Why state care should not mean more childhood adversity

For most mothers, the first embrace and skin-on-skin contact with her newborn, moments after delivery, is one of the most precious and magical moments in the journey of parenthood. But sometimes, perhaps because of family breakdown, addiction or perceptions about a disability, a mother turns away from her baby and abandons him or her at birth.

And so begins the worst possible life-start for many of the 1.3 million children who reside in the care of the state across Central Asia and Central & Eastern Europe.

In those fragile early days of life, the pathway to state care is lonely and brutal. The child will often be taken from the maternity ward to a large-scale state residential institution adorned not with family memories, warmth and affection but rather regulated by administrators with filing cabinets, staff shifts and often even staff uniforms.

Upon arrival, the baby will be placed in a cot like this:

And they will lie and wait and wait and wait. They will wait for the communication, affection and love that a newborn is pre-programmed to expect. But this is unlikely to ever come as large scale institutions have staffing structures that rarely allow for more than a couple of hours attention for each baby each day.

And this is just not enough to enable the healthy physical, emotional or cognitive development of the child.

And as days turn into weeks, and weeks into months, the baby learns to stop crying for attention and to stop expecting affection and love; the parts of the brain that regulate emotional relationships stop flourishing. Statistically, the child is unlikely to ever recover from this early neglect and may remain vulnerable for life.

Could it be different?

For many decades now there has been a consensus across pediatrics, psychology and neuroscience that one-to-one continuous contact between an adult (it doesn’t need to be a biological parent) and a child is needed for normal emotional, physical and cognitive development.

Can we rewind the clock and review the decisions that result in a baby, like the one in the photo, having such an unfair start in life?

What if during routine prenatal visits, a community nurse had the required skills and mandate to identify the risk of abandonment prior to birth, to counsel against it, and to link the mother to family support, social protection and other support?

And what if this could be reinforced by the doctor and the nurse in the maternity ward (over 97% of births in this region take place in a health facility)?

And if all of this failed, what if the baby was delivered to a warm and caring foster care family trained and motivated to give attention, love and affection to the child, while the social worker tries to find a long term home, either within the extended family or if not possible, within a suitable adoptive home?

In my recent TEDx, I talked about the lifelong impact of adverse childhood experiences (ACEs): sexual, physical and emotional violence, living in dysfunctional households plagued by poor mental health, addiction or domestic violence. The other major type of adverse childhood experience is neglect, and the plain truth is that the decision to place a child in a large scale institution results in neglect.

Even with the best of intentions, the human resource structure of large-scale institutions prohibit healthy childhood development, resulting in the neglect of children. It is therefore harder to imagine a decision that has more of an impact on the human rights of an individual than the decision a government makes about what to do with a child placed in the care of the state.

Prenatal interventions; better equipped maternity wards; family support services including cash benefits; even expanded emergency and regular foster care, either within or beyond the extended family; are much less expensive than large-scale institutions a) because the unit cost of childcare is less and b) because long-term health, social and other costs caused by poor outcomes for vulnerable adults from institutionalised backgrounds are high.

The wonderful 19th century French historical novelist Victor Hugo said, “nothing is more powerful than an idea whose time has come”. Thankfully, institutionalisation is an idea whose time has gone.

In December 2012, 20 UN member states across the region supported a Call to Action to eradicate placement of children under 3 in large scale institutions in collaboration with the Office of the UN High Commissioner for Human Rights, UNICEF & the European Parliament. This has to be a departure point for eventually eradicating the placement of any child in a large scale institution.

Under the leadership of the Montenegrin Prime Minister, a multi-sectoral drive for family-based care has seen a 56% reduction in the number of institutionalised children; strengthened kinship (within extended family) care; and a 7-fold increase in the number of children in non-kinship foster care in Montenegro.

Fostering campaign promotion poster -UNICEF Montenegro/Duško Miljanić
Fostering campaign promotion poster – UNICEF Montenegro/Duško Miljanić

A campaign to change negative public attitudes to children with disabilities – who comprise around half of those in state care in our region – has resulted in a dramatic increase in school inclusion and community-based services, thus reducing abandonment.

A long time ago, a model of state care was designed for children who had been abandoned. Strengthened prevention mechanisms are irreversibly reducing such cases. At the same time, public awareness of family violence is increasing and reporting is on the up.

Thus, the child protection system will gradually shift from providing care to abandoned children to protecting those at risk of harm within the family. At the heart of this shift has been the principle that children always need solutions where there is a consistent and solid presence of a trusted adult who will always put their interests first.

Anything less is tantamount to child neglect.

Benjamin Perks is the UNICEF Representative in Montenegro

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  1. Thank you Benjamin for writing this exposure of the human condition. The figures are shocking almost beyond comprehension. Can nothing be done to unite children placed in care with families in other parts of the world who seek to adopt? What does the Church in the Ukraine and other areas mentioned offer in this crisis? Has anyone asked for their support?

  2. Thanks Diana. With the correct systems in place, the priority should be to either work with biological families to enable children to stay and to recruit and manage expanded foster and adoptive care for those who cannot stay in the biological family. We have good and bad practice by church organisations in the region. Good practice is where the church does advocacy with congregations to come forward and register for fostering and adoption. Negative practices in some countries-for example in the South Caucasus are where the Church manages children’s homes with no state knowledge or oversight and where the custody of the child is not managed by any legal process.

  3. It’s Easter Day and I think of all those children without the loving embrace of a mother or family. I can only pray that God will raise up a genuine response to this crisis. That people with loving hearts will commit to visit these children. God bless you Benjamin for illuminating this through your writing.

  4. This article was tough to read, but provided very important insight into the plight of these children. Family friends of ours who adopted from Eastern Europe have noticed these types of issues in their son. He is a great little boy, but it is evident that his treatment in these types of facilities had an impact on his development. Its heartbreaking to think that providing a loving and warm environment for children in that system isn’t given freely. Hopefully changes can be made to improve all the aspects of that childcare system.

  5. Great blog and TEDx… I will share across the CPWG today and include the TEDx as part of our new session on Development, Attachment and Toxic Stress within the CPiE training package. Thanks for sharing!