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The following modes of care have been well documented and are discussed in this section: surviving single parent, grandparent, and child headed household. This section focuses on the effects of parental mortality on household structure and composition, in relation to provision of care to children. The discussion also focuses on the degree of vulnerability of children associated with the change of living arrangements and caregivers.

2.3.1 Surviving Biological Parent.

It has been consistently and overwhelmingly reported that more children live with mothers when their fathers die than with their fathers when the mothers die (Foster 2002a; Monasch, Boema and Ties 2004; Foster and Williamson 2000; Sherr et al. 2008). Monasch and Boema (2004) found out that in 40 Sub-Saharan countries, 75 percent of paternal orphans lived with their mother while 50 percent of maternal orphans lived with their father. The authors also found out that fewer girls (48 percent) who lost their mothers lived with their fathers than did boys (58 percent). However, the authors did not include orphans of 15 to 17 years age hence it is not possible to know the living arrangement patterns for this age group.

Similarly, in Malawi Pullum (2008) found out that when the father died, 56 percent of the orphans lived with the mother, while only 25 percent lived with the father when the mother died. Children Count (2005) also found that 69 percent of paternal orphans lived with the surviving mother and 27 percent of maternal orphans lived with the surviving father in Sub Saharan Africa. These findings suggest that surviving mothers may have a heavier orphan care burden than surviving fathers.

Richter and Desmond (2008) found that in South Africa while female caregivers had an average of 2 orphans per household, male caregivers had on average 1.6 orphans per household and child headed households had an average of 1.8 orphans.

2.3.2 Grandparent Caregiver

There is enough evidence to support the increasing role of grandparents taking care of orphans in Africa (Monasch and Boema, 2004; UNAIDS, UNICEF and USAID, 2004). Foster and Williamson (2000) found that grandparents were looking after about 50 percent of orphans in South Africa and 24 percent in Cameroon. UNICEF (2004) reported that in Eastern and Southern Africa mostly widowed grandparents cared for about 50 percent of orphans. Foster and Williamson (2000) found that in Zambia more grandparents (40 percent) looked after orphans than did young women (28 percent).

Foster et al. (1997b) describes the condition, where children go to their grandmother when the mother dies, as ‘skip-generation parenting'. Foster et al. (1997b) suggests that because grandparents are older and incapacitated, orphans cared for by older people can be more vulnerable to child labour than orphans in other living arrangements.

There are varied views on the care of orphans by relatives other than grandparents. In a study conducted by Foster et al. (1997b) in Zimbabwe, they found that about 88 percent of the households, aunties and uncles expressed reluctance to take orphans into their households. This was because they did not want to reduce standards of caring for their own children due to economic pressure originating from additional children. They were also afraid of contracting AIDS from the surviving children whose parents died of AIDS. In addition, they were afraid of bringing stigma into their home.

2.3.3 Child Headed Households.

There is sufficient evidence to support the observation that in places of high HIV prevalence, there has been an increase in child-headed households (Watts Hellen 2005; Adato et al. 2005; Plan 2008; Baquele 2004). However Richter and Sherr (2008) contend that despite escalation of orphan hood and adult mortality, child headed households are still a minority. In agreement, Children Count (2005) argued that child- headed household only surfaced as a temporary measure while arrangements to shift children to adults’ households are being made.

Foster et al. (1997b) suggested that child headed households emerge because of death of both parents, unwillingness of relatives to foster orphans, death and sickness of relatives, capacity of older children to care for younger children, preference of children to live alone, fulfilment of wishes of a dying parent and inheritance of residence by surviving children.

A question has been raised whether the emergence of child headed and grandparent headed household’s show that the extended family is failing to cope or it is adapting or adjusting to the changes. Literature provides adequate evidence of these divergent views on orphan and childcare (Chirwa 2002; Abebe 2007; Foster 2002b; Foster and Williamson 2000; Munthali 2002).

Some authors suggest that the increased roles that the community is playing to support orphans may suggest that the family is adapting (Hometruth 2009; Foster, Deshmukh and Adams 2008). Authors who hold the views that indeed families are adapting provide evidence of increased roles that the community is playing in supporting orphans. These include mobilising community support to meet needs of children, community provision of emotional support to counter the psychosocial effects of orphans and provide orphans with cultural and appropriate skills (Hometruth 2009; Foster, Deshmukh and Adams 2008). It is suggested that families and communities responded much more promptly to the demands of orphans in comparison with any external support to communities (Foster 2006b).

Authors who argue that the extended family is failing to accommodate orphans point out that the family and community child care systems are failing to cope with orphan care challenge as evidenced by their failure to absorb orphans, with a typical example of emergence of child headed households (Chirwa 2002; Abebe 2007). Consequently, orphans who are abandoned and end up on the streets (Foster 2002b; Foster and Williamson 2000).