The institutionalisation of children—which means putting them in a formal organisational setting that takes care of those who have been separated from their families and lack other family-based care settings such as kinship care, foster care or adoption—has become the first choice for many rural families in Nepal. But over 60 years of research demonstrates the pernicious effects of raising a child in an institutional context. In Nepal, these organisations are understood interchangeably as children’s home, child care home and orphanage. In particular, orphaned, abandoned, maltreated and disabled children are categorised for institutional rearing as they pose problems for societies. Poverty, parental instability, natural disasters, conflict, drugs and HIV/AIDS are the main contributing factors to the increased number of orphaned and vulnerable children in our country.

State of affairs

More than 15,000 children are believed to be living in registered children’s homes and orphanages in Nepal. While Child Policy 2012 and many international and national laws and policies state clearly that the institutional care of children should only be a last resort, and that efforts should be made to keep them with their families or under family-based care, the reality in Nepal is very different. As per the Central Child Welfare Board, 594 children’s homes are presently operating in 46 districts. A number of transit homes are also running in a few districts following the devastating earthquake. Most of them are non-governmental and religious and a very few are governmental organisations. Evidence indicates that children growing up under institutional care are more likely to suffer physical, mental or sexual harm than those living in a family-based care setting. Hence, the concept of good parenting and de-institutionalisation has been highlighted.

First, institutions are often hidden and isolated from the community and not much is known about what goes on inside there. Second, children living in institutions are usually subject to discrimination by the community. The children living in institutions are usually poor, belong to minority ethnic groups, have disabilities, were born out of wedlock or are in conflict with the law. Their needs vary individually. In most cases, a family is the natural protective environment for a child.

Possible risks

Large institutions in general have proved inadequate in caring for children because they focus either on children’s physical wellbeing or formal educational needs. The mechanical way of living and doing may not prepare the children to confront different complexities later in life. A UN Global Study on violence has found disturbing evidence of violence against children in residential care institutions. We are also not ignorant of the principle of best interests of the institution over the best interests of the child. Institutional rearing is neither easy nor economic. The Nepali context is perfect in matters of family bond, care by relatives and harmony.

Studies have shown that children growing up in institutions often demonstrate delays in physical, emotional, social and cognitive development. With a few exceptions, institutions do not encourage children to become attached to a significant adult or be sociable. The consequences of poor attachment in institutionalised children include low self-confidence, lack of empathy and understanding of others, lack of understanding of appropriate boundaries, aggression towards others, cruelty to animals and anti-social behaviours.

Institutionalisation seems to have led to autistic tendencies, stereotypical behaviours, self-stimulation and self-harm.Further, children become highly dependent and are terrified about the future. Some studies have shown that children in institutions are less interactive and highly demanding. Poor moral development (difficulty in understanding right and wrong), relationship problems in childhood and adulthood, delinquent behaviour in adolescence and young adulthood, and manipulative nature are the negative effects of institutional care. Sometimes, there is a risk of physical, verbal and sexual abuse. For example, in 2013, the manager of Abhinas Anath Ashram in Rupandehi was prosecuted for rape and attempt to rape a number of girls in his care.

Better alternatives

Foster care, adoption or keeping families intact is better compared to institutional care. Foster care has greater chances of reducing developmental harm than institutional care. Adoption keeps familial love, care and exposure alive. A family substitute is one of the preferable alternatives to residential care. Hence, care by relatives is a better option. Similarly, children may reside in educational facilities (boarding schools) for studies and hospital facilities for recovery from illness or injury. If all these alternatives fail, residential care needs to be taken into consideration. But the institutions should only function as transit homes. This approach is recommended for the many children that have turned into semi or full orphan by the earthquake. Adult victims can be provided vocational training and career counselling so that they can become self-reliant in the future.

It is important for the government and local communities to realise that the resources being poured into institutional care for children can be better invested in family support, day care, specialist care, education and support and shelter for vulnerable parents and their children. De-institutionalisation is at the heart of developing modern and effective care services for children and families. If children do not get parental care, it is the responsibility of the government to ensure their protection, not of volunteers or tourists. NGOs can often act as pioneers of new ideas, and the state can and should learn from their experiences, but the state must not treat the existence of NGOs as an excuse for giving up financial and administrative responsibility for children in care. Nevertheless, NGOs genuinely committed to de-institutionalisation and upholding the rights of children can be excellent partners of the government.

Regmi is associated with the Nepal Youth Foundation