The Trouble With International Adoption Is not Trafficking: It's the Global Orphan Crisis

This blog is in response to a September 18 article in the New York Times, by John Leland, on the trafficking of babies in China.

Over the 22 years that I have been an adoption medicine specialist, there have been many historic moments where the legitimacy of the adoption of children from abroad has been questioned and revealed on TV and in print media. Countries have closed at these moments, leaving children stranded in orphanages, parents without their children and accusations of trafficking. Inter-country adoptions have gone from 23,000 in 2005 to about 11,000 in 2010 with fewer and fewer choices available to families looking to adopt from abroad.

A September 18 NY Times article by John Leland sensitively highlights recent trafficking of babies in China. The article includes interviews with American parents of adopted children from China, focusing on how it feels for a parent to think that their child might have been bought and sold. The complex issues about how to speak to one's child about such matters in the future are excruciating, but not impossible to handle. That said, most parents who adopt from abroad rarely know the real facts of that desperate moment when their child was abandoned or relinquished. We have hopefully learned not to glorify birth parents and to respect what we do know and what we don't know in an honest and loving way when we speak with our children. Those conversations change and become more sophisticated as children grow and develop.

Trafficking is rare in international adoption. It is not because of trafficking that international adoption has gone south. I don't dismiss the importance of trafficking and I hope that the Hague Convention on Inter-country Adoption in cooperation with each country will continue to work hard to prevent the violation of the rights of birth mothers and to protect the rights of children. That will never happen however, unless there is a financial and educational investment in the sending country's social welfare infrastructure.

Children are typically abandoned in a public place in China so that they can be found and protected, while in other countries like Ethiopia, they are relinquished to a local orphanage. It is safe to say that the cause for the desperate decision to not parent one's own child in countries all over the world, including the US, is poverty and the resultant isolation and depression that darkens the birth mother's thoughts. There is no hope and no one to talk to and no one to help sort out the possible solutions to the dilemma of shame, no education, no work skills, no dignity, and abject and extreme poverty.

I ask myself a bigger and more philosophical question about the millions of orphans when I read articles like this. There is a Global Orphan Crisis. When I started out helping parents manage the health issues of children adopted from abroad, I knew very little about the social conditions that dominated the communities of developing countries. For over two decades I have traveled abroad on medical missions and learned about the despair and hopelessness in countries all over the world where there are no social workers or community workers to openly engage in discussions with women who are pregnant and poor. Economic strengthening is limited and women have little access to education and medical care. Why did we create such a marvelous bureaucracy to improve international adoption practices and not pour some of that money into the welfare of mothers in these countries? It seems immoral to me to accredit US adoption agencies and to not empower women from sending countries to make international adoption a well-thought out choice for a birth mother no matter what her economic status. We do this for all domestic adoptions in the US. If we educated women abroad and showed some respect for their process, we might find that some women would still opt for their children to be adopted...even changing some attitudes about domestic adoption in very poor nations.

I review pre-adoption referrals daily in my adoption practice. More and more of the social histories that I read, are about a dead mother or a dead father and 7 children perhaps ranging in age from 15 yrs old to 6 months of age. The one remaining parent may have AIDS and begins to relinquish the youngest children one by one to a local orphanage. The parent signs papers that state that they cannot afford to care for their child. The stories are pitiful and after years of reading them, I am heartbroken. It is these stories that have likely made adoptive parents reading them, realize that there is a moral moment in adoption from abroad. Any decent person who reads a referral that tells the story above, likely lies quietly in the dark of night while waiting for that baby, thinking about the unfairness in life. This is why adoption has gone the way of "boom and bust" resulting in lower numbers and fewer countries. Governments and the global community are not blind to the conflicting issues that arise from poverty, community disintegration, and increasing numbers of children without parental care, whether true orphans or not. It is not about trafficking.

To help orphans have a better life in their own countries, I created a foundation, Worldwide Orphans, 14 years ago. We started in institutions to enrich the lives of orphans and then we grew and realized that orphans were in the community. In our work with HIV-infected orphans and vulnerable children and their families we help to strengthen the local communities to prevent abandonment and relinquishment and also to re-unify families affected by HIV/AIDS.

It would be wonderful if we could address the Global Orphan Crisis now. There are millions of children who are born without pre-natal care, malnourished, low birth weight, and living in extreme poverty; they cannot all be adopted.

Let's set priorities and reach more children in their communities, provide social services for women, lessen abandonment, lessen relinquishment and trafficking will naturally be less of a threat. Let's strengthen the adoption opportunities so there is complete transparency and finally, let's also be community builders. Let's not be afraid to face all the issues honestly and let's not perpetuate the theory that trafficking is the cause of the demise and demonization of international adoption. Nothing is ever that simple.