In Focus: Ending the institutionalization of children and keeping families together

Every child has the right to grow up in a supportive and caring family environment. Yet nearly half a million children – 456,000 – across the Europe and Central region are growing up in residential care, despite the well-known and devastating impact of family separation and child institutionalization. 

While the rate of children living in residential care has fallen by almost two-thirds in recent years, the region continues to have by far the world’s highest proportion of children who have been institutionalized. Around 232 per 100,000 children are living in residential care across the region – more than double the global average of 105 per 100,000 children. 

The rate of child institutionalization reflects the strength of a country’s child protection system, with a higher rate signaling a system that is broken and the failure of services to keep families together. Recent reductions in the institutionalization of children in the region are a positive shift. Yet other types of formal alternative care are increasing, including foster care and guardianship – a sure sign that too many children are still being separated from their families in the absence of effective services to keep them together. 

The most marginalized children across the region are the most likely to be separated from their families and institutionalized. This is particularly true for children with disabilities who are up to 30 times more likely to live in residential care facilities than children without disabilities. Children from the poorest families, children who are affected by migration and children from ethnic minorities, including Roma children, are also far more likely than other children to be separated from their families. 

At the same time, children from marginalized groups are more likely to be excluded from the basic services that can keep families together, including family support, health and education. Child protection services and specialized family support and social services, including quality community-based social work, are often too inadequate to prevent family separation.

The impact of family separation and institutionalization is severe and can last a lifetime. Children placed in institutions are deprived of the social, emotional and intellectual stimulation that is critical for the healthy development of their brains. The damage can be particularly severe during the early years of a child’s life. Shut away from mainstream society, children in institutions are vulnerable to violence, neglect and abuse.

In later life, children who have grown up in institutional care are more likely to face continued exclusion from society, more likely to struggle with alcohol and drug abuse, and more likely to experience violence, arrest and imprisonment. The long-term impact is so damaging that it is harder to place children who have been institutionalized for prolonged periods of time in family-based alternatives or reunite them with relatives. 

Key reasons for child institutionalization in the Europe and Central Asia region

• Institutionalization is fueled by deep-rooted social norms, particularly for children with disabilities. The persistent stigma around disability reflects public attitudes that hamper both the return of children to their families and efforts to recruit suitable foster parents.
• Social norms also support a ‘medical model’ of disability across the region that focuses on children’s conditions, rather than their potential. This feeds into the view that institutions – rather than families –are the best option for children with disabilities, a view reinforced by a lack of community-based services that can support them and their families.
• The placement of children in institutions is also linked to economic and social inequality, as well as a lack of social protection that can help families stay together, such as child benefits, community-based family support services, adequate housing, and inclusive education and health care.
• The institutionalization of children – as well as the over-use of alternative care – is often a form of discrimination against minority groups such as Roma children, families caring for children with disabilities, children who are affected by migration, and those living in poverty, all of whom are more likely to be removed from their parents or excluded from family-based care alternatives.
• Child institutionalization signals a lack of support for parents during a child’s earliest months of life. The younger the child when they are removed from their family, the greater the potential damage.

A second wave of reforms is now needed. In countries where child care reforms have already reduced the institutionalization of children, it is time for an even stronger focus on keeping families together or, where this is not possible, on family-based alternatives. In other countries, where such reforms have stalled or are regressing, the priority remains to end the placement of children in large-scale institutions. 

Keeping families together is a chance to build social services that meet the needs of vulnerable children and their families. It is also a shift towards approaches based on empathy and outreach to the most vulnerable. And it is a clear sign of government support for the most vulnerable children and their families.

UNICEF is the leading international organization in the region on this issue, with decades of experience and a track record of support for effective reforms. With the right resources we can continue to accelerate reforms that keep families together, advocate with policy-makers and the public for the better protection of children, and ensure the best standards of care for children within the care system across the region.