Civic engagement among orphans and non-orphans in five low- and middle-income countries

As adolescents emerge into young adulthood, their engagement in civic activities becomes an important foundation for their continued growth as well as their contributions to society throughout adulthood [1]. Communities and nations seeking to foster social responsibility in their youth are interested in understanding factors that predict and promote youth involvement in public activities [2, 3].

For many low- and middle-income countries (LMICs), the backdrop of the HIV/AIDS epidemic has not only increased care needs among citizens, but has compromised sustainable development through loss of its citizens who are in their productive years [4–6]. LMICs are also disproportionately affected by increasing numbers of orphans, in part due to the HIV/AIDS epidemic, and encouraging societal engagement of their youth is a critical aspect of their growth [7]. One of the concerns surrounding the AIDS epidemic in South Africa was the consequences for civil society of the growing number of orphans [8].

Civic engagement is increasingly recognized as important not only for democracy, but for health. A recent review argued that enhancing civic engagement would be required to achieve the global health components of the United Nation’s Sustainable Development Goals (SDGs), soon to replace the Millennium Development Goals (MDGs) [9].

While political engagement, such as voting, is often identified as the most tangible form of engagement, other activities such as volunteerism are also considered important. One definition specifies that “Civic engagement describes how an active citizen participates in the life of a community in order to improve conditions for a community’s future” [10]. In a study of civic education among 14 year-olds in 28 countries primarily in Europe, but including the U.S., China, Australia, Chile and Columbia, participant definitions of civic engagement included obeying the law, voting, participating in activities that benefit the community, promoting human rights, and following the news, among others, suggesting consistency across diverse contexts [11].

Few studies have described the prevalence and predictors of civic engagement in adolescents and young adults, particularly in LMICs. To our knowledge, none has examined civic engagement in orphans and separated children in LMICs. In many Western countries, particularly the U.S., exposure to any college-level education is a critical factor driving voter turn-out and volunteerism [12–15]. In the U.S., research on young people has indicated that being part of group settings increases knowledge and fosters social norms whereby participation is encouraged; such settings include faith-based institutions, schools, community organizations, and workplaces [16]. However, access to such opportunities is highly dependent on socioeconomic status (Flanagan [15]); parental education not only provides a mechanism for knowledge and awareness, but creates expected norms of engagement and greater ability to overcome costs associated with volunteering instead of working for pay [17]. In the Civic Education Study, schools were identified as particularly effective at fostering civic engagement when they had rigorous civic content, opportunity for speaking freely and openly, and a school culture that engendered participation [18]. Another analysis of the international Civic Education Study concluded that while home background strongly predicted civic knowledge and skills (largely through expected years of education and literacy), those differences were attenuated when predicting the likelihood of voting [11]. This study also examined subgroups for discrimination which may hinder civic engagement; attitudes toward rights for immigrants and women were fairly positive overall, though the study was unable to measure all the discrimination mechanisms which vary greatly by country [11]. In general, females demonstrated less knowledge but more positive attitudes toward immigrants and toward women’s rights than male counterparts [11].

OSC are a particularly unique population with respect to civic engagement because they are at particular risk of growing up without the aforementioned supports that promote access to civic awareness and activities. Studies of the impact of orphaning on schooling have shown both a significant negative impact in continuing education ([19, 20]) as well as recovery to participation in education equaling non-orphan counter parts after an expected period of lesser participation around the time of parental death [20, 21]. Importantly, a study of schooling in sub-Saharan Africa found that household resources, including the education of the head-of-household, critically influenced a child’s schooling, where as biological parents were much less critical [22]. However, the social safety net that confers those critical resources for OSC in many resource-poor countries is being stretched quite thin. Recent studies in China and sub-Saharan Africa have documented substantial needs for improvements in the safety net for orphan care because families do not have the resources to care for the growing number of orphans, the number of child-headed households is growing, and strong advocacy for deinstitutionalization is increasing pressure to eliminate one of the current options for alternative care [23–27].

It is unclear whether orphaning or separation leaves OSC vulnerable to disenfranchisement from society or whether their experience may facilitate a broader sense of community that promotes civic engagement, or whether that may vary by care setting or by characteristics such as being a single or double orphan. Based on existing literature, we hypothesize that prevalence of civic engagement will be higher among non-OSC than OSC and among single orphans than double orphans due to more limited resources among OSC and double-orphan OSC in particular. However, because prior literature has suggested that civic activities among youth are influenced by group settings that promote education and awareness of such activities, and because existing studies in this population and in other resource-poor settings have not observed differences in other outcomes related to health and mental wellbeing between OSC in institutional-based care and family-based care, we hypothesized that OSC in institution-based settings will have equal or higher prevalence of civic engagement indicators than OSC in family-based care [16, 28–30].

The Positive Outcomes for Orphans study (POFO) presents a unique opportunity to examine civic engagement among statistically representative samples of orphans in both institution-based care and in family-based care, as well as in a sample of non-orphans, in low- and middle-income countries. Here, we describe participation in activities such as volunteer service and voting, with the primary goal of estimating prevalence of these activities and exploring characteristics of adolescents who participate in them to provide an initial description of civic engagement among OSC in LMIC that may inform additional questions and research.

In terms of government trust, the distribution was similar for federal, state and local trust. About 70 % of participants either agreed or strongly agreed that they trust each level of government, and only 10–12 % (depending on government level) either disagreed or strongly disagreed that they trust the government.

Among the 532 participants who were at least 18 years old at 90-month follow-up and reported voting status, 80 (15 %) reported voting in the most recent election. For both 19 year-olds and 20-year olds, about 20 % and 23 %, respectively, voted. Among 18 year-olds, only 16 % reported voting. However, it is possible that those who were 18 at data collection were not 18 and eligible to vote in the last election.

We also found slight increases in the prevalence of regular volunteer work among females compared to males (PR = 1.14 [0.97,1.33]), family-dwelling OSC (PR = 1.08[0.92,1.26]) and non-OSC (1.04[0.82, 1.32]) relative to institution-dwelling OSC, single orphans (PR = 1.06[0.83, 1.36]) and double orphans (PR = 1.07[0.83, 1.36]) relative to having both parents alive, an additional year of age (PR = 1.05[0.99, 1.11]), and an additional year increase in grade-for-age (PR = 1.01[0.97, 1.04]); none of these were statistically significant, however.

We examined prevalence and predictors of service or volunteer work, voting, and trust in the government. We found that approximately 70 % of POFO participants reported trust in their local, state, and federal governments, though only 15 % of those eligible reported voting in the most recent election. However, nearly half (45 %) of adolescents reporting on service activities were engaged in regular volunteer work or community service. With the exception of site, we did not observe significant associations between key demographic factors and participation in regular community service or volunteer work, though the association with being female suggested a higher prevalence of regular service or volunteer work among females than males.

We observed substantial variation in in prevalence of regular service or volunteer work across sites, which may be due to differences in cultural expectations across countries or regions. The variation in estimates across sites may indicate that the relative importance of community service may be more or less emphasized in different cultures. This fairly crude measure may be better nuanced with different measures, or with improved understanding of what constitutes community contributions that would be analogous to more Western measures of civic engagement.

Though not statistically significant, females did report higher prevalence of community and volunteer work. This may indicate that the nature of available community service and volunteer work is more acceptably performed by females in some settings, or that the measure is failing to fully capture activities to which males in these settings may be contributing. It could also signal a need to better engage male adolescents and young adults in community-promoting activities.

Civic engagement is increasingly considered an important domain not only for sustainment of democracies, but for global health [9]. Participation in civic activities can increase social capital, and by extension, contribute to improved community health. For example, a recent study of the role of social capital in the performance of community health workers in Lao People’s Democratic Republic identified citizenship activities (such as engaging village elders or joining with others to solve a common problem) as particularly important for performance of community health workers [35].

The relationship between civic engagement and global health is also reciprocal: increased awareness of or participation in community health can foster broader civic engagement. For example, community and political engagement was increased after a network in Thailand of persons living with HIV/AIDS assisted in delivery of antiretroviral treatment to others in the community [36]. Similarly, civic engagement was increased in a group of Tanzanian youth randomized to an educational program that used health promotion of HIV/AIDS issues to foster self-efficacy and collective-efficacy around civic participation [37].

A key strength of this study is the novelty of both the question and the population. While some attention has been brought to the increasingly recognized importance of civic engagement, particularly among adolescents [3, 7], few studies have actually examined it. Furthermore, the role of orphans is especially relevant: their numbers are increasing [7], particularly in countries most affected by the global HIV/AIDS epidemic, where the need for community engagement and leadership is great. The POFO population is a statistically representative sample of both institution-dwelling and family-dwelling orphans, and includesa sample of non-orphans from six sites in five low- and middle-income countries. To our knowledge, this is the first study to examine these questions in orphans in LMICs. Finally, the longitudinal nature of the parent POFO study is a significant strength. While this analysis is limited to a single follow-up point due to the timing of introduction of relevant questions, the existing rapport developed by dedicated interviewers over time enabled responses from a hard-to-reach population.

Several weaknesses limit the results of this study. First, much of the POFO population has not yet reached the age of voting eligibility. Even those who were 18 at data collection may not have been eligible to vote in the most recent election prior to administration of the survey. Additional rounds of data collection will enable more robust results and greater capacity to examine associations with predictors as well as with longer-term health outcomes. Still, this initial examination is a useful first-step in understanding civic participation in this population. Additionally, the civic engagement questions were limited to the few broad-based questions presented here. We cannot tease out from these data whether, for example, participants vote because of obligation, desire for change, desire to support the government, or other reasons that may be helpful in understanding their motivations for engagement. Likewise, we do not know the reasons for non-participation. Though participants were asked about reasons for volunteering, the primary motivation is unknown. Furthermore, participants had varying opportunity to participate in civic activities depending on their age. While dependence on publically funded institutional support or subsidies could theoretically affect study participants’ willingness to express discontent with the government, the data on funding streams for support were unavailable, in part because funding sources for institutions and families were quite variable across source of organization providing funds/support (faith-based, non-profit, non-governmental organization, government), and across time (multiple different funding streams at different points in time). Only 4 institutions in the study were government run. We also do not have reason to believe the OSC had knowledge of the funding streams supporting them. Given the limited ability to pinpoint which type of funding was primarily driving resources at any given time and given that it is unlikely the OSC were aware of the funding streams supporting them, it is unlikely the participants were adjusting their responses based on such information.

Finally, the extant literature and instruments available to inform this study are limited primarily to European and U.S. contexts that may not be directly applicable to sub-Saharan Africa and South and Southeast Asia. Our study provides an important first look at describing participation in activities widely thought to be important regardless of country, but key indicators of civic engagement in these settings may be quite different.

As the world’s leaders grapple with the many competing demands of global health, economic security, and governmental stability, the participation of today’s youth in community and governance is essential for sustainability. We hope this study motivates additional focus on civic engagement of adolescents to understand what promotes civic engagement in their communities, which may contribute to both sustainable development as well as global health.