Romania’s care system was in crisis. Now, it’s a role model

Romania’s journey from response to prevention holds lessons for countries worldwide

A mother passes a child a dandelion in a lush field

When the Romanian Revolution of 1989 put an end to four decades of communist rule, it wasn’t just people who poured into western Europe and North America.

Images, stories and memories of life under one of the world’s most repressive regimes gripped foreign observers. But none was more searing than the plight of Romania’s children, some 100,000 of whom languished in industrial-sized care homes — many emaciated, traumatised or visibly marked by years of abuse.

“Everybody wanted to respond — kind of like emergency relief,” recalled Voica Pop, formerly a Child Protection Officer at UNICEF Romania. Money flooded in as foreign observers and homegrown activists pushed to close down unfit institutions and rehome the country’s forgotten children.

Almost three decades later, this “deinstitutionalisation” process is still ongoing, but Romania’s journey has become an exemplar of how to move from emergency relief to preventing children from entering care in the first place.

Across the world — from Rwanda to Brazil — similar movements are gathering speed, but what lessons can they draw from Romania’s struggle to reform its care system?

Revolution and response

When Nicolae Ceausescu, Romania’s fearsome Communist dictator, took power in 1965, he prioritised rapid economic expansion through a state-enforced spike in birth rates.

In 1966, he banned contraception and abortion. Taxes on the childless followed shortly after. Women under the age of 45 were mandated to attend monthly gynaecological examinations, and if pregnant, closely monitored to ensure she carried the child to term.

Between 1966 and 1989, the maternal mortality rate nearly doubled, and endemic poverty left many unable to raise the children they were forced to carry. Doctors, encouraged by state government officials, advised that children, particularly those with disabilities, be placed in homes.

“Romania didn’t have social workers,” said Pop, because, according to the state, “Romania had a regime in which social problems couldn’t have existed. It’s nonsense, but that was the party line.”

In the decades that followed, Romania’s homes swelled to accommodate more than 100,000 children, but only a tiny minority were orphans. Instead, poverty, neglect and inadequate state support drove most children into care.

When the regime collapsed in 1989, the first priority was to save the lives of children in the homes through emergency repairs to crumbling buildings, provision of food and clothing, and medical care for severely ill kids. In this first phase of the deinstitutionalisation movement, “there wasn’t time for a comprehensive approach”, said Pop. But as the 1990s wore on, the emergency response settled into a strategic mission.

International donations remained abundant, but the pressures of helping children — many severely ill — were less acute than they had been at the start of the decade. The country developed its first formal foster care system, prioritising keeping children within family settings where possible.

Some policies were controversial, however. The widespread adoption of Romanian children by foreign nationals — sometimes without adequate safeguarding checks — alarmed many child protection specialists.

As Romania began the process of getting EU membership, more rigorous child protection policies were drawn up, and an office to guide the deinstitutionalisation process was established directly under the President’s Office. Tens of thousands were taken out of state care.

Then came the crash. The financial crisis of 2008 put a pin in deinstitutionalisation efforts. Funding streams ran dry, and international assistance — as well as political will — plummeted.

But in 2014 came the first national action plan to focus on preventing children entering the care system at all.

Closing down old-style institutions remained a priority. But the policy strategy sought to “turn off the tap”, in the words of Aaron Greenberg, Senior Regional Advisor for Europe and Central Asia at UNICEF, which co-developed the policy, effectively stopping children reaching care in the first place.

Turning off the tap

Gabriela Coman, President of the National Authority for the Protection of the Rights of the Child and Adoption (ANPDCA), which also developed the policy, argued that successful deinstitutionalisation meant changing the way government and NGOs thought about the process.

“Deinstitutionalisation does not mean the closing of one institution or hundreds of institutions, it means a complex process based on the evaluation of every child in it,” she said.

In Romania, that realisation came after a robust study, conducted with the World Bank, revealed that policy had to focus on three areas.

It needed to address and prevent the causes of institutionalisation; improve the quality of care within homes; and learn from proven methods to help children out of the system and back into their families or alternative care.

Closing care homes is still the end goal — the policy strategy commits to closing all old-style institutions by 2022, and a law banning the institutionalisation of all children under seven will come into effect imminently.

But the focus of the national strategy reaches far upstream of the children already in care. Instead, the government is investing heavily in its social workers — both dramatically increasing their number and providing new training to recognise warning signs for children at risk of being institutionalised, and how to prevent it.

Addressing vulnerabilities within the family, whether due to poverty, substance abuse or insecure housing, will all fall within the expanded remit of social workers. Specialist training to support disabled children and their families, who are most at risk of entering the care system, will also be offered by the government.

And local authorities are now receiving support from the ANPCDA in developing their own plans based on the drivers of institutionalisation in their jurisdictions. Training on both social care best practice and how to leverage EU structural funds to pay for the DI process will be provided.

Lessons learned

Pop expressed scepticism that all of the country’s aims would be achieved by 2022: “If the pace remains the same I think it will take longer to see possible impacts than is stated in current commitments. I think there is no way to achieve the results in two years time.” But, she added, “now we have really strong foundations.”

One lesson from Romania’s story is the need to build ironclad partnerships between government agencies. Understanding that the reasons for children entering care are more often due to poverty, substance abuse in the home or violence than the death of the child’s parents, child protection systems need to be in alignment with healthcare systems, employment support agencies and the education system.

Only by attempting to tackle the root causes of complex social ills can children avoid institutions.

Second is the need for political will. Deinstitutionalisation is a process so complex that progress jars if those with power in government are not champions of the cause. When the ANPDCA was removed from the President’s Office in the mid-2000s, deinstitutionalisation stalled.

Third is to prioritise prevention through building resilience in families and communities in ways specific to each country.

The single best remedy to the ills of institutionalisation is to stop a child entering care at all: in Brazil and Rwanda, that has meant focusing on care within the extended family, while in Bulgaria, prioritising the issues that lead to disabled children being institutionalised.

By strengthening a weak social services system, Romania hopes to solve its own specific vulnerability.

For all of her criticisms, Pop remains hopeful. “I think Romania is a pioneer by considering deinstitutionalisation not only as closing institutions but by focusing on supporting families where there is a risk of separation,” she said.

And while progress might still lag behind where advocates had hoped, finally developing a comprehensive approach is cause for hope. — Edward Siddons

(Picture credit: Flickr/Paul istoan)

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