Domestic and International Adoption

Domestic Adoption

The Adoption and Safe Families Act (P.L. 105-89) requires children in foster care to be placed with adoptive families if they cannot be safely returned to their families within a reasonable time. In fiscal year (FY) 2014, there were an estimated 415,129 children in foster care, and 107,918 were waiting for adoption. Of the 238,230 children who exited foster care, 51% were reunited with parent(s) or primary caretakers(s), and 21% were adopted (see Chapter 9 ).

Many children awaiting adoption are less likely to be adopted because they are of school age, part of a sibling group, members of historically oppressed racial/ethnic groups, or because they have considerable physical, emotional, or developmental needs. A number of policy efforts are aimed at increasing adoption opportunities for these children, including federal adoption subsidies, tax credits, recruitment efforts to identify ethnically diverse adults willing to adopt, increased preplacement services, and expanding adoption opportunities to single adults, older couples, and gay/lesbian partners.

Although same-sex couple adoption is legal in more than a dozen countries worldwide, it is actively debated in the United States. Although legislation regarding same-sex couple adoption varies by state, increasing numbers of gay and lesbian partners have been able to adopt. Current estimates suggest that almost 2 million children, including 5% of all adopted children, are raised by gay and lesbian parents. Adopted children include those adopted domestically, those from foster care, and internationally adopted children. There is increasing evidence that children raised by same-sex couples are as physically or psychologically healthy, capable, and successful as those raised by opposite-sex couples. Pediatricians can advocate for adopted children by supporting gay and lesbian parents.

Open adoption , usually through an agency or privately, occurs when the birth mother arranges to continue to be involved, although in a limited manner, with the legally adopted family. This may occur through surrogacy or more often in an unplanned pregnancy.

Intercountry Adoption

Along with foster care adoptions, international adoptions are a way of providing stable, long-term care to vulnerable children throughout the world. There is concern that in some countries of origin, the rapid growth of international adoption has outpaced regulation and oversight to protect vulnerable children and families. Opportunities for financial gain have led to abuses, including the sale and abduction of children, bribery, and financial coercion of families, but the extent and scope of the potential concern is difficult to ascertain. Increasing global efforts, such as the Hague Convention on Protection of Children and Co-operation in Respect of Intercountry Adoption , have promoted political cooperation between nations and established international law to reduce potential for child abduction and child trafficking and to ensure that the best interests of the child are paramount in decision making. Participating nations, including the United States, are working to address the myriad of sociopolitical conditions that create the need for out-of-family care, and are working to support children within their nation's borders. International adoption is increasingly considered a measure of last resort if the child cannot be cared for within his or her birth family (including extended relatives), the immediate community, or the larger national culture. As a result, children adopted internationally into the United States are more likely to enter their families at older ages or with complex medical, developmental, or social-emotional needs.

Although the vast majority of children adopted internationally enter the United States for purposes of adoption, a small but growing number of children exit the United States for adoption into other countries. For example, in FY 2014, 96 children exited the United States for adoption by families in other countries (e.g., Canada, Netherlands, Ireland, United Kingdom). Little is known about the circumstances surrounding these adoptions and the eventual outcomes of the children who are adopted internationally from the United States.

In 2015, U.S. families adopted 5,647 children from other countries (compared with a peak of 22,884 in 2004). Children from China, Ethiopia, South Korea, Ukraine, Bulgaria, and the Congo represented 65% of children adopted internationally into the United States in 2015; 42% were from China alone. Although individual experiences vary, most children placed for international adoption have some history of poverty and social hardship in their home countries, and most are adopted from orphanages or institutional settings. Many young infants are placed into orphanage care shortly after birth. Some older children have experienced family disruption resulting from parental illness, war, or natural disasters. Still others enter orphanage care after determination of significant abuse or neglect within their biological families. The effects of institutionalization and other life stresses may impact all areas of growth and development. As a result, many children require specialized support and understanding to overcome the impact of stress and early adversity and to reach their full potential.

Role of Pediatricians