Why state care should not mean more childhood adversity

Insider on unicef Connect By Benjamin Perks2 April 2015Share this story:

A three-month-old baby lies in a crib at a hospital in Ukraine. She was abandoned by her mother in the maternity ward.
© UNICEF/NYHQ2005-1796/PirozziA three-month-old baby lies in a crib at a hospital in Ukraine. She was abandoned by her mother in the maternity ward. 

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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