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The effect of child fostering on feeding practices and access to health services in rural Sierra Leone


  • Bledsoe, Caroline H.
  • Ewbank, Douglas C.
  • Isiugo-Abanihe, Uche C.


In Sierra Leone, where infant and child mortality rates are quite high, a large proportion of small children from 1 to 5 yr are fostered: living away from their mothers. This paper examines the relationships between fosterage and child feeding practices and children's access to Western medical care. Ethnographic data from field studies in Sierra Leone are combined with quantitative data from Serabu Hospital, which show that fostered children are underrepresented in hospital admissions and that young fosters present more problems of malnutrition. (Fostered girls appear to be at more risk in both these categories than boys.) Unlike young fosters, however, older ones do not appear to be at more risk than children with mothers. We draw connections between these results and patterns of intrahousehold discrimination in food allocation and access to medical treatment for young fostered children: especially those sent to elderly rural caretakers. Finally, we examine the implications of the findings for applied issues, arguing that fostered children may slip through the cracks of maternal-child health care programs.

Suggested Citation

  • Bledsoe, Caroline H. & Ewbank, Douglas C. & Isiugo-Abanihe, Uche C., 1988. "The effect of child fostering on feeding practices and access to health services in rural Sierra Leone," Social Science & Medicine, Elsevier, vol. 27(6), pages 627-636, January.
  • Handle: RePEc:eee:socmed:v:27:y:1988:i:6:p:627-636

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    Cited by:

    1. Beck, Simon & De Vreyer, Philippe & Lambert, Sylvie & Marazyan, Karine & Safir, Abla, 2014. "Child Fostering in Senegal," CEPREMAP Working Papers (Docweb) 1403, CEPREMAP.
    2. Anne Case & Christina Paxson & Joseph Ableidinger, 2004. "Orphans in Africa: parental death, poverty, and school enrollment," Demography, Springer;Population Association of America (PAA), vol. 41(3), pages 483-508, August.
    3. repec:ilo:ilowps:282085 is not listed on IDEAS
    4. De Wet, Nicole, 2019. "The association between mother's socioeconomic status and non-orphan kinship care arrangements in South Africa," Children and Youth Services Review, Elsevier, vol. 103(C), pages 79-86.
    5. Bilampoa Gnoumou & Thomas LeGrand & Jean-François Kobiané, 2013. "Effects of Parental Union Dissolution on Child Mortality and Child Schooling in Burkina Faso," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 29(29), pages 797-816.
    6. Kalanidhi Subbarao & Diane Coury, 2004. "Reaching Out to Africa's Orphans : A Framework for Public Action," World Bank Publications - Books, The World Bank Group, number 14909.
    7. Simo Fotso, Arlette, 2017. "Child disability and siblings' healthcare expenditures in a context of child fostering," Social Science & Medicine, Elsevier, vol. 182(C), pages 89-96.
    8. Laurie F. DeRose & Andrés Salazar-Arango & Paúl Corcuera García & Montserrat Gas-Aixendri & Reynaldo Rivera, 2017. "Maternal union instability and childhood mortality risk in the Global South, 2010–14," Population Studies, Taylor & Francis Journals, vol. 71(2), pages 211-228, May.
    9. Cassandra Cotton, 2021. "An Enduring Institution? Child Fostering in Sub‐Saharan Africa," Population and Development Review, The Population Council, Inc., vol. 47(4), pages 1179-1206, December.
    10. Arlette Simo-Fotso, 2016. "Human Capital Accumulation of Disabled Children:Does Disability Really Matter?," Working Papers 222, Institut National d'Études Démographiques (INED).
    11. Engle, Patrice L. & Castle, Sarah & Menon, Purnima, 1996. "Child development," FCND discussion papers 12, International Food Policy Research Institute (IFPRI).
    12. Oppong, Christine., 1991. "Relationships between women's work and demographic behaviour: some research evidence in West Africa," ILO Working Papers 992820853402676, International Labour Organization.
    13. Arlette Simo-Fotso, 2016. "Child Disability and Siblings’ Healthcare Expenditures in a Context of Child Fostering," Working Papers 224, Institut National d'Études Démographiques (INED).
    14. Sangeetha Madhavan & Enid Schatz & Samuel Clark & Mark Collinson, 2012. "Child Mobility, Maternal Status, and Household Composition in Rural South Africa," Demography, Springer;Population Association of America (PAA), vol. 49(2), pages 699-718, May.

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