SECTION VI: DISCUSSION AND CONCLUSIONS Chapter 12: Discussion of Results
3.5. Impact of alternate care placements
3.5.1. Foster care
The extended family system has always been well developed in Africa where a collective sense of identity is rooted within the extended family (de la Harpe, et al., 1998). Extended families consist of an extensive network of connections and interdependence between people, extending through varying degrees of relationship to include multiple generations over wide geographical areas and involving reciprocal obligations (Foster & Williamson, 2000). The extended family includes grandparents, siblings, uncles, aunts and cousins. Perceived responsibility for the orphaned children will be determined according to matrilineal or patrilineal cultural practice. Extended families have frequently needed to disperse over wide geographical regions as individuals seek employment or education within industrialised settings. This has created a situation in which grandparents, sick and handicapped individuals and children are left in the more rural environments. The African extended family is still the fundamental source for caring for the sick, aged, weak and helpless (Ntozi &
Mukiza-Gapere, 1995, p. 245). Yet, when family members take on the foster care of orphaned
children, they too will be grieving the recent death of the child's parent who was a relative, frequently their own child.
Informal foster placements are considered normal arrangements for the care, nurturance and socialisation of children. For example, the maternal grandmother often takes on the defacto care and responsibility of her grandchildren, while her daughter completes her education or is employed. Dike (2001, in Burr & Montgomery, 2003) explains the situation among Xhosa families in South Africa:
"when you have your first child, you are considered to be immature and inexperienced. So [your]
mother will bring up the child for you and you will be there to see how... by the time you have your second child, you actually know what goes into bringing a child up" (p. 61). Giese and her associates (2003) confirm this to be a prevalent practice throughout South Africa.
The overwhelming majority of orphans and vulnerable children reside with surviving parents or extended family, many of whom are themselves sick, dying, elderly, or incapacitated (Ankar, 1993;
Cluver, 2003; Family Health International, 2001; Mukuyogo & Williams, 1999). Although foster care in many western countries takes place outside of the extended family system, this form of foster care is infrequent in African countries (Caldwell, 1997, in Foster & Williamson, 2000). The epidemiology of the pandemic suggests that approximately 50% of HIV+ people become infected before their 25th birthday and many of these will die before their 35* birthday (UNAIDS, 2001). This decimation of the parent generation will leave large numbers of children raised by grandparents or siblings.
In fact, it is the grandparents who are most likely to become the spontaneous caregivers of their grandchildren, especially in areas where the AIDS pandemic is the most severe and where the extended family has been seriously weakened (Fox et al., 2002; McKerrow, 1997). In the current context, the majority of foster parents are the grandparents of the orphans: 43% of the guardians of orphans were over the age of 50 and 31% of orphans were in the care of their grandparents (Hunter,
1990). Grandparents are seldom in a position to meet the educational and material needs of their children (Ntozi & Mukiza-Gapere, 1995). Furthermore, due to their age, they may not have the energy and physical fitness needed to actively engage with many of the functions and responsibilities of effective parenting. Rather the new-found caregivers are likely to be elderly, impoverished, struggling to meet the basic needs on their meagre pensions and are themselves frequently in need of care and support.
The focus on foster care as the preferred option of child placement originated with the seminal work by John Bowlby (1988) on maternal attachment and psychosocial consequences of maternal deprivation. The western world began to strongly favour child care arrangements that mirrored family life (Burr & Montgomery, 2003). Adoption and fostering were seen to be more beneficial forms of child placement in situations where the nuclear family had collapsed (Dunn et al., 2003).
By contrast, the orphanage or children's home is the least favoured option. In their survey of 12 European countries, Berridge and Brodie (1998) found a trend to close down large orphanages and small community-based children's homes were only being used in the most extreme situations.
Wherever possible, children in Europe are placed in foster care or adoption 'in the best interests of the child' (Goldstein, Freud & Solnit, 1973). This trend is rooted in the belief that children need the experience of family life for optimal development (Burr & Montgomery, 2003).
However, not all foster placements are ideal. Many foster parents and children experience significant distress and disruption. Children who have led disrupted lives find it particularly difficult to settle and form attachments within their new families. Twenty percent of children in foster care in the United Kingdom have three or more different foster placements over the course a single year (Brindle, 2001, in Burr & Montgomery, 2003). Multiple foster placements are shattering experiences for children as they signal a deeply-felt failure to be accepted and integrated within a family context.
The difficulties experienced with foster care placements in Europe are mirrored elsewhere. Most extended families absorb orphaned children even when their own economic, emotional and social capacity has already been severely over-extended (Burr & Montgomery, 2003; Family Health International, 2001; Ntozi & Mukiza-Gapere, 1995; Richter 2003; UNAIDS, 2001; Wild, 2001). The need to regularly accommodate additional sick family members and orphans, in combination with the fact that the number of functional extended family systems is being steadily diminished, has placed unbearable strain on extended families in the most severely affected countries (Brown &
Lourie, 2000; Foster & Williamson, 2000; Ntozi & Mukiza-Gapere, 1995). As a result, children who have recently experienced the death of their primary caregivers, enter situations that are already experiencing significant distress and profound levels of daily stress.
Research also indicates a tendency to discriminate against, or exploit, orphaned children whether they are in the foster care of relatives or non-relatives (Mann, 2002; Ntozi & Mukiza-Gapere, 1995).
Relatives may suspect that orphaned children are HIV+ and therefore fear that they or their biological children will become infected. This may lead to orphaned children being isolated away from their foster family in order to avoid the family becoming infected (Mann, 2002; Ntozi &
Mukiza-Gapere, 1995).
In addition, in her Malawian study, Mann (2002) found that adult guardians articulate a strong belief that orphaned children have many behavioural problems, are difficult to look after and are ungrateful. Simultaneously, orphaned children in the foster care of extended family members (especially non-grandparents) reveal a startling pattern of abuse and discrimination within their new- found families. It would appear that a vicious cycle of misunderstanding exists. Orphaned children enter the homes of new-found guardians having already been exposed to high levels of distress, stemming from prolonged periods of witnessing, caring for and eventually losing one or both
parents, in addition to being victimised by the stigma that surrounds HIV/AIDS and orphanhood.
Foster parents believe that they have been benevolent in offering shelter and care, despite the numerous explicit and implicit challenges and so they expect the children to behave well, be helpful, be grateful and not complain. Foster parents also tend to discourage children from remembering and discussing past stressful and traumatic life experiences. Conversation and reminders of deceased parents are deemed by their new-found foster parents, to be especially detrimental. They prefer the child to accept the finality of the parent's death, not dwell on past circumstances, adjust to the new circumstances and get on with life. From the children's perspective, there is a profound sense of isolation as it seems to them that no-one is interested in their emotional state or pays attention to their special needs for love and attention as they work through their feelings of grief and sadness.
The feeling of loneliness may be compounded by feeling different to the other children in the family, who may also be perceived as being treated more favourably. They may act out their feelings by being rude or behaving inappropriately or by withdrawing from their foster family. This results in the vicious cycles in which the guardians feel unappreciated and therefore less inclined to be supportive and kind and the children feel sad, angry, alone and unjustifiably discriminated against (Mann, 2002). It is extremely difficult to break or change this cycle of negative person-to-person interactions.
An additional factor is the unfortunate perception held by many community members that access to foster care grants is limited to placements of children with non-relatives. Therefore the extended family is likely to struggle economically without the social service support to which they are entitled.
The lack of financial resources may create a situation in which the extended family resent the consumption of limited resources by sick relatives and additional children. This has negative psychosocial consequences for the children and for members of the extended families who may feel guilt about feeling resentful and having negative attitudes.
Despite all of these difficulties, many extended families are still the primary caregivers for orphans, even in the face of heavy financial burdens (Ntozi & Mukiza-Gapere, 1995). However, failure to harness coping resources and support children through the adversities that they face is likely to have long-term negative impacts for both children and families. Orphans, whether they live within or outside of the extended family, are prone to discrimination, exploitation, neglect, abuse and limited access to health, education and social services (UNAIDS, 2001). For example, fostered children in west Africa experienced higher mortality rates due to poorer levels of general care, increased rates of malnutrition and reduced access to modern medicine (Bledsoe, Ewbank, & Isiugo-Abanihc. 1988;
Orin, 1995, in Foster & Williamson, 2000). Orphans face a bleak future if their primary caregivers are not given additional economic, social and emotional support. In addition, communities can offer support and encouragement to extended family. A feasible way forward is to mobilise and strengthen community responses (Germann & Madoiin, 2002; Hunter & Williamson, 2002).