An estimated 5.4 million children were living in institutions in 2015, and decades of research link institutional care to delays in growth, cognition and attention that moving into family care can partly reverse. Studies suggest that most children in so-called orphanages have a living parent.
Updated October 13, 2026. Written from the sources listed below, not independently peer-reviewed.
Many residential institutions for children are called orphanages. Out of every 100 children living in them, how many have at least one living parent, according to studies reviewed by the Lancet Group Commission?
5.4 million
Children living in institutions
Median of modelled estimates for 191 countries in 2015, based on data from 136 countries. Depending on method and data, the estimate ranges from 3.2 to 9.4 million.
Data year 2015. Source: The Lancet Child & Adolescent Health, 2020
151 million
Children who have lost one or both parents
Children aged 0 to 17 worldwide whose mother, father or both have died, from any cause. Includes children who have lost only one parent.
Data year 2025. Source: UNICEF Data, 2026
13.5 million
Children who have lost a parent to AIDS
Children aged 0 to 17 who had lost one or both parents to AIDS-related causes as of 2025 (modelled range 10.3 to 18.1 million). Three quarters live in sub-Saharan Africa.
Data year 2025. Source: UNICEF Data, 2026
Unit: million children
UNAIDS central estimates (2026 release) of children aged 0 to 17 who have lost one or both parents to AIDS-related causes, as published by Our World in Data; the number peaked in 2012. All values are modelled. AIDS is only one cause of orphanhood, and the series does not show how many children live without parental care or in institutions, for which no comparable global time series exists. UNICEF's figure of 13.5 million for 2025 comes from a later round of the same estimates.
In its 2019 resolution on the rights of the child, the UN General Assembly urged states to progressively replace institutionalisation with quality alternative care, including family- and community-based care, to make alternative care inclusive of children with disabilities, and to improve data collection on children without parental care. The resolution sets no time frame or numeric target, and the incomplete data it describes make progress hard to track.
Using the method with the smallest error, South Asia (1.13 million) and Europe and Central Asia (1.01 million) had the most children in institutions in 2015. High-income countries had the highest average share of children in institutions, and low-income countries the lowest.
Source: The Lancet Child & Adolescent Health, 2020Poverty is the reason most often cited for placing a child in an institution, and children with disabilities are over-represented in institutions worldwide.
Source: The Lancet Psychiatry, 2020The youngest children are most vulnerable: the period between 6 and 24 months of age appears especially sensitive to institutional care, while children who spent only their first 6 months in an institution seemed largely unaffected.
Source: The Lancet Psychiatry, 2020About three quarters of the 13.5 million children who have lost one or both parents to AIDS-related causes, 9.8 million, live in sub-Saharan Africa.
Source: UNICEF Data, 2026Instead of one “percent solved” score, DO GOOD rates three separate dimensions. A problem can have mature solutions that still reach too few people. These ratings are an editorial reading of the sources on this page, not a measured index.
Has the situation improved in the real world?
LowThere is no comparable global time series, and the latest global estimate, 5.4 million children in institutions in 2015, is more than a decade old. Orphanhood from AIDS-related causes, one driver of placements, has fallen from its 2012 peak but still affected 13.8 million children in 2024.
How mature and validated are the available solutions?
ModerateThe harms of institutional care are well documented, and in a randomised trial in Romania children moved into foster care consistently had higher IQ scores than those who stayed in institutions. But children in foster care rarely did as well as children who had never been institutionalised, and the foster care tested may have been better than what is usually available in low-income countries.
How widely are effective solutions actually used?
LowMillions of children still live in institutions, and substantial private funding keeps flowing to them, more than US$100 million a year into Haiti alone. Whether family support and family-based care reach the families who need them is not measured globally.
Global estimates of children in institutions range from 3.2 to 9.4 million depending on method and data, data were available for only 136 of the 191 countries modelled, and the authors call for a standard definition of institutional care and better data collection.
The 2019 General Assembly resolution set a clear international direction away from institutional care, and AIDS-related orphanhood is declining. But the number of institutions rose sharply in Africa after the HIV epidemic began, private funding for institutions remains substantial, and there is no global data to show whether the number of children in institutions is falling.
Children without parental care are children who do not live with their parents, for example because a parent has died, because the family cannot cope with poverty, illness or a child's disability, or because a crisis has separated them. Worldwide, about 151 million children aged 0 to 17 have lost one or both parents, but losing a parent does not by itself mean losing parental care: this figure includes children who have lost only one parent, and orphans can grow up with a surviving parent or with relatives. A smaller group grows up in residential institutions. A 2020 study estimated that 5.4 million children were living in institutions in 2015, although the figure ranges from 3.2 to 9.4 million depending on the method and data used. Studies cited by the Lancet Group Commission on institutionalisation found that 80 to 90% of children in institutions often called orphanages have a living parent. Poverty is the reason most often given for placing a child, children with disabilities are over-represented, and emergencies can lead to placements when children are wrongly assumed to be orphans. After the tsunami in Aceh, Indonesia, 97.5% of the children in institutions studied there had been placed by their own families.
The Commission's review of more than 300 studies from more than 60 countries, covering more than 100,000 children, found strong negative associations between institutional care and children's physical growth, cognitive development and attention, and smaller but significant associations with socioemotional development and mental health. For growth and cognition, at least 80% of children in institutions scored below the average of comparison children, and only 24% were securely attached to a caregiver, compared with 62% in normative samples. Longer stays are linked to larger delays, and the period between 6 and 24 months of age appears especially sensitive. Children recover quickly in many areas once they move into family care, but recovery in socioemotional problems was largely absent and some of the most affected children carry lasting impairments. Children in institutions also face risks of abuse, trafficking and exploitation through orphan tourism. The quality of care matters: where institutions introduced smaller groups and fewer, more consistent caregivers, children's development improved.
The main international framework is the UN Guidelines for the Alternative Care of Children, welcomed by the UN General Assembly on 18 December 2009 (resolution 64/142). They ask that efforts first help children remain in, or return to, their parents' care. The General Assembly's 2019 resolution on the rights of the child, which focused on children without parental care, added a call to progressively replace institutionalisation with quality alternative care. The Guidelines distinguish four main settings and set rules for when each may be used:
Informal and kinship care
Informal care is a private arrangement in a family setting that no court or authority has ordered, such as a child living with grandparents after a parent's death. Kinship care is family-based care within the child's extended family or with close friends of the family known to the child, and it can be either informal or formal.
Foster care
In foster care, a competent authority places a child with a family other than the child's own that has been selected, qualified, approved and supervised to provide care. The Guidelines name adoption and kafala of Islamic law as permanent solutions; once a child is placed with adoptive parents, the Guidelines no longer treat the child as being in alternative care.
Residential care and institutions
Residential care is any group setting that is not family-based, from emergency shelters and group homes to large, long-term institutions. The Guidelines limit it to cases where it is specifically appropriate, necessary and constructive for the individual child, ask that children under 3 years old be placed in family-based settings in most cases, and call for large institutions to be phased out under a deinstitutionalisation strategy with precise goals.
Necessity and suitability
Removing a child from parental care should be a last resort, temporary where possible and regularly reviewed. Financial and material poverty should never be the only reason for separating a child from their parents; it should instead trigger support for the family. Both the 2009 Guidelines and the 2019 resolution state this principle.
What works
Because poverty is the reason most often given for placing a child, support that helps parents keep their children, such as income support, access to services and help for children with disabilities, addresses separation at its root. Both the UN Guidelines and the 2019 resolution say poverty alone should never justify removing a child and should instead trigger support for the family.
Limits
Family support needs social services and trained social workers, and it competes for funding with institutions that already exist. There is no global measure of how many families at risk of separation receive such help.
What works
Many children who cannot live with their parents can stay with grandparents, aunts, uncles or close family friends, keeping ties to their family and community. The Guidelines treat kinship care as a form of family-based care, and the 2019 resolution asks states to look first to the wider family, also for children with disabilities.
Limits
Informal kinship care is arranged privately without any court or authority involved, so carers may receive no support and authorities may not know how the children are doing.
What works
In the Bucharest Early Intervention Project, 68 of 136 young children in Romanian institutions were randomly assigned to foster care. Their IQ scores were consistently higher than those of children who received usual care, and across studies children's physical growth caught up by about one standard deviation after leaving institutions.
Limits
Children in foster care rarely did as well as children who had never lived in an institution, and recovery in socioemotional problems was largely absent. Foster care needs carefully selected, trained and supervised carers, and the foster care in the Romanian trial may have been better than what is usually found in low-income countries.
What works
Gatekeeping means screening each referral so that a child enters care only when support for the family has been tried and placement is in the child's best interests. The Guidelines ask for rigorous screening, for funding that never encourages unnecessary or prolonged placements, and for large institutions to be phased out under a strategy with precise goals.
Limits
Phasing out institutions only helps children if family-based placements, social workers and follow-up are in place first, which takes time and money. The Guidelines and the 2019 resolution set principles, not deadlines or budgets.
What works
While residential care remains, its quality matters. In a quasi-experiment in St Petersburg, institutions that cared for children in smaller groups with fewer and more consistent caregivers saw improvements in children's physical, cognitive and socioemotional development, and growth improved without any change in diet. The Guidelines ask for small facilities organised around children's rights and needs, generally providing temporary care that supports return to a family.
Limits
The St Petersburg study was not randomised, and in studies of better-staffed institutions children still had lower IQ scores than children raised in families. Improved residential care is a complement to family-based care, not a replacement for it.
Promising, but not proven at scale. The stage shows how far each approach has come; it is not a recommendation.
The 2019 General Assembly resolution recognised the harms linked to volunteering programmes in orphanages, including in the context of tourism, which can lead to trafficking and exploitation, and called on states to prevent the trafficking and exploitation of children in care facilities. Turning this into practice depends on travel companies, schools, faith groups and donors changing how they engage, and its effect on the number of children placed in institutions has not been measured.
Private donations are a substantial source of funding for institutions, more than US$100 million a year in Haiti alone, and in sub-Saharan Africa institutions are often run by non-governmental or faith-based organisations. The UN Guidelines say funding should never encourage unnecessary or prolonged placements. Moving donations from institutional care to family strengthening and family-based care would put this principle into practice, but how such shifts affect children has not been systematically evaluated.
Children with disabilities are over-represented in institutions. The 2019 resolution asks that, when their families cannot care for them, they be cared for first within the wider family and then in a family setting in the community. Evidence on how to recruit, train and support families for children with high support needs is limited.
The authors of the latest global estimate call for a standard definition of institutional care and better data collection, and the 2019 resolution asks states to improve data and reporting on children without parental care. Without them, neither the number of children in care nor the effect of reforms can be tracked across countries.
Implementation gap
Poverty is the reason most often given for placing children in institutions. Where social services, cash support and help for children with disabilities are lacking, poverty can push families to place a child in care even though the UN Guidelines say it should never be the only reason.
Coordination gap
Private funding for institutions is substantial, more than US$100 million a year into Haiti alone, and the Guidelines warn that funding must never encourage unnecessary or prolonged placements. Donors, governments and organisations are not always aligned on moving resources towards families.
Implementation gap
Children with disabilities are over-represented in institutions worldwide. The 2019 resolution calls for alternative care that includes them, starting with the wider family, but families caring for a child with high support needs often need services that are not available.
Coordination gap
The Guidelines call for deinstitutionalisation strategies with precise goals, but the 2019 resolution sets no time frame. Moving children safely requires child protection services, family-based placements, follow-up and new roles for staff to be ready at the same time.
Knowledge gap
Estimates of the number of children in institutions in 2015 range from 3.2 to 9.4 million, because there is no standard definition of institutional care and national data were available for only 136 of the 191 countries modelled. Children in informal care arrangements are not recorded by authorities at all.
Knowledge gap
Several of the best-known studies come from Romania, Russia and Greece, and many studies had no information on genetic or environmental risks children faced before entering care. Less is known about which family-based approaches work best in low-income countries, where foster care may be less well resourced.
Unresolved questions, not vetted breakthroughs. Answering any of them would change what is possible.
Which combinations of cash support, social work, parenting support and services for children with disabilities most effectively prevent unnecessary separation where public services are weak?
How can residential facilities change into services that support families and community-based care without disrupting children's lives, and what happens to children over the long term after a facility closes?
For which children, for example adolescents, siblings or children in emergencies, can small, temporary residential care be the most suitable option, and what standards make it safe and supportive?
Children who cannot live with their parents often grow up with relatives in informal arrangements that no authority records. Little is known about how these children fare over time and what support their carers need.
If you support a children's home or a child sponsorship programme, ask how it helps children keep in touch with their families, whether it works with local child protection authorities, and how it supports children's return to family care where that is safe.
The UN General Assembly has recognised the harms linked to volunteering in orphanages, including as part of tourism. If you want to help while travelling, consider supporting community programmes for families instead of short visits to children's homes.
Many countries need more foster carers, and relatives who take in children often need practical help. Ask your local child protection services what kinds of carers and support are needed.
Ask your elected representatives to support social services, cash support and inclusive care for children with disabilities, both at home and through development aid, so that poverty is never the reason a child grows up away from their family.
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The Lancet Child & Adolescent Health (Desmond C, Watt K, Saha A, Huang J, Lu C), vol. 4, issue 5, pp. 370–377, published 2020
Most recent global estimate of children living in institutional care: modelled estimates for 191 countries in 2015 from data for 136 countries (2001–2018), with a median of 5.37 million and a range of 3.18 to 9.42 million, plus regional estimates and a call for standard definitions and better data.
The Lancet Psychiatry (van IJzendoorn MH, Bakermans-Kranenburg MJ, Duschinsky R, et al.), vol. 7, pp. 703–720, Lancet Group Commission on the institutionalisation and deinstitutionalisation of children, published 2020
Systematic review and meta-analysis of more than 300 studies from more than 60 countries on how institutional care and leaving it affect children's growth, cognition, attention, attachment and mental health, with background on why children are placed in institutions. Open-access author copy of the published article.
UNICEF Data, published 2026
UNICEF data page (updated August 2026) giving the number of orphans aged 0 to 17 worldwide (151 million) and the number who lost one or both parents to AIDS-related causes as of 2025 (13.5 million, three quarters in sub-Saharan Africa).
United Nations General Assembly (text hosted by Better Care Network), published 2009
International framework adopted on 18 December 2009 that defines informal, kinship, foster and residential care and sets the principles of necessity and suitability, including family-based care for children under 3 and the progressive elimination of large institutions.
United Nations General Assembly (text hosted by Hope and Homes for Children), published 2019
Resolution adopted on 18 December 2019 with a focus on children without parental care, calling on states to prevent unnecessary separation, progressively replace institutionalisation with quality alternative care, address harms of orphanage volunteering and improve data.
UNAIDS, Global AIDS Update epidemic indicators (2026), via Our World in Data, published 2026
Annual modelled estimates from 1990 to 2024 of children aged 0 to 17 who have lost one or both parents to AIDS-related causes, used for the trend chart.