Why the UK aid agency is investing in getting kids out of institutions

Sofiya, 43, lovingly strokes her 2-year-old son Valeriy’s fair, thin hair as she spoons mushy food into his mouth. The intense focus she has on helping him swallow each mouthful makes it hard to believe she struggled to bond with her son. She is lucky to have a team of support workers around her at the Mother and Child Social Center in Lviv region, Ukraine, where they live. Without them, Sofiya might have placed Valeriy in institutional care from birth. “She didn’t want the child,” said Svitlana Pavlyk, head of the center, when Devex visited in December. Sofiya, whose name and her son’s have been changed to respect their privacy, is a single parent without any family. Her home in Kherson, eastern Ukraine, was bombed during her pregnancy. She evacuated to Lviv, but could not afford accommodation and had health complications. Valeriy was born preterm with the genetic disorder Down syndrome. As a result he has learning difficulties and needs extra help. “Every time anyone asks her about the center, she says: ‘I don’t know what would have happened without it,’” Pavlyk said. The residential service is designed to prevent mothers from abandoning their babies by teaching them how to parent and help them move to independent living. It is exactly the kind of social care provision the British government’s Foreign, Commonwealth & Development Office wants to encourage to keep families together. In January, FCDO announced a new campaign advocating for family-based care for all children globally, and an end to the policy of placing children in institutions or orphanages. Devex set out to discover what progress has been made on this issue so far, why agencies, NGOs, and governments want to see institutions eradicated, and why FCDO has taken this action now. Millions of institutionalized children Global figures of the number of children living in institutions vary. But a 2020 study published in medical journal The Lancet provided a median estimate of 5.4 million children in total. It found Asia had the highest number of children living in institutions, followed by Europe and Central Asia, East Asia and the Pacific, sub-Saharan Africa, the Middle East and North Africa, Latin America and the Caribbean, and North America. According to British charity Lumos Foundation, which campaigns to reform social care systems and advised FCDO on its latest initiative, more than 80% of children in orphanages have a living parent. High numbers of institutionalized children also have a disability. In Ukraine, this is the case for 78% of residential children, according to a 2024 UNICEF report. The country also has one of the highest rates of children in residential care in Europe with nearly 52,000. Centers such as the one in Lviv are rare in Ukraine. Only five similar services exist in the country, according to Pavlyk. Her center is designed to accommodate 10 mothers with their newborns, although some of the current residents also have older children living with them. “We never leave the mothers unattended, even overnight,” Pavlyk explains. Some of the mothers were raised in orphanages themselves and never experienced being mothered. Others have mental health problems that have been exacerbated by traumatic wartime experiences. Down the corridor from the kitchen, Daria is trying to get her 4-year-old to nap. She is very thin and looks tired. Pavlyk tells me the state removed two older children from her care. But with the center’s close support, Daria, whose name has also been changed, is learning to care for her third child. “When the child is older she plans to get all her children back together,” Pavlyk said. “We are looking for housing for all of them at the moment.” A world-wide effort for change FCDO plans to advocate for family-based care of children via a global alliance it is spearheading. Ukraine, Moldova, Bulgaria, Paraguay, the Philippines, and Rwanda have already signed up. Later this year, it will launch a global charter to work with governments around the world to end the use of children’s institutions. While the department declined to provide any details of the amount of funding it is investing in the initiative, it did confirm the plans will continue despite future cuts to FCDO’s budget announced in February. To coincide with the campaign, FCDO has committed to match fund all donations made to U.K. charity Hope and Homes for Children, which campaigns to close orphanages, until the end of March up to the value of £500,000 ($645,000). The approach of replacing institutions with family-based care has proved successful in other countries. FCDO launched its campaign in Bulgaria, where between 2000 and 2024, the number of children in institutions fell from more than 30,000 to just 104, according to information provided to Devex by UNICEF Bulgaria, and a Bulgarian Ministry of Labor and Social Policy report. “The country went through different reform stages including development of the child protection system, building preventative and alternative services as well as capacity of staff, reforming and restructuring of large-scale institutions,” UNICEF Bulgaria’s Director Child Protection Program Dani Koleva told Devex over email. Today, community support centers help children to live with their families. If that is impossible, the preferred alternatives are home-based care either with foster families or extended family members, called kinship care. Koleva added that the U.K. had supported these historic reforms, both by providing funding and a blueprint for change, as the Bulgarian Child Protection Act 2000 was “very much written based on the UK Children’s Act.” UNICEF is a partner on the FCDO campaign, with responsibility for tracking progress in the reduction of the number of children placed in care, she added. Cheaper and healthier The campaign also seeks to highlight the economic benefits of deinstitutionalizing care. FCDO claims family-based care is five times cheaper than financing children’s homes. One financial example is included in a recent policy call by the World Health Organization, UNICEF, and the United Nations It includes data suggesting that every dollar spent on early childhood interventions delivers a 13% per annum return on investment, through better education, economic, health and social outcomes. As well as being more expensive, decades of international research shows growing up in an institution can severely harm children. “Children often experience delays — emotional, cognitive, and social delays,” Sabine Rakotomalala, WHO’s violence prevention unit senior technical adviser, told Devex. “This is due first of all to the lack of stable parental attachment, but then also often very difficult circumstances within the institutional care, and actually quite high levels of violence, ” she added. Lumos Foundation CEO Howard Taylor explained that organizations campaigning for deinstitutionalization had not achieved enough progress to date because they had failed to “make a compelling investment case.” “This agenda of care reform is not just the right thing to do, it’s a smart investment,” he said. Taylor believes the FCDO campaign will help nations and organizations rally together to raise the issue up political agendas. He also hopes FCDO will quickly expand the number of countries included in the coalition, so it reaches a wider geographical area. Taylor particularly highlighted Kenya as a potential member. “We have requested specifically that Kenya be included, because if you look across … Africa, Kenya, in our view, is making outstanding progress,” he said. In 2022, the Kenyan government launched a National Care Reform Strategy for Children, with the aim to transition away from using institutions. Taylor also credited the U.K. foreign secretary, David Lammy, for driving the initiative. “I think it’s personal for him — he wants to use this moment, while he has the office he does, to make a difference,” he said. Lammy stated publicly at the launch of the campaign that adopting a daughter was “the best thing” he and his wife ever did. “Every child deserves a loving and safe family environment where they can thrive and get the best start in life,” Lammy said. Links with another global initiative Another member of the coalition is U.N. Special Representative on Violence against Children Najat Maalla M'jid. Speaking to Devex over the phone, she said FCDO reached out to her to back the initiative because it closely aligns with her mandate to advocate for ending violence against children, and meeting the Sustainable Development Goal focused on that: SDG 16.2. In November, M'jid co-hosted the first Global Ministerial Conference on Ending Violence Against Children. “During all the work I am doing, I am pushing for deinstitutionalization, strengthening social protection for children … and preventing family separation,” she said. She warned that change would take time, as nations would need to develop alternatives to institutions, which included retraining professionals to deliver home-based support and recruiting foster families. Establishing a response has to be integrated, she added, involving health, education, social protection, justice, and community services. “But I am really happy to have this global movement,” she said. “This is very important.” Back in Lviv, Sofiya lifted Valeriy out of his high chair. She and Pavlyk encouraged him to take some steps. He has reached this milestone, which is a significant achievement for him, as developmental timelines can vary for individuals with Down syndrome. But he planted one foot ahead of the other with determination. Pavlyk laughed with pride. In the corridor outside the kitchen she smiled. “I hope Sofiya will be able to look after him in the future — she has changed a lot,” she said. “Valeriy is her sunshine.”