Nearly three million children in the US have lost their parents or grandparent caregivers in the past 20 years, revealing what experts call a hidden public health crisis. The scale of orphanage driven primarily by drug overdose and other “deaths of despair” reflects similar trends in countries that are part of Colombia, Brazil and sub-Saharan Africa. In a recent international webinar, child welfare experts explored new data and discussed practical, community-based solutions to support the remaining children.
The virtual event, “Crisis-Rated Orphanage: Presumptions and Policy Responses to Protecting Children,” was co-hosted by Georgetown University, which was co-hosted with the Global Children’s Issues, Children, Families and Community Prosperity Center in Washington, DC, and the Global Reference Group on Crisis-Impacted Children.
The discussion focuses on a January 2025 report published in Nature Medicine, entitled “Orphanage and Death of Caregivers in the United States from 2000 to 2021.” In this study, the number of US children between 0 and 17 years old who lost their parents or grandparent caregivers increased sharply, with an incidence rate of 49.6% and a 7.9% increase in the 21-year prevalence rate. Drug overdose manifested as the biggest cause of caregiver deaths and was often associated with a wider range of social and economic challenges.
We are isolated and rapidly increasing from the “death of despair”
Gillian Huebner is a global child rights and protection expert in Georgetown University’s cooperation on global child issues, describing “evidence of a significant increase in orphans over the past 20 years in the United States,” explaining that “it effectively demonstrated a personal impact that one child in classrooms at all schools across the country has experienced a parent or caregiver.”
The main cause of orphans in the United States is due to “death of despair,” a term that includes drug overdose, suicide, murder, and unintentional injuries.
“This is a public health crisis,” Hubner said. “And we can learn from other parts of the world how to respond effectively.”
Oliver Ratman, statistician at Imperial College in London, said the US 2.91 million orphans’ figure was “an order of magnitude larger than previous causes-specific estimates.”
He reported that the most affected demographics included non-Hispanic American Indian and native Alaskan children, non-Hispanic black children, and people living in southern and eastern states.
“In 30 US states, drug overdose was the main cause of everything,” Ratman said. “And we found that the highest prevalence rates are in West Virginia, New Mexico, Mississippi, Louisiana and Kentucky. These are also the states with the highest poverty ranking.”
He explained that drug use has increased during the Covid-19 pandemic, contributing to an increase in suicide rates and a wider surge in deaths between parents and grandparent caregivers. This has led to more children becoming orphans. Ratman said that seeing a significant rise in his father’s death, he was likely to be orphaned than his younger children.
UNICEF emphasizes family-based models over institutions
Kirsten di Martino, UNICEF’s senior advisor on child protection, agreed and emphasized that he faced not only “serious trauma” after losing his parents and caregivers, but also “an increased risk of violence, abuse and exploitation in many different forms.”
She explained that there is a high rate of institutionalization among orphans – those separated from birth families often indicate a weaker child protection system in the country that cannot support and preserve families. Diltino said this highlights the value of a family-based care model.
Children placed in resident care are more likely to experience negligence, lack of individual attention, and limited emotional bonds. In addition, they may face the risk of intensified violence, which can quickly harm their development over time.
As of 2024, an estimated 2.5 million children lived in formal care in 87 countries with UNICEF programs.
She said many countries lack trained social workers who can provide vital services to vulnerable families, including parenting guidance, mental health resources and counseling support.
Di Martino said expanding foster care and kinship care is essential for children who lack parental care as part of their efforts to prioritize family-based alternatives.
“The care of relatives in many countries is really picking up because many children are not true orphans,” she said. “They have a living parent or extended family who can take care of them, and all they need is that they can’t take care of that child and remove the child from the environment they have grown up.
Africa and Latin America show parallel trends, local reactions
Researchers at Joel-Pascal N’konzi at the University of Heriot-Watt and the University of Edinburgh said sub-Saharan Africa was “heavily affected by the HIV AIDS epidemic” along with 58 million orphans.
He said HIV/AIDS is a key driver of isolated children in the area, with 5% of children losing their caregivers each year. Other contributors include the Covid-19 pandemic and ongoing conflicts, such as the Democratic Republic of the Congo.
Ntwali n’konzi added that historical data show how armed conflicts have affected children, not just in great powers, but also in small countries like the Central African Republic, which have experienced two civil wars in recent years.
“In countries like Rwanda, we see that it’s the highest in terms of the number of new orphans happening in a year. It was 1994 because of genocide. In that year, almost 40% of children lost either or both of their parents,” he said.
Other data shared at the event highlighted the impact of Brazil, where 1.3 million children lost one or more parents, grandparents or old relatives. The most affected areas are Sao Paulo and Rio de Janeiro, both of which have a higher overall population.
In Columbia, Oxford University researcher Sidney Tucker said the number of children who lost their parents has been steadily rising each year since 2019, with 100,000 new orphans in 2021. “The need is enormous,” she said.
The total number of orphans in Colombia is 650,000, representing 4.5% of the country’s child population. Two-thirds of these children experience hunger and are reportedly in need of mental health support, and are the most common orphanages in economically disadvantaged areas.
Tucker first described an initiative called Hope Group, designed for parents affected by the war in Ukraine, but has since been adapted to serve Colombia and its neighboring caregivers orphans. The program includes 10 sessions covering topics such as mental health, non-violent parenting, and caregiver training.
She reported that participants had a 76% reduction in depression in caregivers, an 80% reduction in physical violence against children, and a 73% reduction in child behavioral problems.
“The good news is there is something we can do about this,” Tucker said. “Parking programs for neighboring caregivers can strengthen caregivers’ mental health, improve parenting practices, reduce violent discipline, and improve child well-being.”
Faith-based networks provide grassroots support to families
Elli Oswald, executive director of the Faith to Action Initiative, was one of the experts featured in the webinars of resources churches and ministries supporting orphans.
Oswald emphasized that dealing with the crisis of orphaned children requires involvement from every corner of society.
Faith leaders and the community of faith are among the most important players in meeting this need, she said. They can play a role in preventing harm, preparing and protecting children and families affected by the death of caregivers, preparing and protecting them for loss.
They often respond first when their family is in pain. In the case of a medical emergency, they can intervene and avoid the tragedy. They can also help you plan with families facing difficult situations.
When it becomes clear that caregivers are unable to survive, faith leaders can empower relatives who are stepping into the role of caregiving and help them support them through the process.
She added that faith communities are well positioned to address harmful cultural beliefs that provide guidance to alienate orphans and re-change attitudes and values.
“If stigma and discrimination are the drivers of children who live without family-based care, faith leaders can call it,” she said. “When culture says that a child who has lost a parent is cursed, the leader of the faith can call it.”
Oswald pointed out that the church can provide not only material help but emotional and spiritual support, and can fill in the void left by the loss of caregivers.
She shared an example from one of the faiths of her partners in Zimbabwean action, where the pastor noticed a teenage girl in danger. Her father died, her mother disappeared, her aunt took her – was overwhelmed by her own children and poverty.
“All of that pressure made my aunt start to abuse the girl,” recalls Oswald. “There was a real threat to her being forced to survive on the streets alone.”
The local pastor approached his aunt, listened with compassion, and emphasized the importance of keeping the girl in her family. He provided church support, including school tuition fees and basic supplies.
“But more importantly, the church began to walk with them,” Oswald said. “They visited frequently, built trust with their families and created a strong care community.”
The aunt was later trained through a church-led program on how to better care for her child, but the girl received much needed emotional care when dealing with her losses.
Oswald says that the story demonstrates the unique ability of a church to come with family during times of crisis, showing caring for children facing the trauma of losing their parents.
“She may have been on the streets of Zimbabwe. No one knew her name, but the church stepped up to supporting her family, so we can talk about her today,” she said.
“We all need to do our best for these children and equip our faith communities to respond in line with the faith communities working for them, so as it has been stated many times, orphanages and children’s homes are not the answer.
“We have learned that lesson in the past, and we know that families are essential to healthy development for children.
“Therefore, we need to support the faith community to turn around family-based solutions for children and families.”
