Actual statistics on adoption are not known, because the majority of adoptions in the United States take place informally among relatives and never come under the purview of the legal system. Children may be raised by grandparents, stepparents, or other relatives. The federal government does not keep records of adoption, although some states collect statistics. Domestic adoptions peaked in the 1970s when approximately
175,000 adoptions per year were legalized. In 1996, the National Council for Adoption Survey recorded 108,463 domestic adoptions. Adoptions were split equally between relatives and nonrelatives. It is estimated that adoption plans are made for fewer than 1% of children born in the United States and only 2% of infants born to single mothers. Of more than 31,000 public adoptions monitored by the Department of Health and Human Services in 1998, nearly one-third crossed racial or cultural lines. Special needs domestic adoptions more than doubled between the 1980s and 1990s (to approximately 20,000 a year). Adoptions from foster care have also increased recently, to about 50,000 in 1998. However, more than 100,000 children in American foster care still await adoption.

The numbers of international adoptions are easier to track because of records maintained by the Department of Immigration and Naturalization Services (INS). The numbers of internationally adopted children fluctuated between 7,000 and 9,000 between 1986 and 1995 but increased to 20,099 in 2002. The sources of these children have changed over time, which reflects political, cultural, and economic changes in the individual countries and the United States (Table 114.1). Nearly 130,000 internationally adopted children have arrived in the United States since 1995, more than 100,000 of them since 1998. Statistics on adoption trends by region, state, and country of origin may be found in Adamec and Pierce and at http://www.travel.state.gov/int’ladoption.html.

Adoptions may be classified in many ways. Adoptions are often described by the amount of information shared between the adoptive and birth parents and the child. These arrangements include traditional or closed adoptions, in which all identifying information remains confidential; semiopen adoptions, in which limited information is shared (directly or through an intermediary) and occasional correspondence may be exchanged; and open adoptions, in which ongoing contact is maintained, including correspondence, phone calls, and visits. Current adoption practices support some degree of openness for the well-being of the child. The constraints of international adoption preclude these practices.

Many types of individuals choose to adopt. Some parents adopt after failed infertility treatment; others with birth children adopt to expand their families. Some gay or lesbian individuals and couples choose to adopt. Single-parent adoption is also increasing; nearly one-third of adoptive parents in the United States in 2002 were single women.

The Internet has greatly expanded availability of adoption resources; for example, a Google search using the key word “adoption” returns over 18 million listings.

Children are cared for in a variety of settings before adoption. In the United States, children adopted after the newborn period often experience multiple foster care placements, with
attendant emotional, psychological, and educational disruptions. Unfortunately, these children also suffer from lack of routine health care, immunizations, dental care, and vision/hearing screening. These deficiencies are especially disturbing as this population has considerable medical needs, including emotional handicaps (33%), serious physical illnesses (13%), mental retardation (19%), and multiple handicaps (15%).

Other countries use different systems to care for abandoned children. In Eastern Europe and China, most children reside in government-run orphanages. Conditions in these facilities vary drastically, but all expose the children to some extent to the risks of institutionalization (Table 114.2). Orphanage caregivers usually try to provide loving, nurturing environments for the children but often are thwarted by financial or other constraints. In some orphanages, children may receive better and more abundant food, clothing, and medical care than poor children living with their parents in the same regions. Nonetheless, these children lack the vital benefits of growing up in a family. In other countries, children may reside in private, often church-run orphanages. Thus, institutionalization is a highly heterogeneous experience for children.

Supervised (usually excellent) foster care is the usual placement for healthy babies awaiting adoption in South Korea. Other countries (Romania, Guatemala) use foster care sporadically. As in our own country, difficulties within the foster care system may occur. Many adoption professionals in Eastern Europe believe that children cannot be adequately supervised in foster care; thus, the institutional approach is preferred.

Most countries evaluate children at different ages to determine the suitability of their placements. This system was the basis of the notorious “switching” centers in Ceausşescu’s Romania, where children were “tracked” into different centers based on brief evaluations at age 3 years. In most locations, this periodic reevaluation is done with genuine concern for the well-being of the child. Most countries maintain parallel systems for healthy or handicapped children. Many children assigned to handicapped facilities have conditions that would be readily treatable in the United States; unfortunately, these children may be consigned to institutions with no chance for rehabilitation or education.

Nearly all orphanages are age-restricted, thus requiring children to make multiple transitions from familiar caregivers and environments during childhood. Even within the same facility, children often move to age-specific units every 6 to 12 months. Sadly, for each child who is adopted, many thousands are left behind in long-term institutional care.