Orphanages linger in the popular imagination as unnatural relics, places from which neglected children need to be quickly rescued. And many international organizations and policymakers have made it a priority to reduce the role of these institutions, trying to place kids into family settings as quickly as possible.



But children in orphanages in less wealthy countries appear to be doing just as well as their orphaned or abandoned counterparts who live in private homes—even those living with family members—according to a new study that examined the well-being of some 3,000 children in five countries. "Health, emotional and cognitive function, and physical growth were no worse for institution-living [children]," the study authors report in a new paper published online Thursday in the journal PLoS ONE. They found, in fact, that "the institution-based children scored higher on intellectual functioning and memory and had fewer social and emotional difficulties."



With some 143 million orphaned or abandoned children worldwide—and tens of thousands more projected to be orphaned by AIDS and other diseases in the next year—a fresh look at the orphanage issue might be coming in the nick of time for many kids, especially where foster or adoptive families are in short supply.



The new findings are "going to be uncomfortable for many people—or at least unconventional," says Richard McKenzie an economics professor at the University of California, Irvine, who was familiar with but did not contribute to the study. The researchers take a "hit [at] the Dickensian imagery," he says, noting the timeworn tale of Oliver Twist, which he calls a "dramatization"—even for the 19th century. To be sure, previous research has found that young children who have been neglected in massive eastern European nurseries exhibit early developmental and even hormonal differences compared with their noninstitutionalized peers, but the six- to 12-year-old children in the new study—many of whom had been in institutions since early childhood and infancy—appeared to be doing relatively well.



What makes the results even more poignant, says McKenzie, is that by design "the study is biased against institutional care." Children with just one dead parent are technically considered orphans (those who have lost both parents are considered "double-orphans"). So, a child whose father has died but still lives with his or her mother and extended family is still classified as an orphan and should, theoretically, have a better outcome. "You would think kids in the care of strangers to be worse off than those in the care of kin," he says. But McKenzie, who has studied the alumni of orphanages in the U.S.—and was an orphan himself, growing up in the Barium Springs Home for Children, an orphanage in North Carolina—says that the conclusion of the paper "doesn't surprise me as much as it might others."



Before embarking on the study (which was conducted in Cambodia, Ethiopia, India, Kenya and Tanzania), the researchers themselves expected children in institutional settings to measure up poorly to their adopted counterparts. But even before all the data were in, the researchers began to suspect that their assumptions were wrong, says lead study author Kathryn Whetten, director of the Center for Public Health Policy at the Duke Global Health Institute in Durham, N.C.



"The stereotype that many of us in the U.S. and Europe have of an institution is not what is being set up in less wealthy nations," Whetten says. "It's not like what we've seen in Romania or Annie or anything like that." Many of the orphanages the researchers visited were grassroots projects, "being set up by local pastors or local couples that really loved kids," Whetten explains. "What people do not realize is that this [institution] is our community response," a medical student from Uganda who had been orphaned told the researchers.



On average, these facilities had 25 to 30 children and were largely staffed by people who stayed on the premises and received little outside pay—people who treated their caregiver roles as more than a workaday job.



These more organic orphanages were largely outside the purview of government record-keeping. Simply finding the 83 institutions that the researchers eventually studied took half a year in each community. An initial inquiry to the government in Moshi, Tanzania, for example, turned up only three orphanages, but researchers later found 23.



Much of the research literature on orphanages has come from eastern European areas, where Whetten doesn't deny that conditions for children can be downright disheartening. Other work, in East Africa for example, has been done in areas that happen to have a deep tradition of taking in children. Many countries and cultures, however, can have very different attitudes toward orphans, she notes, either shunning them or giving them substandard care. So, "making policies around the world based on what we've seen in Africa" doesn't always work, Whetten says. She and her group wanted to see what was happening to these children in countries where there was a large orphan population—in places that were "as politically, historically, religiously and culturally diverse as possible," Whetten says.



There may be several reasons why these children are faring just as well in orphanages as in private homes. The study authors point out that the continuity and stability of care is often better in institutions, as are opportunities for child-centric activities and education. And, McKenzie notes, from his research and personal experience, the simple support from peers in group-care settings can be a booster of security and comfort. He also points out that in developing countries, something as basic as proper nutrition—often more easily obtained and monitored in institutional settings—can make a big difference in physical and cognitive development. Additionally, when orphaned or double-orphaned children are foisted off on relatives, they can fall to second priority over biological children and even end up in abusive or forced labor situations.



Although the authors do not advocate for sending all orphaned or abandoned children to institutions, "it is not an option that should be taken off the table—and it could be very appropriate for children who don't have another place to go," Whetten says. Evaluating what is best for these children should not be based on a type of building where they live, but instead on the care that is being given inside, Whetten says. "There's such a policy push to say institutions shouldn't exist…[but]…some of the care that's happening in the community is really horrific."



The ultimate goal of Whetten's ongoing research is to develop what she describes is a "guidebook" for assessing various community dynamics and finding the best method for caring for the children.



In the meantime, she and her colleagues hope to follow some of the children in the study through their teens and beyond. "My assumption is that we'll be able to look not just at institutions versus family living, but we'll be able to look at the characteristics of care that help kids," Whetten says.



Certainly, evaluating and monitoring care for orphans can be a daunting task, especially where the numbers are great and resources are limited. But, says Whetten, creating community awareness and even an expectation for quality orphan care might be easier in the places where it is needed most.



If the children from orphanages end up with a better quality of life down the road, neither Whetten nor McKenzie will be surprised. From McKenzie's research of U.S. orphanage alumni, he says, he found his subjects to have outpaced not only those who were adopted or went into foster care, but also their peers who grew up with their biological parents.