian goals. It describes how the care of unions, multilateral and bilateral agencies, the media,
children is in a global crisis with millions of children and national and international NGOs. In particular,
experiencing inadequate care in every region of the it is intended to reach beyond the traditional child
world. It explains why children consistently rank protection sector – to those working on broader
their own need for a safe and loving family above all
development objectives. It has lessons for all
other concerns. It examines why children continue
settings – developed, developing and fragile alike.
to experience inadequate care despite widespread
acknowledgement of the importance of good care. This report reflects the views and collective
And it highlights what action is needed – and by expertise of national civil society organisations
whom – to ensure that children are better cared for. working hands on with hundreds of thousands of
How children are cared for matters to all of us. It vulnerable children in all regions of the world. These
affects how we live; determines our capacity to organisations have come together to form Family
develop, both as individuals and as a society; and it for Every Child,7 an alliance aimed at enabling more
reflects our aspirations for the kind of world we wish children to grow up in secure families and access
to live in today and in the future. temporary, quality alternative care when needed.

© Child Rights Centre, Tajikistan

7. See: www.familyforeverychild.org (Ishaque 2008).

8 Why Care Matters: The importance of adequate care for children and society
 2. Who are children without adequate care?
Children without adequate care are those boys and employer, and those associated with armed forces/
girls who do not receive the necessary physical groups; abused in their own home; or experiencing
and psychological support from parents or carers early, forced marriage, are lacking in adequate
in a nurturing family environment. Box 1 below care. Children separated from their families in
explores elements of adequate care in more emergencies and those living with distant relatives
detail. These definitions suggest that children who
are also at greater risk of being poorly cared for
are inadequately cared for include children who
(Family for Every Child 2013b; EveryChild and
experience physical, sexual or psychological abuse
and/or neglect in their own home or at the hands of HelpAge International 2012). Whilst their situations
other carers as well as children who are without any may vary, for all, their lack of care is both a major
parent or carer. For example, children living in large- cause and a consequence of their vulnerability and
scale institutions (care, detention, educational); dictates several areas of their lives and prospects
living alone on the streets or with an exploitative for the future (see section three).

Box 1: What are the elements of responsibility towards their families (Burr 2002;
‘adequate’ care? Mann 2001; Punch 2002). It has been argued that
the ‘basic’ elements of care necessary for child
In recent research in Rwanda, parents and children
well-being and development in all contexts include
were asked what it means for a child to be ‘happy,
‘secure, stimulating and responsive care,’ but that
healthy and well cared for’ as a way of exploring
this care can be provided in a range of different
adequate care. Children and adults spoke of both
ways by a range of different family types (Woodhead
material and non-material needs. Material needs
2006, p.10).
included food, clothing, education materials, clean
water, health care and good housing. Non-material
needs included love, affection, time spent with Supporting children to grow up in a permanent, safe
parents and carers, and time for relaxation and and caring family is at the heart of ensuring children
playing. Respondents also spoke of the value are adequately cared for. Whilst children may want
of good communication between children and and need some time apart from families during their
parents/carers and of having a good atmosphere in childhoods, for well-being and happiness, evidence
the family (Roelen and Shelmerdine 2014). indicates that children should spend the bulk of their
time in safe, caring family environments. Poverty
“They [carers] have to sufficiently well feed children, or a lack of access to services should never be
cloth them, love them, pay school fees and [provide] regarded as sufficient grounds for removing a child
enough materials for them, provide them with from the care of their own family. Where a child
health insurance, make them look clean and stay requires permanent care but cannot be looked after
in beautiful places, get time to discuss with them, by their parents, care by wider extended family
present them to family members, protect them from or kinship networks is often a good option, and
inappropriate work, and give them enough time to adoption or similar practice – such as kafala in the
play with others.” Islamic world – can also be used to give children
(Boy from Rwanda, cited in Roelen and Shelmerdine a home within a family. Where a child requires
2014, p.18) temporary alternative care this should be family-
Other research demonstrates how perceptions based or as close as possible to a family, such as
of ‘good’ care vary greatly by context, with, for foster care or small group homes, and the child
example, some cultures emphasising protecting should be reintegrated back into their own family or
children from risk and then enabling them to placed into a permanent, safe and caring family as
become increasingly independent from their soon as possible (Family for Every Child 2013b; UN
families, and others encouraging children to 2010a). Box 2 below provides more detail on why a
learn how to deal with risk and recognise their family is so important.

9 Why Care Matters: The importance of adequate care for children and society
 Box 2: Why is a family so important? between a child and the services necessary for their
“No one will love you like your mother; she gave survival and development; and growing up at home
birth to you so you are part of her. A mother will helps ensure continuity in children’s educational,
care for you better than anyone else.” cultural and social lives, and fosters a sense of
(A child in Malawi, cited in Mann 2004, p.35) identity and belonging, both of which have been
“Everybody wants to go home to live with their shown to impact on long-term well-being (Family for
parents so they can give you love and attention.” Every Child 2013b; Morantz and Heymann 2010).
(10-year-old girl living in residential care in Guyana, Children from around the world have consistently
cited in Family for Every Child 2013a, p.10) expressed a strong preference for being cared for
A permanent, safe and caring family is widely in their own families (Family for Every Child 2013a;
acknowledged to be the best place for a child to Mann 2004).
grow up. This is enshrined in both international
Whilst families are not always safe havens as
human rights law and in global practice standards
many children do experience inadequate care at
(see Box 3). The reasons for this are manifold:
a secure attachment with a continuous carer home, with proper support, and with effective child
underpins children’s cognitive, intellectual and protection monitoring and response, children are far
emotional development (Oates, Lewis and Lamb more likely to thrive in a permanent, safe and caring
2005); an effective parent/carer is a vital bridge family than in any other care arrangement.

There are children without adequate care in Furthermore, the number of children without
every country in the world – low, high and middle adequate care is rising and very likely to escalate
income, stable and fragile. It is notoriously difficult further due to major global trends.
to know the precise number of children without • Over the next decade it is estimated that 175
adequate care, due to a chronic lack of data and million children worldwide will be affected by
the hidden nature of neglect and abuse (Higgs et natural disasters brought about by climate change
al. 2012). However, existing data suggests a global (Save the Children 2009), many of whom may
crisis. There are an estimated 151 million children become separated from families in the immediate
worldwide with either one or both parents dead, chaos and/or experience abuse and neglect as
with at least 13 million of these children having a consequence of the impact of emergencies on
lost both parents (UNICEF 2013).8 Orphaned household poverty (BCN et al. 2013a).
children, especially those who cannot live with close • A substantial proportion of the world’s poor live
extended family, are at enhanced risk of inadequate in fragile and conflict-affected states, with more
care (Family for Every Child 2013b). Every day, vulnerable livelihoods. For children, this increases
around 3,500 girls under the age of 15 get married, the likelihood of early, forced marriage, sexual
with many such marriages forced, and leading to abuse and separation from families into armed
risky early pregnancies (Bruce 2007).9 An estimated forces and armed groups (International Bureau
150 million girls and 73 million boys experience for Child Rights 2010; Gertz and Chandy 2011;
sexual violence each year (WHO 2006), often at the World Vision 2012).
hands of a family member or whilst living outside • There are almost one billion migrants worldwide,
of family care. And there are many unaccompanied 30 million of whom are under the age of 20. Whilst
and separated children in conflicts and natural migration can bring with it some opportunities,
disasters. In Syria alone more than 1.1 million children many migrant children travel alone, facing
had registered as refugees by 2013, and out of risky journeys and exploitative labour without
those registered as refugees in Jordan and Lebanon adult support; many children are left behind by
alone, 3,700 are living without one or both parents migrating parents and many are cut off from basic
or are without any caregiver at all (UNHCR 2013). services at the point of destination – all of which

8. See for an estimate of the number of ‘double’ orphans who have lost both parents:
www.unicef.org/media/media_45279.html
9. Pregnancy-related deaths are the leading cause of mortality for girls aged 15-19, and girls under 15 are five times more likely
to die as a result of childbirth than women in their twenties (World Vision 2008).

10 Why Care Matters: The importance of adequate care for children and society
 leaves them more vulnerable to inadequate care cannot afford to provide for them or cannot ensure
(BCN et al. 2013b; UNICEF 2012). they have access to basic education and health
• By 2025, 60 per cent of children from developing services (Csaky 2009). Many children from poor
countries will live in cities. This urbanisation is communities are forced to leave their families in
associated with the dislocation of extended family order to access education and health services that
and community networks, and higher rates of are either unavailable or unaffordable at home.
divorce and single parenthood, leaving many For example, more than half a million children live
parents struggling to bring children up alone in children’s homes across Indonesia, largely to
(Roby 2011; UNICEF 2010). access education services not available in their
home communities (DEPOS and Save the Children
• Despite recent improvements in treatment and 2006). Children with disabilities are also particularly
prevention, the HIV pandemic continues to have at risk due to a lack of community-based support
a lasting impact on the care of children. Millions and a misguided belief that they are better cared
of children have been orphaned, and where for in institutions rather than at home by their own
extended family are unable to offer adequate families, which in turn leaves them more vulnerable
care, this increases vulnerability to abuse and
to abuse (EveryChild and BCN 2012). In some parts
exploitation. In some contexts, many enter
of the world extended families may be less willing to
poor quality alternative care, partly as a result
care for children living with HIV (Mann et al. 2012).
of discrimination against children living with HIV
And gender and age also have a major impact
(Mann et al. 2012).
on children’s vulnerability to separation. In some
• Whilst reform is leading to a decline in the use of regions girls are more welcome than boys amongst
institutional care in some contexts, the number of extended family, as they are seen to contribute
children in institutional care is growing or failing to more to housework, and the family will get a bride
fall in many regions of the world (EveryChild 2011). price when they marry (Mann 2001). In other
Although the figures above present a bleak picture, settings, male orphans are preferred as they are
there remains hope for children vulnerable to seen to make a more productive contribution to the
inadequate care. Around the world, traditions family (Cantwell and Jacomy-Vite 2011). Boys are
of extended family care remain strong, and also more likely to migrate for work in many regions
communities have stepped up to the challenges of the world (Dotteridge 2004).
posed by HIV and emergencies to offer care The lack of care experienced by these children is
and support to children separated from families. of enormous concern to children and communities
However, all too often extended families and (see below) and a gross violation of child rights.
communities are left to struggle with growing There are several international and regional human
numbers of separated children alone, with no and child rights instruments that oblige States
or limited support (EveryChild and HelpAge Parties to ensure children are adequately cared for
International 2012; JLICA 2009). This is especially (see Box 3). These rights have been translated into
alarming as many of the most committed extended global guidance, which have received international
family carers are elderly, and vulnerable themselves endorsement, including the Guidelines for the
(EveryChild and HelpAge International 2012). Alternative Care of Children (UN 2010a), which
Whilst children in any circumstance can be at risk were formally welcomed by the UN in 2009, and in
of inadequate care, some are especially vulnerable. the global Minimum Standards for Child Protection
Inadequate care is not limited to children living in Humanitarian Action (CPWG 2012). This led to
in poverty, but it is certainly a major contributing call for an end to the use of institutional care for
factor. Many children are separated from their children under three years of age in Europe and
families because they cannot afford to care for Central Asia by UNICEF and the Office of the High
them. The majority of children in residential care Commissioner for Human Rights (OHCHR) in 2011.
worldwide have parents, most of whom relinquish In 2013 a similar call to action was issued in
their children into alternative care because they Latin America.10

10. See: www.unicef.org/media/media_59030.html and www.crin.org/docs/Call%20to%20Action%20-%20Latin%20America%20and%20

Caribbean.pdf

11 Why Care Matters: The importance of adequate care for children and society
 Box 3: Children have a right to adequate and others responsible for the child to implement
care this right…” (UN 1989, Article 27).
There are several international human and child •T
 he Convention on the Rights of Persons with
rights instruments that safeguard a child’s right to Disabilities also obliges States Parties to provide
adequate care including the following. information, support and services to families to
•T
 he UN Convention on the Rights of the Child prevent the neglect and abandonment of children
(UNCRC) acknowledges that “the child, for with disabilities (UN 2006).
the full and harmonious development of his
•S
 imilarly, Article 16 of the African Charter on
or her personality, should grow up in a family
the Rights and Welfare of the Child demands
environment, in an atmosphere of happiness, love
that governments “take specific legislative,
and understanding.” (UN 1989, Preamble). The
same Convention also recognises “the right of administrative, social and educational measures to
every child to a standard of living adequate for the protect the child from all forms of torture, inhuman
child’s physical, mental, spiritual, moral and social or degrading treatment and especially physical or
development … [and commits States Parties to] mental injury or abuse, neglect or maltreatment,
… take appropriate measures to assist parents including sexual abuse, while in the care of the child.”

© Juconi, Mexico

12 Why Care Matters: The importance of adequate care for children and society
 3. What impact does inadequate
care have on children?
“I looked into the crib and saw a child who looked by families, also leaves children more vulnerable
to be seven or eight years old. The nurse told me he to sexual abuse and unsafe lone migration (Delap
was 21 and had been at the institution for 11 years. 2010).
I asked her how often he was taken out of the crib
In many cases, the effects of inadequate care
and she said: ‘Never. He has never been out of the
are life threatening. The increased risk of early
crib in 11 years.’”
pregnancy amongst girls without adequate care
(Mental Disability Rights International Investigator,
impacts on maternal and infant mortality (World
Serbia, cited in MDRI 2007 p.v)
Vision 2008); unaccompanied and separated
“When your parents are with you, you feel happy. children in conflict settings are more vulnerable to
You know that they love you.” recruitment and use by armed forces and armed
(Girl aged 8-12 in residential care in Russia, cited in groups (Global Protection Working Group 2010,
Family for Every Child 2013a p.10) p.204); and the mortality rate for infants cared
for in large-scale institutions is often higher than
Children without adequate care are amongst
in the general population. For example, in Russia
the most vulnerable people in the world. Many,
the mortality rate for children under four years old
especially the very young, experience physical,
growing up in large-scale institutions is ten times
language and intelligence delays as a result of
higher than that of the general population (Ministry
poor care. For example, children in institutional
of Health and Social Development 2007).
care, particularly those under three years of age,
are more likely to suffer from stunted growth and Children without adequate care often experience
behavioural problems and have a lower IQ than inequity in other aspects of their lives. This includes
those who are raised in a family (Bilson 2009; discrimination and exclusion from basic services
Browne 2009; Williamson and Greenberg 2010). and other institutions that exist to help children
This is compounded by the lack of access to and young people. Married adolescent girls and
education facing many children without adequate children living on the streets without their families
care, who are less likely to go to or to do well face stigma and discrimination from health care
in school. Children who have lost both parents workers, denying them much needed sexual and
are 12 per cent less likely to be in school than reproductive health services (ODI and Save the
other children (UN2010b), and children living on Children 2013; BCN et al. 2012b). Whilst migration
the streets, in detention or with employers are can provide children with new learning experiences
commonly denied access to school (BCN et al. and opportunities, children who migrate alone,
2012b). Children without adequate care are at especially young children, or children who have
greater risk of malnutrition, mental illness and been trafficked across borders, are frequently
disease including that associated with HIV and treated like criminals, and are unable to access
substance abuse (Krug et al. 2002; WHO 2006). services open to other children (BCN et al. 2013b;
They are also far more vulnerable to other child Dotteridge 2004; Punch 2002). Furthermore, social
protection issues, and indeed a loss of parental care protection schemes often fail to reach children
has been acknowledged as a key causal factor of outside of parental care (Kaplan and Jones 2013).
abuse and neglect (Family for Every Child 2013b). And children who have lost parental care, who are
For example, the girls and boys who are most connected to the streets or who have experienced
affected by violence, exploitation and abuse during sexual abuse and exploitation are widely
emergencies typically include children without stigmatised by communities. This discrimination
parental care (Morgan and Beherendt 2008); and may be exacerbated by factors such as gender,
being outside of families, or not properly protected disability and HIV status (BCN et al. 2012a).

13 Why Care Matters: The importance of adequate care for children and society
 4. How does the inadequate care of
children impact on wider society?
The inadequate care of children is creating lost home, and reported far lower earnings over their
generations. The problems experienced by these lifetimes (Currie and Widom 2010). Adults who
boys and girls in childhood severely limit their have experienced inadequate care as children
potential later in life. As we have seen in section are also more likely to require support from public
3, children without adequate care can be set services, at a significant cost to the state budget.
back by physical, language and intelligence In the US the combined costs of lost earnings
delays. Furthermore, children who have grown up and tax revenue as a consequence of child abuse
outside of a community, such as those living in and premature death, and of support services for
institutional care very often do not develop essential abused children is estimated to be 1 per cent of
social networks or skills necessary in adulthood GDP annually (Fromm 2001). Furthermore, the
(EveryChild 2011). As adults, they are often less provision of institutional care homes for children –
able to access employment and are more at risk of which are often inappropriate and of low quality – is
behavioural, physical and mental health problems, far more costly than supporting them to live within a
including depression, obesity, heart disease, cancer, family (EveryChild 2011).
high risk behaviours and sexually transmitted
infections, alcohol and drug misuse, and violence Inadequate care also severely limits the capacity
(Gilbert et al. 2009). These challenges have been of societies to achieve development targets. The
linked to anti-social and criminal behaviour in lack of priority given to the care of children within
adulthood. One study in Russia showed that one in the Millennium Development Goals (MDGs) has
three children who leave residential care becomes already been shown to be a key hindrance to their
homeless; one in five ends up with a criminal achievement (Delap 2010). Amongst child welfare
record; and one in 10 commits suicide (Tobis 2000). charities there is widespread agreement that the
care of children is a key issue underpinning the
“Being isolated from your parents means that your
potential success of the post-2015 development
life will not be good. Children should not be isolated
framework that will replace the MDGs when they
from their parents at all if they are alive.”
come to an end.11 In particular, children without
(Girl aged 8-12 in extended family care in Kenya,
adequate care have been noted as a major target
cited in Family for Every Child 2013b p.10)
group for reducing inequity across all development
“The children don’t know what is happening and humanitarian issues (BCN et al. 2012a). And
outside.” the care of children is a key entry point for tackling
(Boy aged 14 in residential care in Malawi, cited in the full spectrum of child protection issues including
EveryChild 2011 p.13) unsafe migration, harmful child labour, and child
The disadvantages created by inadequate care sexual exploitation.
are often passed onto the next generation. Adults Children themselves have consistently highlighted
who have experienced neglect or abuse in their improvements to their own care as a key priority. In
own childhood are less likely to provide positive 2012-13, Family for Every Child and its members
parenting to their own children (Csaky 2009). consulted 600 vulnerable children across seven
Whilst it would be wrong to value child well-being countries on their priorities for the post-2015
purely in terms of its potential to boost economies development framework. These children gave the
(Woodhead 2006), it is nonetheless true that importance of growing up in safe, caring families
inadequate care has a significant economic impact as one of their top priorities, often over and above
on wider society. In particular, it depletes human material needs and access to services (Family for
capital and, thereby, hinders growth. A US study Every Child 2013a). Similarly, in 2005, a consultation
of adults who had experienced abuse and neglect with children in 18 countries on their priorities for
as children found that they had a 14 per cent lower the MDGs highlighted the value children place on
employment rate than the general population, having strong, caring and protective relationships
were less likely to have a bank account, vehicle, or (Grow up Free from Poverty 2005).

11. This is the consensus of a broad spectrum of development and humanitarian agencies that are working together to campaign for the care and
protection of children to be central to the post-2015 framework. Further information is available from the Protect my future series of papers
exploring the links between child protection and the achievement of central development objectives. See: http://www.familyforeverychild.org/
knowledge-centre

14 Why Care Matters: The importance of adequate care for children and society
 “My security comes from having everyone I love at can be found for children, many of the negative effects
my side.” of poor care can be reversed (see Box 4 below
(Girl, aged 15, from Brazil, who took part in a for an example, and Woodhead 2006). It is also
consultation with highly vulnerable children on their the case that whilst children lose much whilst they
post-2015 priorities, cited in Family for Every Child are inadequately cared for, they can also display
enormous resilience in the face of adversity, and,
2013a)
in some instances, gain skills and friendships from
Thankfully, the longer-term impacts of inadequate time apart from family that can and should be built
care are not entirely inevitable and if caring homes upon (Burr 2002; Dotteridge 2004; Punch 2002).

Box 4: An example of how adequate “No one ever checked my note book to see if I was
care improves children’s lives learning.”

Akiki’s story, Rwanda12 Akiki received no affection or emotional support from

carers within the orphanage.
A case study by Corinna Csaky for Why Care Matters
“The guardian that I used to call my mother in the
28.2.14
orphanage had told me that she was not my mother
“Life in an orphanage is not a life.” and that she had no pity for me.”
Akiki’s story demonstrates the harmful effects of He was never able to express his feelings or asked
institutional care on a child’s health, well-being his opinions. He had very low self-esteem and felt
and prospects. He is just one of the orphans that valueless in society. He argues that:
Rwandan NGO and Family for Every Child member,
“A valued child lives with his family members (parents
Uyisenga ni Imanzi, is helping to access quality care
and siblings) and feels free to express ideas and
and realise their rights. These children and young
opinions without discrimination or exclusion.”
people have been orphaned by genocide or HIV and
many have suffered great trauma and personal loss. He was isolated from the community and had no
Uyisenga provides counselling, vocational training, idea about life outside. For example, he didn’t know
and funds for their education as well as helping to where the food and other items that were given
build homes to enable these children to reconstruct to him came from. Upon leaving he was given a
families that were previously scattered across uniform, which identified him as an orphan, which in
orphanages and foster homes. Alongside this work, turn made him feel even more of an outsider.
Uyisenga also advocates for the rights of children Akiki is the youngest of six children, all of whom
without parental care. experienced their own challenges of inadequate
Akiki’s parents died when he was just two years old. care following the death of their parents. His eldest
He was sent to live in an orphanage until he was 14. sister was sent to live with a wealthy man to be a
The quality of care he received there was so poor domestic worker; she was raped and left pregnant
that he suffered irreparable physical damage. The by a member of the household and subsequently
lack of hygiene led him to develop an infection that dismissed. One of his other sisters died in an accident;
then went untreated. another was sent to live and work in a shop.
“I was quarantined and the person in charge Akiki is now 16 and living in Kigali with five of his
wouldn’t bring me the hot water needed to clean siblings. He moved back to his family two years
my abscesses. My elder sister had to quit school to ago with the help of Uyisenga ni Imanzi who
return to the orphanage to take care of me. But it provided economic support, help with schooling and
was too late.” counselling. His eldest brother, now 28, is the head
of the household and supports his family by working
As a result Akiki is now frequently unwell and requires
as a driver. Akiki cherishes the love and support he
regular hospital treatment. Whilst in the orphanage
receives at home. He describes how his brothers
he was given very little food, drinking water was
and sisters take care of him, take an interest in his
often contaminated, his clothes were torn, sleeping
education, support him with school materials and
conditions were cramped and unhygienic and the
take him to the hospital for treatment.
children were given few opportunities for recreation.
Whilst he did attend school it was of poor quality and “I get enough food at home and no one harasses
he did not receive any individual support. me; I carry out the activities I am able to do and no

12. This case study is from an original interview conducted by Uyisenga ni Imanzi in Rwanda in 2014. Akiki is not the boy’s real name, for
purposes of anonymity. For more information visit www.familyforeverychild.org/es/node/233

15 Why Care Matters: The importance of adequate care for children and society
 one intimidates me; and I believe that I have sufficient “Living without parents, without even remembering
time for rest and leisure: I feel very happy.” if you have ever seen them, it is a serious problem
When he lived in the orphanage he felt his life would for me. I wonder what parental love feels like and
be a short one. Today, he hopes to live longer. I realise that I do not know it at all because I have
He enjoys school, especially maths, physics and never experienced it.” However, he is happy to be
chemistry and wants to become a businessman reunited with his brothers and sisters in their own
once he is grown up. home. He wishes “all children to be brought up in
Despite the support Akiki receives from his siblings a family, with affection, peace, and being protected
he remains affected by the loss of his parents. from any danger.”

۩ David Brunetti/EveryChild/FSCE, Ethiopia

16 Why Care Matters: The importance of adequate care for children and society
 5. What action is needed to
improve the care of children?
Improving the care of children is both a technical children. Civil society can play a particularly crucial
and a political and social challenge. Whilst, research role as they have the flexibility and on the ground
has generated knowledge on the harmful impacts expertise to develop effective, innovative practice,
of inadequate care and examples of effective care which can be usefully replicated by governments
systems,13 this knowledge does not span all cultural (for example: Family for Every Child and JUCONI
contexts, and significant gaps in understanding 2014; EveryChild and Partnership for Every Child
remain. In particular, there is limited appreciation 2013). However, governments must not only be
and analysis of the critical role played by extended willing to learn from civil society, but also to listen
families and wider communities in ensuring that to and assist families and communities. In most
children are properly cared for, and of children’s settings, these groups provide the bulk of support
perceptions of what adequate care is and how for children without adequate care and their role
it can be achieved. The interface between the must be acknowledged and built upon (JLICA
informal care offered by families and communities, 2009).
and more formal, government-led structures is
Tackling the inappropriate use of institutional care is
poorly understood, and there is limited analysis
an especially urgent priority. The wealth of evidence
on how examples of promising practice can be
on the harmful impacts of institutional care,
scaled up to achieve wider change (Oak et al.
2012). There remains a tendency to assume that particularly for children under three years of age,
one size will fit all, and to avoid in-depth analysis of points to the need to end its use as a care option
differences in care practices. When such analysis for children. This can only be achieved alongside
has been completed, it illustrates greatly varying support to families and the development of better
means of achieving adequate care in different forms of alternative care. Children already living in
contexts, suggesting the need for context-specific institutional care need to be either reintegrated and
approaches that understand local care systems, supported back into their own family or provided
and are able to build on strengths and address with quality alternative care where necessary. And
discriminatory or harmful practices (Mann 2001; more regulation and inspection services are required
Woodhead 2006; Inter-Agency Learning Initiative to tackle the proliferation of unregulated and poor
on Community Based Child Protection Mechanisms quality care institutions.
2012). Tackling the poverty and inequity that underpin the
What is also lacking, in many cases, is the political inadequate care of children is also vital. Families
and social will to put learning into practice on a living in poverty need greater access to social
wider scale. Improving the care of children very protection to strengthen their capacity to care
often requires government investment in the most for children. Within this, cash transfers should be
marginalised sections of society – people with combined with broader social supports such as
little political voice who are often targets for social support groups, parenting advice and assistance,
discrimination. The impact of investment may be employment advice and addiction therapy.14
less immediately visible and may take several years Education, health and other basic services
to come to fruition – neither of which is appealing need to be made more accessible to vulnerable
to governments, businesses and donors keen to children to prevent them from having to leave
show results. It may also require governments and home unnecessarily. Social norms and attitudes
other actors to challenge beliefs and practices and that perpetuate inadequate care also need to be
existing legislation that perpetuate the inadequate addressed through, for example, public information
care of children, which can be controversial and campaigns and legal reform. This includes tackling
politically unpopular. Taking on these challenges discrimination associated with disability, gender
requires strong political leadership supported by an and ethnicity as well as sexual violence and
active and committed civil society to change/review harmful traditional practices such as physical and
policies to influence attitudes to improve the care of humiliating punishment and child and early/forced

13. A wide range of resources on the care of children are available on www.familyforeverychild.org/knowledge-centre and
www.bettercarenetwork.org/bcn/
14. See Roelene and Shelmerdine 2014 for further details regarding ways to improve the design of social protection programmes to ensure they
promote better care for children.

17 Why Care Matters: The importance of adequate care for children and society
 marriage. Moreover, it means promoting the family countries have achieved important reforms of their
as the best place for a child to thrive. care systems. The implementation handbook to
Ensuring that all children are adequately cared for is the Guidelines on the Alternative Care of Children
entirely achievable. There are already many positive
examples from around the world, including that of provides several examples and is a useful point of
Brazil, which is described in Box 5 below. Many reference for anyone committed to taking action.

Box 5: An example of care reform from to the family of origin or a new permanent home is
Brazil15 found when necessary. In severe cases, short-term
small-scale residential care for children in crisis is
Brazil is an upper middle-income country with a
provided when more intensive support is needed.
population of just under 200 million people, 59
There is a growing practice of ‘concentrated
million of whom are children.16 37,861 children
hearings’ for children in residential care in which the
are registered as living in formal alternative care
child, the family, representatives from the judiciary
including small group homes, foster care, transit
and care professionals together assess whether the
homes and children’s villages. There are 23,973
child can return to their own family or how best to
children reported to be either living or working on
provide them with quality alternative care.
the streets, although the actual figures may be far
higher (Ministry of Social Development (Brazil) MDS/ There is also greater investment in family-based
FIOCRUZ 2010). The majority of these children are alternatives for children who are not able to be
from poor and marginalised communities and have cared for at home. This includes the recruitment of
one or both parents living. Poverty, violence in the foster families, which has led to an increase in foster
home and substance abuse drive many children care services. Efforts are being made to reduce
onto the streets. In addition, neglect, sexual abuse the amount of time a child spends in ‘transit’,
and abandonment are also key causes of children whilst a permanent care alternative is sought,
being placed into formal care by the authorities. with a maximum limit of two years. And there are
Cultural norms and values associated with violence, numerous ways for civil society to participate in the
gender and race underlie much of the neglect and design and delivery of policies on family support and
abuse of children. alternative care. Alongside investment in alternative
care, there is a growing campaign for national adoption.
In recent years, Brazil has transformed its work
with vulnerable children and families, moving Whilst the full impact of this work is yet to emerge
away from a reliance on residential care towards there are already some very positive indications: the
a stronger focus on families. This is supported number of children placed in alternative care due
by a comprehensive legal and policy framework to poverty has declined and the use of residential
and action plan, all of which seek to strengthen care has also decreased overall; individual cases
the capacity of families to thrive and to care for of inadequate care are also being dealt with more
their children effectively. Poverty, and its impact on swiftly, with children spending less time in residential
care and protection, is taken very seriously and transit centres. A wide range of social services and
responded to through extensive social programmes. professionals from different academic backgrounds
Often this involves vulnerable children and families have spread across the country, increasing the level
being assigned a social worker who helps them to of child protection service provision; and there are
access a range of services including cash transfers, now 12 million families receiving social protection,
counselling, and support for housing, employment arguably benefiting 48 million people overall
and substance abuse. Teams of social workers also (Ministerio de Desenvolvimiento Social e Combate a
help to build community awareness of care and Fome 2009).
protection risks and to identify vulnerable children. Despite these achievements, several challenges
Work is also being done to reintegrate children living remain. The level of need far outweighs resources.
or working on the streets or in residential care with There are not enough social workers and those that
their families, or to find them a temporary foster care exist require more training, and the bureaucratic
placement while social programmes are provided burden placed on social workers prevents them

15. This case study was drawn from Family for Every Child (2013) Improving social work in Brazil. Results of an appreciative inquiry of social work
with vulnerable children and families in Brazil. London: Family for Every Child.
16. www.worldpopulationstatistics.com/brazil-population-2013/

18 Why Care Matters: The importance of adequate care for children and society
 from providing essential support. There is a lack a fundamental reorientation of Brazil’s social
of back-up referral services, especially around and judicial framework. This includes significant
substance abuse. Far more foster families are investment in legal and policy reform – both in the
needed. Many organisations working in care are revision and creation of key documents and plans
not registered or regulated by the State. Moreover,
and the reorientation of staff affected by them;
there is a chronic lack of data collection and sharing
increased resources for social programmes and
– both at a macro level and in the case of individual
social work; and a redirection of resources away
children. More fundamentally, the poverty and
discrimination underlying the vulnerability of children from building institutional care to broader support to
and their families remains persistent (Family for families and to the prevention of inadequate care.
Every Child 2013c). Sustained political commitment, and the formation
of a national working group, chaired by Family for
However, the Government of Brazil remains
committed to improving the care of children and Every Child member Associação Brasileira Terra dos
continues to champion the Guidelines on the Homens, to assist this process have been pivotal,
Alternative Care of Children both nationally and as have the formal structures for enabling children
globally. All of this has been achieved through and families to participate at every level.

19 Why Care Matters: The importance of adequate care for children and society
 6. Conclusion and recommendations
Improving the care of children requires action from 3. Ensure broader development and
all parts of society. This is not just a challenge for humanitarian work reinforces the effective
child protection specialists. Rather, it affects the full care of children.
spectrum of sectors – from education to health, - Make health, education and other basic
from economic planning to humanitarian work. and life-saving services accessible to poor
It is a matter for governments, parliamentarians, and marginalised children in their home
businesses, trade unions, multilateral and bilateral communities, and inclusive of children without
agencies, the media, national and international adequate care.
NGOs, and, not least, children and families
themselves. All of these actors have a role to play - Ensure that actors working on child welfare,
in designing and implementing change and holding health, education, justice, growth, migration,
others to account for improving the care of children. poverty reduction, and disaster preparedness
and response work together to prevent
The following recommendations seek to prevent children from being unnecessarily separated
and respond to the inadequate care of children. from families.
They are based on the collective experience
- Support children without adequate care to
of Family for Every Child’s national member
participate in the design and implementation of
organisations working directly with vulnerable
relevant laws, policies, structures and services.
children in every region of the world.
4. Increase the coverage and quality of social
1. Build an in-depth understanding of care
protection in order to strengthen the
in each context, and develop locally
capacity of families to care for children.
appropriate responses.
- Provide families/carers of vulnerable children
- Gain insights into both formal, government-
with a combined package of cash transfers
led care provision, and the care and support
and broader forms of social support to help
offered informally by families and communities
enable them to care for children properly.
- Build on existing strengths, including the vital
- Carefully design social protection for vulnerable
support already offered by extended families.
families and children to ensure that it benefits
- Explore innovative, promising practice and does not have a detrimental impact on the
developed by national civil society care of children.18
organisations for potential replication on a
5. Ensure that each country adheres to
larger scale
the Guidelines for the Alternative Care
- Understand children’s perspectives on of Children. The following are particularly
adequate and inadequate care. important.
2. Make the care of children a political and - Build on strengths within informal care systems
financial priority. and work to address any discriminatory or
harmful practices that may exist.
- Allocate sufficient resources to ensure the
adequate care of all children. - End the use of institutional care for all children,
particularly those less than three years of
- Incorporate the care of children into the post-
age, and develop safer alternatives, such as
2015 development framework through, for
more effective support for families to enable
example, a specific goal and/or target on care.17
reintegration, small group homes and foster care.
- Make investments in the care of children more
- Review and, where necessary, reform national
visible, with dedicated lines of accountability.
laws and policies so that they prioritise the care
- Regularly collect and monitor data on children of children in a safe, caring and permanent
without adequate care. family environment.

17. An example goal: all children live a life free from all forms of violence, are protected in conflicts, and disasters, and thrive in a safe family
environment. An example target: halve the number of children unnecessarily living outside family care and end the placement of all
children in institutional care (from: BCN et al. 2013a).
18. See Roelen and Shelmerdine 2014 for further recommendations around the design of social protection programmes to ensure that they
enhance the care of children.

20 Why Care Matters: The importance of adequate care for children and society
 - Increase and strengthen care structures as Fulfilling these recommendations is a matter
appropriate to each context (for example, of great urgency. Children have the right to be
kinship care, domestic adoption or kafala and/ adequately cared for. The quality of care a child
or foster care) to ensure that children who receives sets them on a trajectory that will affect the
cannot be cared for by their own parents rest of their lives and the societies we live in. With
have a range of quality options in a family many millions of children without adequate care, the
environment. impact this has on development and humanitarian
- Improve local, national and international child goals cannot be underestimated. Those boys and
protection systems to ensure that inadequate girls currently without adequate care are amongst
care is prevented, detected, and addressed. the most vulnerable and excluded people in the
This includes enhancing the capacity and world. They are casualties of inequity, discrimination
effectiveness of the child welfare workforce. and poverty. Realising their rights is arguably the
- Support children and their families to litmus test of any person or organisation committed
participate in decisions that affect them, to progress and social justice and a reflection of the
including individual care arrangements. kind of world we wish to live in today and in the future.

© Robin Wyatt / EveryChild / P4EC Russia

21 Why Care Matters: The importance of adequate care for children and society
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