Exploring alternative care options for children in China: recent developments and challenges

ABSTRACT

In recent years, there has been increasing recognition of the complexities surrounding alternative care arrangements for children, especially within China’s changing childcare landscape. This paper addresses the gap in understanding the nuances of alternative care options in China by conducting a narrative review of existing literature and governmental documents, focusing specifically on kinship care, institutional care, family foster care, and adoption. The review reveals recent developments and current challenges associated with each form of alternative care, providing insights into the evolving childcare system in China. Key findings include significant progress in diversifying childcare options, increased funding investment in the system, and efforts to standardize alternative childcare practices through policies and legislative measures. However, challenges persist in promoting psychosocial development and preparing individuals living in institutions for leaving care, ensuring adequate resources and support for kinship caregivers, and enhancing participation rates in family foster care and adoption practices. Practical implications for policymakers and child welfare agencies are discussed, emphasizing the importance of promoting family-based care options, providing quality caregiver training, considering various aspects of children’s needs, extending support for kinship care, and formulating inclusive adoption policies.

KEYWORDS:

• Alternative Childcare in China
• Childcare Practices
• Child Welfare
• Childcare System Development
• Narrative Review

Introduction

In recent years, there has been increasing recognition of the complexities surrounding alternative care arrangements for children, especially within China’s changing childcare landscape. Alternative childcare refers to interventions provided by state and civil society organizations when a child’s family is unable to provide adequate care due to incapacity, abandonment, or other circumstances. This encompasses a spectrum of care options, from family-based arrangements like kinship care and family foster care to non-family-based options such as residential care (United Nations General Assembly, 2010). According to UNICEF¹ (2017), at least of 2.7 million children are living in residential care globally based on figures from 140 countries, with the actual number likely surpassing this estimate. Nevertheless, there is a significant concern regarding individuals residing in this type of alternative care due to its association with a heightened risk of social exclusion, child abuse, as well as adverse outcomes in mental and physical development (Johnson, Browne, & Hamilton-Giachritsis, 2006; Šiška & Beadle-Brown, 2020). A commitment to reducing residential care provision is evident across countries (Newton, 2017).

Despite the prevalence of alternative care globally, the specific nuances and challenges within China’s childcare system have received relatively less attention. In China, officially recognized alternative care options encompass kinship care (qinshu fuyang), institutional care (jigou fuyang), family foster care (jiating jiyang), and adoption (shouyang) (the State Council, 2010b). Historically, institutional care – non-family-based settings similar to residential care – has been deeply entrenched within the Chinese childcare framework; however, other forms of alternative care, including kinship care and family foster care, have gained recognition and support from the government in recent years (Chen, 2011; Jia, Li, & Wang, 2019, Shang & Fisher, 2017; Zhao, 2014b). Furthermore, in 2010, China saw the implementation of pivotal policy adjustments and initiatives that directly impacted the lives of orphans and vulnerable children nationwide (Shang & Li, 2015; Zhao, 2014b). Despite such progress, there is a lack of updated understanding of the childcare system in China. Little is known regarding the recent developments and current challenges associated with these alternative care options.

This gap in the literature highlights the necessity for updated research that delves into the intricacies of alternative care arrangements in China. This paper aims to address this gap by offering a narrative review of existing literature and governmental documents, focusing specifically on the four forms of alternative care officially recognized in China. By examining recent developments and current challenges, this paper seeks to shed light on pertinent issues within the childcare system and provide recommendations for research and practice aimed at improving outcomes for children in alternative care arrangements. Through this endeavor, this paper aims to contribute to a deeper understanding of the complexities surrounding alternative care in China and inform evidence-based strategies for enhancing the well-being of vulnerable children in the country.

Who are entitled to alternative care in China?

Children whose biological parents have either both died or have permanently abandoned them are considered orphans, and they are the primary recipients of alternative care in China. Typically, civil society and officials adopt two definitions of an orphan, pertaining to when and how a vulnerable child will be cared for and protected. The initial government definition, aiming to clarify the somewhat ambiguous term “orphan,” refers to individuals without parents, guardians, and any financial support, according to Wubao policy (Yang, 2005). Subsequently, the state emphasized that this referred to citizens under 18 years of age with no parents or for whom neither parent can be found (Zhu, 2018). The other definition is patriarchal, referring to cases where the child’s father has passed away and the birthmother has left the home to remarry (Shang, Fisher, & Saldov, 2010). According to Shang (2007), most of the cases observed in fieldwork conform to this description, particularly in rural China. Shang, Fisher, and Saldov (2010) further elaborate that in traditional Chinese society, children, especially boys, are considered part of the father’s family lineage, and the family often prevents the widowed mother from taking the child away. This is because, upon the mother’s remarriage, the child becomes part of another family. However, stepfathers are unlikely to accept stepchildren due to the absence of a blood connection; consequently, widowed mothers often relinquish their children (Chen, 2019; Shang, 2007).

In this paper, therefore, the terms “orphans,” “orphaned children,” “parentless children,” and “children bereaved of parents” all refer to individuals under the age of 18 whose circumstances meet one of the following three criteria: (i) both parents have died; (ii) both parents have abandoned the child; or (iii) one parent has died, and the other has relinquished the child. In any of these scenarios, the birthparents fail to provide essential support to meet the basic needs of food, water, clothing, shelter, and safety, all of which are critical to any child’s development. Thus, the provision of alternative care becomes essential, requiring involvement from various stakeholders, including the state, individuals, and civil society groups (United Nations General Assembly, 2010).

Historical transformations of the childcare system in China from the early 20th century to 2010

In this context, the childcare system refers to systematic arrangements for protecting and supporting disadvantaged individuals under 18 years old, particularly when their biological parents are unavailable. Childcare systems in various countries have been influenced by distinct historical trajectories and cultural norms. Understanding these factors is crucial for comprehending the size and characteristics of the childcare system (Petrowski, Cappa, & Gross, 2017). Over the past century, the childcare system providing alternative care in China has undergone significant transformations. In traditional Chinese society, the primary responsibility for caring for children without parental support rested with robust kinship networks and local communities (Shang, Wu, & Wu, 2005). However, this stability was disrupted in the early 20th century due to a series of devastating wars, including the Sino-Japanese Wars, World War II, and civil conflicts. These conflicts not only ravaged the nation but also disrupted basic welfare provision. To address this, some NGOs, charities, and individuals established orphanages to provide shelter and care for these children (Shang, 2002).

This situation evolved with the establishment of the People’s Republic of China (Socialist China) in 1949. For political reasons, orphanages founded by Western individuals or organizations were seen as a form of cultural imperialism and were gradually taken over by the new government. Some of these orphanages were restructured into state-run care centers, while others were closed (Shang, 2002). These state-funded institutions, though professional, were typically situated in centralized, isolated urban campuses (Chen, 2019). During this period, the majority of those receiving care were either urban dwellers or transferred from cities (Shang, 2002; Yao & Liu, 2018). These care centers also served political purposes, highlighting the benefits of socialist China (Shang, 2001). These services, combined with improvements in healthcare, child-rearing practices, and medical treatment, played a crucial role in preventing vulnerable individuals from experiencing homelessness and hunger (Wan & Ma, 2018). However, the benefits of the childcare system were largely limited to those in institutional care (Jia, Li, & Wang, 2019).

In recent decades, despite China’s remarkable economic progress, the issue of orphans, especially those who have lost parental care, has emerged as a significant public concern. Each year, nearly 100,000 newborns are abandoned, left on the streets, in hospitals, welfare centers, or even under bridges (Wang, 2016). The number of orphans reached a peak of 712,000 in 2010 (CPRI,² 2010), with many of them also facing health challenges, including autism, developmental delays, cerebral palsy, and physical impairments (CCAFC & CYRA,³ 2012). A national survey on Chinese orphans shed light on the reasons for child abandonment in urban areas: abandonment (49.2%), one or both parents’ death from illness (37.3%), or death due to accidents (12.7%) (Shang, Chen, & Yang, 2008). Scholars have suggested that one factor accounting for this situation is an incomplete social security system. Therefore, treating disabled and/or sick children would significantly increase their parents’ financial burdens (CPRI, 2011; Wang, 2016). Another factor could be traditional values of discrimination against women and preference for sons. People argued that many abandoned children were female, a situation exacerbated under the One Child Policy (Chen, 2019; Johnson, Huang, & Wang, 1998). A third explanation could be the increased social changes over decades, such as divorce, broken marriage, and birth out of wedlock, resulting in more children not being able to receive parental care (Chen, 2019; Shang, 2002). Moreover, the significant migration from rural to urban areas and media coverage have increased awareness of welfare institutions in cities, where unwanted children can be abandoned (Jia, Li, & Wang, 2019; Johnson, 1993; Shang, 2002). The practical question of minimizing the state’s lifetime responsibility for children in care became pressing. In response to these challenges, starting in the 1990s, the Chinese government has sought solutions to care for the growing number of orphans. These strategies have included trials of family foster care, the promotion of domestic and international adoptions, and the allowance for care centers to seek external financial support, such as foreign funding and donations (Shang, 2002). Some revolutionary changes in the childcare system are underway.

What happened to Orphans in 2010?

In 2010, China witnessed the implementation of several pivotal policy changes and initiatives that directly impacted the lives of orphans and vulnerable children across the nation. One noteworthy milestone was the introduction of the “Outline for the Development of Chinese Children (2011–2020)” by the Chinese government (the State Council, 2011). This policy blueprint outlined strategic objectives for enhancing the welfare and protection of children in China, including those in alternative care arrangements. Notable goals included strengthening children’s welfare institutions, exploring suitable parenting models for orphaned children’s physical and mental development, improving the orphan adoption system, and enhancing care quality for orphans in family foster care and kinship care through the establishment of robust supervision, support, and evaluation mechanisms.

Furthermore, the issuance of the “Opinions of the General Office of the State Council on Strengthening the Work of Orphans” officially endorsed and supported various forms of alternative care for children separated from or unable to receive adequate care from their birth parents (Zhao, 2014b). This included kinship care, institutional care, family foster care, and adoption, providing vulnerable children with alternative living arrangements and support systems conducive to their well-being and development. As a result, more options in alternative care have been established.

Additionally, the national policy directive “Notice on Distribution of Basic Living Expenses for Orphans” ensured orphans received monthly living allowance from governmental appropriations to cover their daily expenses (the State Council, 2010a). The groundbreaking policy mandates that local governments, in alignment with the varying standards of living in urban and rural areas, must determine the minimum standard of basic maintenance for orphans. This determination takes into account factors such as the children’s growth needs, financial resources, and the principle of ensuring that the basic livelihood of orphans meets or exceeds the average standard of living in their locality (the State Council, 2010a). In 2010, central financial authorities allocated a significant sum of 2.5 billion yuan (approximately 0.35 billion USD⁴) in special subsidies for orphans across the eastern, central, and western regions of China. These subsidies were disbursed at rates of 180 yuan (approximately 25.01 USD), 270 yuan (approximately 37.51 USD), and 360 yuan (approximately 50.02 USD) per capita per month, respectively (the State Council, 2010a). Moving forward, the amount of central financial assistance will be determined annually based on factors such as the number of orphans in the previous year and their basic upbringing needs, as audited by the Ministry of Civil Affairs⁵ (the State Council, 2010a). This monetary support will be transferred directly by local financial authorities to the individual accounts of orphans or their guardians, or to the collective accounts of childcare institutions. In cases where bank transfer is not feasible, the funds can be disbursed in cash following prescribed procedures (the State Council, 2010a). These measures further ease the financial burden of the system.

Overall, the year 2010 marked a significant milestone for orphans and vulnerable children in China, with the implementation of policy advancements and initiatives aimed at improving their welfare and expanding alternative care options. However, despite these strides, little is known about what has happened since 2010. There is a need for a comprehensive understanding of the recent developments and challenges within the childcare system, particularly regarding the four alternative care options, to ensure continued progress and support for these vulnerable populations.

Methods

To understand the updated development and challenges in alternative childcare in China, I utilized narrative review as the research method. A narrative review is a type of literature review that offers a comprehensive summary and synthesis of existing research on a particular topic, often in a narrative or storytelling format. Unlike systematic reviews, which follow a structured and rigorous methodology to identify, appraise, and synthesize all available evidence using predetermined criteria, narrative reviews typically provide a more qualitative and interpretive analysis of the literature (Grant & Booth, 2009).

During the review, I thoroughly searched prominent Chinese databases, including China CNKI, Wanfang Data, and CQVIP, to retrieve articles related to the alternative childcare system. I utilized subject headings and search terms commonly used in Mandarin, such as “tidaixing yanghu (alternative care),” “qinshu fuyang (kinship care),” “jigou fuyang (institutional care),” “jiating jiyang (family foster care),” and “shouyang (adoption),” to meticulously scan the databases for relevant literature.

The literature included in this paper is based on specific criteria. Firstly, I sought literature that exclusively focused on alternative care options for children within the context of China. Moreover, I prioritized studies that examined each of the four alternative care options individually, delving into their development, implementation, challenges, and outcomes. I also included literature that investigated the impacts of different alternative care options on the well-being, development, and psychosocial outcomes of children in China. To maintain the research scope, I excluded materials such as degree dissertations, news, commentaries, book reviews, or articles primarily focused on populations other than children in alternative care in China. Furthermore, I omitted studies that were outdated (before 1990) or no longer relevant to the current state of research or practice in the field of alternative care options in China.

After the search, I screened the results based on titles and abstracts to identify relevant information. Subsequently, I expanded my search using a snowball strategy, examining useful references and similar articles retrieved from the initial search. Additionally, I consulted experts for additional literature and utilized guidelines and resources from governmental reports and documents where applicable. For example, I used secondary data from yearbooks to provide a statistical overview of the most updated state of alternative care in China. The search process was last updated on March 07, 2024.

Results

A statistics tendency overview

When abandoned infants or orphans are discovered by the public, a standard procedure, recently published by the State Council (2018), involves notifying and involving the police. Following police assessments, if no kinship families are identified, these children are subsequently transferred to a nearby childcare institution, awaiting further placement, such as adoption. According to data from the China Civil Affairs Statistical Yearbooks covering the years 2015 to 2022 (MoCA), there has been a consistent downward trend in the number of children who have received alternative care placement. This trend reached its nadir in 2021, with the count standing at 194,842, which is only one-third of the figure recorded in 2014 (see Table 1). This decline may indicate that there are fewer children who are orphaned or in need of alternative care in recent years. Additionally, it suggests that a significant number of former care recipients have transitioned into adulthood and left the care system.

Table 1. Alternative care in China (MoCA, 2015; 2016, 2017, 2018, 2019, 2020, 2021, 2022).

	2014	2015	2016	2017	2018	2019	2020	2021
Total care population	547,951	539,290	479,186	434,086	325,973	257,024	215,311	194,842
Institutional care	93,522	91,712	87,502	86,025	69,760	64,482	58,989	53,302
	(17.07%)	(17.01%)	(18.26%)	(19.82%)	(21.40%)	(25.09%)	(27.40%)	(27.36%)
Kinship care	408,338	410,000	361,395	316,134	229,317	168,635	134,292	119,414
	(74.52%)	(76.03%)	(75.42%)	(72.83%)	(70.35%)	(65.61%)	(62.37%)	(61.29%)
Family foster care	23,319	15,230	11,553	13,107	10,629	10,863	10,927	9,679
	(4.26%)	(2.82%)	(2.41%)	(3.02%)	(3.26%)	(4.23%)	(5.07%)	(4.97%)
Adoption	22,772	22,348	18,736	18,820	16,267	13,044	11,103	12,447
	(4.16%)	(4.14%)	(3.91%)	(4.34%)	(4.99%)	(5.08%)	(5.16%)	(6.39%)

Note. Data represents the numbers and percentages of receivers in each approach of alternative care in China between 2014 and 2021.

Despite this overall decrease in the care-receiving population, the proportions of the four care placements have undergone different shifts. Notably, the percentage of children residing in institutional care has increased significantly from 17.07% to 27.36%, indicating a rising trend. Conversely, kinship care, which was the predominant option among the four, has experienced a slight decrease in popularity, declining from 74.52% to 61.29%. Family foster care and adoption, the other two options, have maintained relatively low shares, around 5%, throughout the eight-year period (see Table 1). These shifts in care placement proportions suggest evolving patterns in how children in need of alternative care are being supported and accommodated within the Chinese childcare system. They can inform future policy decisions and resource allocations related to child welfare and protection. Further details are discussed in the subsequent sections.

Updates and challenges in institutional care

Institutional care provided by state-funded institutions

State care institutions (fuliyuan), also referred to as childcare institutions in this paper, are state-funded and provide centralized care services delivered by paid employees in isolated campus-like environments (Chen, 2019). In practice, there are two primary types of childcare institutions that receive state funding in China: Child Welfare Institutions (ertong fuliyuan) and Social Welfare Institutions (shehui fuliyuan). Child Welfare Institutions are typically situated in urban areas and specialize in providing care exclusively for children under the age of 18. In contrast, Social Welfare Institutions are located in towns or suburban areas, offering care services to both minors and older residents within the same facility. When kinship caregivers cannot be found for rural orphans, they are often placed in these institutions located close to their villages. According to MoCA data, the number of state care centers is steadily increasing from 2017 to 2021 (see Table 2). In 2021, there are 539 care centers that serve as a final recourse for 53,302 children without parental care, accounting for 27.36% of alternative care receivers (see Table 1).

Table 2. Number of institutions and beds available to children (MoCA, 2018a, 2019; 2020, 2021, 2022).

	2017	2018	2019	2020	2021
Number of children’s Institutions	469	475	484	508	539
Number of Beds	103,000	97,000	99,000	101,000	98,000

Note. Data represents the numbers of institutions and beds available to children in China between 2017 and 2021.

As mentioned earlier, the Chinese government has long been the sole funder of state care centers, assuming both financial and management responsibilities. When facing challenges in balancing its fiscal allocation to state care centers, poor care quality exacerbated circumstances for the underprivileged in these care centers, resulting in high death rates among in-center orphans (Johnson, Huang, & Wang, 1998; Shang, Wu, & Wu, 2005; Wang, 2016). Over the years, consistent efforts have been made by the Chinese government to improve their living conditions. Traditional services offered at state care centers have gradually been enhanced over time; alongside previous assistance with food, clothing, and shelter, residents are now entitled to educational opportunities, free medical care, and monthly living allowances from the Chinese government (Shang & Fisher, 2017).

Notably, recent monetary support has experienced an annual increase of 5.3%, reaching 1,697.4 yuan (235.77 USD) per month in 2021 (MoCA, 2022). Furthermore, it is important to clarify that orphans are no longer the only recipients of care in state care centers. As stipulated by the state, children in the following situations are also entitled to institutional care: (i) both parents are sentenced to prisons or in an addiction treatment center, (ii) the court has ruled against both birth parents having custody, and (iii) all guardians are deemed by law incapable of caring for the child (the State Council, 2018). From one perspective, this policy update may help explain the increasing number of children in institutional care, despite an overall declining trend in the care population (see Table 1). On another note, it signals the development of a more inclusive childcare system in China, encompassing a broader spectrum of children with diverse backgrounds.

Due to increased state funding and projects, existing care centers have undergone significant improvements. For example, the implementation of the “Blue Sky” project in 2006 allowed the state to allocate 6 billion yuan (0.83 billion USD) for the construction and renovation of additional care facilities within five years in response to an increasing number of orphans and subsequent demand for institutional care (Zhao, 2014b). This resulted in an increase from 43,000 beds in those care centers in 2008 to 103,000 beds in 2017 (MoCA). Additionally, more spacious living areas, updated facilities, and nutrition specialists have been incorporated into existing childcare institutions to cater to children’s individual needs and meet child-friendly standards (Wan & Ma, 2018). Furthermore, with increasing public awareness of the importance of the family environment on children’s development, new care practices such as family-like care have also been trialed within childcare institutions (Yao & Liu, 2018).

The increased state funding and projects also benefit children with additional needs. As mentioned earlier, a considerable number of institutional care recipients live with impairments and/or congenital diseases. The “Tomorrow Plan,” in effect since 2004, has resulted in state institutions paying greater attention to children who are ill or disabled (the State Council, 2007). A greater number of orphans are now receiving medical support from the Chinese government through sensory integration training, physical treatment, oral treatment, and surgery (CCAFC & CYRA, 2012). As of 2018, 1.33 billion yuan (0.18 billion USD) has been allocated to this program, benefiting 125,000 in-center children, of which 25,000 were adopted after treatment (MoCA, 2018a). Meanwhile, institutions are increasingly implementing preschool education practices for them, which were previously often overlooked. Special education programs now exist for school-aged orphans with mental retardation, autism, or cerebral palsy (Zhu, 2018). Regarding visually-, verbally-, and hearing-impaired orphans, these are often sent by staff members to special education schools located outside the childcare institutions (CCAFC & CYRA, 2012). These earmarked appropriations and programs have significantly enhanced children’s well-being and life chances in the future.

Additionally, there has been a noticeable improvement in the number and quality of childcare practitioners within state care centers, as evident from data provided by MoCA (see Table 3). While the overall number of employees has remained stable, there has been a noteworthy increase in the proportion of individuals with a university/college degree, rising from 57.3% to 62.6% between 2017 and 2021. Furthermore, the number of employees possessing social work qualifications has also seen significant growth, increasing from 8.7% to 12.7% during the same period. This statistics trend suggests that, with fewer orphans receiving institutional care, the increased presence of highly qualified professionals will likely result in more personalized and needs-oriented care and support. However, it is important to note that the proportion of employees under the age of 35 is declining, dropping from 41.0% to 33.7%. This may indicate a decreasing interest among young generations in pursuing a career in childcare. It is also worth highlighting that the majority of employees in childcare institutions are female, accounting for approximately 70% of the workforce. While female caregivers play a crucial role in child development, this gender imbalance may pose certain challenges. Children living in such environments could potentially miss out on diverse perspectives and experiences that both genders can offer, including the influence of positive male role models.

Table 3. Employees in child welfare institutions (MoCA, 2018; 2019, 2020, 2021, 2022).

	2017	2018	2019	2020	2021
Total number of employees	13,204	12,919	12,418	12,556	13,704
Employees under 35	5,414 (41.0%)	4,929 (38.2%)	4,657 (37.5%)	4,380 (34.9%)	4,612 (33.7%)
Female employees	9,265 (70.2%)	9,163 (70.9%)	8,638 (69.6%)	8,641 (68.8%)	9,542 (69.6%)
University/college degree holders	7,560 (57.3%)	7,423 (57.5%)	7,653 (61.6%)	7,690 (61.2%)	8,580 (62.6%)
Social Work Qualification holders	1,146 (8.7%)	1,209 (9.4%)	1,328 (10.7%)	1,434 (11.4%)	1,739 (12.7%)

Note. Data represents the numbers and percentages of employees in Child Welfare Institutions between 2017 and 2021.

Other than this, there are more concerning challenges. Due to the differences between the two types of institutions in China, concerns have been raised regarding the appropriateness of Social Welfare Institutions for orphaned children. Reports indicate that the care equipment, facilities, and caregivers in these institutions are not always age-appropriate to meet the specific needs of children (Shang, Fisher, & Saldov, 2010). A nationwide study conducted in 2005 identified approximately 12,000 orphans living in such situations, representing roughly 15% of all in-center orphans at that time (Shang, Chen, & Yang, 2008). However, more recent data from MoCA indicates a notable increase in the proportion of children residing in Social Welfare Institutions, reaching 35.15% (see Table 4). Even worse, it is important to note that the relevant literature found in this search predominantly focuses on children living in Child Welfare Institutions. Therefore, further research and investigations into the lived experiences and updated conditions within Social Welfare Institutions are necessary to gain a renewed understanding of the living circumstances for children in these settings.

Table 4. Number of Children in Social Welfare Institutions (MoCA, 2018; 2019, 2020, 2021, 2022).

	2017	2018	2019	2020	2021
Children in Social Welfare Institutions (Percentage)	24,987 (29.04%)	23,624 (33.86%)	24,105 (37.38%)	20,572 (34.87%)	18,737 (35.15%)
Total number of children in institutions	86,025	69,760	64,482	58,989	53,302

Note. Data represents the numbers and percentages of receivers in Social Welfare Institutions in China between 2017 and 2021.

One of other issues is that while significant improvements have been made in addressing the tangible needs of care receivers in childcare institutions, there remains a notable gap in addressing other critical aspects of their development (Chen, 2013; Liu et al., 2022). Elements such as socialization, leaving-care planning, life-skills preparation, and aftercare services are often overlooked in the current landscape (Yin, 2024). To facilitate a successful transition for children leaving the care system, it is imperative for policymakers and practitioners to shift greater attention toward these areas. What is more, despite a consistent decline in the population of children in need of care, there has been a continued expansion in the number of childcare institutions and the availability of beds. This prompts important questions about the future role of existing and well-established childcare facilities. Further discussion and exploration are warranted to determine how these institutions can adapt and continue to serve the evolving needs of vulnerable children in the years to come.

Institutional care provided by non-profit or Private organizations

In addition to state care centers, this search identified two other type of facilities providing institutional care within a limited scope: SOS Children’s Village International (SOS CVI) and private orphanages. As a non-governmental, independent, nonprofit international development organization headquartered in Innsbruck, Austria, SOS CVI established a cooperation with MoCA in 1984; as a result, the organization was allowed to provide institutional care in China as a novel trial to ease the pressure of the then increasing number of orphans. No relevant data are available from MoCA. Instead, according to the China Association of SOS Children’s Villages (n.d..), there are currently ten locations across the country sheltering 3,415 orphans, of which 2,382 are reported to have left care and obtained employment. Furthermore, in contrast to children living in state care centers, those living in SOS CVI are largely physically healthy. While care services in institutions are known for adopting a one-size-fits-all, centralized approach (Hope and Homes for Children, 2019), SOS CVI typically provides family-based care in their facilities. Typically, six to eight care receivers grow up in a symbolic home with one female caregiver. As part of their “home” roles, they use kinship terms when referring to others, such as calling caregivers “mothers” and other young residents “brothers” or “sisters” (Chen, 2019).

According to the China Association of SOS CVI website, 1,157 care leavers (48.6% of the total) have attained higher education degrees, a remarkable difference compared to those leaving state care centers. Those from childcare institutions often discontinue education at a secondary stage or even earlier (Chen, 2011; Shang & Li, 2015; Zhu, 2018). While education appears to be a priority within SOS CVI villages, details of their educational journey, such as challenges and opportunities in how those orphans achieve the high educational attainment, worth exploring.

Additionally, it is suggested that the family-like relationships established in villages can help foster stable attachments between receivers and caregivers, promoting the receivers’ sense of safety and self-esteem, which are beneficial for their long-term development (Chen, 2009). However, the number of orphans enrolled in SOS CVI remains relatively small compared to the overall care population; a more inclusive model should therefore be considered. On the other hand, there appears to be a distinct lack of support for caregivers, who operate within an institutional environment that blurs the work-life balance. Therefore, they may demand significant energy and patience to perform their roles effectively.

As for private orphanages, these are largely initiated by individuals, charities, or religious organizations and often exhibit voluntary and grassroots characteristics (Zhao, 2014a). They are primarily located in suburbs, towns, or mountainous regions (Chen, 2019). Most operate without proper legal authorization and face numerous issues, including inadequate care equipment and medical support, low childcare standards, disorganized management, and untrained caregivers (Yan, 2013). For many years, these orphanages received limited government oversight or attention until a tragic incident in 2013 when seven orphans died in a fire at a private orphanage in Henan province (Zhao, 2014b). In response to it, the Chinese government initiated interventions to improve, close, and merge many private orphanages with state care centers (Chen, 2019). These efforts are assumed to have led to a more organized and regulated management of private orphanages. However, there is limited statistical information and updates available regarding the current status of these orphanages based on this search. Further investigation is needed.

Updates and challenges in kinship care

Kinship care, unlike non-family-based facilities staffed by professionals, is provided by blood relatives or close acquaintances of the children (United Nations General Assembly, 2010). In China, this form of alternative care has deep-rooted traditions, serving as a crucial safety net for numerous orphans, shielding them from homelessness and starvation. There is a social obligation to support one’s orphaned relatives or neighbors in the community (Shang, Wu, & Wu, 2005). The extent of this responsibility often hinges on the degree of blood relationship, which means kinship caregivers can be grandparents, aunts, uncles, with a preference for the paternal side of the family (Shang, 2007). This practice is particularly prevalent in rural areas where tight-knit social bonds prevail (Zhang, 2014). Based on a national investigation conducted earlier, approximately 63% of Chinese orphans were found to reside in kinship families (Shang, Chen, & Yang, 2008). Recent data from MoCA reaffirms this, standing at 61.29% in 2021 (see Table 1).

Kinship care ensures that orphans are nurtured within a familiar environment, under the care of individuals with whom they share existing social connections. This fosters a sense of continuity in their identity and values (Shang, Fisher, & Saldov, 2010). However, this form of care carries inherent risks, particularly when kinship caregivers face health challenges or pass away. Many kinship caregivers contend with health issues such as aging, hypertension, or diabetes, along with a lack of stable income (CCAFC & CYRA, 2012). These factors raise concerns about the caregivers’ capacity to provide quality care. Furthermore, the living conditions that orphans experience often hinge on the socioeconomic status of their caregivers. Consequently, many orphans in kinship families find themselves lacking essential care and support for their daily needs, leading to mental health issues (Chen & Liu, 2021). Some are even compelled to discontinue their education due to their caregivers’ inability or unwillingness to support their schooling (Yan, 2013). Moreover, their emotional needs are frequently overlooked, resulting in a sense of isolation, heightened psychological stress, and a dearth of belonging within their families (Chen & Liu, 2021; Hu, 2011).

Since the Chinese government’s welfare provision expanded in 2010, orphans in kinship families now receive a monthly living allowance and access to educational opportunities with waived tuition fees (the State Council, 2010b). As of 2021, the monthly subsidy for children in kinship care averages 1,257.2 yuan (174.63 USD) in China, marking a 6.3% increase compared to 2020 (MoCA, 2022). Nevertheless, it is worth noting that the circumstances of many have not seen significant improvement. This is because most kinship families are located in remote, underdeveloped rural areas, with limited external financial resources available to support orphans beyond the monthly subsidy (CCAFC & CYRA, 2012).

Given this, it is imperative to develop tailored and culturally sensitive solutions involving the active participation and collaboration between government agencies, NGOs, and local communities to support kinship caregivers and children under their care. Such solutions could include financial assistance, healthcare support, and educational resources for both kinship caregivers and the children they look after. Also, it would be beneficial to explore ways to provide financial assistance beyond the monthly subsidies, such as providing grants or microfinance opportunities to help caregivers generate income and enhance their economic stability. Furthermore, implementing a system for regular monitoring and assessment of the well-being of orphans in kinship care would be helpful. This will likely help identify issues early and provide timely intervention. Additionally, ensuring that legal protections are in place to safeguard the rights and well-being of children in kinship care is essential. This may involve legal provisions for guardianship, inheritance rights, and access to social services, as well as policies that recognize and support kinship care within the broader child welfare framework.

Updates and challenges in family foster care

Family foster care is a practice whereby in-center orphans are cared for and supported outside institutions (Zhao, 2017). Its origins can be traced back to the 1990s when the Chinese government recognized the importance of living in a family environment and began exploring multiple solutions to support orphaned children, as noted by Yao and Liu (2018). Different from kinship care, this type of care allows designated strangers to care for orphans from state care centers at their own homes. Nonetheless, orphans in family foster care continue to receive benefits similar to those provided in institutions, including a monthly living allowance, medical support, and educational opportunities (the State Council, 2010b).

Apart from having relieved the financial burden (Zhao, 2014b), family foster care can offer numerous advantages for the well-being of orphaned children. Unlike their counterparts in institutional care, fostered orphans have the opportunity to build meaningful relationships with both their foster caregivers and other community adults (Shang, Fisher, & Saldov, 2010). They are also more likely to engage in a wider range of social activities in the community instead of living in an isolated environment (CCAFC & CYRA, 2012). Moreover, the family environment exposes them to essential life skills and experiences crucial for their independence in adulthood (Shang & Li, 2015). As supported by a comprehensive scoping review encompassing 23 articles, foster children exhibit better overall well-being outcomes, including physical health, cognitive development, language skills, motor skills, social-emotional development, social adaptability, and academic performance, when compared to children residing in childcare institutions (Xu, Man, Zhang, & Deforge, 2020). Therefore, Shang (2002) once predicted that family foster care would become the most important alternative care option in China, eventually replacing institutional care.

To standardize the practice of family foster care, the Chinese government implemented a comprehensive protocol in 2014. This protocol mandated that individuals seeking to become foster carers must formally contract with local childcare institutions (the State Council, 2014). These foster families undergo a rigorous selection process, evaluating factors such as financial stability and a strong commitment to caring for orphans (Zhao, 2017). Additionally, applicants for foster care must meet specific criteria, including having a permanent household registered near the childcare institution where the child(ren) originate from, ensuring no family members have infectious diseases or mental illnesses, and maintaining a clean criminal record and healthy lifestyle. Prospective foster carers should also have a good relationship with their neighbors and be within the age range of 30 to 65 years old, possess good health, possess the ability and experience to care for children, and hold at least a junior high school qualification. Furthermore, each foster family is restricted to caring for a maximum of two foster children, with no children under the age of six permitted in the household.

According to this policy, families interested in becoming foster families must follow a clear procedure. Initially, they are required to submit a written application to a childcare institution, along with supporting documents such as household registration details, ID card copies, information on household income and housing, and health statuses of family members. Subsequently, the institution will arrange for professional personnel or third-party organizations like social work service agencies to conduct on-site investigations of the applying families. These investigations will assess various factors including the family’s suitability, neighborhood relationships, social interactions, criminal records, and community environment. Based on the investigation results, the institution will review the application and provide feedback. Upon confirmation of eligibility, the institution will report to the relevant civil affairs department for record-keeping. Finally, the institution will offer training to the primary caregivers of approved foster families.

Foster families are entrusted with several crucial responsibilities in caring for foster children. These include providing daily care, ensuring proper nutrition, assisting in developing self-care skills, fostering healthy psychological development, and instilling positive moral values. Additionally, they are expected to liaise with schools to facilitate the educational needs of foster children and promptly arrange medical treatment when necessary. While foster families bear the day-to-day caregiving duties, childcare institutions maintain guardianship and oversee the entire process. They shall regularly monitor the growth and well-being of foster children, receive visits from childcare institutions, and undergo training, supervision, and guidance to ensure compliance with standards. Furthermore, foster families shall collaborate with childcare institutions to offer additional services such as corrective measures, rehabilitation training for physical disabilities, and language development support for hearing-impaired children. These standardizations signify the government’s efforts to ensure the quality and safety of family foster care arrangements for orphaned children throughout China.

Despite this, recent statistics from this search may be frustrating. The proportion of orphans living in foster families only reached approximately 5.0% from 2014 to 2021 (see Table 1). In some regions of China, there are even fewer than one hundred children in family foster care, with Qinghai province suspending foster care practices in 2021 (see Table 5). This low involvement suggests that while family foster care offers substantial benefits, there are still challenges to be overcome in its widespread adoption and implementation in practice. For example, children in foster care often have diverse and additional needs, ranging from medical, educational, physical to psychological domain. Tailoring care plans to meet these individual needs can be challenging for foster families but is essential for the well-being of the children. Furthermore, the current support and resources available to foster families are inadequate (Chen, 2023). Another challenge for family foster care is that many Chinese families may not be aware of the concept of family foster care or may be hesitant to accept non-biological children into their homes due to concerns about the child’s background or potential conflicts with their own children. Such resistance may be more prevalent in some regions than others. In addition to the low participation, existing foster care practices are concerning, with some of them found to be poorly managed due to insufficient training of foster families and supervision from childcare institutions (Wan & Ma, 2018). This gives rise to risks to orphans in such circumstances and therefore necessitates more resources and infrastructure to conduct regular checks and assessments.

Table 5. Number of children in family foster care by regions in 2021 (MoCA, 2022).

Regions	Number of children in foster families	Percentage
Overall	9,679	100%
Beijing	69	0.71%
Tianjin	108	1.12%
Hebei	347	3.59%
Shanxi	973	10.05%
Neimeng	6	0.06%
Liaoning	82	0.85%
Jilin	25	0.26%
Heilongjiang	90	0.93%
Shanghai	148	1.53%
Jiangsu	282	2.91%
Zhejiang	72	0.74%
Anhui	14	0.14%
Fujian	431	4.45%
Jiangxi	290	3.00%
Shandong	175	1.81%
Henan	329	3.40%
Hubei	245	2.53%
Hunan	1,062	10.97%
Guangdong	343	3.54%
Guangxi	494	5.10%
Hainan	6	0.06%
Chongqing	5	0.05%
Sichuan	358	3.70%
Guizhou	134	1.38%
Yunnan	676	6.98%
Xizang	154	1.59%
Shaanxi	201	2.08%
Gansu	102	1.05%
Qinghai	0	0.00%
Ningxia	84	0.87%
Xijiang	2,374	24.53%

Note. Data represents the numbers and percentages of children in foster families by regions in China in 2021.

Therefore, there is an urgent need for targeted policy interventions to promote and support family foster care initiatives. Policymakers should prioritize the development of policies and programs aimed at increasing awareness, recruiting, and training foster families, and providing adequate support and resources to ensure the well-being of foster children. To explore the barriers and facilitators to family foster care in China, researchers may conduct qualitative studies to explore the experiences and perspectives of foster families and children, as well as quantitative studies to assess the impact of different interventions on outcomes such as placement stability, child well-being, and family functioning.

Updates and challenges in adoption

Adoption has deep historical roots in China, primarily because childlessness has long been considered culturally unacceptable (Johnson, 1993; Johnson, Huang, & Wang, 1998). The formal recognition of adoption came with the first publication of the Adoption Law by the end of 1991 (the State Council, 2005). Since then, the Chinese government has prioritized adoption as a means of placing orphans (Shang & Li, 2015). With the publication of Civil Code of the People’s Republic of China in 2020, it regulates specific provisions related to adoption, outlining the legal framework for the process and the rights and responsibilities of adoptive parents and adopted children. According to the legislation, prospective adoptive parents must meet certain eligibility criteria outlined by the government. These criteria include age requirements (over 30; the age gap between adopter and adoptee should be over 40 if not married), health and financial stability, family status (having no or only one child), and the ability to provide a suitable environment for the child’s upbringing (the National Congress of the People’s Republic of China, 2020).

Despite the formal recognition and legislative efforts, the proportion of adopted orphans has fluctuated in recent years, representing only a small percentage of the total population of children in alternative care (see Table 1). This trend can be attributed to several factors. One significant barrier to adoption is the bureaucratic and time-consuming administrative procedures and paperwork involved, which can pose financial burdens for prospective adoptive families (Zhang, 2014). Additionally, there is a notable absence of supportive policies for adoptees with disabilities, as the medical expenses are typically the responsibility of the adoptive family. This lack of support discourages many from adopting children with disabilities (Zhao, 2014a). Consequently, only a small number of orphans find adoptive homes. For healthy infants, state care centers often serve as temporary placements while awaiting adoption, but for those with diseases or disabilities, these centers become their long-term residence (Wang, 2016). Nonetheless, this low proportion highlights the importance of addressing barriers to adoption, particularly for children with disabilities, and ensuring that adoption processes are as efficient and affordable as possible.

Furthermore, adoption in China consists of two main categories: domestic adoption and international adoption. As a signatory to the Hague Convention 1993, China agrees to adhere to international standards and regulations for intercountry adoptions. This includes implementing safeguards to ensure the protection of children, birth parents, and adoptive families involved in intercountry adoption processes (UNICEF, 2015). In this context, China once served as a leading source of international adoptees, with families in the United States alone adopting over eighty thousand children from China since 1999 (Marn & Tan, 2015; Wang, 2016). The remarkable increase in international adoptions during the early 2000s not only reflected a growing interest among foreign families in adopting Chinese children but also underscored China’s willingness to place children internationally. It showcased a cross-cultural exchange of families and children that spanned continents. At the same time, however, China has been facing criticism amid “baby buying” scandals, where state care institutions are alleged to engage in international adoption by receiving babies from smugglers and traffickers, subsequently facilitating their adoption abroad (Loyd, 2008; Parry, 2014). Concerns have also been raised about the ethical implications of international adoption, particularly regarding the potential exploitation of birth families and the commodification of children (Bartholet, 2007). The repercussions of these scandals and concerns have reverberated within adoptive communities (Marn & Tan, 2015), potentially causing heightened anxiety and influencing a potential decline in the ongoing interest in adopting Chinese infants.

Therefore, the number of adoptees sent to families outside China has experienced a dramatic decline according to recent data from MoCA. The percentage hit a record low of 0.57% in 2020, a stark contrast to the 11.84% observed just four years earlier (see Table 6). It is also worth considering external factors such as the global COVID-19 pandemic, which led to stringent travel restrictions between 2020 and 2023, and other economic, political, as well as socio-cultural forces that may have contributed to the decrease. A thorough examination of this shift is warranted, as it should have offered significant implications for China’s adoption policies and practices.

Table 6. Adoptees in China (MoCA, 2018a; 2019, 2020, 2021, 2022).

	2017	2018	2019	2020
Domestic adoption	16,592 (88.16%)	14,582 (89.59%)	12,074 (92.56%)	11,040 (99.43%)
International adoption	2,228 (11.84%)	1,685 (10.35%)	970 (7.44%)	63 (0.57%)
Sum	18,820	16,276	13,044	11,103

Note. Data represents the numbers and percentages of adoptees in China between 2017 and 2020, Source.

Conclusion

This paper offers a comprehensive overview of the four alternative care options available in China: institutional care, kinship care, family foster care, and adoption. Drawing from a narrative review of relevant literature and governmental publications, recent updates and current challenges in each form of alternative care are discussed, along with proposed suggestions where applicable. The findings highlight significant progress in diversifying childcare options in China, indicating a shift away from the traditional institutional care model. While childcare institutions remain crucial for providing alternative care for orphans and vulnerable children, enhancements in psychosocial development, preparation for leaving care, and aftercare services are deemed imperative. In the realm of kinship care, although financial support is available, challenges may emerge in ensuring adequate resources and support services for both kinship caregivers and the children under their care. Family foster care arrangements are backed by specific policies and guidelines, including eligibility criteria for foster caregivers and financial assistance. Nonetheless, low participation rates underscore significant challenges, including a lack of awareness or acceptance of family foster care and concerns regarding non-biological children’s backgrounds. Poorly managed foster care practices with insufficient training and supervision further exacerbate risks to children’s well-being in such placements. Efforts to improve the adoption system in China include streamlining procedures and regulations to enhance accessibility. Nevertheless, challenges persist, such as lengthy and bureaucratic adoption processes, as well as ethical concerns surrounding international adoption. These ethical concerns encompass the potential exploitation of birth families and the commodification of children, necessitating careful consideration and review within the adoption process.

However, the reported data in this paper relies heavily on secondary sources, primarily from government publications. It is unbale to verify its accuracy and credibility. To minimize the impacts, I applied data triangulation (Noble & Heale, 2019) by comparing data from both yearbook statistics and relevant literature. Furthermore, literature selection in a narrative review often relies on the researcher’s subjectivity (Ferrari, 2015). This can exert a bias in the sources used, as some other important literature might have been overlooked during the initial screening. Such a situation could influence the overall picture presented in the field. Therefore, future researchers could adopt more standardized ways to review literature, such as scoping review or systematic review (Munn et al., 2018). Also, they could conduct interviews or surveys with caregivers, children in care, or child welfare professionals, which would provide primary data to inform insights into the childcare system. Despite limitations, this paper contributes to the literature through promoting a state-of-the-art understanding of alternative childcare in China. It emphasizes the need for ongoing research, practice and policy development, as well as community engagement to ensure the well-being and future opportunities of orphaned children in any challenging situations.

In an ever-changing society, where the concept of family and community develops, the welfare of children remains a collective responsibility (United Nations General Assembly, 2010). To further enhance the quality of alternative care practices in China, policymakers, child welfare agencies, and civil society organizations must work collaboratively. Specifically, key practical implications of this paper include the needs to (i) Promote family-based care options. Given prevailing criticism on children living in non-family-based circumstances, child welfare agencies could promote family-like care within institutional settings and exploring ways to expand family foster care participation. (ii) Provide Quality Caregiver Training. Child welfare agencies could ensure that caregivers in all forms of alternative care receive comprehensive training in child development, trauma-informed care, and gender-sensitive approaches. This will help provide a nurturing and supportive environment for children in their care; (iii) Consider other aspects of children’s needs. Due to a disproportionate emphasis on tangible support for care receivers, policymakers and practitioners could pay more attention to other aspects of their needs, such as social and life skills development, leaving-care preparation, aftercare services and policies. (iv) Extend Kinship Care Support. Child welfare agencies could recognize the importance of kinship care as a culturally significant practice in China. This requires to provide tailored social support in addition to the financial aspect to kinship caregivers, particularly when they are elderly or facing health issues, to ensure the well-being of children in their care. And (v) Formulate Inclusive Adoption Policies. Policymakers could review the current adoption policies to make them more inclusive, especially for children with disabilities. Implement measures to reduce the administrative burden and financial constraints on adoptive families as well as reestablish reputation within the adoptive community, thereby encouraging more adoptions, both nationally and internationally. With these measures, I believe the well-being and opportunities of orphaned children in China will be further improved at large.

Disclosure statement

No potential conflict of interest was reported by the author.

Additional information

Funding

No funding support.

Notes on contributors

Shian Yin

Shin YIN is currently a lecturer at Coventry University London, holding a PhD degree from the University of Nottingham. His research interest falls in the following themes: Child Social Care; Care Leavers; Lived Experiences in Care and Leaving Care; Child Welfare Practice and Policy; Youth Agency and Voice

Notes

1. United Nations International Children’s Emergency Fund.

2. China Philanthropy Research Institute.

3. China Children and Adolescent Charity Relief Foundation and China Youth Research Association.

4. Chinese Yuan : US dollar = 1 : 7.20.

5. Will be abbreviated as “MoCA.”