The MAD Study on Longterm Outcomes of Institutionalisation in India

While there are multiple studies correlating the experience of childhood trauma to adult outcomes in the US context, there are no such studies in the Indian context. In order to fill this gap, and to gather data on the effects of institutionalization of children, MAD conducted a mixed-approach study between January 2018 and June 2019. Through qualitative interviews and quantitative surveys, 953 individuals from the age of 28 and above were contacted, and 583 of these individuals were interviewed (60% men and 40% women) across 5 cities (Tier-1 and Tier-2) in India.

Despite encountering a findability bias, the lives of the interviewees were mapped chronologically across four stages:

  • Pre-shelter life: how, when and why they ended up in institutional care

  • Institutionalised life: life in shelter-care

  • Transitional life: reintegration back into society

  • Mainstreamed life: Current adult life

Pre-shelter life

The study found that Adverse Childhood Experiences (ACEs) were common among children placed in institutional care. Nearly 2/3rd of the respondents had experienced ACEs ranging from violence, deprivation, neglect, fear for personal safety, and abuse. Almost half the children were placed in institutional care by family members for various reasons, such as poverty, familial breakdown, and abandonment or orphanhood. Nearly 1/4th of the children were found lost, missing, or illegally working by authorities, and turned over to shelter-care.

Institutional care

Since a majority of the children entered shelters between the ages of 4 and 13, 90% had spent over five years in shelter-care, while over half the respondents had spent more than ten years in institutional care. Nearly 1/3rd reported physical abuse and 10% of the respondents reported sexual abuse from shelter-staff, confirming the children’s experience of one or more ACEs. Despite the fundamental right to education, only 1/4th of the respondents had passed 12th standard, while another 1/4th did not make it past 8th standard. These severely affected adult outcomes, as we shall see in the next paragraphs.

Transitional life

The law mandates that children leave shelter-homes when they turn 18 years of age. This is usually enforced irrespective of whether the child is in the midst of his or her education, though shelter authorities sometimes use discretion to extend stay. Over half of the respondents left shelter-care with no employable skills or the capability to further their education, and only a quarter were fortunate to find apprenticeships.


Transitional life brings to the fore problems hitherto not experienced in institutional care. For the respondents, food, shelter and a job became of paramount importance. They faced multiple problems acquiring all three, not least because of the difficulties in obtaining official identity documents. While this has become much easier with the Central Government Circular mandating that Child Care Institutions acquire Aadhaar cards for resident children, adult outcomes are still bleak. 

Mainstream adult life

The impacts of institutionalization on children are many. From the stigma they face upon return to mainstream society, the lack of capabilities to find or utilize opportunities (due to a lack of monetisable skills or incomplete education), to the lack of support networks (accredited Aftercare centres are few and far between), institutionalized children suffer greatly. Only a quarter own property of some kind; the majority live in slums, and some are homeless, while 12% of women have continued to be in other care institutions, foregoing a turbulent reintegration to mainstream society. 

The struggle of mainstream adult life is so overwhelming that nearly 2/3rd of the respondents reported pleasant memories of shelter life – one where they were not constantly stressed about the next meal or shelter, or crippling poverty. However, our study shows that institutional care does not prepare children for mainstream life, and thus traps them in a cycle of poverty and disease, leaving them susceptible to health-risk behaviours, including addiction and substance abuse. It is clear that ACEs experienced both prior to and during institutionalization leave children vulnerable to dysfunction in their adult lives.

The Lost Generation

One finding of the MAD study that stood out was that for every 3 individuals interviewed, at least one of their peers was reported missing or had died. This is made worse by the finding that over 90% of those reported missing or dead were under the age of 35, with over 45% reported lost within 10 years of leaving institutional care. The impact of ACEs and life under institutional care is believed to have contributed crucially to early death from preventable or treatable illnesses (such as tuberculosis and fever), accidents, addictions (alcohol and/or substances), and suicide.