International Questions and Answers
Q. Can we really do this?
Q. How can I protect my family from unethical practices?
Q. Are there any warning signs to look for?
Q. What about the ethics of licensed adoption agencies?
Q. Are there other potential areas of concern?
Q. How are countries with centralized adoption processing different?
Q. What happens in countries that allow private parties to place children with families?
Q. How can we avoid unethical adoption practices?
Q. Are we doing the right thing by adopting internationally?
Q. How does the health of internationally adopted children compare to other children?
Q. How are children impacted by their birth family?
Q. What kind of an impact does living in an orphanage have on a child?
Q. What diseases and conditions should we worry about?
Q. How healthy are the children available from other countries?
Q. Do we have any responsibilities to our child’s country of origin?
Q. What if we have concerns soon after we return to the United States?
Q. When will our child become a citizen and no longer need a green card?
Q. What can we do to help the children in the orphanages?
Q. Do we have to re-adopt our child in the United States?
A. You have legally adopted your child in the eyes of both the foreign and United States governments. You are now legally responsible for the welfare of your child, and can now claim your child as a dependent on your taxes. If you are a single parent, or a married couple who has traveled together for the adoption, your child probably does not legally need to be re-adopted. However, re-adoption is very strongly recommended.
If you are a married couple, and one spouse does not travel, the child enters the country with a different status in the eyes of the US Immigration. Your adoption is not complete and re-adoption is required, or your child will become an illegal alien. Your child will not automatically receive a Certificate of Citizenship, but will receive a green card good for 18 months. If you are planning to travel without your spouse, and do not plan to re-adopt your child, you may wish to consult an adoption attorney and/or your local U.S. Immigration office.
Most adoptive parents do re-adopt their children in their state of residence. By re-adopting in the United States, you create a paper trail of your adoption in the United States. A court takes official notice of the adoption, and a birth certificate and adoption decree are issued for your child. Having a United States birth certificate can be very useful when applying for schools and proving that you are the parents of your child. If you ever need official copies of your child's adoption decree or birth certificate, you will not need to obtain them from your child(ren)’s birth country. Further, you will protect your child’s inheritance. There have already been lawsuits filed to have internationally adopted children, with no U.S. adoption decrees legally disinherited and ineligible to receive their portion of the adoptive parent’s estate or insurance benefits. We strongly recommend that anyone who adopts internationally re-adopt their child in the United States.
Most adoptive parents then hire an attorney and petition the local courts to re-adopt their child. Some states, including Washington, allow adoptive parents to petition for the adoption themselves without hiring an attorney. We can help you find an attorney, or you can complete the re-adoption on your own.
Q. Can we really do this?
A. Yes you can! Thousands of families all over the country and overseas have successfully completed adoptions from all over the world. Our international adoption professionals will guide you each step of the way.
Q. How can I protect my family from unethical practices?
A. Begin by thinking about these issues, and making them a part of your decision making process. Talk to both the agency and their references about these issues. One of the most effective ways of checking the ethical practices of an agency is by asking specific questions of the references for that agency. It is not enough to hear that the family had a great experience, and that they loved the agency and the staff in the foreign country. Even if those references are provided by the agency, you may be able to determine a lot about the practices of that agency by looking for patterns in the following questions:
- Did you sign a contract?
- Did you have a clear understanding of the fees, and were there any surprises?
- How much were the total costs of your adoption, and how much of that was fees to the agency?
- Were you shown a picture of an available child,
- and told that you had to act quickly to adopt that child?
- and were eventually able to adopt that child, or was a different child substituted during your adoption process?
- and given identifying personal information about that child?
- What was the interaction like with the foreign facilitator, did you get the impression that they had found the child?
- Was the child anonymously abandoned, and is that typical for the culture? Or do you think it is possible that the birth family was compensated, or that documents were falsified?
- Was the child’s health and age what you expected, and was independent medical information available to you?
By asking several families these questions you can get a lot of information about how the agency works, even if all of the overall impressions are positive.
There are also membership organizations that agencies can join that assert their members follow ethical adoption practices. These organizations may not have any actual enforcement mechanisms to oversee or verify ethical practices by their member, and may provide families with a false sense of security.
Q. Are there any warning signs to look for?
A. Yes. First and foremost, an agency should be able to discuss ethical issues with your family. Agencies should have printed material that describes their program in detail, and specifically how children come to be available through their program. This is a particular concern with agencies that have photolistings of available children. If a central government has assigned a child to an agency for placement, then it is likely to be an ethical placement. If an agency facilitator has located a child, and that child can only be adopted through that agency, then you may want to consider asking deeper questions. Some agencies have even offered the same child to multiple families, then told the family when they arrived in the foreign country that the child they were requesting was no longer available. Families are then quickly matched with different children, frequently having to pay higher fees while traveling or experiencing unexpected delays.
Agencies should not be in a hurry to have you become a client. It is rare that there is a need to hurry in adoption. If you are presented with information about a specific child, and told that you must act quickly to receive this placement, it may just be a technique to rush you into working with that agency. Families are better protected if they first choose a country and an agency, and only then start considering specific children. Looking at pictures of children and falling in love with one and using that as a basis to select an agency has created many problems for adoptive families.
Some voices calling for ethical reforms in adoption have come to see photolistings of children as child trafficking, particularly if a child being listed is only available from the agency paying for the listing. Adoption agencies are generally intended to market their adoption services, not specific children. While photolistings are clearly an effective tool for placing children, the ethical, emotional, and financial risks to families who view the listings and agencies who place the listings are substantial.
Identifying information about specific available children should not be presented to families until the family has made a commitment to that child. Just as you wouldn’t want your name and health history posted on the Internet, or sent in large mailings to groups of strangers, agencies should protect the privacy of the children they place.
Always sign a contract with an agency. The contract should discuss how and when fees are paid, and what dispute resolution policies the agency has. You should have a clear understanding of the purpose, amount, and timing of each fee you pay. Any agency should be willing to send you a copy of their contract in advance of your sending in an application.
Q. What about the ethics of licensed adoption agencies?
A. Sadly, some agencies have been notoriously lax about ethical standards. Families have been lied to about their adoption process, or have reported that they have been encouraged to participate in falsification of documents. It is incumbent on adoptive families to know the laws of the country from which they plan to adopt, and to decide if the country, program, and agency or facilitator they choose meets with their standards. Check with the licensor of the agency, first to be sure the agency is licensed, and second to see if there are any outstanding complaints. When talking to the references of agencies, be sure to ask questions that relate to the law of the country from which they adopt. Many times families will know if something wasn’t quite right, or will innocently give answers that suggest practices that make you uncomfortable.
Don’t just ask an agency or facilitator to provide their own references. Find a public forum where adoptive families get together. There are many clubs, support groups, and events for adoptive and pre-adoptive families.
Q. Are there other potential areas of concern?
A. Yes, in most developing countries public officials are often paid less than they need to live. This creates an environment where they might expect gifts in order to perform the tasks required for their jobs. Regardless of whether you are a pre-adoptive parent or a local construction company that needs a permit to build a house, paperwork may not be able to move through such a system without gifts and special considerations. Adoptive parents and adoption agencies must resign themselves to this possibility if they wish to complete an international adoption. Providing these gifts is allowed under a US law called the Foreign Corrupt Practice Act (FCPA).
Unfortunately once public officials begin accepting gifts to simply do their jobs, it is an easy step to take larger gifts to perform actions that go beyond local laws and ethical adoption practices. This can lead to false birth certificates or abandonment certificates being created for children who would not otherwise be eligible for adoption. Or families who should not be eligible to adopt being assigned children they should not be allowed to adopt. If a country has a rule that adoptions are limited to families who have two children or less, and a family with four children is assigned a child, there is a good chance that a public official was "encouraged" to do more than his job. This kind of activity is a violation of the FCPA.
The greatest exception to all of this is China, which has fixed fees throughout the country, and enforces compliance on the part of local officials. This, coupled with centralized adoption processing, makes China the most ethical of developing countries from which to adopt.
Q. How are countries with centralized adoption processing different?
A. In countries with centralized adoption processing, all adoption materials must be sent directly to the central (as opposed to provincial) government. This applies both to adoptive parents and orphanages. The government then matches children with adoptive parents. When there is no way for private individuals to make this connection, there is no incentive for them to make more children available for adoption. Any family can end up adopting any child. Facilitators help with interpretive services, document assistance, and clearing administrative log jams. Just getting public officials to do the jobs they are supposed to do in a timely manner can be a mark of a great facilitator. Like the ones who help our families.
Different countries approach this in different ways. China asks families to write a profile of the kind of child they want to adopt (boy or girl, infant or older, etc.) Adoption officials then look at information about different children provided to them by orphanages, and match families with appropriate children. Ukraine gathers information about available children at a central office in Kiev and then allows families to select the child(ren) they want. A family cannot be legally matched with a child who is not potentially available to any other family.
Q. What happens in countries that allow private parties to place children with families?
A. In the most extreme cases, pregnant women can be held hostage until they deliver, children can be kidnapped, or birth families can be paid to relinquish their children. It is for this reason that the US government has begun DNA testing and extensive interviews, to be certain that relinquishments from birth parents are legitimate in some countries, including Guatemala. It is important that adoption agencies, and parents adopting independently, take steps to address these concerns.
According to U.S. law, children must either be legally or anonymously abandoned (as is generally the case in China), or they must have been knowingly and willingly relinquished by birth families who were not coerced or financially rewarded for their choice, or the parental rights of the birth family must have been permanently terminated by the local government. Documentation must be provided to both you and US Immigration officials that show how the child came into the custody of an orphanage, foster home, or facilitator. If a facilitator can earn thousands of dollars for each child they match with a US family, and if spending a few hundred dollars in bribes can produce forged documents, some practitioners will choose to engage in unlawful practices. If there are relatively few legitimately available children in the facilitator’s area of operation, then it is an easy step to bring children into adoption through intimidation, theft, or outright bribes to birth families.
Independent practitioners more concerned about finances than about children or families are more likely to provide false information about children. An adoptive family takes a child and leaves the country, often having little recourse when they return home and find their child is much older, sicker, or disturbed than they were led to believe. This is a particularly serious risk for families adopting without the backup and assistance of a licensed adoption agency. Here again, testimonials from families who have adopted previously can be of little help. References provided by facilitators will be carefully chosen to only represent good outcomes, and families who have grave problems with adoptive children are often too ashamed, embarrassed, or just plain busy to have a large public profile as adoption references.
Q. How can we avoid unethical adoption practices?
A. Every country has a different adoption procedure, each with its own risks of ethical concerns. Adoptions generally happen in two ways. Some countries like China and Ukraine have chosen to centralize adoption processing and the assignment of children. When problems are seen in adoption, they are frequently associated with private individuals (facilitators), attorneys, or orphanages that are able to directly match specific children with pre-adoptive families. These parties have the opportunity to make vast amounts of money by the standards of their country in this process. Such a large amount of wealth can cause them to ignore or actively violate adoption laws and standards.
It can be difficult to be sure you are engaged in an ethical adoption. Simply getting referrals from other families may not give you the whole picture. A foreign facilitator may have excellent English skills, be very attentive to the family’s needs, be able to process paperwork very efficiently, yet still be committing fraud in the child’s country. Understanding the adoption process in each country and determining for yourself if laws are being followed is an important part of an ethical adoption.
Q. Are we doing the right thing by adopting internationally?
A. Absolutely! There are millions of children around the world who will never know homes or families without your help. Bringing hope and love to a child is one of the best things people can do. There are risks, however. The United States is so rich and powerful compared to other countries that adopting families can inadvertently corrupt private parties and government officials. Children have been kidnapped, birth parents coerced and government officials bribed to bring children into U.S. homes. Most adoptive parents do not want to adopt a child on these terms. You need to do careful research to protect the interests of your family and of children around the world.
Q. How does the health of internationally adopted children compare to other children?
A. Despite the warnings in this section, it is important to remember that all children come with risks. At least 5 percent of all kids are born with birth defects. Adoptive parents can choose whether they want to adopt children with certain challenges. A physically active family can choose not to adopt a child with mobility problems. Biological parents do not have that choice. Children adopted domestically are not necessarily healthier than those adopted internationally. Use of alcohol and drugs, from cocaine to heroin to methamphetamines, is much more common in our open, affluent society. The great spreading out of families and lack of close communities, due to inexpensive transportation and housing, has robbed our society of some of its protections for children. Physical and emotional abuse of women and children, with the resultant damage to health, development, and ability to bond, is far too easy and common in anonymous apartments, where "nobody knows your name." The health risks to internationally adopted children are not substantially different from the health risk to any child born to your family, or adopted here in the United States. While every child brings joys and challenges into your home, there are more international adoptions every year because they work for both the kids and the parents.
We strongly recommend that families educate themselves about medical conditions commonly found in internationally adopted children. Several recommended books may be found in our adoption book store. Please take particular note of The Handbook of International Adoption Medicine.
Q. How are children impacted by their birth family?
A. There is no good reason for children to be in an orphanage. It usually means that the birth family has been destroyed, or is under tremendous pressure. Some reasons are less hard on children than others. With most developing countries, severe poverty often coupled with single parenting and/or substance abuse is what frequently brings families to the desperate decisions to relinquish their children. China is the biggest exception to this rule, with most of the available children coming from functioning families who are choosing not to parent for legal and political reasons.
With Asian and South American adoptions, most birth mothers have not used drugs or alcohol to any great degree. The exception can be women from larger cities with significant amounts of prostitution. This means that the biggest concerns for parents adopting from Asia are going to be related to nutrition. Poor prenatal and inadequate early nutrition can impact brain and body development. While most adopted kids will bounce back from their impoverished beginnings, parents will need to be alert for special challenges in learning and development.
The biggest challenge to internationally adopting parents is alcohol use by Eastern European birth families. This problem manifests itself in two ways - First, through Fetal Alcohol Syndrome (FAS). This is significantly damaging to a child, with physical symptoms including facial deformities of the lip, head, teeth, and ears. Families adopting from the United States or Eastern Europe should become familiar with the warning signs. Most studies we have seen suggest that at least 5 percent of kids in orphanages throughout the region have FAS.
More common, but also more subtle, is Fetal Alcohol Effect/Exposure (FAE). There are normally no outward or testable signs of this condition. Affected children can be indistinguishable from their peers, with symptoms only appearing when a child is several years old. FAE children will frequently have learning disabilities, emotional control problems, or bonding and attachment issues. Probably 15 to 25 percent of children from all Eastern European countries will have to deal with significant challenges in their lives from their birth parents’ use of alcohol. Families adopting from the region need to be particularly alert to the needs of their children.
We do not mean to suggest that FAE children should not be adopted, or will not do well in families. Rather, these children may take more time, effort, care, treatment, and love than children not exposed to alcohol before they were born. Some adoptive parents place a great deal of importance on knowing the genetic history of the birth family. Most adoption professionals find this concern to be over-emphasized. Aside from the difficulty of verifying the accuracy or reports from birthparents, environment and parenting have a far greater impact on a person’s life than genetic makeup. While biology may influence tendencies, it is parenting that establishes values and learning.
Q. What kind of an impact does living in an orphanage have on a child?
A.
As you might expect, children do best in loving caring families. Orphanages in developing countries are often under funded and staffed by poorly paid, indifferent staff. Even foster care can be problematic, with families becoming foster parents for purely financial reasons, and having little consideration for some other person’s child. This frequently means that children come to adoptive families with developmental delays, repetitive motion syndromes, or challenges in bonding and attachment. Again, China leads the developing world in the care of children. Thanks to their decision to provide better funding of orphanages through international adoption, and a centralized placement system that rewards orphanages for placing healthy children, infants from China have extremely low rates of bonding and attachment problems, and normally bounce back very quickly from any developmental delays.
Ukraine is also benefiting from their centralized adoption process.Orphanages are developing reputations, and competing with each other to provide the healthiest, best cared for children. Among Eastern European systems, they have done a great job. Still, adoptive parents should spend as much time as possible with available children to get a sense of their level of activity, alertness, and bonds to caregivers. Seeing a child and caregiver in a clearly close relationship is a great sign.
Q. What diseases and conditions should we worry about?
A. The most common serious disease risk for internationally adopted children is Hepatitis B. This is a viral disease that attacks the liver. In most infected children, it will remain relatively inactive for decades, and then can lead to liver failure or cancer in their 40’s or 50’s. In some cases it can be active, and be immediately life threatening. It is passed by blood or stool contact. Safe, effective immunizations are available for this disease and any caregiver or personnel likely to have close personal contact with an adopted child should be immunized. This is particularly true for older relatives who may help with bathing or diaper changing, or other children who may engage in active play, such as siblings or daycare and pre-school classmates. For comparison, in children adopted from China, the rate of infection among infants is around 2 percent. Most other countries, including the United States, have rates at least double that of China. While available children from all countries are tested for Hep B, children who have been exposed to the disease can falsely test negative for six months or more after exposure. Some children who have Hep B have been cured of the disease by new drug therapies.
The most feared disease is AIDS. While this disease is considered to be a death sentence, it is also very rare in adoptions. Most children adopted through all of our programs are routinely tested for AIDS. There has never been a child adopted from China who has AIDS. With over 6,000 adoptions per year from China for the past several years, this indicates an AIDS rate of far less than 1 percent. Our agency has seen more children impacted by tumors and cancer than by AIDS. AIDS rates from our other programs seem to be around a half of a percent. AIDS can also hide from testing for several months after exposure, or after birth from an infected birth mother, so testing is recommended both before and after your adoption.
Most other diseases are readily treatable, and not likely to have long-term effects, but children should certainly be tested for parasites, syphilis, tuberculosis and anything else your doctor recommends, once you are home with your child. Families should protect themselves from contagion until test results are back, which means precautions like always changing diapers with gloved hands.
It should be noted that these tests and precautions should also be considered for domestic as well as international adoptions. Many of the diseases found in adopted children are associated with drug use and unsafe sexual practices. Both are far more common in the United States than in the rest of the world. Asian women in general, and Chinese women in particular, are culturally unlikely to smoke, drink or use intravenous drugs.
Q. How healthy are the children available from other countries?
A. In general, the children are very healthy. They integrate well into families, and do well throughout their lives. Long-term studies have shown that adopted children do as well or better in life than children in biological families. To be sure, these studies have built-in biases. Adoptive families tend to be relatively affluent and well educated, both great advantages to a child. Still it is clear that most internationally adopted kids do well. We have divided the health risks into three categories. The first is biological diseases -- parasites and congenital birth defects. The second is environmental damage -- changes of caregivers, indifferent or abusive orphanage care, sometimes called the "orphanage effect." Finally, there is the physical and emotional impact of the history of the child’s separation from the birth family -- poverty, neglect, poor prenatal care and prenatal exposure to alcohol and other drugs.
Q. Do we have any responsibilities to our child’s country of origin?
A. You will be responsible to tell your child’s birth country about the progress your child is making. China requires two post-placement home study reports, one at six months and one at 12 months. They are updates of the home study you received at the beginning of the whole adoption process. A social worker will again visit your home, probably from the same agency that performed your original home study. The social worker will evaluate how your child has integrated into your family. These reports will then be forwarded by your agency to China. If you are planning to re-adopt, and if no problems are noted, then one of these reports can be filed with the court, along with your original adoption documents from China. Ukraine requires that you register your adoption with the Ukraine Embassy in Washington, D.C. They also require one post placement report from a social worker one year after your return, annual reports thereafter written by your family until the child reaches 18 years of age, and to have access to the child if Ukrainian officials choose to visit your home.
Q. What if we have concerns soon after we return to the United States?
A. Adoptive parents often have concerns they need to discuss. These can be simple concerns about diet or sleeping habits. They may be more involved matters like bonding or child development issues. These might be a small issue you think is barely worth worrying about, or it may be a major problem that's keeping you awake at night.
You are not alone! There are resources to consult, and they start with Americans Adopting Orphans. As a licensed social work agency, it is our goal to make sure that adoptive children and their families are comfortable together. Whatever your concern, chances are good we've seen it before and have some advice that has worked for other clients. For more serious issues, we can guide you to resources or experts. The best way to contact us is by telephone, but feel free to e-mail us or schedule a meeting.
We have found that the sixth month or more before the first post-placement home study required by the foreign country can be too long. A minor problem can become a major one, or something you thought of as too small a problem can still be addressed. You will be interviewed by your home study provider a month after you return. This interview is for your benefit so that you may bring up any concerns. No report is sent to the foreign country.
Q. When will our child become a citizen and no longer need a green card?
A. Your child will no longer need a green card when they become a citizen of the United States. For married couples who travel together, and singles, your child becomes a citizen as soon as you enter the U.S. Within a few months of your return you should receive permanent proof of U.S. citizenship for your child. If only one spouse of a married couple travels, your child is not eligible to become a citizen until you have readopted your child, and applied for U.S. citizenship for your child. Most international adoptive parents provide U.S. citizenship to their children, and many also maintain their child’s citizenship in their country of origin. Without American citizenship, it is possible that your child could be deported if they commit a crime when they grow up.
Q. What can we do to help the children in the orphanages?
A. Our strongest recommendation is that you begin saving your money to adopt a child. If you already have one or more children, then start saving for the next! Almost as good is donating to our Giving Program. We will use the money as you direct, by helping a specific orphanage, making it easier for kids to be adopted, or to just help us do all of our work more efficiently. However, all contributions are voluntary. No donations to our charitable causes are built into your adoption fees.