Introduction

In the Lao People’s Democratic Republic (also known as ‘Laos’), 6 % of children live with neither biological parent and 5 % of children have lost one or both of their parents as a result of death (MoH and LSB 2012). While most children live with both (84 %) or one (9 %) of their biological parents (MoH and LSB 2012), there are nonetheless instances of child separation. Children without appropriate care include, among others, orphans, children living on the streets, victims of trafficking and unsafe migration, and children in adult detention centers (Save the Children 2011). Concerns are being raised about “the breakdown of traditional family structures as parents and/or young people leave home to seek better opportunities elsewhere” (UNICEF 2015). In some villages, migration of Lowland Laotian children into Thailand is common, including many who leave without informing their parents (Wille 2001). A baseline study conducted in Luangprabang and Xayaboury provinces found that parents sent children to work outside of their hometowns or to live with relatives due to the divorce or death of one parent. In addition, parents’ awareness of any possible negative consequences of such living arrangements was very low (Save the Children 2012).

Research is limited in Laos about the circumstances leading to child-parent separation, alternative care options available, and the perceived effect of these living arrangements on child wellbeing. Besides the informal care provided by the extended family,Footnote 1 Laos has several orphanagesFootnote 2 and no formal foster care system. Additionally, government-run boarding schools for children from different ethnocultural backgrounds can be found throughout the country (Faming 2012). There is a long tradition of Buddhist monastic schools where young male apprentices spend variable amounts of time. Monastic schools range from small, rural monasteries with a few students and a teacher to large, urban schools with several classrooms and instructors. The oldest known monastic school was located in Luangprabang, the then capital of the kingdom, and a center of Theravada Buddhism to this day (McDaniel 2012).

Laos is a landlocked country in mainland Southeast Asia with a population of 6.5 million, comprised of a female population accounting for 50 %; 37 % of the population is under 15 years of age, and two thirds live in rural areas (largely engaging in the cultivation of rice) (LSB 2012). Despite large efforts and improvements in the provision of basic services such as education and health care, these essential services often do not reach populations living in remote areas without road or railway access. Children in rural areas are particularly disadvantaged (MoH and LSB 2012). Lao is the official language although many other languages are spoken by ethnocultural groups as well as foreign languages. The main ethnocultural groups are Lao-Tai (67 %), Mon-Khmer (22 %), Hmong-Mien (7 %), and Chinese-Tibetan (3 %) (MoH and LSB 2012). Buddhism is the religion most frequently practiced in Laos although ethnocultural groups in the mountain regions have maintained animist rituals and traditions (Dommen et al. 2013). Local authorities and institutions—including the Lao Women’s Union, established in 1955; the Child Protection and Assistance Committees (CPAC); and over 400 Child Protection Networks (CPN)Footnote 3 at community level play an important role in the protection of women and children (Lao Women’s Union 2009; UNICEF n.d.).

The United Nations Convention of the Rights on the Child (UNCRC) (1989), ratified by Laos in 1991, acknowledges the primary role of parents and family in the care and protection of children. To enhance the implementation of the UNCRC in matters of protection and wellbeing of children, the UN Guidelines on the Alternative Care of Children (2009) were adopted by the General Assembly. The goal of the guidelines is to prevent the unwarranted use of alternative care (informal or formal kinship care, foster care, domestic and international adoption, and institutionalization) and to ensure that where out-of-home care is needed, it is provided under appropriate conditions and with respect to the child’s rights and best interests. In Laos, the Law on the Protection of the Rights and Interests of Children (2007) briefly outlines the principles to guide the alternative care of children, including (a) primacy of the best interest of the child, (b) family members as preferred caretakers, (c) preservation of the culture and religion of the child, (d) residential care as a measure of last resort, (e) child participation in decision-making, and (f) regular monitoring and review of cases (art. 42–43). However, given that the UN Guidelines for the Alternative Care of Children are not yet transcribed into the Lao context, the country lacks a national alternative care strategy. In addition, local research evidence is limited to inform policy-making in this area.

As a first step in responding to this gap in strategy, this study gathered information regarding children in any form of formal or informal care, including care by relatives or non-relatives, as well as children in any form of residential care in Luangprabang and Xayaboury provinces. The perspectives of both adults and young people were gathered for a full perspective of experiences. Researchers have repeatedly found that the most reliable informants are people with firsthand experience (e.g., (Wille 2001), and young people’s participation in research allows more complex and relevant understandings of their contexts and realities (Ruiz-Casares et al. 2013). The main aim of this paper is to answer the following research questions: (a) what are the determinants of child-parent separation in Luangprabang and Xayaboury provinces? (b) What are the alternative care options available in both provinces? And, (c) what are adults and young people’s perceived consequences of these arrangements for children in both provinces?

Methods

Participants

Given its exploratory nature, this study used qualitative methods to map childcare in Luangprabang and Xayaboury, target provinces for Save the Children-Laos child protection work. Information was obtained from key informants through interviews with community leaders (n = 26) and an online-survey for child protection professionals (n = 8). Additionally, group discussions were conducted with adults (n = 192) and children (n = 103 ages 7–11 years and n = 191 ages 12–17 years) in family-based and residential care settings (i.e., orphanages, ethnic boarding schools (EBS), and monasteries (watt)Footnote 4 in Luangprabang and Xayaboury provinces in Northern Laos. Interviews were conducted in two urban sites in each provincial capital and another two or three rural sites per province. Key informants were selected among government officials, village chiefs, and leaders of groups working with children and families in the community (e.g., Child Protection Network and Lao Women’s Union) as well as head staff at residential institutions (i.e., two orphanages, four EBS, two watts) and child protection organizations providing or funding services to children and families. Sites and group discussion participants were selected to represent a diversity of perspectives related to childcare and wellbeing, living conditions, and access to basic services and community supports. Females (n = 286) and males (n = 234) from different ethnocultural groups (primarily Lao Loum, Hmong, Khmu, and Prai) participated in group discussions.

Procedure

In preparation for fieldwork, local research team members, together with government representatives from the Ministry of Labor and Social Welfare, first selected and approached community leaders for permission to conduct the study. Community leaders identified group discussion participants using guidelines provided by the research team (i.e., balanced number of males and females from different ethnocultural groups who were residents of the community and represented adult caregivers of children, children ages 7–11 years, and children ages 12–17 years). On average, there were ten participants per group (range 5–13). In all sites except in some EBS (as advised by their staff), gender-segregated meetings were held with adults and adolescents; group discussions with younger children involved both boys and girls. Data collection took place between January and March of 2013.

Individual and group interviews with adult caregivers and adolescents in residential and family-based care explored child caregiving beliefs and practices in the community, supports and barriers that caregivers faced in caring for children, and the consequences of this situation for children and families. Age-appropriate questions and activities were used with children aged 7–11 years to explore their daily routines, identify people who provided different types of supervision and support, and detect gaps in the provision of care. Each group discussion contained one facilitator and one notetaker. Group discussions with young children were moderated by experienced child workers (Krueger and Casey 2009). Semi-structured key informant interviews were audio recorded and also documented through handwritten notes by the co-authors. Child protection staff at non-governmental organizations (NGOs) and donor agencies in Vientiane (n = 8, representing 44 % response rate) provided input through a brief online survey on the Lao legal and policy framework on alternative care, prevention, and intervention activities having an impact on child separation and family care, and strengths and gaps on regulations and practices in this regard. Finally, a review was conducted of publications and statistics on children in EBS provided by the Ministry of Education and Sports (MoES). At the end of each day, research team meetings were conducted to reflect on and plan data collection activities and to identify emerging themes and patterns. Notes were taken during those meetings.

Data Management and Analysis

All notes taken during individual and group interviews were transcribed and translated into English on a word processor and de-nominalized before analysis to protect participants’ identities. Notes taken at daily team meetings and memos written during fieldwork were also included in the analysis. Descriptive, process coding, and sub-coding were performed on all interview notes. Jotting was also used to flag diverging views and to identify issues deserving analytic attention. Inductive codes were later grouped around specific themes and explanations using pattern codes (Miles et al. 2014). Content analysis was manually performed by one researcher at two points in time on all notes (Schreier 2014).

Informed consent was obtained from adults (including parents of participating children) and children before all interviews. All identifying information was changed to protect participants’ identities. Refreshments were provided during the group discussions. Permission to undertake the study was granted by the National University of Laos. Ethics approval was obtained from the first author’s university. An ad hoc Advisory Committee comprised of researchers and representatives from child-oriented organizations ensured contextual appropriateness of research design and procedures.

Results

Determinants of Child-Parent Separation

Across all age groups, participants indicated that parents have the primary responsibility for children and that child abandonment was rare. Nonetheless, there were situations that resulted in the separation of children from their parents which explained transitions across different types of care. These included primarily parental death or divorce, material poverty, access to school, infertility, and religious and ethnocultural beliefs. Adultery, drug abuse, and gaming were said to break up marriages and result in child abandonment. In cases of divorce, children often stayed with their mother and/or grandparents whereas in cases of death of a parent, children might stay with the surviving parent or move to live with relatives. In both instances, children might be sent to an orphanage or EBS. “For poorer families who cannot support their families by themselves, they come to ask village organizers who can look after their child; especially fathers who have no wives,” explained a government official in Xayaboury. Similarly, large families unable to provide for all their children were said to “have to send children to live with other families with paper note agreement between them” or “to [an] SOS school” (village and provincial authorities in Luangprabang).

For big families who have more children, parents have to work hard... [and if] they couldn’t support them all, it is necessary for parents to send their children to live with other families being adopted children. Some adopted children... are successful in their lives. In these cases, when their child is brought up with other families as a little child, the parents who gave birth have no right to call him/her their child... When they send their child to live with other family, they [often] don’t have any paper signed between them. They discussed on adopted child orally (village authority in Luangprabang).

Material deprivation not only might lead to the placement of children in institutions but it also may contribute to a non-completion of placement in institutions. One provincial authority in Luangprabang explained how, in boarding schools, “when children observe other friends who are different from them in status, they may feel embarrassed and depressed and, in the end, they can drop out of school.” Indeed, insufficient food and poor living conditions were said to contribute to children running away from home or school. Reportedly, in some villages, families send their children for employment to construction sites in Thailand. Cases of government employees and other parents relocating out of the province and leaving children with grandparents or other relatives were also described.

The desire to escape poverty in combination with the understanding that there would be no opportunities to pursue education (secondary or vocational) in their village were the most common reasons for young people to move to EBS or to be sent to live with relatives (primarily aunts and uncles) in urban centers. In other cases, parents built a small hut close to the school where children could live during the week, coming back home during the weekend or, “if some families have enough money, they rented a house for their children to stay in town during their studies there” (adult caregivers in Luangprabang).

Couples who were unable to conceive might also seek to take in children: “Some [people] from another village came to ask for children to live with them because they have no children,” explained a village authority in Luangprabang. According to an adolescent in family-based care, “Some parents from another village who didn’t have children came to our village and took children to be adopted and supported them on education because they wanted someone to continue their race.” Adolescents in Xayaboury also described how, on occasion, “people from outside ask [for] children to be adopted child; they gave money to grandparents.” The agreement was often made between the “adopting” parents and the village committee so that “some families have adopted children legally because they have permission notes from village authorities” (village authority in Xayaboury).

There is a family that took a baby from Vientiane hospital to be their child. When the child was born in the hospital from a mother who did not really intend to have a child, the child was announced to relatives, then to other parents. In order to take a child to be adopted, the parents should have admission note from the hospital, and when the parents arrive in their province, they have to get letters from the village headmen and judge” (key informant in Xayaboury).

Some cultural norms and practices entailed the separation of children from their parents. For example, a practice described by a village authority in Luangprabang as applying mostly to highland ethnic families, was “swap care.” Based on the belief that if newborn children were kept at home, the parent would fall ill, babies were sent to live with someone else who could care for them until they “grew enough” and could be returned to their parents. Also, a provincial authority in LBP explained how “before 1975, villagers believed in the superstition that when a lady gave birth, the baby brought unlucky symbol for parents if they kept that child with them or parents would die.”

Finally, young males might become novices in a Buddhist monastery, mainly to complete their studies in the “monk school” if their family was poor; other cases followed a different motivation such as in gratitude to family elders (e.g., to accrue karma or spiritual merit for a recently deceased family member) to improve the child’s character and behavior or to respond to an inner calling to become a Buddhist monk and learn about the teachings of Buddha. Like motivations, length of stay also varied widely:

There are some children [who] come to live in temples when they are in school holiday for a short time. Some temples have two to three children. Some children said that they wanted to study in the temple during school break. When the school started, they left the temples and went [back] to school (provincial authority in Luangprabang).

Alternative Care Arrangements

In the absence of parents or if they were unable to care for children, aunts and uncles were generally approached first; the closest cousins/relatives were approached next. If kin was unable to assist, orphanages or other families were contacted via the community authorities. Over time, children commonly experienced different types of care. Following the death of one parent or parental divorce, for example, children might stay for some years with the surviving parent then move to live with an aunt or uncle, who sent them to an EBS or vocational ethnic school when they reached adolescence. On occasion, in several of the communities visited, these children may be solicited to move to an orphanage or boarding school or to live with another family.

According to adolescents living in family-based care in different communities, the decision to send children to live away from their family was made by the village authority or by parents; the latter may have consulted with grandparents and the village authority but not with children. Others acknowledged that it was children who took the initiative “because they want to go to school for studying” or their “families are poor and do not have enough food to eat.”

At the time of this study, there were over 1000 children in six SOS Children’s Villages (CVs) in Laos (including one in the study provinces); five of these CVs comprised a school, where other children from the surrounding communities were educated too. Each CV consisted of 10–15 group homes where approximately 10–11 ethnoculturally diverse children lived under the direct care and supervision of an adult female referred to as “mother.”Footnote 5 By SOS’s own estimates, every ten children living in CVs in Laos, eight were double orphans and two were single orphans with the surviving parent not being able to care for the child. Children originated from different provinces and ethnocultural groups. Orphanhood, application to the Minister of Labor and Social Welfare through the corresponding local authority, and consent from relatives were necessary conditions for admittance.Footnote 6 While individuals might initiate a request too, one key informant in Luangprabang described how “for SOS school, there is an announcement by the social welfare office [in the district] to select children [to be sent to SOSCV].” Each case was assessed individually, including visits to the community of origin. An effort was made to admit and keep siblings together. Houses were co-ed, yet bedrooms were segregated by sex and age. At adolescence, boys moved out to live with the “mother”’s brother while the girls stayed in the house until they grew of age or became independent (if after 18 years). Children were not allowed to leave the CV without a staff member, and contact with outside relatives was limited to four times in the year. More often than not, however, visits did not occur due to long distances and inability to pay for transportation. Buddhist practices were followed in the CVs although children were allowed to practice other cultural beliefs and eventually visit their communities of origin for special festivities. Although “mothers” prepared adolescents for leaving the village and being part of the community, children’s limited ability to leave the village was identified as preventing them from understanding the reality of life outside the community.

In 2011, there were 27 EBS in Laos, housing almost 9000 children (64 % male). In the two study provinces, there were over 1500 students (59 % males) in four EBS in 2013 (MoES 2013). Often times referred as “orphanages” or “orphanage schools” by the communities visited, they were said to attract mostly children from very poor households in the province, and, to a lesser extent, orphans and specific ethnic groups. Every year, the MoES set a quota that was used to recruit children for EBS; village heads in each district made the announcement and coordinated recruitment in their communities.Footnote 7 “The district contacted the villages, and villages chose who can be selected to study in orphanage school. The selection focused on orphans and poorer families. Some years, villages send more children than the capacity of the district,” indicated a government official in Xayaboury. Demand was said to be high and supply, low—“Schools are not enough and also announcement to rural areas is still late. Some children in remote villages can’t go because they don’t receive the announcement,” explained a government official in Luangprabang. The government provided a monthly allowance per student for food, while educational materials, clothes, and food for breakfast were provided by children’s families, international non-governmental organizations, and private donations.Footnote 8 Children might arrive at 8 or 9 years old or at 13 years old, depending on whether or not the school offered primary or secondary education, and stay for the duration of their formal education. Teachers and the school director looked after students; there was generally one teacher per sex-segregated dorm, and dorms were organized by grades (approximately 16–20 students per room/grade in bunk beds, and 10 rooms per block). Although the ratio was officially set at 15 students per teacher, this ratio was not always attained nor was it considered adequate in cases of children with increased needs and behavioral problems. Children were allowed to visit their families once a year for up to 2 months during vacation and major celebrations (e.g., Lao New Year, Buddhist festivities). Some children from the EBS benefitted from scholarships to study in Vietnam or at the teacher-training center in Vientiane.

Between 7 and 20 years of age (most often starting at age 10 years), young males might take the robe of a sammanen (Pali word for “novice”) in a Buddhist monastery.Footnote 9 Several monks under the guidance and leadership of the Abbot provided care. Dependent on daily food donations from community members, other expenses were covered with funds raised by celebrating household and other ceremonies in the community. Whenever assistance was needed (e.g., to cover cost of surgery), community members were also approached for support. Children were to behave decorously and follow the code of conductFootnote 10 as well as the instructions and recommendations of more ancient novices and monks. Novices in Luangprabang had exposure to English and the Internet, yet some adult family-based caregivers shared a concern that former child novices did not know how to work when they came out of the monastery.

Wealthier and smaller families were perceived to provide better care because poor parents “have no money to support children to go to school and … to vocational school,” and to provide enough clothes and food “for all five components.”Footnote 11 This perception also explains participants’ generalized belief that children “living in orphanages” (i.e., EBS or CV) could not go back to their parents if their families had many children and were poor; they might, however, go back when they had “finished their study and have a job” (adolescents in EBS in Luangprabang). In contrast, “for middle and better-off families, children can go back home,” participants in a group discussion in Luangprabang indicated; in order to do so, “the village authority will contact the EBS or SOS to bring the children back home, in case their families can care for them continuously and sufficiently.” An adolescent participant also explained:

I think that if we send children [from orphanages] back to their homes, they don’t have an opportunity to study [because] in their home town [there is] no school and [they are] very poor; if they go back home they can’t go back to study at the ethnic boarding school. The school does not accept them.

Perceived Impact of Residential and Informal Kinship Care on Child Wellbeing

Some group discussion participants indicated not being aware of any problems that happen when children live away from their parents. For children living with relatives, there were testimonies that caregivers love them “like their own children, buy clothes for them, [and] support them to go to school.” Similarly, an adolescent living with her aunt shared how “she loves me as her real daughter.” From the perspective of grandparents themselves, one participant indicated, “We teach and love our grandchild like our real child and when they grow up to be adults, they will take care of us.” Experiences of kinship orphan care ranged widely, though, and sibling separation was not uncommon. For example, an adolescent shared the case of two children whose mother died and their father remarried, and the “younger brother was sent to study in ethnic school, and the sister lives with a cousin.” Compared to biological children, “adoptive” children and children who lived with relatives were said not to receive always enough food and clothes and were required to work harder in household chores. In contrast, an interviewee in Xayaboury indicated that in “some families, parents take more care of adopted children than their [biological] children because parents don’t want to hurt their feelings.” Both relatives and “second parents” (i.e., unrelated local villagers) provided material, emotional, and informational support to children living away from their parents in kinship care and in monasteries. Children were said to sometimes “receive warmth from second parents,” who may also serve as a link, sending news about their children to their parents.

Overall, participants agreed that it was better for children to be cared for by their parents than to be sent to institutions “because they receive affection and live together in family;” additionally, children living in families were said to be “better in behaviour, and they know how to respect and relate politely to elder people” (key informant in Luangprabang); in contrast, children in schools were said to “become more responsible on their own.” “It could be said,” indicated a key informant in Xayaboury, “that the school is better because there are facilities for them such as: accommodation, food and school has regulation for children and there are people who work in the school and are on duty from morning to evening.” Indeed, some participants highlighted the fact that EBS provided children from remote villages with access to schooling and more time to study (rather than helping in the family or going “outside of the school to play”), health care, utilities (i.e., water and electricity), and good care “because all caregivers in those schools … were trained on how to look after children.” Several public authorities in both provinces indicated that “children at school were having better lives than families” and teachers provided better care than some parents to the point that some “children really want to leave home” and/or they “don’t’ like to visit their own village and their own families.” Several adolescents in EBS indicated that teachers took good care of them, including looking after them when they were sick and teaching them how to be good and how was life outside of the school. Adolescents also appreciated the opportunity to study and make new friends.

Some adolescents in residential care, however, indicated not receiving sufficient care, complained that young children received more attention and that some children received no news from their parents. Concerns over inadequate care were also voiced by survey respondents: “In relation to ethnic boarding schools, care varies significantly and there are vulnerabilities there in terms of quality of care and the lack of psychosocial support for children.” Adults were aware of this too—a key informant in Luangprabang indicated that “children who live in orphanage school, sometimes they think of their parents and feel homesick because they come back to visit their own parents once a year [only].” Similarly, EBS staff and students mentioned homesickness and insufficient food and hygiene (at school and in their home communities/families of origin) as having a negative impact on children’s health and school performance. According to EBS and orphanage caregivers and adolescents, adapting to residential care was difficult for many children who missed their families, friends, village grounds, and rice fields. Homesickness was compounded by some children from ethnocultural groups who did not speak Lao upon arrival and originated from poor families in remote rural areas (i.e., unable to afford family visits during vacations). In the words of a survey respondent, “language and gender can pose additional risks to children in these environments resulting in exclusion.” Children with parents or relatives nearby were said to visit them on weekends “to get some food;” in contrast, others did not see their families often even if their parents might still support them “by sending them money and other things.” For example, parents of EBS children in a village in Xayaboury indicated “they have to send food to their children to eat during vacation because in the ethnic boarding school food is insufficient.” Adolescents explained how, whereas it might take 4 to 5 weeks for some children to become familiar with the school, others would cry for a year. According to EBS staff, strict rules and regulations (e.g., re: eating, studying, living, and sleeping) and lack of familiarity with a new place—including school, dormitory, classmates, teachers, food, and daily routine—might also add to the difficulty of adaptation. Children experienced homesickness particularly around the time of meals—“I have to prepare it [breakfast] so food is not enough for me; then I miss my parents,” indicated one youth. This perception extended into the community; as an adolescent in family-based care indicated, “I am afraid that if I go to school I will not have friends to play with me nor food to eat.”

In all the EBS visited, lunch and dinner were provided by the school but not breakfast. Some EBS did not have a functional kitchen, which forced children to cook in their dorm, and youth participants described having to carry water when the pump was not functioning. Some children arrived in the school only with their own pair of clothes, and the school had to provide new clothes, sleeping mats, mosquito nets, and blankets. EBS teachers indicated the dirtiness of bodies and rooms as one of the main barriers in caring for children. It was also difficult when children became ill, particularly when their families could not provide financial support as this often resulted in a school’s indebtedness. Some children were reported to drop out of school and even walk back home without informing the principal and threatened to commit suicide if the teachers did not send them back to their families. “There was one child who escaped from school, and [the Lao] Women Union coordinated with other parents to follow them and persuaded them to come back to school,” shared a key informant in Luangprabang. As a result of these concerns, few or no children were sent to EBS in some communities.

Child protection professionals who responded to the online survey shared their concern with the lack of follow-up and ongoing assessment of the placements and variable standards of care in institutional care settings. The absence of “formal checks conducted in-country on adoptive families by Lao authorities” (until a moratorium on inter-country adoptions was adopted in 2012) and the vulnerability of teenagers to sexual abuse and other “exploitation of children within care settings that are not monitored or formal” were matters of concern to them too. Punctual incidents of stealing and “kidnapping” of females by males during the Hmong festivals were described by adolescents and staff in EBS, respectively; more commonly, school staff described substance use (alcohol and tobacco) and playing video games at the computer shop near the school by adolescent males in EBS as problematic.

Discussion

Although most children in Laos live with at least one of their parents (MoH and LSB 2012), our study documented that informal kinship care and residential care are frequently used following parental death, divorce, and in response to family’s material hardship. The inclusion of EBS and monasteries side-by-side with more conventional orphanages as sites of institutional care in this study aimed to raise awareness about the most frequent reasons for child placement and to question families’ real abilities to choose alternative care options to support their children’s education. Further qualification may be explored in subsequent studies to reflect commonly agreed understandings of alternative care.Footnote 12

The UN Guidelines for the Alternative Care of Children (2009) applies the principles of necessity and suitability to ensure that alternative care is genuinely needed and appropriate for the child; as mentioned above, this may also apply to other settings that have the responsibility to care for children such as boarding schools. Necessity entails reducing the perceived need for formal alternative care and discouraging its use whenever possible. Suitability ensures that the quality of care provided in formal alternative care settings meets minimum standards and that the care setting meets the needs of the child (Cantwell et al. 2012). Consistent with research in other low- and middle-income countries (Boyden 2013; Kassa and Abebe 2014; Zimmerman 2003; Williamson and Greenberg 2010), our findings showed that material poverty and educational aspirations are a major driver of child-parent separation and delayed family reunification in Laos. Indeed, both adults and young people in our study indicated that improving families’ socioeconomic situations was a prerequisite for successful reintegration of children. Other studies in settings with more established formal care systems have also documented the effect of neighborhood area socioeconomic disadvantages on placement and reunification of children (e.g., (Esposito et al. 2013; Esposito et al. 2014), even if findings are not consistent about poverty as a matter of place and children’s return to their families (Wulczyn et al. 2011).

Considering the stated reasons for child separation and inability or unwillingness of some children to visit their families during vacation, poverty alleviation policies and programs and those that address social factors that provoke family breakdown through prevention and support (e.g., daycare centers) should be prioritized to reduce the necessity for formal alternative care and facilitate family reunification (Boothby et al. 2012). Strengthening (extended) families is also needed so that they can continue to be the first line of response when child separation becomes inevitable in another household. Given the benefits of both formal and informal kinship care, developing policies and social services to support and strengthen family- and community-based systems of care should be prioritized over developing institutions that provide only for the most basic needs of children (Groza et al. 2011).

Promoting informal coping strategies and dialog among children, parents, and other family/community members in decision-making can also help reduce the perceived need for formal alternative care (Cantwell et al. 2012). In Laos, informal relocation of children to live with relatives is a common practice that enables young people to complete (secondary) schooling while sustaining kinship interdependence and reciprocity. With this rationale, informal kinship fostering has the potential to have a positive effect for both the child and all families involved as it expands rather than replaces kin caregivers and provides children with positive opportunities for learning and development (Leinaweaver 2014). Further research of customary practices of support and separation is needed to ascertain the extent to which they are adaptive coping strategies (e.g., swap care as a temporary response to postpartum depression?) and the impact on family ties and wellbeing more broadly (e.g., promotion of mutuality). It is also necessary to develop a comprehensive map of traditional coping mechanisms for children lacking parental care throughout the country so that effective approaches to protecting children can be promoted in an alternative care policy rather than substituted by formalized care that may be inappropriate to the Lao context. This last point is particularly important considering the ethnocultural diversity of Laos.Footnote 13 Many children indicated that the decision to send them away was made by adults in the house and the community. Further understanding of family communication and decision-making practices across ethnocultural groups (e.g., Zha et al. 2006) is also needed to ensure that children’s voices are incorporated into care decisions and care settings (UNGA 1989, 2009). When conducted in ways that are age-, culturally, and contextually appropriate, the inclusion of children’s perspectives is likely to benefit the child and the family of origin (Leinaweaver 2014).

Another strategy to discourage the recourse to alternative care involves prohibiting the recruitment of children for placement in care. The systematic recruitment of children to attend orphanages and EBS, as described by key informants at the village, provincial, and central levels together with extensive unawareness of the risks of child-parent separation and misuse of basic terminology, raises concerns about unwarranted use of residential facilities. As Boyden documented in India (2013), the government’s provision of free boarding facilities, instruction, and (some) food continues to induce children from remote rural areas to migrate. While EBS are expanding schooling opportunities for highly deprived populations (Faming 2012) and boarding vs. day students in other settings do not necessarily display worse psychological outcomes (Martin et al. 2014), school transfers involve risks and costs. Comparisons may be hampered by contextual differences. For example, limited contact with the surrounding community (particularly in orphanages) may interfere with young people’s ability to transition smoothly to independent living and limited interactions with close families. Restricted social interactions may cause distress as documented among boarding school adolescents in Malaysia (Wahab et al. 2013) and impact children’s abilities to form the attachments needed for healthy development. At times, though, these institutions may provide children with a more stable environment, and positive relationships with teachers trained in child socio-emotional development may result in positive mentoring opportunities and wellbeing (Agmon et al. 2015; Martin et al. 2014). More inter-disciplinary research will be needed to analyze the extent to which (a) close-kin social and emotional ties are dependent on physical proximity; (b) children’s care arrangements take into account the psychological and emotional needs of each child; (c) children’s learning, socialization, and integration into the outside world are adequately provided for in different care settings; (d) children’s autonomy and socioeconomic opportunities are expanded; and (e), in the case of kinship care, whether this care arrangement contributes to consolidating ties across sending and host households and generations of kin.

Some group discussion participants indicated not being aware of any problems that occur when children live away from their parents. Whether these views accurately represents lack of awareness or rather resistance to admitting any wrongdoing by alternative caretakers is unclear although oftentimes, issues were raised at other points during the discussion. Thus, attention needs to be paid to differential treatment of children by orphan status, ethnicity, age, and gender. Differential treatment has also been documented in other studies in the country. For example, the most recent Lao Social Indicator Survey found that 17 % fewer orphans 10–14 years attended school compared to non-orphans who have not lost both parents and who live with at least one parent (MoH and LSB 2012). Overall, there is a need to raise awareness of these risks and to clarify basic terminology. Confusion about the terms “orphanage” and the composition of residential institutions (e.g., “ethnic school” and “orphanage school”) as well as “adoption” (“permanent” and “non-permanent”) was observed.Footnote 14 “There are only orphans in the orphanage school” and “in the ethnic school, there is only one ethnic group,” indicated two government officials in the study areas. Also, “for adopted child, their parents are still alive, but they move to live with relatives and their parents can come to visit them sometimes” (village authority in Xayaboury). These misunderstandings highlight the need for close monitoring of the situations of separated children as well as public education more widely.

For cases where institutional and other formal alternative care is recommended, it is critical for the government to develop and monitor the implementation of standards of care and to facilitate the prompt reintegration of children with their family or development of another appropriate long-term solution for each case (Lao P.D.R. 2007). Developing and enforcing adequate care standards would ensure that children have access to sufficient, nutritious food, proper living facilities, and basic services (especially physical and mental health care and education); that children and goods are properly protected; and, additionally, that contact with parents and family members is adequately promoted and facilitated. Inevitably, the creation and enforcement of care standards will entail developing an inspection mechanism and a permanent professional social work infrastructure to monitor all alternative care placements. It is urgent to regulate adoptions (both domestic and international) to ensure they are conducted in the best interest of the child, a process which includes approaching family members first, using residential care only as a last resort, including children in decision-making, and guaranteeing children’s safety and wellbeing (UNGA 1989, 2009). As a part of the development of an alternative care and deinstitutionalization program, it is recommended that a full assessment of the social welfare workforce and key actors, including service providers as well as officials, is carried out identifying opportunities to address the skills, attitudes, and resource gaps to deliver the program(s) effectively.

In order to strengthen and preserve families and assist them with reunification, family and risk assessments and service plans need to be carefully developed, implemented, and monitored. This approach implies the existence and consistent use throughout the country of a family assessment model or protocol and its adaptation to cultural or regional specificities (Groza et al. 2011). This approach also requires certain competencies of social service workers, who may need to receive specific training to effectively navigate different types of alternative care options. The service plan should always guided by the best interest of the child. Children placed in alternative care should be as much as possible in geographical proximity to relatives and other people close to them (e.g., friends and previous caregivers) in order to facilitate contact, as visitation is linked to successful reunification (Warsh et al. 1994). Whenever visitation is not feasible, children should at least receive “consistent and updated information about his/her family, community, or cultural group” (Groza et al. 2011, p. 175).

Findings from this study cannot be considered representative for Laos as a whole or the research areas where it was conducted. This study collected data from particular sites in two provinces only, and participants were purposively selected by community and institution leaders. This limitation, together with the fact that interviews took place in normative settings, may explain a large overlap of perspectives between adults and children and may have precluded more diverse perspectives from being heard. Direct observation in this study was limited to visiting (some of) the environments in which children live in the study areas. No detention or transit centers, transitional shelters, or street children were included in the study. Nonetheless, the high number of participants and relatively large diversity of their backgrounds provide a broad picture of alternative care in Luangprabang and Xayaboury and the different perspectives of various actors.

Despite these limitations, this study is the first to explore culturally and religion-based alternative care practices for children outside of parental care in Laos. Rigorous research with a national sample and over a longer period of time should be conducted to identify the drivers of child separation; variations in formal and informal alternative care arrangements across geographical, economic, cultural, and political contexts; and the impact of these arrangements on child and family functioning and wellbeing. This study contributed to the development of an emergent evidence base to support the creation of a national strategy, policy, and plan of action on alternative care that promotes family stability, preservation, and reunification and that becomes part of the Eighth National Socio-economic Development Plan 2016–2020 and long-term vision 2016–2030.