Keeping families together in Central Asia
Working to end the region’s long history of institutionalizing children, and support the creation of social services that meet the needs of all vulnerable children and their families
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The goal: By 2030, zero children in institutional care in Central Asia
Every child has the right to grow up in a nurturing family environment. Yet nearly 60,000 children aged 0-17 years across five countries in Central Asia are growing up in residential care, despite the well-known and devastating impact of family separation and child institutionalization. This figure may well be the ‘tip of the iceberg’, given current limitations in data availability, consistency and coverage.
The rate of children in residential care can reflect the strength of a country’s child protection system, with a higher rate signaling a system that is failing to keep families together. Today, an estimated 203 children for every 100,000 children, on average, live in residential care across Central Asia, almost double the global average of 105 per 100,000.
The impact of family separation and institutionalization on children can be lifelong. When children are separated from their parents it is often under tragic circumstances, triggered by distressing and traumatic events. Family separation can leave children – and their parents – feeling worthless, and imprint lasting scars on their mental health and psychological well-being.
Children who are housed in large-scale institutions face emotional neglect, abuse and exploitation that compound their distress and trauma, with an impact that often extends into adulthood. Child institutionalization has serious consequences for children, families and for society by perpetuating stigma and social isolation, and feeding an intergenerational cycle of disadvantage.
Children who are already vulnerable as a result of poverty, disability and lack of support services are the most likely to grow up in an institution. Children with disabilities, for example, are up to 30 times more likely to live in residential care facilities in some countries in the region than other children. And marginalized families are more likely to miss out on the basic services that help families stay together, including childcare, healthcare, education, early intervention and family support services. Child and family support and child protection services often lack the resources – financial and human – to prevent family separation.
UNICEF’s position is clear: no child should ever be placed in alternative care because of poverty, disability or challenging behaviour, or because their family lacks access to services they need to care for their own child at home. On the rare occasions when alternative care is in the child’s best interests, it should always be family-based – never institutional. Keeping families together will help to end the region’s long history of institutionalizing children, and support the creation of social services that meet the needs of all vulnerable children and their families.
The challenges
The impact of family separation and institutionalization on children 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 younger the child when they are removed from their family, the greater the potential damage, yet child institutionalization often signals a lack of support for parents during a child’s earliest months of 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 reunite children who have been institutionalized for prolonged periods of time with their biological parents or place them with relatives or in other forms of family-based alternative care.
There is a continuing reliance on institutional care for children who have been separated from their families in parts of Central Asia. In Uzbekistan, for example, most children in care are still living in residential institutions: 58 per cent compared to 42 per cent for children in family-based care. These percentages are almost reversed in Kazakhstan, where 44 per cent are in residential institutions and 56 per cent are in family-based care. In Kyrgyzstan, 69 per cent of children in care are in family-based care, compared to 31 per cent in residential care – but this may well mask considerable numbers of children who are being cared for through informal family arrangements that are not monitored or captured in the data as they fall outside the main child care system. Indeed, all data should be treated with caution, given current limitations, as they do not include all children in alternative care or reflect the precise proportions of children in institutions, formal family-based care, or informal care arrangements.
Recent reductions in the institutionalization of children in Central Asia are a positive shift. However, other types of formal alternative care are increasing, including foster care and guardianship. In Kyrgyzstan, the government is working to ensure formal guardianship arrangements for the children of parents who migrate for work, in a context where informal support is often provided by relatives. Nevertheless, an increase in alternative care signals that many children are still being separated from their families. While family-based arrangements – formal or informal – may be preferable to child institutionalization and may reflect a strong tradition of family support across Central Asia, they are no substitute for enabling a child to stay with their immediate family if at all possible.
Support to keep families together
UNICEF is working with governments and partners in every Central Asian country to support the development of robust family support services, the closure of large-scale residential facilities for children, and the transition to family-based alternatives to institutional care.
Keeping families together in Uzbekistan
More than 30,000 children remain in residential care facilities in Uzbekistan, the vast majority of them children with disabilities. UNICEF and the Government are making strenuous efforts to change this, and Uzbekistan is now spearheading Central Asia’s efforts to keep families together.
Presidential Decree No. 6275 ‘On Measures to Further Improve the System of Ensuring the Guarantees of the Rights of the Child’ adopted on 9 August 2021 halted the creation of new large-scale residential care facilities for children and set out to close all four of the country’s ‘children’s towns’, 14 of its 16 orphanages, and two of its 11 baby homes. As a result, between 2021 and 2022, hundreds of children were either reunited with their families or placed in family-based care, including foster care. The remaining residential care facilities came under increased scrutiny, and a facility for girls was closed as reports of systemic abuse and appalling conditions came to light.
The Decree also mandated the development of a national strategy for deinstitutionalization and the scaling-up of family-based alternative care solutions. As a result, a new Social Worker Centre of Excellence will train thousands of additional social workers in the coming years - a critical investment in Uzbekistan’s deinstitutionalization efforts. Social workers will receive specialist training to help keep families together and provide ongoing support to children in foster care.
Practical, family-centred support in Tajikistan
UNICEF and its partners in Tajikistan are working to help children grow up in family settings rather than institutions. The Family and Child Support Centre in Istaravshan city for example, opened by the President of Tajikistan in 2021, is one of a number of ‘baby homes’ in the country that has been transformed into a family-oriented centre with UNICEF’s support. The services offered by these centres include:
- early intervention and rehabilitation services for children with disabilities and their parents
- day care for children while their parents are at work
- ‘five-day care’ for parents of children facing difficult life situations
- ‘respite care’ or ‘give a mom a break’ services for parents of children with disabilities
- mother-and-child units for mothers who are facing a crisis, including those who have given birth to a child with a disability and who, in the absence of support, might feel they have no option but to place their child in an institution
- multidisciplinary teams of professionals who can connect children and caregivers with other services.
The main goal is to ensure that each child is integrated into their biological family – or when this is not feasible, to place the child in an alternative family-based form of care.11 Within its first year of operations, the country’s four Family and Child Support Centres provided support to 359 families, and 373 children (including 322 with disabilities) were diverted from institutional care.
The partnership between UNICEF and the Ministry of Health and Social Protection of the Population has included providing parents and other caregivers with online support to help them build their skills and prevent the placement of children in residential care. In all, 928 children, including children with disabilities received online support in the initiative’s first year, including information on how to prevent COVID-19, legal support to access medical and social services, and psychosocial support.
Recommendations to governments
UNICEF calls on governments and institutions in countries across Central Asia to keep families together wherever possible and end the institutionalization of children
by 2030. This requires strong support for families and action to address the heightened risks faced by the most vulnerable children.
A policy framework for action is already in place, based on the Convention on the Rights of the Child, the Convention on the Rights of Persons with Disabilities, the UN Guidelines for the Alternative Care of Children, and the Sustainable Development Goals.
Government and non-government stakeholders in child care reforms are urged to close all large-scale residential facilities for children by 2030.
To achieve this, they should take the following steps.
1. Design and implement effective child care reforms
Design and implement effective child care reforms, based on international commitments to keep children with their families where possible. They should plan for the gradual closure of large-scale institutions and the development of a comprehensive continuum of child and family support and protection services. This means reallocating resources from today’s residential facilities for children to high-quality family support services, family- and community-based alternative care and inclusive education.
2. Invest in the development of a range of child and family support services, including statutory family support services, and a strong social service workforce
Invest in the development of a range of child and family support services, including statutory family support services, and a strong social service workforce, for the early identification of, and intervention in, situations when children are at risk of separation. Authorities across Central Asia need to increase the number of trained, community based social workers who work with children at risk of family separation or in alternative care.
3. Ensure that alternative care is family-based
Ensure that alternative care is family-based. This includes strengthening support for extended family members who care for children, ensuring they have the resources and guidance they need; investing in the development of professional foster care services; and implementing strategies to keep siblings together where possible, recognizing the importance of family bonds
for child development.
4. Ensure that children who are already in alternative care are protected against violence, neglect and abuse
Ensure that children who are already in alternative care are protected against violence, neglect and abuse. This includes robust safeguarding policies and practices (such as safe channels for the reporting of sexual exploitation and abuse), returning children to their families wherever possible, or finding other appropriate, safe permanent family-based solutions.
5. Invest in more and better data on children who are at risk of family separation, in alternative care or who have left care
Invest in more and better data on children who are at risk of family separation, in alternative care or who have left care. Countries are encouraged to increase investment in the availability, quality and international comparability of data on family support and alternative care by strengthening administrative data collection and management systems and integrating them with other information management systems related to children’s well-being. Importantly, children in alternative care and care leavers should be incorporated into national surveys and censuses.
6. Raise public awareness of the benefits of keeping families together
Raise public awareness of the benefits of keeping families together and the urgent need to prioritize family-based care, using robust data and other evidence, including examples of best practice, and sharing family- and child-friendly information on the services and support that is available.
7. Ensure that children have a voice in the decisions that affect them and are consulted when new policies and practices are developed to meet their needs and rights
Ensure that children have a voice in the decisions that affect them and are consulted when new policies and practices are developed to meet their needs and rights.
Highlights
Every child has the right to grow up in a nurturing family environment. Yet nearly 60,000 children aged 0-17 years across five countries in Central Asia are growing up in residential care, despite the well-known and devastating impact of family separation and child institutionalization. This figure may well be the ‘tip of the iceberg’, given current limitations in data availability, consistency and coverage.
UNICEF’s position is clear: no child should ever be placed in alternative care because of poverty, disability or challenging behaviour, or because their family lacks access to services they need to care for their own child at home. On the rare occasions when alternative care is in the child’s best interests, it should always be family-based – never institutional. Keeping families together will help to end the region’s long history of institutionalizing children, and support the creation of social services that meet the needs of all vulnerable children and their families.
