The situation of orphans in Botswana
The AIDS pandemic is creating a generation of orphaned children who have lost 1 or both parents to the deadly disease. By 2004, an estimated 15 million children between the ages of 0 and 17 years had been orphaned by HIV/AIDS,1 and the rate of orphaning is increasing. Worldwide, the number of orphans increased by 23% between 2001 and 2003, although it would have declined in the absence of HIV.1 Almost 80% of children orphaned by HIV/ AIDS, or 12.3 million infants and youth, are
living in sub-Saharan Africa.1
Nearly 1 in 5 children in Zimbabwe and Lesotho, and 15% of children in Zambia, Swaziland, and Mozambique, require fostering and care.1 In Botswana, the nation with the highest rate of orphanhood (20%), an estimated 120000 children aged 0 to 17 years had lost their mother, father, or both parents to AIDS by the end of 2003.2 In addition, an estimated 200000 children in Botswana will be orphaned by 2010.3
Papers from Botswana
Miller, C., Gruskin, S., Subramanian, S.V., Heymann, J. (2007). “Emerging health disparities in Botswana: Examining the impact of AIDS and the public sector response to the orphan crisis.” Social Science and Medicine. (64):12, 2476-2486.
Abstract: Botswana has the second highest HIV prevalence rate and highest rate of orphanhood in the world. Although child mortality rates have doubled in 15 years, the extent to which health disparities are connected to orphan status remains unclear.
We conducted an analysis of the 2000 Botswana Multiple Indicator Cluster Survey to examine whether orphan-based health disparities exist. We measured health inequalities using anthropometric data among 2723 under-five year olds, nested in 1854 households, and 208 communities. We calculated multilevel logistic regression models to estimate the child, household, and regional determinants of growth failure. We found that orphaned children aged 0–4 are 49% more likely to be underweight than nonorphans (po0.05) controlling for household poverty and other factors; and orphans disproportionately live in the poorest households.
Throughout sub-Saharan Africa (SSA), Botswana is a leader in responding to the AIDS epidemic, in particular as one of the first countries to offer universal antiretroviral treatment. However, orphan-based health disparities confirm that the orphan response is still insufficient. Better data are needed to fully understand the mechanisms that lead to these disparities, and the public sector needs an increased capacity to fully implement the policies and programs designed to meet the needs of orphans. Findings from this study have important implications for countries throughout SSA, and Southern Africa in particular, where the number of orphans has doubled to tripled over the past 15 years.
Heymann, J., Earle, A., Rajaraman, D., Miller, C., and Bogan, K. (2007). “Extended family care for children orphaned by AIDS: Impacts on child welfare & economic survival.” AIDS Care (19) 3: 337-345.
Abstract: While over 90 per cent of the 15 million children who have been orphaned by HIV/AIDS are cared for by family members, there is little information about whether adults can meet orphans’ essential caregiving needs while working to economically survive. Using a survey we conducted in Botswana of 1033 working adults, we analyse the experience of adults who are caring for orphans. Over one-third of working adults were caring for orphans and many with few financial resources: 82% were living on household incomes below US$10 purchasing power parity adjusted per person per day. Because of their caregiving responsibilities, they were less able to supplement income with overtime, weekend, evening, or night work. At the same time caregiving responsibilities meant orphan caregivers spent fewer hours caring for their own children and other family members. Nearly half of orphan caregivers had difficulties meeting their children’s needs, and nearly 75% weren’t able to meet with children’s teachers. Pay loss at work compounded the problems: One-quarter of orphan caregivers reported having to take unpaid leave to meet sick childcare needs and nearly half reported being absent from work for children’s routine health care. This paper makes clear that if families are to provide adequate care for orphans while economically surviving there needs to be increases in social supports and improvements in working conditions.
Miller, C., Gruskin, S., Rajaraman, D., Subramanian, S.V. and Heymann, J. (2006).“Orphan care in Botswana’s working households: Growing responsibilities in the absence of adequate support.” American Journal of Public Health. 96.1429-1435.
Abstract: Objectives. Botswana has one of the world’s highest HIV-prevalence rates and the world’s highest percentages of orphaned children among its population. We assessed the ability of income-earning households in Botswana to adequately care for orphans.
Methods. We used data from the Botswana Family Health Needs Study (2002), a sample of 1033 working adults with caregiving responsibilities who used public services, to assess whether households with orphan-care responsibilities encountered financial and other difficulties. Thirty-seven percent of respondents provided orphan care, usually to extended family members. We applied logistic regression models to determine the factors associated with experiencing problems related to orphan caregiving.
Results. Nearly half of working households with orphan-care responsibilities reported experiencing financial and other difficulties because of orphan care. Issues of concern included caring for multiple orphans, caring for sick adults and orphans simultaneously, receiving no assistance, and low income.
Conclusions. The orphan crisis is impoverishing even working households, where caregivers lack sufficient resources to provide basic needs. Neither the public sector nor communities provide adequate safety nets. International assistance is critical to build capacity within the social welfare infrastructure and to fund community-
level activities that support households. Lessons from Botswana’s orphan crisis can provide valuable insights to policymakers throughout sub-Saharan Africa.
Miller, C. (2006). “How do children experience poverty? Orphan based disparities in health and education in Botswana.” A. Minujin, E. Delamonica and M. Komarecki eds.: In Poverty and Children: Polices to break the vicious cycle. The New School and UNICEF. New York.
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