International Adoption: What You Need to Know

international adoption

Winn and Scott Castagno adopted their daughter from China.

When Valerie and Matt met more than 10 years ago, they discovered that they both wanted to adopt and have biological children. But after attempts to get pregnant on their own didn’t work out, and a round of IVF was unsuccessful, the Frohns decided to focus on adoption. “There are children out there who need a family, and we want a family too. It’s a perfect union,” says Valerie. After researching foster care, domestic adoption, and international adoption, the Frohns were drawn toward adopting from Ethiopia. “We started learning about the orphans there and the people—and the Ethiopian culture just spoke to us,” says Matt.

The fact that there are more restrictions placed on parents who adopt overseas as opposed to within the U.S. was not as daunting to the Frohns as the potential hurdles involved with domestic adoption. Though other countries have requirements for parents relating to marital status, age, health, and even weight, with domestic adoption, “we were afraid of the possibility that a birth parent wouldn’t pick us,” says Valerie. “International adoption didn’t feel as open-ended.” Instead of having to negotiate relationships with a birth family or navigate the foster care system (both of which often drive people to adopt abroad), the Frohns hoped international adoption would be a clearer route. What’s more, they were told that once their paperwork was completed, they would have to wait only about seven months for a baby girl, which was their preference.

Today, more than two years after they completed their adoption dossier (which includes piles of paperwork along with financial, medical, and background checks) and passed their home study with a social worker, the Frohns are still waiting to be matched with a child. Once they do get matched, they’ll need to make two trips to Ethiopia—the first trip to meet their child and verify their intent to adopt, and the second trip (once all paperwork has been finalized) to finally bring their baby home. But at this point, there is no telling when that day will come. “There is nothing we can do about it. So we just try to stay positive,” says Valerie.


Unfortunately, the Frohns’ experience is all too typical these days. Though conservative estimates suggest that there are 10 to 20 million children worldwide who need parents, international adoptions are taking longer, costing more, and are resulting in fewer children being united with forever families, according to the nonprofit group Center for Adoption Policy, in New York City. The U.S. Department of State’s latest numbers show that international adoptions by Americans have dropped by more than 60 percent within the last decade—from 22,991 in 2004 (at its peak) to 8,668 in 2012.

The reason? Bureaucratic red tape both here and abroad, political barriers, corruption, nationalist sentiment, and changing economic conditions in various countries, plus inefficient systems that are getting more convoluted each year. Some countries, such as Russia, Romania, and Guatemala—with no shortage of parentless children in institutions or on the streets—have halted international adoptions entirely due to some of these issues. “It’s often an individual bureaucrat who has the ability to stop adoptions, which is just devastating,” says Susan Soonkeum Cox, who was adopted from Korea, and is vice president of policy and external affairs at Holt International Children’s Services, an adoption agency based in Eugene, Oregon. In many cases, adoptions were stopped when they were nearly finalized—after parents and children had already met and begun referring to each other as Mommy/Daddy and son/daughter. Some of these families continue to wait for years in a state of painful limbo.

Under the best circumstances, the average international adoption takes three years to complete, and costs about $30,000—if it goes smoothly. But it often doesn’t. “The international adoption system is broken and failing,” says Louisiana Senator Mary Landrieu, who serves as co-chair of the Congressional Coalition on Adoption Institute.

One big factor often cited as an impediment to international adoptions is the Hague Adoption Convention. This international agreement—which was implemented by the U.S. in 2008—was developed to set standards for ethical international adoptions, improve transparency, and remove corruption from the system, among other things. Unfortunately, many countries haven’t had the resources to restructure their adoption systems and implement the Hague’s standards—one of which requires that countries have a central authority to process adoptions. All these extra steps require more paperwork and time, so the Hague Convention has seemingly contributed to the slowdown of international adoptions over the past several years. “The Hague is great in ideology but it fails in functionality,” says Craig Juntunen, an adoptive father and founder of Both Ends Burning, an advocacy organization in Scottsdale, Arizona, that aims to improve the current adoption system and defend the rights of a child to belong to a family.“We need to have highly ethical and transparent adoptions, but because of the difficulties in implementing the Hague treaty, when a country signs on to the Hague, the country’s adoptions decrease. We need to ratify the Hague to make it more effective,” he says.


In the meantime, millions of parentless children overseas are languishing in overcrowded, impoverished orphanages and on the streets, while there are thousands of would-be parents waiting to love and nurture them. Without the support of a parent, however, children suffer monumentally. Studies show that when children live in an orphanage, they are more likely to have poor health, stunted growth, developmental delays, behavioral issues, and emotional attachment disorders. “For every three months in an institution, a child loses one month of development,” explains Jane Aronson, M.D., an adoptive mother, CEO of the nonprofit Worldwide Orphans, and a pediatrician specializing in infectious diseases and adoption medicine. It is sometimes possible for children to regain those losses, but they need the help of a permanent and loving family to do so.


Even with countless children abroad in need of homes, there are people who oppose international adoption— preferring instead that efforts be made to reunite children with relatives or new families in their own countries, within their own culture. “It’s a very difficult thing for a country to say that we can’t take care of our children,” says Cox. “And philosophically, many times people don’t believe children should go away to another country, to a family of a different race, culture, and nationality.” In the U.S., there are also people who question why Americans would choose to adopt a child from a foreign country instead of an American child here who needs a home.

international adoption

Jane and Christian Hoffman, who have two biological kids, adopted their daughter from China.

For Jane and Christian Hoffman, of Westfield, New Jersey, the choice was clear. They had two biological children, but they felt a connection to Chinese culture and wanted to adopt. Their now-4-year-old daughter had a cleft lip and palate (she has since had surgeries to correct them) and would most likely not have been adopted in China. “In an ideal world, my daughter would be with her birth mother in China, but that simply wasn’t possible for her, and we loved her and wanted to make her a part of our family,” says Jane.
“Beautiful families have been created through international adoption,” says Aronson, who is also the author of Carried in Our Hearts: The Gift of Adoption. “The gold standard for an orphaned child is to give them a permanent home, whether it’s in their country or your country.”


If you’re considering international adoption, first do your research to get a sense of what it entails, and learn about which countries are still participating in international adoptions. (In 2012, the countries that sent the most children to the U.S. for adoption were China, Ethiopia, Russia, South Korea, and Ukraine; Russia has since closed its doors to international adoption.) “Have realistic expectations about how long the process will take, and use the wait time to educate yourself about adoption and your future child’s culture,” says Cox. The first resource to consult is the U.S. Department of State’s website, adoption., where you’ll find info about each country, government regulations, adoption agencies, and how to begin the adoption process.

Once you start researching, the learning curve is often steep. For instance, many hopeful parents are shocked to discover that there is currently an eight-year wait to adopt a healthy child from China, says Nicky Losse, social services director at Children’s Hope International, an adoption agency in St. Louis. So be prepared to ask yourself if you would consider other options. According to Adam Pertman, author of Adoption Nation, and president of the Evan B. Donaldson Adoption Institute based in New York City, a growing number of children adopted from other countries are children who are older or have special needs.

Winn and Scott Castagno, of Round Rock, Texas, adopted their daughter from China through a special needs program (called the Waiting Children program) in March 2013 after a wait of less than a year and a half. And they couldn’t be more thrilled. Their daughter, who was 18 months old and had a cleft lip and palate, is now charming everyone she meets with her new smile. “We are so in love with this little girl,” says Winn. “Somehow the universe brought us this beautiful, amazing, intelligent girl who is now our daughter.”


Whether you adopt a child who is considered to have a special medical need (such as a cleft palate or a joint disorder), or you adopt a child who is considered to be healthy, know that every child who comes out of an orphanage requires special medical attention. “Many children come to the U.S. with a handful of issues such as infectious disease exposure, malnutrition, stunted growth, attachment disorder, developmental delays, auditory processing disorder, ADD, ADHD, and learning disabilities,” says adoption medicine specialist Jane Aronson, M.D.

Some parents are given considerable medical information about children before bringing them home, but many parents receive very little—and often the information is incomplete. The best way to tackle your child’s health care is to contact a doctor who specializes in international adoption who can interpret your child’s medical records and discuss them with you, help you line up the necessary treatment, and refer you to a doctor in your area. From there, you may be directed to early intervention services or special education, if needed. To find a doctor who specializes in adoption medicine, visit the American Academy of Pediatrics’ Council on Foster Care, Adoption, & Kinship Care at

Want to help? Here, three organizations that support orphans:

SPOON Foundation
This nonprofit works to improve nutrition for orphans and helps influence policies in order to offer better food choices.

Half the Sky
Working to help orphans in China, this group improves kids’ day-to-day care, including focusing on education and social skills.

The Miracle Foundation
This organization strives to create nurturing environments through food, healthcare, education, and other resources.