This regional portrait describes Catholic-sponsored care for children in Eastern Africa using data from Kenya, Malawi, Uganda and Zambia. The first large study of its kind, it focuses on children who are particularly vulnerable—those at risk of or those who have been separated from their families. Many are in institutional care. This portrait also describes growing efforts, led by women and men religious, to ensure children can grow up in safe, nurturing families or family-like environments rather than institutions. Through national associations of religious, Catholic Care for Children programmes are part of and contributing to a much wider global trend in care reform seeking to reduce recourse to institutional care in favour of family- and community-based care for children.