Vulnerability Of Children Contributing Factors Health And Social Care Essay

Vulnerability Of Children Contributing Factors Health And Social Care Essay The purpose of this chapter is to establish an understanding of the state of children in South Africa, to understand the contributing factors to their vulnerability affecting their quality of life on a multi-dimensional level, and the impact of HIV and AIDS as one of the primary contributors to childrens vulnerability. In light of the information provided within this chapter, the full extent of the basic needs of children in South Africa could provide a foundation for understanding the churchs past successes and failures in order to promote a possible urgent consideration of new approaches. the state of children There is an urgent call for the involvement of faith-based organisations (FBO, like the church), non-governmental organisations (NGO) and local governments to assist in addressing the needs of vulnerable children (Blackman, 2007; Musa, 2005; Olsen, Knight Foster, 2006; Stephenson, Gourley, Miles, 2004). This urgent call stems is in light of the poor quality of life for these children, as well as the contributing factor of the HIV and AIDS pandemic. The church and other FBOs have been recognised by various authors and organisations in their partnership and role in community-based organisations (CBO) (Hoff, 1998; Olson, Messinger, Sutherland Astone, 2005; Olson, Knight Foster, 2006; Unruh Sider, 2005). The role of churches is widely recognised as a change agent whose involvement goes beyond just the here and now. But Unruh and Sider (2005) as well as Mitchell (2001) argue that churches, who are already involved in community development as their approach to social ministries, are not as effective as they ought to be and call for the urgent consideration of their approaches, underlying perspectives and motives. This urges the church to comprehend what the specific needs of orphaned and vulnerable children are, and to consider its effectiveness and its perspectives on how these needs can be addressed. Within the recommended community development response for the church as outlined by various authors (August, 1999; Dreyer, 2004; Du Toit, 2002; Liebenberg, 1996; Myers, 1999; Myers, 2006 and Vilanculo, 1998), there is an urgent call to be needs-based that is developed through the various methods and principles such a response involves. It is therefore essential to comprehend the general state of children, as the causes of vulnerability amongst children can only be understood when their realities are explained and projected. Only within the understanding of their vulnerability and contributing factors, can childrens needs be effectively met and thereby their quality of life improved. There are various statistical estimates and projections on the realities of children, concerning the numbers of orphans and vulnerable children (OVC) in South Africa. Within these various sources, discrepancies were identified between the different sources. The data include projections with regard to HIV prevalence, orphanhood, AIDS related deaths and even total populations. These discrepancies were compared and discussed within the work of Dorrington et al. (2006:27) for the year 2005. No actual data on the true state of orphans and vulnerable children (OVC) were found or concluded as the available statistical data are all projections. Dorrington et al. (2006:17) reaffirm the use of the ASSA2003 Model, but encourage comparison with other projections. Bray (2003:44) raises further concerns regarding the methods used to calculate the estimates and projections in respect of orphans and vulnerable children (OVC), but Bray is even more concerned with what one does with these projections and calls for the careful use of such projected data. Her concerns are based on the labelling of the children as well as the intended outcomes of interventions and the nature thereof. No source could however be found that denies the estimates and projections of orphans and vulnerable children (OVC). For this reason, only statistical data from four authoritative sources, due to their global involvement, leadership and advocacy in this regard ASSA2003 Model (University of Cape Town), Statistics South Africa, UNAIDS and UNICEF will be referred to in considering the regional and national data. The sources used in this study can be accepted as authentic and trustworthy due to the sources national and international activism for children and research within this field of study. Due to the trend in the past ten years of projected figures fluctuating to an unreliable extent, these projections will be handled with great caution. It also needs to be stressed that all projections and statistics provided here are estimates only. The statistical data provided within this study are included merely for the understanding of the realities children are facing and the contribution of these circumstances to the vulnerability of children. Statistical sources from primarily the past eight years (2001 2009) will be quoted and referred to, and all other sources (older than four years and other than ASSA, Stats SA, UNAIDS and UNICEF) will be weighed against these to determine the autonomy of their arguments and statements. 2.2.1 Defining orphans and vulnerable children In order to comprehend the reality of vulnerable children within the context of this study, a clear understanding of the two terms orphans and vulnerable children is needed. Skinner et al., (2006:620) refers to the importance of considering the situation of children orphaned by AIDS, but emphasizes that by looking at orphans affected by AIDS only, does not encompass the full scale of the reality of children, since the HIV pandemic as well as surrounding poverty are creating a context in which large numbers of children are made vulnerable. It needs to be stated clearly that within the understanding of the reality of children and interventions to assist them, it is acknowledged that HIV and AIDS are a major contributor, but not the primary cause or contributor to the vulnerability of children. HIV and AIDS feature as prominent factors contributing to the vulnerability of children but it cannot be separated from other contributing factors. Orphans According to Skinner et al. (2006:620) the most accepted definition of an orphan is a child who has lost one or both parents through death But this definition could also include loss of parents through desertion or if the parents are unable or unwilling to provide care. They refer in most cases to the absent parent as being the father (Skinner et al., 2006:620). Within the literature consulted, the age of the child includes from birth and varies up to between 15 and 21, depending on the context and the level of dependency on care-givers. According to Skinner et al., (2006:620), within the orphan grouping, levels of vulnerability are discerned by an understanding of the direct environment of these children. These environmental understandings are used to understand these orphans within an implicit classification system, such as the nature of their caregivers i.e., extended families, foster parents, community caregivers, child-headed households and institutional care, the level of additional assistance required, and between maternal, paternal and double orphans (2006:620). Various authors have raised their concerns with regard to stigmatizations when defining an orphan within a group such as AIDS-orphans; or their level of vulnerability within their environmental understanding such as the term OVC (Engle, 2008:9; Save the Children, 2007:29; Skinner et al., 2006:620; Smart, 2003:4). Care must therefore be taken with how any term relating to orphans and vulnerable children (OVC) is used as they become objectified or targets for stigma and segregation which further contributes to their vulnerability. Vulnerable Children Vulnerability is not an absolute state because there are degrees of vulnerability which depend on the situation of the child. According to Skinner et al. (2006:620) there are a number of contributing factors to a childs vulnerability and each of these adds to the cumulative load that the child carries. For them, the extent of the crisis and additional problems associated with it also affect the impact on the child (2006:620). Vulnerability is a very complex concept to define and very often the understanding thereof is limited to the circumstance of the child. According to Smart, (2003:4) the concept of vulnerability is not only restricted to individuals, such as children, but is often used to refer to households as well. There does seem to be a link between poverty and vulnerability suggesting that policies and interventions to improve vulnerability among the poor in general, will also have a positive impact on disadvantaged orphans and vulnerable children (OVC) (Smart, 2003:4). The South African Department of Social Development, defines a vulnerable child as a child whose survival, care, protection or development may be compromised due to a particular condition, situation or circumstance and which prevents the fulfilment of his or her rights (2005:5). These conditions could be identified by the following criteria according to Department of Social Development (2005:13), Engle (2008:10) and Skinner et al., (2006:623): A child who is below the age of 18, and meets one or more of the following criteria, is made vulnerable by it as it influences their quality of life: Has a chronically ill parent/caregiver (regardless of whether the parent/caregiver lives in the same household as the child), or Lives in a household where in the past 12 months at least one adult died and was sick for 3 of the 12 months before he/she died, or Lives in a household where at least one adult was seriously ill for at least 3 months in the past 12 months, or Living with very old and frail caregivers, or Lives in a household that receives and cares for orphans, or Lives outside of family care (i.e., lives in an institution or on the streets), Is born of a teenage or single mother; Is abused or ill-treated by a step-parent or relatives; Is living with a parent or an adult who lacks income-generating opportunities; Has lost one or both parents; Children whose survival, well-being or development is impacted by HIV or AIDS; Any physical or mental handicap; or any other long-term difficulty that would make it difficult for the child to function independently Skinner et al., (2006:623). These indicators could include the following constantly present signs: insufficient nutrition, signs of hunger, signs of insufficient sleep, poor hygiene or cannot engage in personal care and does not have clothing or clothing is dirty or damaged (Skinner et al., 2006:623). Illness, either HIV or other major illness; and emotional or psychological problems (Skinner et al., 2006:623); According to them these indicators could include apathy or helplessness that might show in the child as being unhappy, dull, being miserable or lack of motivation, neglect of schoolwork, irregular attendance of school or not performing well at school, low school enrolment rates, high repetition rates, and/or high drop out rates (2006:623). Low immunisation and limited or no access to health services, malnutrition, and a high burden of disease; Abuse at emotional, physical or sexual level; use of drugs (e.g., glue, alcohol, cigarettes, marijuana or crack) and not receiving adequate care (Skinner et al., 2006:623) particularly love, guidance and support; intra-household neglect when compared to other children in the household (2006:623). At a higher risk than their local peers of experiencing infant, child and adolescent mortality; Family and community abuse and maltreatment (harassment and violence); Economic and sexual exploitation, due to lack of care and protection It can be concluded, that even though the HIV and AIDS pandemic is evident as a major contributor and the presence of it will be visible in almost every aspect of being vulnerable; these as well as other factors contributing to vulnerability, must be acknowledged and considered within the wider context of other children. HIV and AIDS is not the only contributor to the problem of orphanhood and vulnerability. Other factors like poverty, wars, abuse, non-HIV related illnesses and natural and unnatural deaths, contribute significantly to the problem of orphanhood and vulnerability amongst children (Simbayi, Kleintjies, Ngomane, Tabane, Mfecane Davids, 2006:20). It is thus important that HIV and orphan interventions attend to the needs of all children, rather than focussing solely on those children affected by HIV/AIDS. 2.2 The SOCIAL STATe OF CHILDREN in SOUTH AFRICA South Africa is being considered as a developing country and an inspiration for the African Renaissance and humanitarian development. With South Africa supposable having the worlds best Constitution and Bill of Rights (Dinokeng, 2009:9), one would expect a reflection thereof in the reality of the lives of the children of South Africa. The National picture the general state of South Africas children The following data are year specific, but reflects the vulnerability of children in South Africa which is the primary focus of the inclusion of this data in this study. In 2006, there were 18.2 million children in South Africa and they constituted 38% of the countrys population, of which 38% were between 6 and 12 years, 34% being younger than 6 years and 28% were teenagers (13 17 years old) (Proudlock, Dutschke, Jamieson, Monson Smith, 2008:64). The livelihood-realities of South African children From all the children in South Africa, in 2006 an estimated 12.3 million or 68% of them lived in households with an income of less than R1 200 per month (Proudlock et al., 2008:63). A further 2.8 million or 16% of all children were living in households across South Africa where children were reported as hungry (sometimes, often or always) because there was not enough food (Proudlock et al., 2008:63; Stats SA, 2006:41). An estimated 10 million or 54% of South Africas children lived in rural areas according to research done in 2004. The Eastern Cape, KwaZulu-Natal and Limpopo provinces were home to about 74% of all rural children in South Africa of which Limpopo was proportionally the most rural province, where only 12% of children lived in urban areas. In the Eastern Cape and KwaZulu-Natal provinces, there is more of an equal split between children living in urban and rural areas. In Gauteng there were 96% and in the Western Cape 87% of the children urban-based. It is a general practice that adults living in rural areas, often move to urban areas in search of work, while their children remain in the rural areas and are cared for by the extended family. There was an indication that babies younger than one year were more likely to be living in urban areas than older children, which suggests that babies born in urban areas initially remain with their mothers (Proudlock et al., 2008:87). The number of children living in informal housing (backyard dwellings or shacks in informal settlements) increased from 2.3 million in 2002, to 2.6 million in 2006 and also accounted for 12% of all South African children (Proudlock et al., 2008:86). Children living in formal areas are more likely than those living in informal or traditional dwellings to have basic services on site. They are also more likely to be closer to facilities like schools, libraries, clinics and hospitals than those living in informal settlements or rural areas. Proudlock et al. (2008:90) reflects on children living in informal settlements as being more exposed to hazards such as shack fires and paraffin poisoning. For them, childrens rights to adequate housing means that they should not have to live in informal dwellings (2008:86). Overcrowding is related to a shortage of housing and also to the size of houses being built. In 2006, 5.2 million or 28% of the total child population lived in overcrowded households (Proudlock et al., 2008:90; Stats SA, 2006:41). For Proudlock et al. (2008:90), Overcrowding is a problem because it can undermine childrens needs and rights, and refer to the right to privacy, and health as communicable diseases spread more easily in overcrowded conditions. For them, children in crowded households may struggle to negotiate space for their own activities. These children may also have less access to basic services such as water and electricity (Proudlock et al., 2008:90). Good sanitation is vital for healthy childhood as there are a number of negative consequences for children who are unable to access proper toilets. It is very difficult to maintain good hygiene without water and toilets children are exposed to worms, bacterial infection which compromises nutrition. A lack of adequate sanitation also undermines human dignity (Proudlock et al., 2008:91). In 2006, only 9.9 million, or 55% of South Africas children had access to adequate toilet facilities and 11 million or 61% of South Africas children had access to drinking water on site (Proudlock et al., 2008:91). In 2006, 10.6 million or 96% of all children of school-going age (7 17 years) were attending some form of school or educational facility. These figures however, are not an indication of the regularity of childrens school attendance; the quality of teaching and learning in schools, or about repetition and throughput rates (Proudlock et al., 2008:74; Stats SA, 2006:9). A reason for concern is the number of children who did not attend an educational facility, as according to Proudlock et al., (2008:74) and Stats SA, (2006:9), in 2006 there were about 447,000 children of school-going age that were not attending an educational facility, of which 337,000 were children aged 13 17. Every year there are 20 000 babies stillborn and a further 22 000 babies die before they are a month old (28 days), which accounted for 30% of all child deaths in 2006 (UNICEF, 2008:6). The mortality data for 2006 showed that the highest number of deaths in the whole population occurred in the 0 4 years age group of which the under five year mortality rate (U5MR) increased from 40 deaths per 1,000 live births in 2001 to 72 per 1,000 live births in 2005. The infant mortality rate (IMR) increased from 29 deaths per 1,000 live births in 2001 to 43 per 1,000 live births in 2005 (Proudlock et al., 2008:78;). It is estimated that one in every 17 children dies before the age of 5 (UNICEF, 2008:6). According to Proudlock et al., (2008:80) the leading causes of death in children under five may be divided into four categories: Complications during and shortly after birth According to them (2008:80), the leading causes of death among children younger than 15 years (for 2000 to 2005) are related to perinatal disorders (disorders that occur in the period of late pregnancy to seven days after birth), which means that newborn children and infants under one year are particularly susceptible to diseases. Respiratory and cardiovascular disorders remain the primary cause of death in the perinatal period and, since 2002, it is the highest specific category of death among children under 15 years. By the end of 2003, the perinatal mortality rate was 35.8 per 1,000 for all deliveries, and 26.4 per 1,000 for all infants weighing more than 1,000 grams (Proudlock et al., 2008:80). HIV-related illnesses HIV/AIDS remains the biggest threat to child survival as the HIV- and AIDS-pandemic continues to devastate the well-being and survival of children (Proudlock et al., 2008:80). Diseases directly related to poverty (for example intestinal infectious diseases and malnutrition) Gastrointestinal and respiratory diseases have shown a decline in incidence since 1997, and malnutrition as a cause of death, has halved between 2000 and 2005 (Proudlock et al., 2008:80). Trauma Unnatural causes of death that account for trauma are classified under unspecified unnatural causes, which makes up 7% of child deaths in 2005 (Proudlock et al., 2008:80). It was estimated for 2007, that for every 100,000 people, 41 were raped (of which 40% were children). This statistic is accepted as under-estimated by UNICEF and states that under-reporting of crime is common, especially when it involves people from the same family or community (2008:7). In the majority of crimes that happen within social or domestic settings, the perpetrators and the victims know each other they are family or friends (UNICEF, 2008:7). HIV and AIDS regional data South- Africa According to Smart (2003:7) the HIV- and AIDS-pandemic can be illustrated as a succession of three waves. The first wave is HIV infections, and it is followed some years later by the second wave of AIDS illness and death. This in turn, is followed by the third wave of children being orphaned by HIV and AIDS, with its impact at multiple levels (2003:7). But according to UNICEF (2004a:4) HIV and AIDS start to affect a child early in a parents illness, as children and young people in an HIV and AIDS-affected household begin to suffer long before a parent or caregiver dies, due to the effects resulting in household income that plummets, interrupted schooling and even total fall-out, either to care for a sick parent or to earn money. The impact thereof continues through the course of the illness, as well as throughout the childs development well after the parents death. Various survival strategies are pursued, such as eating less and selling assets, which are contributing to and intensifying the vulnerability of these households. For UNICEF, Children who are deprived of the guidance and protection of their primary caregivers are more vulnerable to health risks, violence, exploitation, and discrimination (2004a:4). According to UNICEF (2004a:3) children affected by HIV and AIDS are not only affected by orphanhood, but they are also made vulnerable when they have an ill parent, are living in poor households that have taken in orphans, are discriminated against because of a family members HIV status, or who have HIV themselves. For then, HIV and AIDS has joined a host of other factors and includes extreme poverty, conflict, and exploitation, which impose additional burdens on societys youngest and most vulnerable members (2004a:3). It is believed that due to the discrepancies in data older than 2005, there was a global under-estimation of the impact of HIV and AIDS pandemic in South Africa, to such an extent that South Africa was not considered to be a country facing the biggest impact of this pandemic, as compared to neighbouring countries like Botswana, Lesotho, Swaziland and Zimbabwe. Only in recent literature (from ASSA, UNAIDS, UNICEF and World Bank) dated from 2005, it was realized that South Africa will have the biggest impact of HIV and AIDS thus having the biggest burden of orphans and vulnerable children (OVC) due to this pandemic. In 2007, the total South African population was 47.8 million people, of which 18.2 million where children under the age of 17 years (Proudlock et al., 2008:82; UNICEF, 2008:5). In the same year, it was estimated that 5.7 million South Africans were living with HIV, making South Africa the largest pandemic in the world (UNICEF, 2008:7 something not previously considered (UNAIDS/WHO, 2007:16; UNICEF, 2008:7). Women, especially those in their child bearing years, bear the biggest proportion of the HIV infection and a third of pregnant women are estimated to be HIV-positive (UNICEF, 2008:2). The HIV data from antenatal clinics in South Africa suggest that the countrys pandemic might be stabilizing, but there is no evidence yet of major changes in HIV-related behaviour (UNAIDS/WHO, 2007:12). By 2006, 294,000 children under the age of 15 years of age were living with HIV in South Africa (ASSA, 2005:n.p.; Proudlock et al., 2008:82) and the majority of them have been infected through mother-to-child transmission and therefore child prevalence among infants is largely influenced by the HIV prevalence of pregnant women and the interventions to prevent mother-to-child transmission (ASSA, 2005:n.p.; Proudlock et al., 2008:84). The highest prevalence amongst these children was in KwaZulu-Natal with 3.2%; Mpumalanga and the Free State with 2.6%; and Gauteng with 2.5 % (ASSA, 2005:n.p; Proudlock et al., 2008:84). The estimates from the ASSA2003 model further suggested that an overall prevalence of 1.2% in 2000 has doubled to 2.1% in 2006 for children under the age of 18 years (ASSA, 2005:n.p.; Proudlock et al., 2008:63). According to UNICEF (2008:24), life expectancy has plummeted by 15 years, from age 65 in 1996 to age 50 in 2005 and 1,000 people die every day as a result of AIDS-related illnesses.. In 2006, approximately 69% of children and adults with advanced HIV infection were receiving antiretroviral treatment (ART) (UNICEF, 2008:24) while still between 270 000 and 420 000 people died of AIDS related illnesses in 2006 (UNAIDS/WHO, 2008:7). KwaZulu-Natal had the highest number of deaths (15,209) due to AIDS related illnesses, as well as the second highest number (6,378) of children on ART in that year. Gauteng had the second highest number of child deaths due to AIDS related illnesses, but in the same year it had the highest number of children on ART (6,992) (ASSA, 2005:n.p.; Proudlock et al., 2008:85). According to Proudlock et al., (2008:84), the HIV-pandemic has progressed at a rapid pace over the last decade, and the necessary health services to address the needs of HIV infected children, have not been put in place. This has caused children to not be able to access the life-saving and urgently needed antiretroviral treatment (ART). Children in the path of HIV and AIDS orphans With a large number of factors already mentioned that are contributing to the vulnerability of children, the impact of HIV and AIDS can be expected to be another big contributing factor. In South Africa the number of orphans has been increasing slowly, and as a result has attracted relatively little public attention. In years to come however, the number of orphans is likely to rise rapidly as AIDS mortality increases (Johnson Dorrington, 2001:1). In 2001 they (2001:5) considered South Africas AIDS pandemic as still in its early stages, relative to other African countries, as South Africa has yet to experience the levels of orphanhood observed elsewhere in Africa. This is because there are more people infected with HIV in South Africa than in any other African Country, and it is therefore quite possible that the country will ultimately have more orphans due to AIDS related causes, than any other country on the African continent (Johnson Dorrington, 2001:5). According to UNICEF (2008:24), of all the countries affected by HIV and AIDS, South Africa has the most crushing burden, as a result of having the worlds highest number of HIV infected people. According to Proudlock et. al (2008:66), in 2006, there were 3.7 million total orphans this is equal to 21% of all children in South Africa with 619 000, or 3% of all orphans documented to be maternal orphans, 668 000, or 4 % of all orphans documented to be double orphans and 2.4 million orphans, or 14% of all orphans documented to be paternal orphans. According to them, the number of paternal orphans is this high because of the higher mortality rates of men in South Africa, as well as the frequent absence of fathers in childrens lives (Proudlock et al., 2008:66). Per province, the estimates for 2006 were as follows: KwaZulu-Natal with 978 000 orphans. Eastern Cape 816 000 orphans Limpopo 481 000 orphans Gauteng 392 000 orphans Mpumalanga 286 000 orphans Free State 284 000 orphans North West 281 000 orphans Western Cape 198 000 orphans Northern Cape 52 000 orphans (Proudlock et al., 2008:66) There has been an increase in the number of orphans in the past five years, and according to Proudlock et. al (2008:66) there were approximately 750,000 more children living as orphans in 2006 than in 2002 and consider this increase in light of the HIV- and AIDS-pandemic (2008:66). Further to this, they state that there where about 122,000 children living in an estimated 60,000 child-headed households across South Africa (2008:68). Of these, 89% were located in the following three provinces: Limpopo, KwaZulu-Natal, and the Eastern Cape (Proudlock et al., 2008:68). Yearly an average of 1.1 million babies are born, of which 300,000 were born to HIV-positive mothers and an estimated 78,000 of these babies run the risk of getting infected if nothing is done to prevent mother-to-child transmission of HIV. Half of these children die before they reach two years of age (UNICEF, 2008:13). Orphan projections As mentioned, the HIV- and AIDS-pandemic needs to be understood in terms of a series of waves Smart (2003:7). In South Africa, the first of these waves represented new HIV infections which according to Johnson and Dorrington (2001:5) peaked in 1998 at about 930 000 infections per year. This was followed by the second wave of the total number of infections, which was estimated to peak in 2006 at 7.7 million infections (2001:5). The third wave being AIDS deaths, is expected to peak in 2010 with about 800 000 (2001:5 deaths per year, which will lead to the fourth wave being AIDS related orphans. Johnson and Dorrington (2001:4) estimates this wave to peak at 3.7 million maternal orphans (children under the age of 18 years) (2001:13) and 4.71 million paternal orphans (children under the age of 18 years) in 2015, (2001:14) while the total number of children having lost one or both parents is expected to reach its highest level in 2014, at 5.67 million (2001:14). Johnson and Dorrington estimates that in 2015, these orphans (children under the age of 18 years and having lost one or both parents) would be 33% of the total child population, of which 18% would have lost a mother (maternal orphan) and 28% would have lost their father (paternal orphan) and 11% would have lost both their parents (double orphans). They further estimate to remain at these high levels for an expected 15 20 years, due to the general consideration that if a child lost one parent due to AIDS related illnesses, it is most likely for the other parent to also die of AIDS related illnesses, to the extent that by 2020 a total of 40% of all orphans would be considered double orphans (Johnson Dorrington, 2001:14). Giese and Meintjies (2004:2), Johnson and Dorrington (2001:22) call for these projections to be understood as merely predictions in the absence of any major treatment intervention or behaviour changes. Johnson and Dorrington (2001:ii) also states that within these projected orphan estimates, one needs to consider that firstly, relatively few orphaned children are likely to be HIV positive, as most HIV positive orphans do not survive for long enough to constitute a significant proportion of the orphan population. Secondly, the rate of orphanhood is likely to be the highest in the black African population group amongst poor socio-economic groups (2001:ii). Con