BETWEEN EXCLUSION AND INTEGRATION: ANTHROPOLOGICAL RESEARCH ON CHILDCARE IN ROMANIAN HOSPITALS
Graduate School of Humanities and Social Sciences, University of Tsukuba, Japan
Address correspondence to: Naoki Asada, Graduate School of Humanities and Social Sciences, University of Tsukuba, 1-1-1, Tennoh-dai, Tsukuba-shi, Ibaraki, 305-8577, Japan. Ph.: 0080-47-727-1472; E-mail: firstname.lastname@example.org
Objectives. This article aims to anthropologically investigate a space where abandoned children in Romania live. The space appears as a result of exclusion of the children from family and following lives in hospital where they are, nonetheless, included in Romanian society. Through examination of Romanian abandoned children, there were critically analysed conceptual dichotomy of social exclusion and inclusion.
Material and methods. To achieve the objective above, there were used both qualitative and quantitative data. Qualitative data was collected as a result of the author’s own fieldwork in Romania in May 2012, and as qualitative data, the study regards some statistical data provided by the Romanian government and international organisations. For fieldwork, there were conducted semi-structured interviews to social workers, NGO staffs and governmental officers in a county office and a city hall. In addition to this demarche, there was carried out the observation in hospitals where the social workers and NGO staffs worked.
Results. Consequently, abandoned children were not excluded from the society and actually were included from legal and societal points of view. However, there was found that these children were not integrated or related to their families as well as the society. This unrelatedness seems to lead them to vulnerability in physical, psychological and spiritual meanings.
Conclusions. Eventually, it can be described the space where the children lived as a space between exclusion and integration, insisting on the fact that these children need to be examined by a three-layer concept of exclusion, inclusion and integration.
Keyword: social exclusion, relatedness, abandoned children, Romania.
"I don’t want a rich family with an expensive car in a big garden, but I want somebody who supports me" (fieldnotes, 9th November 2019).
This is a description of himself by one of the interlocutors. After we finished our meeting, the director of an NGO who had supported the interlocutor for more than 20 years described him as a person who "doesn’t have base of him" (ibid.). The interlocutor was in his 40s and had been abandoned by his parents. He had spent his life in some institutions until 18 years old and was not adopted by any families. He did not have a full-time job and lived alone. Even though there is divergence in lives of abandoned children, it can be said that his life history is one of typical figures of abandoned children in Romania.
His story and feeling of insecurity portrayed in 2019 are likely to be related to a scenery, which appeared in another fieldwork carried out in 2012, of a maternity ward in a Romanian hospital. In an interview to an NGO staff working at a hospital in Brasov, an in-situ visit revealed a childcare unit of 20 abandoned infants who were relinquished just after their birth. As a result, these infants were taken care of by the NGO and the hospital until their parent(s) would agree with taking the infants to home, otherwise they would be sent to public childcare system.
This article aims to examine abandoned children in Romania and the space where they are not excluded either integrated. The analysis is based on a fieldwork in Brasov, Romania for one month from the end of April in 2012. The fieldwork consisted of observation and semi-structured interviews to people working for the children. The observation took place in two hospitals in the city, and the interviews were carried out with social workers, NGO staffs and governmental officers.
To achieve the purpose, this article follows discourse of social exclusion and anthropological concept of relatedness. At first, in next chapter, there is a brief outline how the discourse of social exclusion has been discussed and developed in anthropology and sociology.
Social Exclusion and Inclusion
When social exclusion has been mentioned in anthropology, its analysis sometimes mentioned or started from Erving Goffman. Goffman carried out his research on some types of institutions such as psychiatric hospital and identified them as "total institution" (Goffman, 1961). Because of the book’s title, the total institutions are also called asylum. In asylum, inmates were segregated from outer societies, stripped their belongings, relations to outside and social identities, and trained to go back to normal societies (ibid.).
Following Goffman, Naito (2012) introduced his concept of "asylum space" to investigate space where people were segregated from major societies. The author emphasised the importance of investigating both people who were excluded and the way these people were identified and targeted to be included again (ibid.). In fact, he pointed out that those who were excluded lived in a space where inclusion and exclusion were intertwined (Naito, 2014). As a result, "asylum space" became a theoretical flamework which appeared as a result of connection between a space of exclusion and that of adjustment to re-include these people (Naito, 2012). In anthropology, exclusion is not phenomenon which happens in a segregated space but which exists as a mixture of exclusion and inclusion.
Young (2007) also mentioned these institutions as a function for inclusion because inmates were corrected and trained to be included again. Nonetheless, the author suggested that the institution for inclusion was peculiar to modern societies, and contemporary post-modern societies changed to exclusive societies. According to him (ibid.), the end of grand narrative and relative deprivation, people lose social identities. Consequently, people intended to construct their social identities through labelling those who were different as the evil.
If one connect his notion of the aforementioned space where inclusion and exclusion are meshed, in contemporary (or late-modern, if following Young’s term) societies, groups of people segregate (and are segregated) each other and build their social identities at the same time, function of adjustment starts to work to include them into broader contexts as a society and/or a country. However, if people live in such a space, how does the exclusion affect people? Why is it considered so problematic? Thus, it is necessary to investigate the way exclusion has influence to human beings.
Social Exclusion and Deprivation
When social exclusion and its effects are investigated, this article, firstly, follows Silver’s discussion about social exclusion. According to Silver (1994), the exclusion became a topic of social discussion in France in 1960s, and then, the term expanded its meaning from living in poverty. The author differentiated three paradigms in discussion of social exclusion; Solidarity, Specialisation and Monopoly. First of all, the paradigm of solidarity can be realised as a lack of social bond, i.e. a connection between individual and society. Silver (1994) actually described historical aspects of the terminology and identified social exclusion as a term which "referred not only to the rise in long-term and recurrent unemployment, but also to the growing instability of social bonds" (ibid., p.533) in French Republican meaning as a matter of solidarity. Secondly, the specialisation paradigm occurred as a result of "social differentiation, the economic division of labour and the separation of spheres" (ibid., p.542). Therefore, this type of exclusion is not necessarily negative. It can have unfavourable results only if it works excessively. Thirdly, in monopoly, exclusion appears due to "interplay of class, status and political power" (ibid., p. 543).
In a historical process of change in terminology, the term social exclusion had contained multiple meanings and application. What Silver (1994) did is in fact to disassemble the term and to make it analytical concept. Sen (2000) employed social exclusion as the first paradigm and combined it with his capability approach. For this researcher, poverty firmly connected to free will to choose one’s activity in society. Because of this lack of choice, poverty became capability deprivation, and, subsequently, social exclusion, which meant lack of access to the society where people belonged, could be "constitutive components of the idea of poverty" (ibid., p.5).
If these two discussions of social exclusion by Silver (1994) and Sen (2000) are combined, social exclusion can be identified as a mixture of both a process of lack of social bonds and a following result of capability deprivation which leads the excluded person to poverty. Nevertheless, it does not mean that people in poverty have no social bonds in their lives. Paugam (2016) maintained that there were four types of social bond which poor people still had; bond of family, bond of selective participation, bond of basic participation and bond of citizenship. Therefore, poverty as a consequence of social exclusion and capability deprivation means circumstance where people can obtain less access to other parts of societies although they still have some bonds.
In terms of social bond, how is it constructed and how does it work? In order to examine the questions, anthropological study of relatedness may give a hint. Relatedness is an analytical concept which Carsten (1995) employed. This concept appeared as a consequence of discussion about substance (Olabarria, 2018). Olabarria summarised how new kinship studies rose starting from Schneider’s study of kinship in American society as well as his notion of substance. According to her (ibid.), Carsten inherited and developed the discussion to reach her concept of relatedness.
With her ethnography of Malay people in Pulau Langkawi, Carsten insisted of importance of food/feeding in kinship among indigenous people and concluded that "kinship itself is a process of becoming" (Carsten, 1995, p.223). That is, kinship is not only mean a biological tie between parent(s) and child(ren) but also a social tie which continues and renews through their lives through sharing substance. Eventually, Carsten called this life-long relationship relatedness. This concept of relatedness does not only mean connection between parent(s) and child(ren) but also the relationship between husband and wife due to the fact that they share the substance through food from same hearth (ibid.).
What needs to be emphasised here is that the way substance relates people depends on and, thus, are different from each society. In fact, Nakazora and Taguchi (2016) summarised discourses about two types of social conceptualisation and connection of substance and code; Indian model and Melanesian model. Nonetheless, substance and relatedness are likely advantageous concepts to examine human relationship and social bond because relationship among people is not static or inherent but variable in interaction with/through substance.
If this dynamic construction of relationship by substance is applicable for discussion of social bond, it seems possible to say that social bond is also tied through sharing and/or exchanging substance even though what kind of substance can build the relatedness is variable in each society.
Material and methods
Following theoretical introduction, this chapter will describe material which is investigated in this article. As mentioned in Introduction, qualitative data comes from the fieldwork in Romania. The fieldwork lasted for a month from the end of April 2012 in Brasov. Six organisations and two hospitals in Brasov were the setting for semi-structured interviews and observations. Among the organisations, three of them were NGOs, two of them were public offices (county office and city hall) and one was a private company which ran programmes of volunteer tourism. Generally, there was no opportunity to communicate with their beneficiaries including children, that is, the interviewees were only social workers, NGO staffs and officers who worked in child welfare. Interviews were conducted in English. When some interviewees did not understand English, one or some of them who could understand English translated the questions and what the other interviewees said. For their confidentiality, their names will be referred with pseudonyms and will not mention their organisations’ names.
In addition to the fieldwork, some quantitative data from governmental and international institutions such as the Romanian government, Eurostat and UNICEF is presented. In general, the quantitative data is shown to depict overall image of circumstance which Romanian abandoned children have been placed and of historical struggles.
Historical and Social Background
The background information about Romanian child welfare is likely to make it easier to realise the context in which the interviewees talked about the children.
According to Eurostat (2019), 37.9 % of children younger than 16 years old faced risk of poverty and social exclusion in 2018. Moreover, it is said that there were 60,000 children in child protection system in 2014 (Stănculescu et al., 2017). Actually, Ministry of Labour and Social Justice published data about the number of children in the system and it indicated that 54,960 children were in care in 2018 (Ministerul Muncii si Justitiei Sociale [Ministry of Labour and Social Protection], 2018).
When child welfare in Romania is talked about, we cannot avoid past communist Romania, especially that under the Ceausescu regime. It may be able to say that a root of misery in Romanian orphanages was constructed by Romanian pronatalist policy and by economic recession in 1980s. Notorious Decree 770 was implemented in 1966 under the Ceausescu regime, which illegalised abortion with some exceptions; (1) abortion was the only method to save a woman’s life from any dangers by pregnancy, (2) a parent inherited chronical disease, otherwise malformation of new-born baby was predictable, (3) the mother was older than 45, (4) the mother had already had more than 4 children and (5) the pregnancy happened as a result of rape or incest (Kligman, 1998).
Decree 770 was introduced as a reaction to a drop in fertility rates. A report which was submitted by National Authority for Child Protection and Family (NACPA) and UNICEF reported that the percentage decreased by about 35% i.e. from 89.9% in 1956 to 55.7% in1966 (NACPA and UNICEF, 2004). As the regime intended, illegalisation of abortion rocketed up Romanian fertility rate from 1.9 in 1966 to 3.66 in 1967 (World Bank, 2019) even though the phenomenon could not continue so long.
Due to the implementation of the decree and economic recession, a certain number of parents became unable to raise their child(ren) and consequently child abandonment occurred more frequently. The governmental response to the situation was to promote child institutionalisation. In 1970 the Law 3/1970 which intended to protect minors was introduced, and its initial purpose was to institutionalise those abandoned children rather than to prevent the abandonment or encourage parental responsibility on their child (NACPA and UNICEF, 2004). Under the circumstance, as Tomescu-Dubrow points out, "[f]amilies unable or unwilling to raise their children could easily give them up to state care" (2005, p.64). Eventually, some poor people tended to keep a mind-set that the government had ultimate responsibility in child care (ibid).
After the revolution in 1989, which removed and executed the communist dictator Nicolae Ceausescu, the new government abrogated the decree immediately. In addition, the government has struggled to improve environmental condition for abandoned children (Rus et al., 2011). In fact, orphans were a topic for Romanian participation process to EU. For example, EU Committee on Foreign Affairs, Security and Defence Policy (1998) pointed out insufficiency of improvement in childcare, and it indicated that progress in child welfare was one of criteria for EU membership.
Eventually, Romania acquired membership of EU in 2007, however, the country has still got some struggles for abandoned children. One of points which has got impact on child welfare in Romania is governmental policy on adoption, especially international adoption, because the Romanian government has strictly controlled international adoption. For instance, UNICEF TransMonEE (2015) shows that Romania had 14 and 3 international adoptions in 2013 and 2014 respectively following no international adoption from 2006 to 2012. This policy was a reaction to criticism for "market in children" or "laundering of children" (Bainham, 2009, p.530). This happened when western mass media sensationally reported Romanian institutionalised children. Then, those who lived in western countries intended to rescue these children from the awful environment. UNICEF reported more than 10,000 children from Romania were internationally adopted from January 1990 to July 1991 (UNICEF, 1997), and there is also a study which indicated that the number of adopted children from Romania occupied one-third of international adoption in 1990 (Kligman, 1992). As a result, there was a situation that marketized children and some poor families sold their children in the name of adoption (ibid.). Following these historical background, Romanian government still hesitates to loosen its strict control on international adoption even now.
At the same time, Romanian government introduced alternative care rather than large-institution care for abandoned children. Consequently, as NACPA and UNICEF (2004) mentioned in their report, the number of institutionalised children decreased by 40% from 2000 to 2004. This is because of the closure of old-style institutions and of enforcement of child protection in families or familial environment, for example, protection by extended families or by foster parents (ibid). In fact, the number of children in family-based care increased from 30,829 in 2001 to 47,723 in 2005, on the other hand, the number of those in institutional care decreased from 57,060 in 2001 to 28,786 in 2005 (Chou and Browne, 2016). Although there were still institutionalised children, the institutions were refurbished in order to contain less children and to take care of them better. NACPA and UNICEF (2004) reported the number of institutions with less than 50 inmates doubled from 2000 to 2003.
The Romanian government accelerated alternative care system from 2005 onward. The National Authority for the Protection and Child’s Rights (NAPCR) launched in 2005 and they put priority on 2 points, that is, (1) promotion of child’s rights and (2) prevention of child’s separation from their parent(s) (Rus et al., 2011). Since then, NAPCR has developed and promoted alternative care such as smaller-scale institutionalisation, family type, residential and day care services (ibid.). As a result of these struggles, as Stănculescu et al. (2017) showed, 66% of children in protection, which counts 34,300 children in number, could be in family type care services in 2014.
When abandoned children in hospitals are examined, it can be said that, as Dumitrescu (2016, p.205) described, "the journey begins from birth, when it is clear that the mother cannot take care of the new-born child". However, it does not mean that they are completely excluded from any kinds of societies in Romania. Actually, the Romanian government has attempted to include or re-include abandoned children into families or quasi-familial environments such as foster care, residential care and domestic adoption. This policy was implemented because no or little attachment from family, especially parents, exposed them a risk of cognitive underdevelopment (Zeanah, Smyke and Koga, 2005).
Aforementioned children in Introduction, who were relinquished in the hospital, were exactly those who started "the journey" since they were born. In a conversation with a psychologist, Maria, she said, "they (parents) go away without the child" and "parents say they don’t want children" (fieldnotes, 14th May 2012). While supporting social care for children, Maria and her colleagues talked with the parents to persuade them to accept their child(ren). At that moment, they worked with local authorities such as police and city hall. Nonetheless, according to her, only two-fifth of parents changed their minds. Then, the rest would be in longer-term hospitalisation and finally be sent to child protection process.
This is not the case only for new-born. In another hospital one of the NGO staffs, Diana, described the situation and said, "children come to hospital because parents cannot buy food", therefore, "they (parents) hospitalise children and never come back" (fieldnotes, 5th May 2012). In the hospital, almost all of them came from poor family and parents sometimes left them in the hospital because the parents cannot pay fees. Diana also said that medium of stay was about a month, but even if parents took children, they came back in next three or four days (ibid.). Hospital was not a place for social care, nevertheless, the NGO worked there and took care of them.
Under the circumstance, as Naito (2014) pointed out, children seem to live in a space where inclusion and exclusion are meshed. It is possible to insist that the children were excluded from their own family but included in NGO’s support, hospital and Romanian legal system. However, if social exclusion is investigated from perspective of Silver (1994), can we consider the situation as a space where children have social bond with family or society including NGOs? From her point of view, the antonym of the social exclusion is not inclusion but "integration" or "insertion" (ibid.), so that, mere inclusion is not enough to reconcile abandoned children with both family and wider society.
This is the reason for inserting the discussion of relatedness in order to examine how integration is constructed. Even poor people have four types of social bonds including bond of family (Paugam, 2016). If we consider this bond of family as relatedness between children and parent(s), can we think that the abandoned children in Romanian hospitals had such a bond of family? In Carsten’s argument (1995), feeding is an essential factor to transmit substance from parent to child. From this perspective, parents of the abandoned children did not feed them and left children in the hospital, therefore, they might not have any paths of substance from parent to child. If so, children and parents were not related with each other even though they were biologically parents and children as well as though the children were included in childcare system. In fact, feeding is possibly perceived as a key factor to promote integration of children into family in Romania as well. Diana, aforementioned social worker, mentioned an abandoned child’s mother who said that she would accept her baby if Diana gave her a milk to raise the baby (fieldnotes, 5th May 2012). In addition, one of the Romanian friends of the author described Romanian food as a source for her foster child to get "energy" and "force" as a Romanian man (fieldnotes, 6th November 2019). These two narratives seem to indicate two possibility; (1) For family, especially mothers of abandoned children, whether they can feed children or not becomes one of criteria to accept their children into their familial space, and (2) Romanian food is a substance which makes a person Romanian in wider social context. That is to say, in Romania, eating/feeding is a possible path of substance which becomes a medium to relate children with family as well as society.
Furthermore, if this argument will be connected to that of the sacred and the profane by Mircea Eliade, these children also lose the relatedness to the sacred, that it, feeling of security in spirituality due to the lack of the house. Because he argued that the house was "the universe that man constructs for himself by imitating the paradigmatic creation of the gods, the cosmogony" (italic in original, Eliade, 1987, p.56). Although children themselves do not build their own houses, the fact that they do not belong to a specific house possibly escalates their spiritual vulnerability as well. Maria, the psychologist, also said that "they (doctors and nurses) work with body, and I work with mind or soul" (fieldnotes, 14th May 2012). Her notion of care hints that the abandoned children also need compensation for their loss in spirituality.
To sum, it can be said that abandoned children are in a space which exists between exclusion and integration in physical, psychological and spiritual meanings even if they are included in the society. What they seem not to obtain is social bond of family, that is, relatedness with parents and other family members. In addition, this lack of relatedness is a beginning of the "journey" to poverty and vulnerability, and they may also lose capability to some extent due to the fact that loss of attachment as a result of abandonment leads them to cognitive underdevelopment.
This article discusses the space where abandoned children exist and live. It is a space where these children are included but not integrated. This disintegration from both/either family and society seems a reason why they found themselves in vulnerability and insecurity even after they get older. In addition, the vulnerability and insecurity are not limited in social aspects, but those who are abandoned may find their fragility in physical and spiritual ways. The fieldwork reveals that there may be a possibility that anthropological discussion is also applicable to Romanian society when investigating their conception and behaviour toward eating/feeding from a perspective of substance. Furthermore, this eating/feeding attitude is possibly a point in which anthropological discussion may show its applicability to promote further integration of abandoned children into family and wider society for their welfare.
This article has a lot of limitation. First of all, the qualitative data employed was collected in 2012 with short-term fieldwork. There may be huge possibility that long-term fieldwork will indicate other perspectives on abandoned children. In addition, the discussion does not assess the contemporary situation. For example, soon after the moment of the research, the Romanian government approved the 2014-2020 National Strategy for Protecting and Promoting the Rights of the Child and the 2014-2016 National Strategy for Protecting and Promoting the Rights of the Child by Government Decision no. 1113/2014 in 2014. With these strategies, the government also intended to promote further integration of abandoned children. Therefore, further examination will be required also from legal points of view. There is not, by far, a full description of the way Romanian family actually relate with each other and what kind of substance, if any, mediates the relatedness in Romanian society from anthropological perspective. Therefore, it is necessary to continue ethnographical research on the way to construct child-parent relationship in Romanian society.
However, as a tentative conclusion, this research, through its findings, aims to stress the necessity of a discussion on whether dichotomous concepts of exclusion and inclusion or any other theoretical framework rooting on the dichotomy is appropriate to investigate people who are socially excluded. Considering the case of Romanian children, at least, abandoned children are included in the society. Thus, to examine them more appropriately, integration or relatedness seems to become a point to see. From this perspective, for the case of the abandoned children in Romania, if the children are perceived from three-layer conception of exclusion, inclusion and integration, it can be said that eating/feeding habit investigated from anthropological discussion of substance is one of factors to realise how Romanian children, especially abandoned children, can be integrated into family and society.
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