Maria, Kaloyan and their parents at the kitchen table

Why it matters: Inclusive societies

Discrimination creates inequality. It drives poverty, and reinforces damaging systems – like institutionalisation. Care reform is a crucial step in building a more inclusive society.

There are many facets to inequality – read our key recommendations on disability, gender, ethnic and migratory status discrimination, and the links between care reform and Strategic Development Goals 5 (SDG5) Gender Equality and 10 (SDG10) Reduced Inequalities below:

Around the world, children with disabilities are disproportionally placed in institutions. Even in countries that have reduced the number of children in institutions, children with disabilities often remain institutionalised, left behind in the care reform process

Discrimination against children with disabilities

The UN Convention of the Rights of Persons with Disabilities state the right of all people (including children) with disabilities to independent-living, family life and to access the highest standard of health care, and inclusive education without discrimination. However in many countries, children with disabilities cannot access universal or specialised health or therapy services or education within their communities, which act as a serious barrier to realising their rights. This can lead to families and/or authorities concluding that the only way to access essential services is in an institution.  In some societies, medical professionals actively encourage parents to institutionalise their children with disabilities – often straight after birth. This is due to a still prevalent ‘medical model’ that looks at disability as a medical ‘issue’ that should be treated – ignoring the social and human rights of the child and denying their right to a family life.

Institutionalisation has particularly devastating consequences for children with disabilities. It puts them at risk of extreme neglect, as well as inappropriate treatment practices. This can result in physical under-development and motor skills delays (such as muscle atrophy from a lack of movement and exercise), psychological harm, and in some cases premature death. In addition, evidence demonstrates that many institutions fail to provide children with disabilities with even the most basic levels of education

Families or children with disabilities are at enhanced risk of falling below the poverty line as they can experience additional assistance needs but also the costs of accessing specialised services for their children. This can lead to the intergenerational transmission of poverty, generating a vicious circle of social exclusion and marginalisation, which can result in an increased risk of institutionalisation.

Gender discrimination and institutionalisation

Single mothers typically experience higher rates of poverty compared to dual-parent households. There are also cases where single mothers are forced to migrate to find a job, and consequently children are left in institutional care.

The lack of access to sexual and reproductive health services in the community, including family planning, also increases the risk of child institutionalisation. Historically, women and girls in some countries have been forced into institutions and subjected to work in slavery-like conditions to conceal unwanted pregnancies or as a punishment for defying conservative norms.

The challenges that women with an ethnic minority background and/or disabilities face are compounded by the multiple and intersecting forms of discrimination they face

Discrimination based on race

Institutionalisation has a disproportionate impact on people of colour and other marginalised groups. Indigenous children and children belonging to ethnic minorities are also more likely to experience violence within an institution.

Structural racism leads to the over-representation of children from ethnic minority backgrounds in institutions. The families of children from ethnic minorities experience persecution and discrimination based simply on who they are. They are denied opportunities and easy access to services, and they often know that this treatment is ingrained and unlikely to change. 

The poverty that is so often a driver of institutionalisation can in itself be a manifestation of intergenerational poverty or trauma. In certain communities it is often a consequence of longstanding inequity, lack of diversity and exclusion, and that is rooted in forms of discrimination. This is exemplified by examples of children of particular ethnic backgrounds being over-represented in institutions over many generations.

Institutions are a legacy of, and perpetuate racist, and post-colonial attitudes. Colonialism and post-colonial attitudes cast a strong shadow over care systems around the world. In many parts of the world, institutions were unknown before colonial times. They were built and funded by white people from ‘outside’ and live on as a legacy of the colonial past. They replaced traditional community approaches with a charitable model imported and imposed from abroad that robbed children of their cultural identity, while driving further inequality and removing power from communities and authorities. In some countries, institutions were used as a tool of colonialism with the specific aim of breaking links with indigenous cultural traditions or language and affirming the language, customs of the colonial or dominant ethnic power. 

The care system needs to be relevant and grounded in the communities it seeks to serve, so it is essential that alternative family-based care is appropriate to different cultural needs, and the workforce reflects the communities it serves. This will not only keep children out of institutions, but will open up communities.

Migratory Status

Institutional care is often used as a response or as the first resort for unaccompanied migrant and refugee children across the  world,  even  by  countries  who  have moved away from institutional care for their own citizens.  On arrival to their destination county, many children end up in camps, detention centres, institutions, or are left to fend for themselves on the streets. In addition, services for migrant and refugee children are often developed in parallel to national systems of care – this can lead either to poorly resourced, sub-standard care, or missed opportunities to strengthen the overall system of care, or both.  

Placing children in institutions, particularly in detention, does not meet their needs and puts them at serious risk of being trafficked and/or becoming victims of violence. Family- and community-based care has the potential to better meet migrant and refugee children’s needs, and help them integrate into the community.

Identifying promising practice – nationally and internationally, will help to understand how the system can develop to meet the needs of new populations with different cultural background and who may have been exposed to significant child protection risks.