Affiliation: Gillings School of Global Public Health, Department of Epidemiology
Caring for the world’s more than 150 million orphans and separated children (OSC) is a global priority. Current polices advocate deinstitutionalization, but recent evidence from low- and middle-income countries (LMICs) shows similar outcomes in institution-based and family-based care settings. We used data from the longitudinal POFO cohort of OSC from five LMICs to examine the effects of transitioning OSC from institution-based care to family-based care on incident abuse, emotional difficulties, and cognitive functioning among institution-based OSC. We characterized the familial adult structure among family-based OSC, and assessed associations between changes in that structure and wellbeing outcomes.
Among the 1,194 institution-based OSC in Aim 1, we found a small effect of transitioning from institution-based care to family-based care on incident abuse (risk ratio (RR): 1.2, 95% confidence interval (CI):0.58, 2.43; risk difference (RD): 0.01; 95% CI: -0.03, 0.05), a slight decrease in cognitive functioning (mean difference: -0.96 ; 95% CI: -2.17, 0.25) and a slight increase in emotional difficulties (mean difference: 0.24 ; 95% CI:-0.91, 1.39). For the 1,357 family-based OSC in Aim 2, up to 61.2% reported living with a mother, 12.9% with a father, and 45.4% with a grandmother during follow-up. Approximately 60% experienced at least 1 change in their familial adult structure over follow-up. Cumulative changes in the structure were not associated with incident abuse or cognitive functioning, but more changes were associated with a small increase in emotional difficulties (1 change: mean difference 0.23, 95% CI:-0.33, 0.79; 2 changes: mean difference: 0.57, 95% CI: 0.00, 1.16; ≥3 changes: mean difference: 0.73, 95% CI: 0.18, 1.29).
Global deinstitutionalization policies may not confer the presumed benefits of reductions in abuse and improved cognitive functioning, but the disruption may increase emotional difficulties. Changes in the adult familial structure for family-based OSC are not uncommon, and are associated with emotional difficulties.