Youth Who Have Lived in out-of-Home Care in Sub-Saharan Africa: Exploratory, Comparative Analyses of Nationally-Representative Data

Background: Youth who have been in out-of-home care, also called care leavers, are at elevated risk of mental health problems in the US and Europe. Little is known about outcomes for care leavers in African nations, where the child welfare context tends to rely more heavily on informal foster care and institutional care. The CDC Violence Against Children Surveys (VACS), nationally-representative surveys of youth in low- and middle-income countries, have in recent years begun to ask if their respondents have lived in out-of-home care. The purpose of this study is to examine the extent to which youth who have experienced out-of-home care experience greater adverse outcomes than those who have not experienced out-of-home care, drawing from nationally-representative samples in Sub-Saharan Africa.

Methods: The sample included N=6,405 children ages 13-17 pooled from the Nigeria, Zambia, and Zimbabwe VACS. Weights were applied such that each country was equally weighted in the analyses. We ran chi-square tests and logistic regressions to examine relationships with the variable, “Has [the respondent] lived outside of family care in the last five years? E.g., an orphanage, shelter or foster care, or with other relatives/families/friends” (Yes=care leaver). Controlling for country, socioeconomic status, age, gender, and education levels, we used logistic regression to look at its association with dichotomous outcome variables of having experienced physical abuse, emotional abuse, peer violence, sexual assault, sexual risk taking, suicidality, self-harm, mental distress (per the Kessler-6 Scale cutoff), and school enrollment.

Results: 60% of care leavers were living with one or both biological parents at the time of the survey, compared to 80% of non-care leavers (chi2(3)=172.37, p<.001). 9% of care leavers were double orphans, compared to 4% of non-care leavers (chi2(3)=46.35, p<.01).

Logistic regressions indicated that care leavers had heightened odds of physical abuse by a caregiver (OR=1.81, p<.001), emotional abuse by a caregiver (OR=1.74, p<.01), having experienced peer violence (OR=1.57, p<.05), and having engaged in sexual risk behavior (OR=1.87, p<.05). They also had lower odds of being enrolled in school (OR=.65, p<.05), and lower odds of mental distress (OR=.25, p<.01). Being a care leaver was not significantly associated with having experienced sexual assault or suicidality or having engaged in self harm or substance abuse.

Conclusions: This study is the first that could be identified using nationally-representative data to examine care leavers in Sub-Saharan Africa. Results showed that children with histories of out-of-home care have many co-occurring risk factors, including experiences of violence, but surprisingly, lowered levels of distress. These results should guide service provision for care leavers. However, the surveys are severely limited by not measuring whether the adverse events happened before, during, or after children lived in out-of-home care. They also conflate foster care and institutionalization in their definition of “out-of-home care”. Thus, many pressing questions remain for future research, and future national surveys must prioritize this often overlooked population.