Millions of children in low and middle income countries around the world live in adverse environments and suffer from ill health and disease, chronic undernutrition, deprivation, abuse, neglect, and exploitation.1 Many of these children are also excessively affected by violence; a study published in the February 2016 issue of Pediatrics revealed that more than half the world’s children had experienced violence during the year prior to the study.2 In the most severe circumstances, children live without permanent or protective care, in abusive living situations, on the streets or in inadequate institutional settings, or are subjected to sex trafficking, conscripted into armed groups, or exploited for labor. Children consistently exposed to cumulative, toxic stresses inherent to these circumstances, as well as children who live in environments in which they do not receive adequate nurturing and cognitive and psychosocial stimulation, can suffer from health difficulties and developmental delays and ultimately fail to achieve their full development potential. Sustained developmental deprivations and traumatic experiences can inhibit learning, constrain capacity to build relationships, and reduce a child’s potential to mature into a productive adult member of society (Fergusson & Horwood, 2003). These challenges can also potentially compromise a country’s social and economic progress.

This is the ninth annual report on Public Law (PL) 109-95, The Assistance for Orphans and Other Vulnerable Children in Developing Countries Act. Public Law (PL) 109-95 was signed into law in 2005 to promote a comprehensive, coordinated, and effective response by the U.S. Government to the urgent needs of the world’s most vulnerable children. This report is submitted on behalf of U.S. Government Agencies involved in supporting the provision of assistance to vulnerable children around the globe, the implementation of research on how to improve the development outcomes and health status of this population, and the promotion of policies to sustain improvements in child welfare. It describes significant work undertaken by U.S. Government Agencies over the past year and outlines progress made to date under the Action Plan on Children in Adversity (APCA) through Calendar Year (CY) 2016, both by Objective as well as in the six priority countries of Armenia, Cambodia, Colombia, Moldova, Rwanda, and Uganda.