New research finds institutions are no less safe for orphans than family care

August 26, 2015

Orphans living in families are at least as vulnerable to sexual and physical abuse and other traumas as orphans living in institutions, a new study finds.

Christine Gray

Christine Gray

Dr. Brian Pence

Dr. Brian Pence

Christine L. Gray, MPH, epidemiology doctoral student at the UNC Gillings School of Global Public Health, is lead author of the work, published online Aug. 26 in the journal Global Health: Science and Practice. Brian W. Pence, PhD, associate professor of epidemiology at the Gillings School, is a co-author.

The research, which analyzed longitudinal data from 2,235 orphans from five low- and middle-income countries participating in the Positive Outcomes for Orphans (POFO) study, challenges the commonly held perception that institutional care puts children at higher risk for experience of trauma than does family-based care.

The POFO study, based at Duke University’s Global Health Institute and carried out in Cambodia, Ethiopia, India, Kenya and Tanzania, is led by principal investigator Kathryn Whetten, PhD, professor at Duke University’s Sanford School of Public Policy and director of the Center for Health Policy and Inequalities Research at the Duke Global Health Institute.

“We found that the incidence of traumatic events is high in both institutions and in families,” Gray said. “The most commonly experienced trauma was physical or sexual abuse – and that was higher among children placed in families.”

Annual incidence of physical or sexual abuse was 13 percent among orphans in institutional care, and 19 percent among orphans in families.

The new study provides a counterpoint to a recent review published by The Lancet which advocated global deinstitutionalization to improve child protection.

In contrast, Gray and colleagues recommend a nuanced approach, which is in line with other recent research indicating that institutions may play an essential role in providing care to the world’s orphaned and vulnerable children.

“Our findings suggest that eliminating institutional care may be removing a viable – and in some cases protective – placement option for vulnerable children,” Whetten said. “We need to use all of the available evidence to identify support services and appropriate care for children, rather than applying sweeping policies that may have unintended consequences, including a rise in street children and child-headed households.”

Co-authors of the current study also include faculty members from Duke University’s Department of Medicine and Duke’s Center for Child and Family Health.

Gillings School of Global Public Health contact: David Pesci, director of communications, (919) 962-2600 or

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