International : Benefits, Risks, and Vulnerabilities By Tamsen Rochat and Linda Richter, ZERO TO THREE Corner , Youth, Family and Social Development Programme, Human The of children who have been raised in Sciences Research Council, South Africa institutions abroad is on the rise in the and is not without controversy. Reasons for the increase include higher rates of infertility in The issue of international adoption couples who have delayed parenthood; increased numbers of children has featured prominently in media who are relinquished, abandoned, or orphaned around the world; and headlines, spurred in recent years by the influence of third party agencies. Internationally adopted children public interest in the family-building activities of superstars such as Angelia face numerous risks and vulnerabilities, including the loss of their family, Jolie and Madonna. Although newsworthy country, language, and culture. Critics argue that international adoption and fashionably interesting, neither the helps a relatively small number of children who find adoptive parents practice nor the controversy surrounding but may impede countries from developing social programs that would international adoption is new. As Rosenblum and Olshansky (2007) highlight benefit the vast majority of children who are suffering due to poverty or in their discussion of diverse pathways to social and political problems. parenthood, adoption plays a significant role in the formation of kinships in the United States, with roughly 2.5% (16 brought to the United States. International other countries, the United States has million) of all children under age 18 being adoption in this earlier period was shown the biggest growth in international adopted (U.S. Census Bureau, 2007). motivated by care and concern for children and now accounts for over half Likewise, international adoptions have in distress in foreign countries. of all such adoptions worldwide. increased from 5% of all adoptions in the In the latter part of the 20th century, Most analysts agree (Hollingsworth, 2003; late 1980s to 15% of all adoptions in 2001 American involvement in conflicts in Johnson, 2005; Kane, 1993; Selman, 2002; (Kane, 1993; Selman, 2002), a threefold and Vietnam increased the motivation for Weil, 1984) that three important factors increase that indicates significant growth and practice of international adoption. have driven the increase in international in the popularity of adoption as a method Other factors included the humanitarian adoptions to the United States: of family building (Johnson, 2005). fallout from civil conflicts in countries such as Greece, El Salvador, and Haiti, and, 1. Increased demand for children from International adoption is currently within the United States. estimated to involve over 40,000 children more recently, the collapse of communism a year moving between more than 100 in Eastern Europe and the introduction 2. The abject poverty of southern countries (Juffer & van IJzendoorn, 2005). of population control initiatives in hemisphere countries and the The 2000 U.S. census reported 199,136 (Hollingsworth, 2003; O’Halloran, 2006). subsequent abundant number of children who have been abandoned, international adoptees younger than 18 Trends and patterns in international left destitute, or relinquished by their years living with families in the United adoption over time suggest that increases birth families, in addition to those who States (Johnson, 2005) and official U.S. in international adoption are not generally have been orphaned. immigration data indicates a further motivated by humanitarian responses to increase of 107,841 over the four years war and conflict (Selman, 2002). Instead, 3. The activities of third parties, such as 2001–2005 (U.S. Department of State, they have become an attractive option for adoption agencies, who strongly 2007a; U.S. Department of State, 2007b). infertile couples in western societies, who influence and facilitate the current Given the scale of the increase, there can may or may not also be motivated by the child migration process.[ be little doubt that hundreds of thousands desire to care for children in need. Whereas In addition, the following factors have of American families, their child-care in the 1960s and 1970s adopters might played a specific role in the increasing practitioners, and other service providers have been motivated to assist children in demand for international adoption in the are participating in and are directly or need of a home, potential adoptive families United States. indirectly affected by the explosive growth today are seeking babies who are healthy in international adoption. and voluntarily relinquished (Momaya, Increased Reproductive Health 1999; O’Halloran, 2006). Choices and Decreased Fertility Trends in International During the last three decades, several studies (Kane, 1993; Selman, 2002; Most western societies have seen a drop in Adoption in the United States Weil, 1984) have examined the growth fertility rates over the last few decades, and and trends in the migration patterns of the United States is no exception. Current The early history of international adoption children through international adoption, reproductive trends indicate that at least has been well documented (Altstein & both worldwide and to the United States. one quarter of American women have their Simon, 1991; Selman, 2002; Weil, 1984). It These studies have demonstrated a rapid first baby after 35 years of age. This, along emerged as a valued, legal, and morally and significant increase in the number with greater reproductive choices, has led motivated practice in the aftermath of of international adoptions to the United to increased involuntary infertility. The World War II, when thousands of orphaned States since the 1980s. In comparison to net result has been that fewer unplanned and destitute European children were or unwanted are born in the U.S.,

19 WORLD ASSOCIATION FOR MENTAL HEALTH JULY - DECEMBER 2010 and many more parents find themselves to spend significantly more money than support services and poverty increase the unable to build a biological family later in they would for a national adoption. Factors likelihood of abandonment of children, their lives (Darnell, 2004; Johnson, 2005; that may influence eligibility in the United in particular if birth parents feel they are O’Halloran, 2006; Selman, 2002). States are often much less restrictive in the giving the child a chance at better care international adoption arena and more (Hollingsworth, 2003; Wallace, 2003). Increased Maternal Choice and influenced by other eligibility criteria, Furthermore, postadoption opportunities Support for Unmarried such as income and willingness to adopt for contact are limited, either by the (O’Halloran, 2006). nature of the adoption, or by the inability Increased maternal choices to retain rather to practice openness because of the than relinquish a nonmarital child have distance and financial resources required. played a significant role in reducing the Consequently, access to “open” adoptions is number of children available for domestic Risks and Controversies severely limited (O’Halloran, 2006). adoption. Declining stigma, coupled with welfare benefits and support services, Along with the increasing demand for and Market-Driven Economies Introduce has allowed single parenting to become a rapid growth in international adoption, New Risks for Children feasible option, and has resulted in fewer growing concerns have been raised by or American children being made eligible for on of behalf of sending countries. These The current rapid growth in the domestic adoption (Hollingsworth, 2003; concerns have mainly centred on the movement of children across borders Johnson, 2005; O’Halloran, 2006). following issues. and the increased demand and supply of children has resulted in market-related Birth Parents’ Rights and Open The Removal of Adoptable Children conditions developing for the legitimate Adoption Systems From Their Birth Country trade of children (Kane, 1993). However, such developments create precisely Increased protection of birth parents’ International adoption, in particular the conditions under which it becomes rights, the development of the foster recent trends demonstrating an increase difficult to protect the rights of children care system, and the movement away in the demand for younger, healthy and the “best interest of the child” are from closed adoptions have influenced infants, may lead to the removal of the less and less likely to be taken into the number, age, and nature of children most adoptable children from their own consideration (O’Halloran, 2006). Market- available within domestic adoption countries (O’Halloran, 2006). International related conditions for adoptions raise systems. Currently, a child’s eligibility for adoption preempts the possibility of concerns that the legality of an adoption adoption is determined more by court meeting the needs of native adopters and process may be compromised on account processes than by parental choice. Children leaves behind children who are statistically of the wealth or financial status of the being made available for adoption tend less likely to be adopted. Several analysts adopter or of their representing agency, to be older, with some level of mandated (Hollingsworth, 2003; Selman, 2002; as was demonstrated by the recent contact with birth parents (Johnson, Wallace, 2003) have raised concern over adoption by Madonna from Malawi. 2005). Despite the changing demographic issues of social justice and inequity in the Although the Hague Convention on in nationally available children (e.g., in current era of explosive growth. Intercountry Adoption (see box) provides 2001 only 2% of children adopted from an international regulatory framework, its were less than 12 months, The Removal of Children From Their capacity to standardise and raise levels as compared to 44% of international Birth Culture and Kin of practice is limited by the fact that a adoptees that year), the demand for number of countries that participate in International adoption often results in younger children and international adoption and send children a permanent removal of a child, either has remained constant (Johnson, 2005; to the United States are not yet signatories, directly, through a closed adoption process O’Halloran, 2006). have not yet ratified the convention (Kane, still allowed in many sending countries 1993; O’Halloran, 2006), or do not have the although prohibited in the United Commercially Driven Adoption capacity to implement its provisions. Agencies and Third Party Placements States. or indirectly, by the financial and geographic barriers to continued contact The Risks of Increased Baby Trafficking The United States (unlike the United with birth culture and kin (O’Halloran, Kingdopermits independent and third- 2006). This may have implications for the International adoption regulations within party adoption placements; consequently, future development and identity rights the US are stringent, but very little can commercially driven agencies are of the internationally adopted child be done to ensure that sending countries frequently involved in facilitating adoption (Mohanty & Newhill, 2005). Despite the fact adhere to those regulations, regardless placements from overseas countries that international standards encourage of whether they are signatories to the (O’Halloran, 2006). Evidence suggests that adoptive parents to ensure the child has Hague Convention (D’Amato, 1998; international adopters in the United States an opportunity to learn about their birth O’Halloran, 2006)—as evidenced in the are economically advantaged, educated, culture, evidence shows that very few cases of Romania in the early 1990s, and older (Juffer & van IJzendoorn, 2005; adopting families are able to sustain this in the late 1990s, and current Momaya, 1999; Wallace, 2003). Waiting over time (Wallace, 2003). growing concern over the adoption trade periods for national adoption tend to be in Guatemala (Bainham, 2003; Wittner, longer regardless of wealth and somewhat Circumstances of Poverty Often Create 2003). The problems remain the same. less certain, based on age or marital Greater Vulnerability Only the countries of focus change; as one status. In the international adoption arena gateway closes, another opens. Although wealth, or buying power, is often able to The unremitting poverty and hardship proponents of international adoption facilitate adoption placements. Adoptive experienced in poorer sending countries argue that child trafficking is an unlikely parents may have greater choice in the often make birth parents more vulnerable and frequently exaggerated outcome age and background of the child and a to pressure to relinquish a child for (Johnson, 2005), recent history seems shorter waiting period, if they are willing financial gain (O’Halloran, 2006). A lack of to suggest otherwise (Bainham, 2003;

20 THE SIGNAL JULY - DECEMBER 2010 Fieweger, 1991; Wallace, 2003; Wittner, children and vulnerable communities in (Miller, 2005b). Internationally adopted 2003). A case in point is how unscrupulous sending countries. children have often come from deprived baby brokers took advantage of loopholes settings and from cultures in which they in Romanian law after the fall of the Soviet have multiple caregivers, and they need to Union (brought to the attention of the make tremendous and rapid adjustments general public in an expose by the U.S. The Challenges Facing upon arrival in the United States (Mohanty television show “60 Minutes”), facilitating & Newhill, 2005; Shapiro, Shapiro, & Paret, over 10,000 Romanian adoptions in International Adoptees 2001). Some commonly cited challenges 1990–1991 and resulting in an emergency include the following. There are many difficulties in achieving moratorium on adoptions from that a match between the adoptive home country (Bainham, 2003). Likewise, the The Initial Transition and Adjustment circumstances and the needs of the exposure of baby-selling rings in Cambodia internationally adopted child (O’Halloran, to a New Environment by the U.S. television program “20/20” and 2006), often because of the high degree of the resultant moratorium on adoptions Internationally adopted children and their uncertainty within the adoption process from that country by the U.S. in 2001 new families face multiple challenges itself, the great geographic distances over (Wittner, 2003). These examples provide in their adjustment to family life in the which the process has to be managed— ample food for thought about the threat United States. Many children adjust well, often with considerable costs attached that international adoptions can be used but understandably some find this sudden (Bledsoe & Johnston, 2004; Johnson, for trafficking. It is naive to presume such transition difficult and often display 2005)—and the difficulties in accessing actively does not present serious risks for behavioral and emotional difficulties verifiable information regarding parental related to everyday activities such as sleeping, eating, or bathing (Miller, 2005a). The Hague Convention on Intercountry Adoption The length of prior institutionalisation, if any, as well as the age of the child at The Hague Convention strengthens protections for adopted children by: adoption, can affect the ease with which children adjust to their new environment; Ensuring that intercountry adoptions take place in the best interests of children; and younger children tend to adjust more Preventing the abduction, exploitation, sale, or . quickly than older children (Diamond et al., 2003; Gold, 1996; Goldberg & Currently, 68 countries have joined the Convention, which was completed and Marcovitch, 1997). However, any young circulated for comments by member countries on May 29, 1993, under the auspices child who experiences a complete change of the Hague Conference on Private International Law, an international organization in environment and routine may as a formed in 1893. The Convention is expected to be fully implemented in the United result become withdrawn or distraught. States in 2007. At that time, private adoption service providers will need to be Although new parents are excited, they accredited, temporarily accredited, or approved, or be supervised by a provider that may be ill prepared to deal with this is accredited, temporarily accredited, or approved, in order to provide adoption transitional period and require additional services in cases involving the United States and another Convention country. support (Groza & Ryan, 2002; Groza, Ryan, & Cash, 2003; Haradon, 2001; Levy-Shiff, Zoran, & Shulman, 1997; Mohanty & Top 10 Convention Countries from which U.S. Citizens Newhill., 2005). Adopted in FY05 COUNTRY No. of Adoptions 1. China 7906 2. Guatemala* 3783 3. India 322 Medical, Developmental, and 4. Colombia 291 Behavioral challenges 5. Philippines 271 6. Mexico 88 7. Poland 73 Internationally adopted children face 8. Thailand 72 greater risk of possible exposure to 9. Brazil 66 10. Moldova 54 infectious diseases (Chen, Barnett, & Wilson, 2003; Lebner, 2000) or other illness, Top 10 non-Hague Countries / Territories from malnutrition (Altemeier, 2000), or failure to thrive, which adoptive parents may not be which U.S. Citizens Adopted in FY05 fully aware of or prepared for at the time COUNTRY No. of Adoptions 1. Russia 4639 of adoption. Many children may display 2. South Korea 1630 developmental delays or cumulative 3. Ukraine 821 4. Kazakhstan 755 cognitive deficits depending on their age, 5. Ethiopia 441 the impact of the quality of care they have 6. Haiti 234 7. Liberia 183 received prior to adoption, or the length 8. Taiwan 141 of pre-adoption institutionalisation (Juffer 9. Nigeria 65 10. Jamaica 63 et al., 2005; Mason & Narad, 2005; Serbin, 1997; Weitzman & Albers, 2005). These *Although Guatemala is a party to the Convention, its adoption procedures do not children face learning a new language meet the standards of the Convention. under great communicative pressure and Source: U.S. Department of State are likely to need specialised assistance in developing the particular knowledge essential to thriving in their new cultural context (Gindis, 2005; Mohanty & Newhill, 2005). Sensitive and timely preschool consents, health, and genetic background

21 WORLD ASSOCIATION FOR INFANT MENTAL HEALTH JULY - DECEMBER 2010 placement and long-term remediation functioning, family support services building needs of western society. The fact are crucial (Caro & Ogunnaike, 2001; should be sensitive to issues which may that countries such as South Korea, China, Costello, 2005; Gindis, 2005). Children’s undermine parental support for the child’s Thailand, and the former communist states developmental outcomes can often be identity (Feigelman & Silverman, 1984). of Eastern Europe are sending children significantly improved by access to family to the United States and Sweden despite and community services and resources in having birth levels below replacement the postadoption period (Barnett & Miller, level warrants both political and ethical 1996; Bledsoe & Johnston, 2004; Caro & Implications for Policy, consideration (Kane, 1993; Selman, 2002; Ogunnaike, 2001; Galvin, 2003; Groza et al., Research, and Practice Weil, 1984). 2003; Haradon, 2001; Mohanty & Newhill, 2005). Social policy changes in adoption In contrast, international adoption as a processes within the United States, means of family building is proving to be the protection of parental rights, and fairly successful for American adopters. the provision of legislative and welfare Younger, healthier children from closed Dealing with Issues of Culture support to keep young children with adoptions from other countries are better their biological parents in all reasonable adjusted than domestically adopted and Identity circumstances and to encourage open children (Miller, 2005b). A recent large adoptions have resulted in fewer young, meta-analysis (Juffer et al., 2005) of the Many studies report international healthy children being available through behavioral and mental health outcomes in adoptees’ confusion about their race, public and private adoption systems internationally adopted children suggests ethnicity, and cultural identity, and within the United States (Johnson, 2005; that most internationally adopted children experiences of racism and O’Halloran, 2006). In the 2002 national are well adjusted. Even though they (Mohanty & Newhill, 2005; Silverman, survey of attitudes about adoption are more frequently referred for mental 1997; Vonk, 2001). Although in most (Harris Interactive, Inc., 2002, p. 29), 84% health services than their nonadopted situations a child’s culture has a positive of respondents stated that, if they were peers (Juffer et al., 2005), international meaning and helps a child to identify with thinking about adopting, a major concern adoptees have fewer behavior problems others and define him- or herself, in the would be making sure that birth parents and are less frequently referred to mental case of international adoption, culture could not take the child back. Many health services than domestically adopted may have both positive and negative prospective parents felt they wanted to children (Juffer et al., 2005). Trends meanings for the child, because an adopt the child, not the child’s family nor indicating that the demand for younger internationally adopted child’s cultural the problems that prompted the adoption children is more frequently being met background may be closely related to process in the first place (Johnson, 2005). through international adoption (Johnson, experiences of loss, deprivation, or abuse 2005) at the expense of domestically (Benson, Sharma, & Roehlkepartain, 1994; The development of increased maternal available older children (O’Halloran, 2006) Mohanty & Newhill, 2005; Silverman, and paternal rights in the United States is should give us pause for thought. 1997; Vonk, 2001). Ethnic identification aligned with the international principles and pride play an important role in the established by the Hague Convention development of positive self-esteem and that champion the right of children to be overall psychological adjustment and raised by their birth parents in their birth Concluding Thoughts can serve as a protective factor against cultures and countries unless compelling behavioral problems, particularly during circumstances dictate otherwise. To Superstar Angelina Jolie, despite critiques adolescence (Mohanty & Newhill, 2005). some extent, the wealth—and the of her family building activities, in fact Research suggests that internationally social policy protection associated with models quite well the Hague requirements adopted children adjust better if they are that wealth—of the United States has for preserving a child’s cultural heritage provided with a nurturing environment protected these rights for its youngest by ensuring that her children have that openly acknowledges the physical citizens. Yet this circumstance—although frequent contact with their birth culture differences they may have from their perhaps inadvertently—has created a and country, and by drawing attention to adopted family or peers. It is also helpful demand for younger, healthier children the needs of children in their countries of if internationally adopted children are accessed from outside the country origin. Critics would be hard pressed not to exposed to positive role models from their through closed adoption with a greater concede that she has met the international countries of origin, and if acknowledgment and greater frequency from somewhat standards enshrined by the Hague is given to the psychological similarities poorer countries that are less or not Convention. The questions is to what between themselves and their new family able to provide their children with such extent the average international adopter and country (Mohanty & Newhill, 2005; protections (Hollingsworth, 2003; Wallace, in the United States can afford, or is willing Trolley, Wallin, & Hansen, 1995; Vonk, 2003). and able, to do the same. 2001). Cultural competence on the part of the adoptive parents is critical, and the Although there can be no disputing that It is often argued that the practice of internationally adopted child’s self-esteem adoption presents a healthier and more international adoption helps to save is often positively correlated to parental successful option for children without children from a life of institutionalisation, cultural competence and the extent to family care than any nonpermanent social but in reality very few institutionalized which children are exposed to their culture program (Bartholet, 1993), we need to ask children in sending countries benefit of origin. Further research is required to whether international adoption reduces from international adoption. International fully understand the exact mechanisms political will to develop systems that adoption does little to change the status of positive adjustment in internationally encourage and support domestic adoption quo or encourage and support the adopted children and to better in more prosperous sending countries (as development of family preservation or operationalise the construct of cultural evidenced in South Korea) or exploits the domestic adoption systems in sending competence. To strengthen internationally inability of poorer countries to do so while countries. It is quite possible that adopted children’s adaptive psychosocial providing for the parenting and family- international adoption may be courting

22 THE SIGNAL JULY - DECEMBER 2010 inertia around developing adequate child Costello, E. (2005). Complementary and www.adoptioninstitute.org/survey/ welfare programs in sending countries alternative therapies: Considerations Adoption_Attitudes_Survey.pdf (Hollingsworth, 2003; Selman, 2002; for families after international Hollingsworth, L. D. (2003). International Wallace, 2003). adoption. Pediatric Clinics of North adoption among families in the United America, 52, 1463–1478. Although in no way invalidating the States: Considerations of social justice. rights of individual children to a better D’Amato, A. (1998). Cross-country Social Work, 48, 209–217. adoption: A call to action. Notre Dame and more stable family life, we must Johnson, D. E. (2005). International Law Review, 73, 1239–1249. acknowledge our responsibility to strive adoption: What is fact, what is fiction, for the same conditions and opportunities Darnell, C. L. (2004). “I wanted a baby so and what is the future? 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23 WORLD ASSOCIATION FOR INFANT MENTAL HEALTH JULY - DECEMBER 2010 Creating a family: Diverse pathways to Will international treaties and adoption parenthood. Zero to Three, 27(5). moratoriums accomplish the job in Cambodia? Pacific Rim Law & Policy Serbin, L. A. (1997). Research on Journal, 12, 595–629. international adoption: Implications for developmental theory and social policy. International Journal of Copyright 2010, ZERO TO THREE. All rights Behavioral Development, 20, 83–92. reserved. For permission to reprint, go to Shapiro, V., Shapiro, J., & Paret, I. (2001). www.zerotothree.org/reprints International adoption and the formation of new family attachments. Smith College Studies in Social Work, 71, 389–418. Silverman, B. (1997). Cultural connections in international adoption. Adoption Therapist, 8, 1–4. Trolley, B. C., Wallin, J., & Hansen, J. (1995). International adoption: Issues of acknowledgement of adoption and birth culture. Child and Adolescent Social Work Journal, 12, 465–479. U.S. Census Bureau. (2007). United States census 2000. Available from United States Census 2000 Gateway, www. census.gov/main/www/cen2000.html U.S. Department of State (2007a). Significant source countries of immigrant orphans (totals of IR-3 and IR-4 immigrant visas issued to orphans) fiscal years 1992–2004. Available from Bureau of Consular Affairs, travel.state. gov/visa/frvi/statistics/statistics_2541. html U.S. Department of State. (2007b). Significant source countries of immigrant orphans (totals of IR-3 and IR-4 immigrant visas issued to orphans) fiscal years 1996–2005. Available from Bureau of Consular Affairs, travel.state. gov/visa/frvi/statistics/statistics_2541. html Vonk, M. E. (2001). Cultural competence for transracial adoptive parents. Social Work, 46, 246–255. Wallace, S. R. (2003). International adoption: The most logical solution to the disparity between the numbers of orphaned and abandoned children in some countries and families and individuals wishing to adopt in others? Arizona Journal of International & Comparative Law, 20, 689–724. Weil, R. H. (1984). International adoptions: The quiet migration. International Migration, 18, 276–293. Weitzman, C., & Albers, L. (2005). Long- term developmental, behavioural, and attachment outcomes after international adoption. Pediatric Clinics of North America, 52, 1395–1419. Wittner, K. M. (2003). Curbing child- trafficking in intercountry adoptions:

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