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Gibson, Christine Concetta.
Neoliberalism and dependence :
b a case study of the orphan care crisis in sub-Saharan Africa
h [electronic resource] /
by Christine Concetta Gibson.
[Tampa, Fla] :
University of South Florida,
Title from PDF of title page.
Document formatted into pages; contains 31 pages.
Thesis (M.A.)--University of South Florida, 2009.
Includes bibliographical references.
Text (Electronic thesis) in PDF format.
ABSTRACT: Scholars have examined the impacts of neoliberal policies on women, children, small farmers and more, but little attention has been paid to the impact of these policies on orphans. The issue of orphan care is crucial now, and will become increasingly more urgent in the future. Even as HIV/AIDS rates are on the decline, more and more children are being orphaned by the disease. This paper examines the policies, positions and language of the World Bank and I.M.F. regarding orphans in order to understand the biases and assumptions within neoliberalism about orphans, and who is responsible for providing care for them. I then compare the assumptions, commitments, policies, and language of neoliberalism with those of community based organizations working with orphans in sub-Saharan Africa. To personify the effects that neoliberal policies have on orphans and orphan care, I interview orphan care providers in South Africa, Zimbabwe and Zambia. I conclude that the neoliberal approach relegates orphan care to the private sector (charities, extended families, NGOs). That approach is flawed in many ways. An alternative theoretical foundation, the Feminist Ethic of Care, argues for public sector support. The Feminist approach contends that care is not the "burden" of private citizens, but the "duty" of a democratic government.
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Advisor: Michael Scott Solomon, Ph.D.
Structural adjustment programs
x Political Science
t USF Electronic Theses and Dissertations.
Neoliberalism and Dependence: A Case Stud y of The Orphan Care Crisis in S ub Saharan Africa By Christine Concetta Gibson A thesis submitted in partial fulfillment of the requirements for the degree of Master of Arts Department of Gover nment and International Affairs College of Arts and Sciences University of South Florida Major Professor: Michael Scott Solomon, Ph.D. Bernd Reiter, Ph D Dawood Sultan, Ph D Date of Approval: September 25, 2009 Keywords: HIV/AIDS, IMF, World Bank, Structural Adjustment Programs Feminism Copyright 2009, Christine Concetta Gibson
i TABLE OF CONTENTS ABSTRACT vii CHAPTER I: INTRODUCTION 1 Theoretical Foundations 4 Research Questio n 4 Methodology 5 Findings 5 CHAPTER II: REVIEW OF THE LITERATURE 7 Neoliberalism 7 Social Welfare Policy 8 HIV/AIDS 8 Orphans 9 Fostering and Adoption 9 Extended Family Care Challenges 10 Orphans in the Care of Extended Family 13 CHAPTER III: THEORETICAL FOUNDATIONS 15 Liberal Theory and Neoliberal Policies 15 Criticisms of Neoliberalism 17 Neoliberal Institutions 18 Structural Adjustment Programs 19 The Effect of Neoliberalism on Social Welfare Policy 20 Feminist International Relations 21 Important Concepts 22 The Public/Private Myth 23 Feminist Security Theory 23 Feminist Critiques of Neoliberalism 24 The Feminist Ethic of Care 26 CHAPTER IV: BACKGROUND ON THE TOP IC 28 HIV/AIDS in sub Saharan Africa 28 Confronting the Problem 29 HIV/AIDS Orphans 30
ii CHAPTER V: REVEALING BIASES IN NEOLIBERAL CONCEPTUALIZATIONS OF DEPENDENCY AND ORPHANHOOD 33 The F ailure to Theorize Dependency in Liberal Theory 33 Critiques of Liberal Treatment of Dependency 34 Dependency and Feminist Theory 35 Conceptualizing Orphanhood 36 38 United Nations 38 World Bank and IMF 39 Critiques 41 CHAPTER VI: CASE STUDIES 44 South Africa 44 Healthcare 46 Education 48 Social P rograms for Orphans 48 Zimbabwe 51 Unemployment 52 Education 53 Nutrition 54 Healthcare 55 Zambia 57 Education 59 Land 59 Industry 60 Healthcare and Nutrition 60 CONCLUSION 62 BIBLIOGRAPHY 66
iii NEOLIBERALISM AND DEPENDENCE: A CASE STUDY OF THE ORPHAN CARE CRISIS IN SUB SAHARAN AFRICA CHRISTI NE CONCETTA GIBSON ABSTRACT Scholars have examined the impacts of neoliberal policies on women, children, small farmers and more, but little attention has been paid to the impact of these policies on orphans. The issue of orphan care is crucial now, and will become increasingly more urgent in the future. Even as HIV/AIDS rates are on the decline, more and more children are being orphaned by the disease. This paper examines the policies, positions and language of the World Bank and I.M.F. regarding orphans in order to understand the biases and assumptions within neoliberalism about orphans, and who is responsible for providing care for them. I then compare the assumptions, commitments, policies, and language of neoliberalism with those of community based o rganizations working with orphans in sub Saharan Africa. To personify the effects that neoliberal policies have on orphans and orphan care, I interview orphan care providers in South Africa, Zimbabwe and Zambia. I conclude that the neoliberal approach rele gates orphan care to the private sector (charities, extended families, NGOs). That approach is flawed in many ways. An alternative theoretical foundation, the Feminist Ethic of Care, argues for public sector support. The Feminist approach contends that car
1 CHAPTER I INTRODUCTION The surge in children orphaned by HIV/AIDS in SSA represents the worst care crisis in history (Howard, et al 2006). There are an estimated 14 million children orphaned by AIDS in Africa today, and by 2025 the number is expected to rise to 25 million (UNAIDS, WHO, 2008). Even as countries such as Uganda curb their HIV adult prevalence rate, millions of children have been orphaned, and as adults d ie the number continues to rise. In 2001, 20% of children under 15 in Uganda were orphans (Levine, 2001). Orphans suffer special disadvantages; they work more, are less likely to be enrolled in school, are more likely to become ill, and suffer from social pathologies (Levine, 2001pg. ii). In total, the efforts aimed at assisting foster children (HIV/AIDS orphans), including the work of NGOs, governments and donors, reach less than 5% of orphans (Deinenger, Garcia and Subbarao, 2003). In other words, childr en orphaned by HIV/AIDS in SSA are not receiving adequate care. Africa, like much of the developing world, has been led down a path of economic liberalization. Most of the countries on the continent joined the World Bank and the International Monetary Fun d shortly after independence. Membership in these organizations soon led to the adoption of Structural Adjustment Policies (SAPs) and loan conditionalities. SAPs, meant to stabilize economies, have been criticized by many for
2 the impact they have on poor a nd marginalized populations. The austerity measures prescribed by the I.M.F. and World Bank promise long term gains, but are often painful in the short term. Countries accept conditionalities because partnership with the I.M.F. and World Bank are importan t benchmarks for developing nations in order to attract foreign investment and capital. This paper focuses on the impact of economic liberalization on children orphaned by HIV/AIDS in sub Saharan Africa. Neoliberalism, the theory guiding economic liberali zation, assumes that individuals are autonomous and independent. It champions the private sector as the best providers for orphans, but I demonstrate that extended families, charities and orphanages are unable to handle the sheer number of orphaned childre n. The neoliberal dialogue on orphans is laced with the word vulnerability but I will argue that orphans are not just are dangers to which they might succumb. Labeling that there are certain goods and services that they need, and it begs the question: Who is responsible for providing those goods and services? I argue that these children are dependent upon the state for rights and posit ive freedoms such as food, housing, education and healthcare. Neoliberal policies have been particularly controversial in SSA because of the effect of their coupling with the HIV/AIDS pandemic. HIV/AIDS has taken a devastating toll on societies and economi ills caused by HIV/AIDS through education, public health and anti poverty initiatives have been taken away by neoliberalism (Batsell and Boone, 2001). Neoliberalism
3 advocates slashed social spen ding as a measure to lower inflation. It is guided by the above mentioned belief that people can purchase education and healthcare in the market. I argue that it is time for a new paradigm that can comprehend the dependence and vulnerability of children o rphaned by HIV/AIDS, and the paradigm that I propose using is the feminist ethic of care. I am using feminist theory because it does a better job of theorizing dependency, and has been successful in generating a response from the World Bank. A Latin Amer Campaign formed to pressure the Bank to increase participation of grassroots women in decision making on economics, to instill a gender perspective in policy and program planning, to increase i nvestment in services that benefit women, to grant women better (Williams, 1997:10 4). In response to this and other critiques, the World Bank formed a project titled Structural Adjustment Participatory Review Initiative (SAPRI), which investigates concerns about the impact of SAPs on vulnerable populations including women. SAPRI works i n eight countries: Bangladesh, Ecuador, El Salvador, Ghana, Hungary, Mali, Uganda, and Zimbabwe. SAPRI began by initiating grassroots discussions among civil society groups representing marginalized populations in each of the eight countries. The concerns raised by these groups were presented in seminars and conferences and finally a Global report and Forum was formed in 2001 with the goal of based lending, setting the stage for changes in
4 Bank operations and for de mocratizing economic policymaking ( www.saprin.org/overview.htm ). Theoretical Foundations To explicate neoliberalism and its roots in classical political economy, I examine seminal works of liberal theory by Adam Smith and Thomas Hobbes. I then move on to neoliberal theories, policies and institutions, focusing on Structural Adjustment Policies (SAPs), World Bank loans, trade liberalization, removal of subsidies, anti inflation and unemployment and their m ain criticisms. I then examine the theoretical foundations of feminism. I look at both the broad theory of feminist international relations, and important concepts, such as feminist security theory. I then present the feminist ethic of care, and explain wh care crisis. Research Question The question that this paper seeks to answer is: What are the impacts of a neoliberal approach to political economy on the HIV/AIDS orphan care crisis in SSA? My hypothesis is that neoliberal policies hurt orphans in a number of ways, such as creating barriers to education and healthcare. I argue that orphans are dependent upon the state since existing structures of care (extended families, charities) are over burdened with the sheer volume of orphans. Neoliberalism, as an approach to political economy, is unfit to handle the orphan care crisis. A better framework would be feminism, specifically the feminist ethic of care, which posits that participation in a democracy implies that all citizens live in varying degrees of dependence on one another, and that all citizens are able to give or receive care as needed.
5 Methodology I rely primarily on secondary source data in my three country case studies. I used p ublished studies, but also interviewed orphanage staff in each country and pulled information from World Bank and IMF papers, books, conferences and toolkits. I conducted three case studies, using states as my unit of analysis. The countries, Zimbabwe, Zam bia and South Africa, were chosen because they are all sub Saharan African nations with high orphan populations, a high HIV/AIDS prevalence rate, and each has enacted neoliberal policies over the last two decades. In addition, English is widely spoken in a ll three countries. Findings Neoliberalism favors a transition towards private care in hospitals, schools or at home, rather than in public hospitals or other institutions such as orphanages. For gating care to three private sphere actors: the individual and the family, charities and NGOs and private businesses However, evidence shows that the private sector is not able to absorb the numbers of orphans in need of care. Feminist care theory argues that care is the responsibility of the state in a democracy. The extended family in SSA is being hit hard by the HIV/AIDS epidemic. Traditionally, when one or both parents die, an aunt or uncle would take in the children. However, the n ature of the HIV/AIDS epidemic is such that aunts and uncles are also passing away, leaving elderly grandparents to provide care to their orphaned grandchildren. Orphanages are able to provide the minimal food, healthcare, and education necessary to young orphans. But institutions are not able to meet all of the
6 needs of orphans. When orphans reach adulthood, orphanages scramble to link the orphans with employment, higher education and housing. Also, when orphans become sick in orphanages, staff must rely o n public hospitals or private clinics when available, and orphans end up losing out on quality care because public hospitals operate under the assumption that children will be accompanied by parents or caregivers. Piecemeal national grant programs are not sufficient, and underfunded public positive orphans. Therefore, a new paradigm must be ushered in with states taking on responsibility for parentless children either b y reintroducing subsidized education, healthcare and food or by creating special ministries for orphan care which can properly funnel resources to those providing care. The best framework for designing orphan programs would be one guided by the feminist et hic of care.
7 CHAPTER II REVIEW OF THE LITERATURE I survey the literature on the intersection between neoliberal theory, economic liberalization, and the orphan care crisis in sub Saharan Africa, and identify the major arguments presented thus far as well as identify the gaps in the literature. This review presents research and arguments about neoliberal theoretical assumptions regarding who is responsible for the care of orphans and evaluates the ability of the extended family, charities and NGOs to c are for the millions of orphans in need. Neoliberalism development. Neoliberal globalization is blamed for increasing the gap between rich and poor inside and across countries and ov erall increases in poverty; both relative and absolute (Benatar, 2001). One view, blending dependency theory with globalization studies, posits that SSA has been underdeveloped by colonialism and is now being further underdeveloped by its integration into Another way in which neoliberal globalization has disadvantaged SSA is through the use of Organization for Economic Cooperation and Development (OECD) farm subsidies which forbid less developed countries from protecting their agricultural industries, while allowing powerful nations such as the United States to maintain subsidized agriculture,
8 making African crops uncompetitive at home, and impossible to export abroad Social Welfare Policy A consensus exists in the literature that neoliberalism has had an especially disastrous effect on social welfare policies (Ellison, 2007, Benatar, 2001, Okuonzi, 2004). Neoliberal states do not care for the poor in the same way that they did before neolibe ral reforms. For example, in Uganda, social welfare has been eroded due to an economic policy aimed at free markets. Economic indicators such as inflation and government spending are decreasing at the same time that indicators of human development such as infant mortality are worsening (Okuonzi, 2004). Some scholars posit that the lack of social protection in many sub Saharan African nations explains the dissimilar outcomes between advanced industrial nations and SSA. In industrial countries, social prote ction is financed by public spending, taxes and regulations. It is possible to say that SSA is being asked to develop using a neoliberal framework, without the same social protections that advanced industrial nations had during their rise to power. I will dismantling of social welfare policy is disastrous for the millions of orphans in SSA. HIV/AIDS The origin of the orphan care crisis lies in the HIV/AIDS pandemic. SSA was straddled with debt and under going structural adjustment programs at the same time that the pandemic reached critical heights. The state, stripped of its power and ability to spend money on this public health crisis, was unable to formulate policies capable of addressing the epidemic
9 biomedical and global. For example, neoliberalism defines people living with HIV/AIDs through prov There are several flaws with the biomedical approach to HIV/AIDS. For example, it ignores the millions of poor, rural women caring for HIV positive relatives. Caring for the sick takes women away from daily chores that are necessary for the survival of their unpaid and therefore invisible to neoliberals. The double duty of caring for their home and for sick fam hands of structural adjustment, but their analyses stops short of questioning the impact of the neolibera l approach to HIV/AIDS on the children who are orphaned by the disease. Orphans Fostering and Adoption Traditional fostering norms in African culture vary greatly from the crisis fostering going on today (Adato et al, 2005, Aspass, 1999). There is a rich tradition of voluntary fostering in SSA, in which parents send children away to relatives in another area (generally from rural to urban) for better educational opportunities. Voluntary fostering is mutually beneficial for both the sending and receiving fa milies as educational opportunities and family bonding are both nurtured in the process. The HIV/AIDS pandemic has led to a new type of fostering known as crisis fostering. Crisis fostering occurs when one or both parents pass away and children are taken in by siblings or parents of the deceased. Crisis fostering is seen as a social
10 obligation, devoid of the benefits of voluntary fostering, and orphans in foster homes often lag behind in nutrition and education compared with non orphaned children (Aspass, 1999). Most orphan fostering households in SSA receive help informally from neighbors and friends who are poor themselves. In South Africa, just 30% of orphan fostering households received state grants such as the Foster Care Grant or the Child Support Gra nt (Adato et al, 2005). Barriers to receiving the grants include lack of information regarding the application process and lack of proper documentation needed to demonstrate that one is the primary caregiver. The Extended Family The extended family in SSA has been weakened by changes in labor practices, 2000). Traditionally, the extended family in SSA was a tight knit safety net for its members. Aunts and uncles tradi tionally took on the responsibility of caring for orphans, but as the extended family net has weakened, grandparents have begun taking on the role of caregiver. Recent history has also seen the breakdown of traditional marriage. Customarily, marriage in S SA involved the bringing together of a man and a woman with a bride price, unification of two families, rather than two individuals. For this reason, the concept of the care of their extended relatives. In addition to caring for vulnerable children, the
11 extended family was also responsible for passing down values, education, and providing care for sick family members. Since the introduction of capitalism and neoliberal economics in SSA, marriage has transformed into a contract between two individuals and the practice of giving cattle the right to marry has been replaced with the practice of paying cash. Many grooms could not afford the bride price these marriages were not legal and therefore when a child was orphaned, the extended family did not feel responsible for caring for the child. contribution because it demonstrates that neoliberalism has been harmful to the pl ight of children orphaned by HIV/AIDS, there is a major flaw in his thesis. He fails to question the assumption that orphan care is the responsibility of the private sector. He is faulting neoliberalism for weakening the family, but never challenges the id ea that orphan care is strictly the responsibility of families. The dynamics of inside orphan fostering households has been a major field of study for researchers. Freeman and Nkoma surveyed 1,400 current and prospective caregivers and concluded that thou gh extended family members are willing to foster orphaned children, they do not have the means to do so. 12% of parents surveyed were unable to name a caregiver who would look after their child once they passed (Freeman and Nkoma, 2006). Their research als decisions about whether to take in an orphan, showing that orphans face stigmas and biases (Freeman and Nkoma, 2006).
12 Freeman and Nkoma concluded that strengthening the ability of the extended family is paramount. In fact, they argue that children who do not have extended family to care for them should be placed in the care of non family members to avoid being placed fat hers and 17.1% of grandparents reported that if an orphan was HIV positive, it would make an impact on their decision of whether or not to take the child in. That fact demonstrates that there is a need to devise alternative care schemes for these children Some orphans end up living in child headed households or living on the street. One study found that HIV/AIDS orphans in Tanzania who opt to live on the street rather than suffer explo itation and rejection at the hands of their extended family caregivers often end up serving as domestic servants with extended family members or in wealthy households in city centers. These children are vulnerable to sexual violence, abuse and HIV infectio stigmatization surrou nding AIDS. Evans, like most other scholars, favors approaches that strengthen home based care for orphans, rather than orphanages. She fails to consider orphans who do not have family to care for them. She also fails to see a role for Foster, Freeman and Nkoma all demonstrated that some children do not have extended families willing or able to care for them, and therefore the neoliberal
13 assumption that orphan care is a private sector matter is an inadequate approach t o the orphan care crisis. Extended Family Care Challenges Orphans face special challenges in comparison with non orphaned youth when living in foster homes (Adato et al, 2005, Case et al, 2004, Ntozi and Kakayiwa, 1999). School enrollment is markedly low er among orphans compared to non orphans of similar socio economic status. Enrollment has been found to be lower for orphans living in the same household as non orphans (Case et al, 2004). Orphans who do attend school face discrimination because of outwar d signals of their poverty such as tattered or dirty uniforms. The discrimination and stigma that orphans suffer at school is compounded by the psychological trauma of losing their parents. As orphans increase in age, their likelihood of being enrolled in school decreases (Case et al, 2004). In addition, orphans are disadvantaged according to the level of relatedness between them and their caregivers. The findings of Case et al. have been advanced by another study which found that orphans being raised in male headed households were less likely to attend school than their non counterparts within the same household, whereas orphans in female headed households attend school at the same rate as their non orphan counterparts (Aspass, 1999 ). Another reason why orphans in the care of relatives may not have successful outcomes is that many of the households are headed by the elderly who are not mentally or physically able to care for them (Ntozi and Kakayiwa, 1999). Scholars argue that tra ditional patterns of orphan care are not sufficient to cope with the AIDS epidemic, as
14 surviving family members are either too old/young, or too ill to care for the orphans. The research done by Case et al., Aspass and Ntozi and Kakayiwa demonstrate that e xpecting extended families to shoulder the care of orphans is a flawed plan as many orphans in the care of relatives are shown to perform poorly in school. In addition, the level of care that orphans receive with extended family members depends on the gend er and age of their caregiver. These studies do not, however, challenge the macroeconomic ideology within SSA which dictates that orphans are best cared for by individual families and communities. In conclusion, scholars have demonstrated that the extend ed family is becoming too weak to support the burgeoning orphan population, resulting in lower outcomes in school enrollment, health and nutrition among orphans. In extreme cases, orphans are living on the street or in child headed households. The rest of this paper will demonstrate that an alternative paradigm to neoliberalism is needed, since neoliberalism cannot theorize the existence of a dependent. I will argue that feminism, specifically the feminist ethic of care, represents the best framework for p roviding for the needs of sub
15 CHAPTER III THEORETICAL FOUNDATIONS The purpose of this chapter is to explain the foundations and principles of neoliberalism in order to challenge its ability t o address the orphan care crisis in sub Saharan Africa (SSA), an area greatly influenced by neoliberal policies. After explaining neoliberalism, I explain why feminism is a more suitable theory for understanding the needs of children orphaned by HIV/AIDS. Liberal Theory and Neoliberal Policies Neoliberalism is rooted in liberal political theory, a product of the European Enlightenment. It privileges political freedom, democracy, constitutionally guaranteed rights, and champions market capitalism. Liberalis m is founded on the work of social contract theorists Thomas Hobbes, John Locke and Jean Jacques Rousseau, philosopher Immanuel Kant, and economists Adam Smith and David Ricardo. Liberalism sees human nature as neutral or good and prone to cooperation and regimes as facilitating cooperation between states. Adam Smith, in reference to economics, wrote that human nature is to From liberalism came neoliberalism, an approach to political economy that advocates for th e elimination of artificial barriers to trade, privatization of state owned firms and a limited role for the state in other areas as well. The market, according to neoliberals, is simply a meeting place for consumers and firms. Perfectly competitive
16 market s are expected to naturally settle to the most advantageous level of output and price, and any government induced movement away from the market equilibrium is believed to reduce social welfare. Institutions have a significant role to play in neoliberalism One such institution is the International Bank for Reconstruction and Development (the World Bank) and the International Monetary Fund (IMF). These institutions were formed at the 1944 Bretton Woods Conference in New Hampshire. The goal of the IMF was to facilitate post war international economic stability by providing funds for countries facing an economic downturn in order to facilitate a return to full employment. The IMF would do this by disbursing short term loans to help rescue nations in balance of payment crises. The IMF financing on affordable terms to meet its net international payments while maintaining netary Fund). The Fund Growth Facility (PRGF) and the Exogenous Shocks Facility (ESF) provide loans at a lower interest rate to low income countries. The IMF does most of address short term balance of payments crisis in one to two years. The Flexible Credit prevention. The Extended Fund Facility is for countries with long term balance of conflict countries and countries who recently suffered a natural disaster (I nternational Monetary Fund).
17 economics. Keynesian economics refers to the ideas of John Maynard Keynes who envisioned a world in which governments provided oversight and made oc casional Ronald Reagan in the United States and Margaret Thatcher in Great Britain, the ton represented a consensus between the U.S., the IMF and World Bank based on free markets and limited government (Stiglitz, 2002). Criticisms of Neoliberalism Critics ch arge that driven by the theory of comparative advantage, neoliberalism facilitates the exploitation of labor and the environment by multi national corporations who seek out countries with the lowest standards to do their business, therefore creating a protections by claiming that all countries do not share the same values. They claim that less developed countries have lower labor and environmental standards out of raise their standards if they so choose (DeMartino, 2000). Another criticism of neoliberalism deals with hypocrisy. Historically, the most powerful states in the neoliberal e conomy have exempted themselves from the most basic legal constraints on international commerce, and no artificial protection or subsidies constraining the freedom to e
18 Additionally, neoliberalism contains an inherent assumption that any and all societies are best suited for the neo liberal economy and global free trade, but critics argue that the whole world cannot possibly fit into one specific type of economy (DeMartino, 2000). Neoliberal Institutions Another realm of neoliberal criticism deals with the World Bank and IMF. Critics charge that these institutions have failed in the areas of reducing poverty and increasing stability (Stiglitz, 2002). One main explanation of this failure is that Western countries, who wield an uneven amount of power in these institutions, skew t he results of trade liberalization in their favor by pushing developing nations to eliminate trade barriers while keeping their own barriers and subsidies in place. The capital market liberalization that is being pushed onto developing countries by the IM Western economies until late in their development (Stiglitz, 2002). The main criticism of the IMF is that it has abandoned its mission. John Maynard eered the idea that markets need overall governance, and that view has been all but tossed aside in governance structures of the IMF and World Bank are problematic. Though t he institutions mainly work in developing nations, the heads of both institutions come from the United States and Europe. The representatives of less developed countries in the IMF are often elite members of the business or financial community, and therefo re are often looking out for their own special interests rather than the good of the entire country.
19 Critics also claim that there is a lack of accountability and transparency at these institutions. For example, IMF and World Bank voting rights are determ ined by economic size and the WTO has a consensus system that favors the powerful. Representation and voting within the IMF favors richer nations who receive votes proportionate to their contributions. This system gives an uneven amount of power to the Uni ted States and Europe in making decisions (Greig, Hulme and Turner, 2007). In addition, the representatives from each country at the IMF are trade ministers or financial officials with little interest in human rights, or the environment. Transparency is a problem as well due to the fact that although the IMF is a public institution, average citizens do not have a real say in the decisions that are made by the IMF and the inner workings of the IMF (and World Bank) are not open to public discourse or scrutiny Structural Adjustment Programs Structural Adjustment Programs (SAPs) are arguably the neoliberal policies that most negatively affect orphans by slashing spending on healthcare, education and other rights guaranteed to children under the UN Convention on the Rights of the Child. SAPs are the conditionalities attached to IMF loans which are meant to reinstate growth and ampbell, 1989: 2). Generally, SAPs involve the removal of price controls and subsidies, an increase in the ratio of savings to GDP and the phase out of public enterprises (Sonko, 1994: 94). SAPs can be divided into two phases. Phase one focuses on short t erm economic stabilization and it encompasses devaluation, budget austerity, price liberalization and the de indexation of salaries. The second phase includes trade liberalization, liberalization of
20 the banking system, privatization of state owned firms an d land, tax and labor market and pension reforms, management of poverty and good governance (Toussaint, 1999: 140 150). The privatization and elimination of social safety nets that come along with SAPs have a particularly disastrous effect on orphan care (Greig, Hulme and Turner, 2007). benefiting the multinationals, the ruling group, technocrats, bankers and some business s often result in the elimination of services which the poor depend on, while the financial community benefits from the relaxing of regulation. The Effect of Neoliberalism on Social Welfare Policy Neoliberal policies have particularly devastating ef fects on healthcare policies. One scholar condemns the theory and its policies in regards to health services. that they reduce government expenditure on health care, education and other social services, and encourage privatization, even with health care. The availability of condoms, STD treatments, anti tuberculosis therapy and treatments for co infections of HIV is subject to user charges and is still encouraged by the World B ank in many African countries. The whole public health agenda has thus It should be noted that nations in SSA joined these institutions and adopted neoliberal policies for strategic reasons. Post independe nce, new African nations joined in order to gain legitimacy in the international arena and attract desperately needed foreign investment. Not being a part of the World Bank and I.M.F. would cast a shadow of doubt upon countries in the eyes of multinational corporations and other actors. States needed to be IMF members in order to borrow from the World Bank, and states that were
21 not IMF members in good standing were ineligible for bilateral loans, commercial bank loans and other important revenue streams (Gr eig, Hulme and Turner, 20007). Neoliberalism is not equipped to properly theorize and provide for the needs of orphans for the reasons stated above. Feminism, specifically the feminist ethic of care, does allow for theorizing the needs of dependent popula tions. The following sections explain feminism and why it is a stronger framework for the argument I am making. Feminist International Relations Feminist International Relations is a part of the Critical IR third wave, countering mainstream theories such as realism and liberalism. Marysia Zalewski writes that its purpose is to show that accepted assumptions within the discipline are in fact not Feminist IR challenges the status quo in three ways (Carr oll and Zirelli, 1993). First, by challenging the way that political theory and empirical research have traditionally excluded women as actors. Women were not just left out; they were intentionally taken out and men justified the exclusion of women by labe ling them irrational and apolitical, viewing their work as philanthropic, rather than political. This 1993). A second category of feminist theory aims to put women back in to politics and make them visible actors within mainstream political science and empirical research. A third category of feminism challenges the entire framework of political science, including the division of life into public and private spheres. Scholar s in this category, including Cynthia Enloe, seek to understand, among other things, how women define politics (Enloe, 1990).
22 Important Concepts Feminists have developed concepts to explain the situation of women in developing nations under conditions of neoliberalism. Until decision makers within The triple role concept describe s the situation of women in low income households who must take on the duties of reproduction, production, and community management. Policy makers tend to only value the productive role of women, since it eventuates in a tradable good. Reproductive and com munity roles are seen as natural and are assumed. Therefore, the majority of work done by women is invisible (Moser, 1993). The burden on women intensifies under SAPs because they have to assume roles that the government is cutting back on such as water an d health services and the provision of education. The sexual division of labor is a concept which goes beyond the pattern of work distribution between the sexes to address the social practices which assign some types of itable for men, and other sorts of work as shift from non tradable to tradable goods, economies of developing countries are seeing surges in labor intensive manufactu ring jobs. These jobs are, for the most part, filled by women. When women are pulled away from domestic duties to work in places such as factories, their housework and childcare duties are passed on to other women, rather than to their husbands who may hav e been laid off due to public sector downsizing or privatization. Therefore, scholars argue that the sexual division of labor and neoliberal
23 economic development leads to male unemployment and double duty workloads for women who take on factory work in add ition to unpaid domestic labor (Beneria, 1999). The Public/Private Myth There is a consensus among Western feminists that women have been largely relegated to the private sphere and excluded from the public sphere where politics are conducted. Rachel Sim on Kumar described the private/public dichotomy when she access to micro credit, improve skill levels and increase representation in formal politics is the implicit beli better social condition and position to negotiate their rights. Its antonym, the private, is Kumar, 2004: 486). By studying the s pace and ideology involved in the public sphere concept, it becomes apparent that gender assumptions inherent in the construction of public space need to be interrogated. Feminist Security Theory Within mainstream international relations, security is base d on ideas of sovereignty, self interested nation states, and military strategy. Mainstream conversations about security center on war and peace (Blanchard, 2003). Feminists, however define security as the elimination of all forms of violence including phy sical, structural, and ecological violence. From this perspective, security is not just about avoiding war. Feminists argue that researchers should also focus on what happens during war particularly the impact of war on women (Tickner, 1997).
24 Feminist sec urity focuses on the exclusion of women from decisions on peace, war and security (Stiehm, 1983). Women face difficulties being heard during civil or bi lateral peace talks, such as in the Democratic Republic of the Congo. One possible solution would be to institutionalize the role of women in the process of peace making and peace building (Stiehm, 1983). Mainstream theorists have attempted to classify the HIV/AIDS crisis as a security threat, a classification which feminists take issue with. Since the end of the Cold War and especially since the terrorist attacks of September 11, 2001, there has been a slow merger of development and security. Poorer nations, in the global South, are seen as security threats, rather than as underdeveloped. This analysis igno res historical explanations of Those who posit that HIV/AIDS is a security threat say that it can destabilize national armies, stunt local and national economies, limit the next generation of skilled workers and government leaders, and they see AIDS orphans as being potential targets for rebel armies as child soldiers. Proponents of this view include Bill Clinton, Colin Powell and Richard Holbroo ke. A Feminist perspective would look at the threat HIV/AIDS poses to people living with the disease and their community, including children orphaned by HIV/AIDS, not to the United States. Feminist Critiques of Neoliberalism An inherent male bias exists in neoliberal policies (Williams, 1997, Elson, 1987, which is a product of its cultural historical time period, and relies on views of human
25 behavior held by dominant race s, ethnicities and genders (Sparr, 1994). Neoliberal institutions such as the IMF and World Bank have credited themselves and their policies with being gender neutral, but a set of concealed assumptions which deal with human resources, their allocation to production, and their own reproduction and maintenance exists (Elson, 1987). Neoliberal policies and institutions all have the capability of negatively impacting women because of their failure to consider gender. The first bias concerns wage labor and wom market. Men and women have historically experienced different and unequal links to the Masculinity therefore has been associated with the ma rket and public life while doing is substantial. For example, the UNDP estimates that approximately 70% of total world output consists of unpaid activities, and almost 69% of that work is done by women (Beneria, 1999). Neoliberalism assumes that all societies are monetized and market oriented. This assumption leaves women out because some countries exclude women, either legally or de facto, from participating in the market thr ough ownership of property and other exclusions (Sparr, 1994). A second bias concerns the lack of attention paid to power relationships within households. The division of power relations within households, communities and countries is an important issue w hich is ignored by agents of neoliberal globalization. Concerning women who work in agriculture, research has demonstrated that women do not benefit from new technologies in agriculture, even when the technology was designed with their benefit in mind, bec ause the power relations inside their households,
26 The Feminist Ethic of Care The Feminist Ethic of Care is an alternative pa radigm to neoliberalism developed by feminists and other postmodern theorists. It argues that traditional assumptions about women, such as their ability to care and the obligation that they feel towards others, are values which should guide all human inter the private into the public realm. The Feminist Ethic of Care differs from other theories because it does not espouse broad values about how people should act, but rather its and relationships (Engster, 2004). It challenges the traditional idea that care is a feminine value, asserting instead that is non gender specific. individualism overlooks other wa ys of understanding human interaction. Care theorists see people as starting out connected and aiming to achieve some freedom, whereas neoliberals see people as starting out separate and individualist and aiming to balance connections and relationships wit h their freedom. Feminists ask how they can attain some freedom and remain connected and carry out their obligations (Sevenhuijsen, 2000). Care Ethic analysts view democracies as encompassing people who live in networks of care, not as a community of equa l rights holders. This approach argues that the giving and receiving of care should be available to all citizens in a democracy; making care a democratic exercise. The idea that everyone needs care and is capable of giving care and that a democratic socie ty should make space for both of those activities is
27 activity, in the sense of caring about and for daily needs, and as a moral orientation as an ethics or a set of val (Sevenhuijsen, 2000, p.6). The paradigm argues that a democratic politics requires going beyond the negative freedoms endorsed by neoliberalism. Rather than protecting citizens from threats, Ca re theorists see the main task of democracies as facilitating caring relationships. Care Ethics upholds the following four values: attentiveness, responsibility, competence and responsiveness. This is vastly different from neoliberalism which views socie ty as made up of abstract individuals who can have all of their needs met in the market. Thinking about societies through a Feminist Ethic of Care framework affects how policies on healthcare, education, city planning and business management as well as fam ily practices are designed. For example, according to this paradigm, issues such as childcare would be based on decisions not just made between mothers and fathers, but institutionalized through employment law. Orphans, who do not have parents or in some c ases extended families, would have their needs met on an institutionalized basis from the government through services such as housing, education vouchers, access to healthy food and adequate health insurance and medical care. For these reasons, feminism is a more helpful theory when thinking about how to resolve the problems facing children orphaned by HIV/AIDS.
28 CHAPTER IV BACKGROUND ON THE TOPIC HIV/AIDS in Sub Saharan Africa HIV/AIDS is a transcontinental problem, but sub Saharan Africa (SSA) has been the hardest hit region. According to a 2008 Report on the Global AIDS Epidemic from UNAIDS, 67% of people living with HIV/AIDS worldwide reside in SSA, and 72% of a ll new HIV infections and deaths from AIDS took place in Southern Africa (UNAIDS, WHO, 2008). Zimbabwean adults face a one in five chance of becoming infected with HIV. impact on societies and economies and while strides have been made in stemming the number of new infections and disseminating drugs to treat those living with the disease, one problem persists. Millions of children have been and continue to become orphaned becau se of HIV/AIDS. This chapter provides background information on HIV/AIDS in the region and the orphan care crisis that the disease has created. There are several reasons why the disease spreads at such a rapid pace in the region. The most common mode of transmission in SSA is through heterosexual intercourse, and certain practices such as multiple concurrent sexual partners, the
29 commercial sex worker industry, low condom use, circumcision, urbanization, breast feeding and high fertility rates serve to acc Ukaga, 2005). Confronting the Problem Improvements have been made in providing treatment to people living with HIV/AIDS. For example, more than one million people in SSA were receiving antiretroviral (ARV) treatmen t by June of 2006, which is ten times more than the number of those who received them in December of 2003, according to UNAIDS. However, one million represents less than 25% of the estimated 4.6 million in need of ARVs. Treatment is vital. UNAIDS reports t hat young people in Zambia face a 50% life time risk of dying of AIDS in the absence of treatment. There are a variety of reasons that treatment is not reaching the majority of people living with HIV/AIDS in the region. Poverty is just one of many signifi cant barriers which exist in the delivery and usage of medicine in SSA (Karim and Karim, 2005). For example, transportation can be too costly, preventing the person from getting to their point of care. In addition, unstable domestic environments such as mi grant labor inhibit individuals from keeping to a normal routine of treatment and care. Other barriers to proper usage of anti retrovirals are cultural factors such as traditional beliefs about HIV/AIDS as well as stigmas around the disease (Karim and Kari m, 2005). Attempts have been made on both domestic and global levels to stem the tide of new infections and to scale up the delivery of medicine to people living with HIV/AIDS. Governments have attacked the disease in a myriad of ways such as launching pu blic
30 health and education campaigns, providing medicine, distributing condoms and changing public policies. Studies have demonstrated that policy changes such as legalizing sex work, decriminalizing homosexuality and providing condoms to prisoners have res ulted in a drop in new infections in Uganda and Senegal (Goyer and Gow, 2002, Putzel, 2003). Much of the work to curb the HIV/AIDS pandemic is done on the global level through organizations such as UNAIDS. At the 2001 United Nations General Assembly Speci al Session on HIV/AIDS, countries signed onto the Declaration of Commitment. In addition to the Declaration of Commitment, UNICEF, UNAIDS and other partners launched a five year initiative, the Global Campaign on Children and AIDS: Unite for Children, Unit e against AIDS in 2005, to meet the Millennium Development Goals and other global commitments. The mechanisms in place to tackle HIV/AIDS globally are large and complex enough to be called a form of governance in which NGOs rule (Seckinelgin, 2005). Seckin emerging around HIV/AIDS (Seckinelgin, 2005, p. 357). HIV/AIDS Orphans UNAIDS reported in 2008 that national epidemics in SSA have become stable for the most part, and some nations are seeing a decline (UNAIDS, WHO, 2008). Though the pandemic is stabilizing, the number of children orphaned by AIDS is increasing and will continue to increase. For example, in South Africa, seventy five percent of HIV positive people were in stages one and two of t weight loss, and upper respiratory infections (UNAIDS, 2008). Because so many people
31 are still in the early stages, Sou th Africa can expect to experience a surge in the number of orphaned children within seven years, putting South Africa on the brink of a major care crisis (Adato et al, 2005). An AIDS orphan is defined by UNAIDS as a child, under 15, who has lost one or b oth parents to AIDS. If only the mother is deceased, then the child is referred to as a maternal orphan. If both parents are deceased, the term double orphan is used. UNICEF estimates that there are more than 12 million children orphaned by AIDS in sub Sah aran Africa, and that number is projected to exceed 25 million by the end of the decade. Children orphaned by AIDS face challenges in accessing necessities of life. Orphans are at risk of losing the basic rights afforded to children under the Convention o n the Rights of the Child such as education, rest, protection from abuse and protection from exploitation (Phiri and Webb, 2002). Most African governments are not able to provide the public goods needed by these orphans. Uganda, for example, provides no se rvices for orphans, meaning that 2.5 million children, one tenth of the entire population, receive zero social support from the government (Okuonzi, 2004). Not only are there no publicly funded nationwide welfare programs for orphans, the ability of Uganda families to care for orphans is eroding due to population mobility and the trend towards nuclear family structures (Okuonzi, 2004). Some view large orphan populations as a threat to development and stability on the continent. The World Bank posits that orphans grow up to be adults with low productivity levels, which causes nations to suffer a loss in Gross Domestic Product
32 (GDP). The Bank also argues that large populations of disenfranchised youth will present problems with significant social consequence s for African nations (World Bank, 2009). In conclusion, HIV/AIDS ravished through the region of SSA, but is now stabilizing. The pandemic, however, has left a major issue in its path; children orphaned by HIV/AIDS. This paper will examine whether neolibe ral economics is the best framework for addressing the needs of these millions of orphans.
33 CHAPTER V REVEALING BIASES IN NEOLIBERAL CONCEPTUALIZATIONS OF DEPENDENCY AND ORPHANHOOD In this section, I demonstrate that notions of abstract individualism a nd equality are embedded in liberalism, which leads to an assumption that every individual is able to to theorize the dependency of orphans. In order to understand w hy dependency is not a recognized concept in neoliberalism, it is helpful to analyze seminal pieces of liberal theory to see how dependency was discussed. Liberal theory laid the foundation for free market capitalism. Liberal theorists wrote broadly about men in the state of nature, and the ways in which states and economies should be structured. Liberal political theorists fail to account for dependent populations within a society. It is therefore possible to understand why neoliberalism rejects dependency discussing orphans. The Failure to Theorize Dependency in Liberal Theory Thomas Hobbes, in Leviathan, maintains that all men are physically and mentally equal to one another. Their equality, he argues, causes them to desire the same things as each other and their competition for those things breeds enmity or warfare. This leads
34 which declares that the market brings all things back to equilibri um. His theory, in some ways, is the basis for neoliberal economics. Surprisingly, Smith came close to dealing with dependency when he wrote that laborers are responsible for saving some of their r one absolutely dependent on us for immediate subsistence, would not be treated in this manner. His daily subsistence arguing for separate policies of payment for depe ndent persons so that they can continue to survive throughout the year, while others (laborers) should be responsible for saving their own wages and making them last throughout the year. It will be explained later, bodied adults. Critiques of Liberal Treatment of Dependency Though Hobbes and Smith do mention dependency, there are several flaws in these early liberal writings. Both are deeply gendered, and both employ an abstra ct individualism which assumes that all members of society are equal. are earning wages, which, in many societies, leaves out women and children (including orphans) and those unable to work because of a disability. Feminists, such as Carole Pateman, have written extensively on the exclusion of women in social contract theories.
3 5 Pateman argues that a (Pateman, 1988, p. 6). Social contract theories, argues Pateman, marry patriarchy and citizenship. By sta ting that all men are physically and mentally equal, Hobbes ignores physical and mental illnesses that people may be born with or develop during their lifetime, as well as the needs of children, orphans and widows who cannot necessarily support themselves. As Amartya Sen points out, capabilities are not distributed equally among people. The abilities of someone with a physical or mental handicap are not equal to the ability, or income earning potential, of someone without similar disabilities (Sen, 2001). T he notion of abstract individualism explains why dependence is not fully understood in liberalism and neoliberalism. Since the theory defines all people as abstract in their individuality, it assumes that all people have the same opportunities and capabili ties. It ignores gender, class, race, age and more. Dependency and Feminist Theory Feminism is better suited to tackle the care crisis presented by AIDs orphans, because feminism understands and theorizes the dependent. Feminist scholars argue that societi es are made up of people who are dependent upon one another in varying degrees, as well as those providing the care to the dependent (Kittay, p. 36). Those who provide have shown that these workers are overwhelmingly female and their jobs are among the lowest paying (Kittay, 1998). In the case of AIDS orphans, the orphans would be the
36 dependent population, and extended family members and orphanage staff would be the Conceptualizing Orphanhood As mentioned earlier, the United Nations sets the precedent for defining orphanhood. Neoliberal institutions, however, break from the United Nations and smaller NGOs and charities in their ideas about how best to make policy for orphans. Issues such as separately identifying children orphaned by AIDS from other orphans reveal deep ideological commitments on the part of these institutions. benefit from reaching the Millennium Development Goals in the areas of education, health, nutrition and poverty. In order to reach its goals regarding orphans, the Bank has created an OVC (orphans and vulnerable children) Toolkit for sub Saharan Africa on its website for World Bank staffers or outside organizations/individuals whose work involves orphans. The toolkit provides core definitions, data, cost management and tips on formulating policy, best practices and project evaluation. According to the to be responsible for delivering the services that result from the policy (World Bank, 2009). It is clear from that statement that the World Bank assumes that the role of caring for orphans should be carried out by the private sector, a position to be expected from an organization operating under a neoliberal ideology. It displays a bias against governm ental spending for social services or governmental involvement in caring for orphans and vulnerable children.
37 The United Nations also takes the responsibility away from the government and transfers it to communities. In Children on the Brink, the UN priv ileges a bottom up communities are in the best position to determine which children are at greatest risk and what factors should be used to assess vulnerability and set (UNAIDS, UNICEF, and USAID, 2004, p 3). asserts that preventing children from becoming orphans or vulnerable children is more economical than supporti ng children who are already in the category (World Bank, 2009). This bias towards prevention rather than administration of care to orphans is also Children on the Brink, the U.N. argues that or phanages are not beneficial for emotional and psychological needs of children. It states that orphanages are too costly, and that the system is being abused, citing that children in orphanages often have living relatives (UNAIDS, UNICEF, USAID, 2004). Rese arch shows, however, that extended family members cannot always adequately care for orphans at the rates in which children are currently becoming orphaned. The Bank also takes the position that poverty can be a worse fate for children than other settings or country contexts, the risks of orphanhood may not be that serious; indeed, in some countries the poverty induced vulnerability among children Subbarao, 2004, p. 5 6). In an IMF Working Paper, economists Gonzalo Salinas and Markus Haacker explore the link between HIV/AIDS and poverty using the Millennium
38 Development Goals as a benchmark. They write that orphanhood hinders access to education and therefore inhibits the achievement of the second Millennium Development Goal, which is to achieve universal primary education. Salinas and Haacker, however, clear bias against inc luding orphan data. For example, when studying the impact of HIV/AIDS on household poverty, they do not account for changes in household composition which discounts experiences of families who take in HIV/AIDS orphans. In addition, when looking at income transfers, the researchers look exclusively at horizontal transfers (between households), which leaves our orphans who would require a vertical transfer from the central government. NGOs, the World Bank, IM F, and CBOs all have differing ideas regarding the best policy interventions for children orphaned by HIV/AIDS. By examining the proscriptions advocated by each sector, I hope to expose biases towards pushing the orphan problem off onto the private sector by neoliberals. United Nations The United Nations articulates several best practices and guidelines for policies to help orphans through reports, such as Children on the Brink, and through commitments and declarations made by agencies within the U.N. such as UNAIDS, UNICEF and UNGASS. Earlier in the Background chapter, the principles of the UNGASS Declaration were explained, so this section will focus on the recommendations made in the Children on the Brink report.
39 The authors of Children on the Brink argu problems, violence, and exploitation mandate that policy makers, leaders and practitioners in public health provide orphans with care and support. The authors write ity to care for and protect children, national governments have the ultimate responsibility to protect them and ensure their According to the U.N., policy makers, or governments, are seen as having two key responsibilities in the provision of care for orphans. The first is ensuring access for orphans and vulnerable children to education, healthcare, birth registration, and other vital services. Secondly, governments should seek to improve policies and le gislation and provide the necessary resources to communities. World Bank and IMF The World Bank and IMF also advocate for several orphan policies through papers, books, conferences and online toolkits. In 2001, the World Bank and World Vision (a faith base d international relief and development agency) sponsored a conference aimed at identifying the best practices for working with orphans and other vulnerable children as well as contemplating the role of social protection in these initiatives. In a paper su specifically, should aim to ensure that governments have the capacity to protect the most vulnerable a with the feminist ethic of care, in asserting that care is an integral part of governance. In addition, governments should not only make special concessions for orphans while
40 planning budgets, but governments should work with the private sector and international community to streamline its efforts. A 2003 World Bank study of HIV/AIDS orphans and their foster families in Uganda demonstrated that free healthcare and education i mproves the quality of life for children orphaned by HIV/AIDS. When the study began in 1992, the government provided free public healthcare, but during the course of the study, user fees were introduced for public healthcare. The researchers were able to demonstrate that access to health services decreased among orphans during the 1992 2000 time periods, suggesting that user fees created a barrier to healthcare for orphans (Deinenger, Garcia and Subbarao, 2003). The government of Uganda introduced Universa l Primary Education (UPE) in 1997, halfway through the study. Following the UPE policy, Ugandan orphans showed an increase in primary school enrollment. The authors conclude that the most economical interventions for governments are in the areas of school ing and access to food. The most effective mode of distribution of aid would be through fostering households, not to orphanages, which were deemed too expensive for most African states. Additionally, the researchers concluded that support should be reserve maternal and double orphans (Deinenger, Garcia and Subbarao, 2003). World Bank economists Francisco Ferreira and Michael Walton reiterate the role of subsidized services. Ferreira and Walton e xplore the role of equity, defined as in an article that appeared in Finance and Development, a quarterly magazine of the IMF
41 (Ferreira and Walton, 2005). The types of o pportunities that they are talking about include universal education and healthcare. Critiques The recommendations made by the U.N., World Bank and IMF are flawed on two fronts. Ferreira and Walton argue that the goal of development policy should be to pr IMF is failing to consider the physically or mentally handicapped, orphans and other groups who require care beyond just education and healthcare. Orphans require comprehensive care, including shelter, food and more. This is a position which Amartya (Sen, 2001). Sen would argue that even if two people from such diverse backgrounds were given the same opportunities or chances, the outcomes would be different based on o them. Sen policy decisions. OVC Toolkit displays a clear bias against state spending or subsidized services for orphans. The Toolkit advises staffers and other practitioners to steer clear of any causes or consequences o
42 entire overhaul of the healthc are system (World Bank, 2009). In other words, the World Bank is saying that the status quo, or the structure of the economy, should not be criticized in the attempt to care for orphans. The bias against state spending is displayed yet again when the Toolk development when certain interventions or gaps in services simply cannot be ues against that point. Sen would argue that delivery of social services such as education and healthcare create development by creating an educated, healthy workforce (Sen, 2001). The hollow states which neoliberalism create, cannot meet the needs of the millions of orphans living within their borders. One informant, Jaime Bugawski, served as the Interim Director of Sons of Thunder orphanage outside Livingston, Zambia from 2007 2008. Her experience is demonstrative of the impact of structural adjustment p services. The orphanage received no grants or subsidizations through the Zambian government. estimat ed to be upwards of one million orphans in Zambia, a country with just 12 and underfunded. Social
43 In conclusion, neoliberalism fails to understand the dependency of orphans because its theoretical foundation, liberal political theory, also misunderstands dependency. Liberal theory understands all human as equal. It assumes that all individuals in a society are able bodied, wage earning males. This definition leaves women and children out of the equation, suggesting that liberal theory assumes that all children live at home with parents who provide for them. It is possible to see why neoliberal theory slashes social programs that children, particularly orphans, would depend upon. I demonstrated that orphans are dependent upon government services by using data collected from an interview, and theoretical advocated by the World Bank and the IMF concerning orphans. In the next chapter, I present case studies from South Africa, Zimbabwe and Zambia.
44 CHAPTER VI CASE STUDIES This chapter contains case studies of the connection between neoliberal policies and the welfare of orphans in three countries: Zimbabwe, Zambia and South Africa. Using primary and secondary source data, I demonstrate that neoliberal policies have contributed to declining outcomes for orphans. In each of these three states, there are large populations of children orphaned by HIV/AIDs, and neoliberals IFIs have had a hand in shap ing the domestic political economy. Time did not permit a full examination of the entire region; however I believe these cases are all suggestive of a general trend in the region. South Africa South Africa joined the IMF on December 27, 1945. When South A frica transitioned to democracy between 1993 and 1994, the World Bank and IMF were instrumental in helping to shape the economy of the post apartheid South Africa to fit a neoliberal model. The new economy was marked by individualism, privatization and a r ise in the influence of NGOs. During apartheid, NGOs were seen as scions of white power and were largely mistrusted by black South Africans. The new economy saw local communi represented a shift in focus away from structural social problems towards individuals and
45 communities (Mindry, 2008). In other words, widespread poverty was seen as a problem to solve on the local broad and radical change. The new neoliberal model has several important implications for orphans in South Africa. Before examining the ways in which orphans are affected, I will first expl ain how South Africa came to adopt neoliberalism. The framing of the new economy was a process which lasted from 1993 to 1996, and was participated in by the National Party (NP), the ANC and the IFIs. The IFIs had a threefold agenda: privatization, reducin g or eliminating budget deficits and reducing inflation. The World Bank advocated for also pushed a strong anti inflation agenda and wage consolidation. At first, The ANC was critical of and rejected IFI suggestions, while the NP embraced them. Labor unions were one sector of the South African society which strongly pushed for a rejection of the IFI policies. However, at the World Economic Forum in Cape Town on June 9, 1994, Nelson Mandela said, in the opening session, that social policies. This included privatization of state owned industries valued at $18 billion dollars (Hanson and Hent z, 1999). This turn towards neoliberalism shocked many South Africans since the ANC had promised, while still in exile, to radically redistribute wealth and resources through their Reconstruction and Development Program (RDP) once they came to power. RDP s tood in stark contrast with the plan implemented by the ANC once they took power, which was named Growth, Employment and Redistribution (GEAR).
46 GEAR, adopted in 1996, pandered to the neoliberal market oriented international economy by transforming the de livery of social services into a business model, and cutting costs through privatization and other measures aimed at macroeconomic stability (Mindry, 2007). Services such as water and electricity were privatized, resulting in 75,400 water cut offs in the G reater Cape Town area between 1999 and 2000 (Mindry, 2008). Since GEAR was implemented, more than 500,000 jobs were lost and housing construction, which was promised, slowed down. South Africans have also seen rising inequalities in access to health care a nd education, and a rise in crime (Benatar, 2001). GEAR can be understood as a self imposed Structural Adjustment Program, undertaken under pressure from the IMF/WB and the NP. Benatar argues that the ANC faced with the necessity of dealing with a global corporatist and consumerist society in which the power of the market seriously affected by neoliberal policies and borrowing. I n the year 2000, 20% of budget went to debt servicing, 20% for education and 10% for health (Benatar, 2002). Healthcare Healthcare is one sector of South African society that has been affected by neoliberal policies of privatization. Presently, the South African healthcare system is being ravished by HIV/AIDS; hospitals are overcrowded and cannot keep up with the amount of adults (and children) with HIV/AIDS related health problems. In an attempt to deal with the demand on the healthcare system without inc reasing spending, services for patients are simply being turned away and forced to seek treatment either at home or in
47 excludes orphans who do not have families to turn to for medical treatment. Thirty two million South Africans (80% of the population) rely on public healthcare. The South African public health budget is used to provide primary, secondary and tertiary level health care to those people (Benatar, 2002). In addition, sixty percent of South Africans doctors exclusively treat patients with private healthcare, leaving the remaining forty percent of doctors to care for the eight y percent of the population without private healthcare. This amounts to an average expenditure of $85 US per person per year. With HIV treatments costing $50 per person, per month, it is easy to see how people living with HIV/AIDS are losing out (Benatar, 2002). Orphans especially lose out because of their inability to rely on parents and families to purchase their healthcare, particularly orphans who are HIV positive. One informant, Lyn Croote, is the Executive Director of Lambano Sanctuary, an AIDS orpha nage in Johannesburg, South Africa. I interviewed Ms. Croote via email. Croote explained the varying levels of quality at hospitals in South Africa: A facility like the Chris Hani Baragwaneth ho spital is world renowned and, although it is a public facility, it offers a good service. Then you get a hospital like Natalspruit Hospital, which serves most of the children that we get and it is absolutely useless and their HIV clinic does not have many children on Anti Retroviral drugs and so many children are dying unnecessarily. A good public health facility is absolutely essential because without Anti Retroviral drugs the Lyn Croote, Lambano Sanctuary. 11/10/2008. Croote explaine d that quality healthcare is a crucial issue for children infected with HIV. They suffer from a whole range of illnesses which are related to their illness in spite of them being on Anti Retroviral drugs. They suffer from severe ear infections and pneumonia. They can also acquire
48 things like chicken pox more than once as their immunity is still not as good as a healthy Lyn Croote, Lambano Sanctuary. 11/10/2008. Lambano employs a doctor to visi t the community it serves once a week, as well as an Occupational Therapist, who volunteers her time to care for children with HIV/AIDS. Croote and her staff are hoping to expand their medical outreach to include a hospice for children dying of HIV/AIDS. 10 bed hospice for children in 2008. Our objectives are to improve the quality of life of HIV infected children, with advanced HIV disease (WHO III and IV disease), by providing a continuum of palliative care services to child ren and to address the psycho Lyn Croote, Lambano Sanctuary. 11/10.2008. Education South Africa has a large orphan population. It is estimated that one in five school aged children will be orphaned by 2010. Previous studi es have shown a correlation between orphanhood and low school attendance (Adato et al, 2005, Case et al, 2004, Ntozi and Kakayiwa, 1999). Low school enrollment leads to declining output in the labor force as fewer children receive the necessary education they need to perform. The current situation regarding education in South Africa represents a reversal in the standards of the country. Social Programs for Orphans The neoliberal approach of the World Bank favors home based care initiated by communities as opposed to national expenditures. The government has adopted this philosophy by funneling resources to orphans through caregivers and communities, rather than adopting wide reaching policies such as free education or healthcare for all orphans.
49 The flaw with this approach is that the cost on the family and community is great and it often forces children to become caregivers to sick parents. The South African government has three grant programs: Child Support Grant, the Foster Grant and the Care Dependenc y Grant. The Child Support Grant provides R110 per child per month. The Foster Grant provides R410 per child per month to children who have been legally fostered through the court. The Care Dependency Grant provides R570 per child per month to children wit h severe mental or physical disabilities. The grant programs are not reaching the majority of orphans. The child support grant is only for children from birth to six years old, but many orphans are between the ages of six and nineteen (Desmond and Gow, 200 2). The Dependency and Care grant excludes red tape. Lyn Croote explained that Lambano Sanctuary, like so many orphanages in SSA, needs more support than it receive s from the government. Lyn Croote, Lambano Sanctuary. 11/10/2008. n supporting fostering households, which reveals an assumption that all orphans are in the care of families. In fact, 94% of institutions for children in South Africa have closed due to lack of funding (Desmond and Gow, 2002). The South African government has placed a moratorium on the construction of new homes, but to pick up the slack for the many people in need of homes, churches and community based organizations are constructing houses fervently. This is yet another example of the private sector taking on the duties that were once performed by the public
50 sector. Lambano Sanctuary provides one example of a private sector organization stepping in to fill the gap of services for children with HIV/AIDS. they test negative they are sent out for adoption. As we are full, once they have tested positive, we make sure they are placed on Anti Retroviral drugs and TB, and then we have them placed in facilities that can look after them. We are, more and more, t aking in the really sick children from the community and getting them onto the Anti Retroviral drugs and then we are able to put Lyn Croote, Lambano Sanctuary. 11/10/2008. Despite evid ence to the contrary, prominent Western institutions, such as the CIA, fiscally conser vative but pragmatic, focusing on controlling inflation, maintaining a budget surplus, and using state owned enterprises to deliver basic services to low income Factbook/South Africa) The Factbook also conceptualizes the lack of services such as electricity in a different manner than critics of neoliberalism do. The Factbook states, power suppli Factbook/South Africa). Zulu Nata l, South Africa. We corresponded via email. S ubsidies from the South African government and private donations help to cover the cost of food, healthcare and education for the children. Ms. Fredlund explained that while the local schools are free, there are costs involved for items such as books, uniforms and educational materials,
51 which Mseleni must pay for. Ms. Fredlund echoed the remarks of other informants regarding the prospects for employment and higher education for the children in the home. ly bright kids can do very well, but for the ones who pass but not with great marks, project, Lulisandla children who have been orphaned. Lulisandla Kumntwana recruits teams of volunteers to visit orphans and provide practical, spiritual, and emotional help. Volunteers distribute food, plant community gardens, provide school uniforms, teach life skills and also work to help orphaned children find adoptive parents. Lulisandla Kumntwana is another example of a private organization struggling to meet the needs o f orphans on a shoestring budget. The subsidies that the government provides cover only two thirds of the operating costs. Zimbabwe In 1980, after a protracted and bloody struggle to achieve independence from Britain, Robert Gabriel Mugabe became the fir st president of Zimbabwe formerly PF party was ideologically structured around Marxist Leninist socialism. His policies centered on redistributing wealth to the poor by allocating resources for public healthcare, education an d job creation. Zimbabwe joined the World Bank and IMF shortly after independence, and the a Z375 million standby credit, President Mugabe agreed to devalue the Zimb abwean
52 currency, reduce spending on development and eliminate subsidies. However, he failed to meet the budgetary reduction criteria and the IMF suspended the loan, halting business between Zimbabwe and the IMF for the following eight years. During the 19 led to an over expenditure which caused the government to turn back to the IMF in 1991 with a more sincere promise to obey IMF conditionalities (Kawebe and Dibie, 2000). This time, Zimbabwe adopted a formal Structural Adjustment Program. The decision to adopt an SAP did not involve input from the ministries of education or health and social services (Kawewe and Dibie, 2000). The decision to adopt structural adjustment policies came from com mercial banks and the finance ministry. The finance ministers and commercial bankers were mostly white elites who would benefit most from the adjustment programs. (Kawebe and Dibie, 2000) The most vulnerable members of society, children, stood to benefit the least from structural adjustment. When Zimbabwe implemented SAPs, it meant: labor retrenchment, trade liberalization and currency devaluation, removal of subsidies, and an increase in user fees in education and healthcare (Kawewe and Dibie, 2001). In the scholarly literature on this topic, a consensus seems to exist around the idea that the SAPs had negative impacts on children throughout Southern Africa. Unemployment Between 1990 and 1996, poverty in Zimbabwe worsened, especially in the rural areas. Female headed households, which usually contain the most children, were most affected (Alwang, et al., 2001). In urban areas, the deepening poverty has been linked
53 with the economic structural adjustment through the elimination of jobs, especially for high ly skilled and educated workers (Alwang et. al. 2001). Unemployment and rural poverty affects children both directly and indirectly. For example, unemployed parents tend to cut back on expenses like school fees, proper nutrition and health care. Structural adjustment policies led to high unemployment in the public sector. Those who were laid off also lost healthcare, educational opportunities for their children, and their homes. Family nutrition decreased due to loss of income and the rise in food prices t hat comes with an economy in the throes of high unemployment (Kawewe and Dibie, 2000). Orphans living with extended family members would be susceptible to these economic changes. Women also became vulnerable to HIV/AIDS because many husbands left home in search of work. One study found that Zimbabwean men who went to urban areas in search of work tended to engage in sexual activity with multiple casual partners or sex workers, potentially contracting diseases and bringing them home to their wives (De Vogli and Birbeck, 2005). Education In addition to increasing unemployment, the SAP also affected education. School fees, abolished by Mugabe after independence, were reinstated in urban primary schools in 1992. Budget cuts in education affected rural areas thr ough loss of funding for rural district councils and school development councils. Secondary school participation fell during the 1990s, most dramatically in urban areas (Alwang, et al 2001). Girls were affected disproportionally more than boys. Structural adjustment policies are accused of
54 marginalizing women and children by making education so expensive that families were forced to keep girls home due to patrilineal traditions. Kerry Varano is a former preschool teacher and nursery worker at the Thembiso Thembiso was mostly funded through a Church in Scotland, along with local donations. In 2007 the orphanage was receiving Z$ 1,000 per child which at the time was roughly US25 cen ts per month. Ms. Varano noted that social spending by the Zimbabwean government waned considerably after neoliberal policies were introduced and explained how orphans were impacted. At the orphanage where Ms. Varano worked, she often heard staff talk abo ut how school uniforms used to be better, teachers in the on campus primary school used to come more often, and lessons used to be more competitive. Nutrition overall food p roduction and raising food prices. Following the removal of food subsidies, low income urban Zimbabwean families saw the cost of living rise by 45% between mid 1991 and mid 1992 (De Vogli and Birbeck, 2005). As food prices rose, low income households had l ittle money left over after purchasing food to spend on basic commodities. Women continue to bear the brunt of the food subsidy cancellation and price reforms because they are responsible for securing the food and other basic needs in the house hold. Sch olars argue that job cuts, agricultural policies and healthcare cuts all dealt blows to children. Scholars also contend that structural adjustment policies exacerbated
55 the spread and impact of HIV/AIDS in Zimbabwe. The macroeconomic policy of removing food subsidies led to a spike in food prices which forced some women to turn to commercial sex work, putting themselves and their future children at risk of contracting HIV/AIDS (Birbeck and De Vogli, 2005). Lastly, the switch to export led agriculture contrib uted to malnourishment in children. In fact, 80% of malnourishment in children occurs in states where farmers switch from subsistence farming to export production for industrialized nations, on the advice of the IMF and SAPs (Kawebe and Dibie, 2000). Shor tages in the food and water supply have a direct impact on orphans. Ms. Varano noted: water every morning. Every now and then there would be a piece of meat in it with oil or salty minnow fish. There was no water or juice or vegetables. They just drank tea once a instead. One time they had these big corn kernels as their meal. Starting in 2007, the water situation got really bad, because the country stopped purifying the water. Since Thembiso gets city water, all the kids got really sick. They were out of school, just lying that their bodies Healthcare became sick and had to be taken to the state hospital. According to Ms. Varano, in the state hospital, parents are responsible for bathing, feeding, changing and monitoring the care of children. With just two nurses for a floor of seventy six sick children, orphans (without parenta l supervision) left at the hospital had little chance of survival. (Washington) had stopped eating, and no one noticed. He was really stunted. He was five, but he looked two. He slept in a crib, and was never potty trained. His mother died when he was born, and his father was blind. One day when I was there, they took to him to
56 Mpilo (the state hospital). Two days later, I wanted to go visit him. Well, at these state run hospit als, the parent has to be with them to feed them, change them, bathe them. had snot all over his face. No one had fed him, no one had changed him, and he had just be would bathe him, feed him. Once a day, there was food that would come on a cart. It was sudza (maize meal) with peanut butter. It would just be this nurse that would pus h this cart; the mother would have to get it and put it in a bowl and feed the kid. No one told me what to do; I went and found a chair. Anyone could have come in and taken him. There was no security. Once a day a doctor would come around, but there were 1 2 kids in a Five days before she was scheduled to return to the United States, another baby fell ill and had to go to th e hospital. scabies. One of his eyes was swollen shut and he was lethargic. Five days before I left He had an oxygen mask on his face and the nurses taped his fingers together so he The public hospital in Bulawayo was severely understaffed with just two nurses assigned to a floor with seventy six children. While Ms. Varano was there, she observed a representative from the United Arab Emirates recruiting the overworked and underpaid nurses to work in the UAE. Private clinics were sluggish as well. Ms. Varano recalled waiting for an entire day with a child so that he could get a blood sample drawn. upon government services, in this case the services of a state run hospital, in the absence of parents to advocate and care for them. Studies have shown that orphans in child headed households lack proper nutrition, education and healthcare (Adato et al, 2005). Her stories demonstrat e that a private sector response is not sufficient to handle the orphan care crisis, without sufficient support from the public sector.
57 Zambia decreases in wages and increases in i nflation and unemployment from restrictions in the money supply and rolling back of credit. Per capita income in 1986 was US $70, down from US $600 in 1980. During that same period, inflation rose 60% and unemployment increased from 14 to 25 (Jere Mwiindil ia, 1994). Former Zambian president Kenneth Kaunda and his United National Independence Party (UNIP) broke with the IMF program on May 1, 1987, calling the policies neo colonial. He was referring to the policies of removing subsidies and liberalizing trade Zambians protested the higher food and fuel prices that structural adjustment had brought, as well as the devastating economic changes. subsidies on maize meal. Turning his b ack on the IMF meant that Kaunda had cut Zambia off from all sources of future aid. Zambia fell into arrears with the World Bank and IMF, claiming that the debt repayment burdens were simply too high. Initially, breaking ties with the IMF led to growth in Zambia, but as a result of the break, Zambia found itself shunned from its multilateral and bilateral donors, making further growth impossible (Hanson and Hentz, 1999). In 1991, the pro neoliberal Movement for Multiparty Democracy (MMD) was elected with P resident Chiluba at the helm. By 1995, Zambia had implemented a Structural Adjustment Program with the IMF calling for currency devaluation, trade
58 liberalization, slashed social spending, privatization, anti inflation measures, raising of interest rates, p romotion of export led growth and deregulation. The social spending cuts affected education, health services, sanitation, water and irrigation, electric power supply, roads, and transportation (Jere Mwiindilia, 1994) In 2006, 80% of Zambians were living i external debt amounted to US$605, while the annual per capita national income is just through the Highly Indebted Poor Country Initiativ e in 2005 (CIA World Factbook/Zambia). HIV/AIDS prevalence is particularly high in Zambia and the orphan population is subsequently expected to exceed one million by 2010, with 77% of those orphans being victims of the pandemic (McPherson, 2006). The IMF approved a Poverty Reduction and Growth Facility (PRFG) arrangement with Zambia in June 2008. During a September 2008 mission to assess the progress of the plan, IMF Resident Representative to Zambia Birgir Arnasan, said the Zambian economy was performing economic resurgence in recent years owes much to improved economic management. Continued adherence to prudent macroeconomic policies is essential for sustaining this lease, 2008). These statements show that the IMF is not considering changing their policy prescriptions for countries like Zambia, straddled with an HIV/AIDS pandemic and the need to care for millions of orphans. The following sections demonstrate that ne oliberal policies on education, healthcare, land, and food all disproportionately affect orphans in Zambia.
59 Education The spending cuts of structural adjustment made education unaffordable for many Zambian families and created disparities between boys and girls, orphans and non orphans. Families who were affected by the higher prices of education were more likely to keep daughters home and send only their sons to school, disadvantaging girls throughout Zambia (Jere Mwiindilia, 1994) Neoliberal policies a re compounded by the HIV/AIDS epidemic. Thirty percent of teachers are HIV positive, and more than three public school teachers were dying every week in 2001 (Boone and Batsell, 2001). It is possible to say that a fragile education system is particularly d isadvantageous for orphans who already face an increased risk of not being able to attend school (Case et al, 2004). A World Bank discussion paper on education policy in Zambia published in 1990, displays a clear bias on the part of the World Bank towards blaming problems on national contributed to a deterioration of decreased spending on education but never mentions that the cuts were sanctioned by the IMF in order for Zambia to qualify for aid (A chola, 1990). Land Part of the Structural Adjustment Program implemented was the Land Act of 1995, which privatized land in Zambia by converting customary tenure into long term
60 lease holdings (McPherson, 2006). The privatization of land has led to a phenom enon members, leaving orphans with no inheritance (McPherson, 2006). Industry The Sons of Thunder Orphanage, where Jaime Bugawski served as Interim Director, was the l argest employer in a community outside Livingston, Zambia. I interviewed Ms. Bugawski via phone. As Director, Bugawski spent a large portion of her time filing compliance reports to ensure that the orphanage was keeping up with Zambian labor laws. Industry in Zambia fell after structural adjustment policies forced the privatization of several large sectors including coal production. Healthcare and Nutrition The SAPs in Zambia included a mandate for currency devaluation, which drove up the price of food. Ms Bugawski shared that many families would prefer to foster orphans from extended family members, but poverty prevented them from caring for the youngest of orphans, infants, who required formula. babies. Most of our kids Jaime Bugawski, Sons of Thunder Orphanage. 10/23/2 008. Food prices also affected the quality and amount of food that Sons of Thunder could afford to serve to the orphans who live there. For lunch and dinner there is a reli sh to go along with it. We tried to have one
61 protein a day, chicken twice a week and some little fish. The kids ate porridge in Bugawski reported that when orphans fell ill, private clinic, leaving the state hospital as the last resort. better condition than Livingston General (the public hospital in town ). There were a couple of private clinics in town primarily staffed by Indian doctors and we would take the kids there (rather than the hospital) to get x rays done when necessary. An x ray cost Jaime Bugawski, Sons of Thunder Orphanage. 10/ 23/2008. These case studies illustrate that neoliberal policies in South Africa, Zimbabwe and Zambia have not led to a reduction in poverty, but have in most cases increased poverty. Research has shown that women have been hit hardest by structural adjus tment by taking on extra responsibilities at home, looking for dangerous and exploitative work outside the home, and experiencing increased exposure to HIV/AIDS, which drives the d emonstrate that private orphan care schemes are not able to absorb the shocks of adjustment. Higher food prices and user fees for education and healthcare mean that orphans go hungry and fail to receive quality medical care. Children in orphanages experien ce malnourishment, lack of access to education and face meager prospects for employment and housing once they age out of the orphanage.
62 CONCLUSION As evidenced by the policies and statements of the World Bank and International Monetary Fund, ne oliberal assumptions regarding the care provided to orphans by extended family members and orphanages are out of touch with the issues faced by SSA today. Neoliberal policies are meant to stabilize macroeconomies of countries in crisis. Tackling one crisis while ignoring another (the orphan care crisis), however, is from imagining that there are children who are dependent upon services such as the provision of food, healthcare and education. This paper demonstrated that orphans are not abstract individuals who can participate freely in the market because they cannot rely upon parents to secure them with healthcare, education or adequate nutrition as other children can. Three crucial points arose from my research. First, I showed that liberal theory, which gave birth to neoliberalism, fails to understand the concept of dependency. I did so by examining the works of seminal liberal theorists to tease out their statements on dependency. Since neoliberalism champions the private sector, neoliberal policies assume that orphans are best cared for by extended family. That assumption is incorrec t as evidenced by the studies, reports, and case studies on children orphaned by HIV/AIDS
63 living with extended family which I presented (Adato et al, 2005, Case et al, 2004, Ntozi and Kakayiwa, 1999). The research that I presented demonstrated that exten ded families are unable to cope with the number of orphans being thrust into their care. This is because extended families lack resources and the caregivers are often elderly or sick. As a result, orphans living with extended families have been shown to ha ve lower rates of school enrollment and attendance. In addition, many orphans are not accepted into their extended families because of stigmas surrounding HIV/AIDS or other reasons. These children often end up living on the street, making them vulnerable t o a number of dangers. Additionally, child headed households are on the rise because of the orphan care crisis (Adato et al, 2005). After showing that families cannot absorb the millions of orphans in SSA, I homes and charities were sustainable solutions to the orphan care crisis. I did so by conducting personal interviews with orphanage staff in South Africa, Zambia and Zimbabwe. Staff in these three countries all expressed that they, at times, could not affo rd to adequately feed, clothe and educate the numbers of children thrust into their care. They also worried about the children being able to afford secondary school or college, and the general fate of the children once they aged out of the orphanage. To p rovide a broader context for my interviews, I examined World Bank and I.M.F. and which types of loans and adjustment programs they took on. I also looked at the acces s that orphans in each country had to healthcare, education and food where data was available. In each case study, I found that neoliberal policies are not generous to orphans.
64 Third, based on the inability of neoliberal theory to recognize dependency an d the inadequacy of the private sector (families and charities) to adequately handle the orphan care crisis in SSA, I call for a shift away from neoliberalism towards feminist theory in the formulation of orphan care policy. The feminist ethic of care plac es the responsibility of caring for dependents in the public sector. A feminist perspective on orphan care is needed to properly understand the dependence of orphans, and their rights as citizens in a democracy, to needed services. Future research on th is topic could include an analysis of, or development of, best practices for orphan care from a feminist perspective. Research should include perspectives from children who have been orphaned by HIV/AIDs to give agency and lend a voice to this growing popu lation. Perhaps the answer lies in increased government funding to orphanages and foster families. Or perhaps the solution is to cancel user fees for education and healthcare and reintroduce subsidies on food, fuel and other vital necessities. Further, per haps a ministry on care for orphans, or special schools, hospitals and housing communities should be planned and constructed for orphaned children. One likely objection to my argument might be that countries in SSA do not possess the resources needed to pr ovide orphans with healthcare, education, or housing. In response, I would say that moving away from neoliberalism would include the canceling of debts owed to neoliberal institutions, fairer terms of global trade and other measures that would create more wealth in these countries. Neoliberal policies that are currently in place, such as SAPs, should be reformed to include provisions for human security, public health and education funding.
65 Another likely objection might be that poorer nations, such as those in SSA, should focus on their economic growth and deal with issues of human development later on. I would argue however that having a healthy and educated population is crucial to states that the constitutive role of freedom in development is the very act of expanding substantive freedoms. He defines substantive freedoms as freedom from starvation, premature morbidity, as well as the freedom to be literate, participate in politics, and freedom of speech. The instrumental role of freedom in development is the idea that In this way freedom is both a means to as well as an end of development. Ther efore, freedom is the path to development, rather than the objective of development. Applying his thesis to this paper, it is possible to say that states must provide substantive freedoms to orphans in order for economic growth to be realized.
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