SECTION VI: DISCUSSION AND CONCLUSIONS Chapter 12: Discussion of Results
3.4. Changes consequent to the death of a parent
stress, stigmatisation, exploitation, uncertainty about their education and lack of tangible support from relatives in the form of visits and expressed concern (Foster et al., 1997a). AIDS orphans reported that the social and self-imposed silence surrounding issues pertaining to death, reinforced feelings of grief, loss and failure since it prevented them from preparing for the inevitable death and left them feeling that they did not do enough to try to prevent the death (ibid.). AIDS orphans also report more disruptions to their education ( Ankrah, 1993; Foster et al., 1997; Fox et al., 2002;
Gilborn & Nyonyintono, 2000), more depression (Sengendo & Nambi, 1997) and higher levels of emotional distress than children orphaned through reasons other than AIDS (Foster et al., 1997a).
It seems that the loss of consistent nurturance is a critical predictor for developmental problems (Fox etal., 2002; Rutter, 1984).
Over and above these factors, AIDS orphans experience extreme poverty (Ntozi, 1997). They live in fear that they will be Hrv infected (Foster et al., 1997b) and will die in similar terrible and painful ways as they have observed family members die. Many do. The distress of losing a parent can leave children feeling stigmatised, more prone to dropping out of school, socially isolated and alienated from friends, exploited through increased work loads, hopeless, fearful and anxiety-ridden (ibid.).
They hold lower expectations for the future and are less likely to believe that they would be able to find employment (Foster & Williamson, 2000). In a Zambian study, 82% of primary caregivers noted that subsequent to the death of a parent, children became worried, sad, tried to help in the home, stopped playing with friends, became more solitary and fearful of new situations (Poulter, 1997), If orphaned children are to develop the resilience they need to deal with the challenges in their lives, their psychosocial needs must receive proper and prompt attention (Cook, 1998; MadQrin, 2000).Therefore, the way in which a parent's illness and death are handled within the family are critical to a child's future psychosocial functioning (Rutter, 1994). Psychosocial support is a mechanism through which the feelings and experiences of those children orphaned by AIDS could be ameliorated (Madorin, 2000).
(ibid.).The vast majority of orphaned children live within the extended family (UNAIDS, 2001;
UNICEF, 1999). A Kenyan study, for example, found that 36% of orphans lived with their grandparents, 13,5% lived with uncles and 26.6% continued to live in their original parents' house (Ayieko, 2003). In fact it seems that before the AIDS pandemic, no-one knew which children were orphans (Mann, 2002). The HIV/AIDS pandemic, against the background of extreme and pervasive poverty, has changed this scenario.
Children need the opportunity to grieve and resolve their losses both during the period of the parent dying and upon bereavement (Bowlby, 1988). There are several factors that enable a child to cope:
(i) a secure relationship with the dying or deceased parent; (ii) prompt and accurate information being given to the child by the adults in the situation; (iii) participation, both privately and publically, in the grieving; and (iv) access to a trusted and significant other who can be relied upon to offer comfort and continuity of care (Bowlby, 1969; Fox et al., 2002). Perhaps the single most important factor is to speak about and prepare the child for the impending death, so that grieving in anticipation of the actual death can occur (Christ, 2001; Jewett, 1994).
3.4.1. The decision-making process:
The sheer scale of the pandemic, particularly in countries north of South Africa, has changed the traditional strategies for deciding who should take on the custodial care of orphaned children (Cook,
1998; SCOPE & Family Health International, 2001). In the most severely affected countries, most adults feel that the choice of where children will go after the death of their parents is a luxurious concern that they can not afford amidst poverty, illness and the inability of most families to support another child. Children are placed with the "best of the worst" options available to their families (Mann, 2002, p. 31). They seldom participate in the decision-making process of where they will reside, or who will take care of them (Mann, 2002; SCOPE, 2002). However it is striking that children would use very different criteria for the selection of foster parents to those used by adults (Mann, 2002).
In their qualitative study of factors that motivate and discourage people from taking in an orphaned, or otherwise vulnerable child, SCOPE - Malawi (ibid.) found the following factors were cited by adults as being significant in the decision making process: (i) lack of choice - "there is no-one else";
(ii) perceived obligation to extended family - one cannot refuse to take in the child of a relative, although this responsibility is perceived to lie most strongly with those relatives who appear to be financially better equipped; (iii) concern for the welfare of the child, expressed in statements such as "If no-one takes them in, what will become of them."; (iv) to remove a child from an abusive situation in which the child may be suffering unduly or being exploited; (v) moral obligation to comply with a dying person's wishes (at times expressed out of fear that the deceased may haunt one for not complying with his/her dying wishes); (vi) to make an investment in the child's education, such sentiment is often accompanied by the hope that either the educated child will reciprocate and
take care of the benefactor or as an investment in terms of decreasing the chances that a child will be a burden in the long term; (vii) for self-benefit: girl children are preferred as they can be of assistance with domestic work; to gain a share of the deceased's estate; or to become eligible for government grants and other forms of financial assistance; and (viii) As the child is perceived to be relatively problem-free and so unlikely to create difficulties - young children are considered more adaptable, whereas older children are perceived to be more aware of the differences between the deceased's and current household functioning and so are considered to be more difficult to handle (Mann, 2002).
On the other hand, there are various factors that discourage relatives from taking custodial care of orphaned children (Mann, 2002): (i) Poverty and general lack of resources: some families feel they simply lack the financial and material resources to take in additional mouths to feed, (ii) If the deceased parent had been on bad terms either through strong disagreements or jealousy then it is less likely that the orphans will be offered care and protection. If the orphans are nevertheless taken in, there is an increased potential for exploitation, (iii) "Umbombo" - a concept considered to reflect a selfish desire to hoard one's own resources for the benefit of self and one's own biological children, (iv) No perceived personal gain with the implicit belief that the child will never view them as parents, nor will they feel obligated to assist them in old age or illness, (v) If the child is perceived to be highly intelligent, or otherwise gifted, then there could be a fear that the orphan will out-shine the biological children of the family, both at school and in terms of future employment prospects, (vi) Stigmatization and discrimination associated with HIV/AIDS: if HIV+, the child will need medical care and HBC, will impoverish the family and then will die of AIDS, (vii) Orphaned children are perceived to have many problems and consequently will be more difficult. This applies especially to older children, (viii) Lack of a sense of obligation as the child is not well known to them (usually through urbanisation), or they believe the responsibility belongs to others (when there are matrilineal or patrilineal assumptions about family responsibility).
This Malawian qualitative study clearly demonstrates that adults and children use different criteria when considering care arrangements subsequent to the death of parent/s (Mann, 2002). Adults place emphasis on the financial resources and material challenges posed by taking in an additional child.
They therefore expect that children will be grateful and appreciate the opportunities that are being offered and the sacrifices that are being made. Most adults predict that orphaned children will misbehave and are difficult to look after (ibid.). Children, if given the opportunity, would base their decision on emotional factors, selecting the extended family members who have previously shown them the most love, care and attention or who showed respect and kindness towards their deceased parent/s, regardless of this person's economic resources (ibid.).
Since it is the adults who make the decisions, it is largely the practical issues that decide the fate of orphaned children in poverty stricken communities. Children are not given the opportunity to express
their own emotional needs and wishes. Love, care and concern for the child is strikingly absent from the adults' list of expressed motivators for 'taking-in' orphaned children. It would seem that Maslow's (1971) hierarchy of needs may be of relevance in terms of the way in which decisions are made about the future care of the children, since without being able to meet children's physical needs, there is a perception that families would have nothing to offer orphaned children.
Furthermore, many extended families have reached saturation point and feel that they can no longer continue to stretch their already meagre resources. In many communities, the extended family system is in a state of collapse and can no longer provide the safety net into which vulnerable children fall (Foster & Williamson, 2000).
3.4.2. Sibling dispersal:
Economic factors also usually dictate that siblings will be divided out between relatives (ibid.). The rationale given for separating siblings is based on the fact that it is more practical for extended family to take on the additional responsibility of one rather than several children. As one participant in the COPE focus group discussions said "[Choosing a place for an orphan to live] does not depend on who is who but on who has what (Mann, 2002, p. 32). However, sibling dispersal is a source of emotional distress and other problems (Nampanya-Serpell, 1998). The threat to the secure and meaningful attachment relationships between siblings is the probable cause of this suffering in both the short and long term. In addition, siblings may feel closer to one another since they know that they have faced similar circumstances and adversities, whereas friends/cousins are more likely to be perceived as being unable to understand. Siblings also provide a strong link to one's family history, can share stories and collectively develop a sense of belonging. There is a need for further empirical exploration into the role that siblings play in offering each other emotional and social support.
3.4.3. Inheritance praxis:
It is only in modern times that the death of a mother, as the primary caregiver and nurturer, has received so much attention (Foster & Williamson, 2000; Gilborn & Nyonyintono, 2000). Previously inheritance practices were largely patrilineal in nature (World Bank, 1997) so that the death of a father was significant in terms of its socioeconomic impact. Through much of sub-Saharan Africa, inheritance praxis is largely dependent upon whether (i) a society is patriarchal or matriarchal in structure; and (ii) the writing of wills has been accepted and is practised (Foster & Williamson, 2000; Mann, 2002; Ntozi & Mukiza-Gapere, 1995). Inheritance practices usually include consideration of who assumes responsibility for the children and widow, as well as who will take over the possessions, dwellings and land. Much of Africa is patrilineal in kinship structure and polygamy is widely practised in some regions (Foster & Williamson, 2000; Mann, 2002), where
widows are 'inherited' through remarriage to the brother of a deceased husband and property is inherited by paternal relatives9 (Foster & Williamson, 2000).
Asset stripping and property grabbing are frequent occurrences (Fox et al., 2002; Gilborn &
Nyonyintono, 2000; Mann, 2002; Ntozi & Mukiza-Gapere, 1995), leaving many children and widows destitute, unless the traditional leaders intervene. Sadly in certain situations where the parent has made financial provision for the children, this may make them vulnerable to being perceived as financial assets by relatives eager to take on the care of the children simply because they bring money and other resources (Gilborn & Nyonyintono, 2000; SCOPE & Family Health International, 2001). In general however, when a parent has signed a will or indicated where the children will go, the transition into orphanhood is easier for the children (Fox et al., 2002).
3.4.4. Impact of multiple losses:
Along with the death of their parent, children frequently experience multiple losses. They lose status, opportunities, dreams and hopes for their future, economic power, home, familiar routine, structure, discipline and property. The loss of home/family is usually precipitated by the need to move and live with other families/people. This leads to loss of friendships, familiar school and neighbourhood networks as well as a sense of belonging (Hunter 1990; Hunter & Williamson, 2002; Kandt, 1994;
Reyland et al., 2002; Wild, 2001). In addition, many children suffer the deaths of several family members as a result of the various modes of HIV transmission (Hunter & Williamson, 2002). The impact of these multiple losses may deprive them of their childhoods in terms of the spontaneity, playfulness and freedom that is usually associated with children.
Orphaned children, both prior to their parent/s' death and after, are at increased psychosocial risk of physical, emotional and sexual abuse (UNAIDS, 2004): (i) orphaned children are more likely to be exploited for their labour; (ii) they are more prone to enter early and forced marriage; (iii) they tend to be initiated into sexual activity at an earlier age and are more prone to being sexually abused and/or exploited due to economic pressure, loss of parental care and attention and interrupted socialisation. These factors place them at increased risk of HIV infection, STI's, tuberculosis, pneumonia and other diseases (US AID and the Synergy Project of TVT Associates, 2001, p. 12).