International Vs. Domestic Adoptions

In domestic adoption, birth parents often choose the adoptive parents for their child. In international adoption, adoptive parents choose their child.

Domestic adoption isn't right for everyone. You may not feel 100 percent comfortable with the concept of open adoption. You may not be willing to agree to letters, phone calls or face-to-face visits from birth parents and wish for an absolute right to privacy. You may need to minimize the risk that an adoption could be reversed in court. Or you might wish to choose the gender or race of a child or to adopt more than one child at once. If you are an older couple with biological children, birth mothers who prefer youthful or childless parents could overlook you.

Is International Adoption Right For You?

In international adoptions, birth parents rarely play a role in their child's adoption overseas and usually have relinquished parental rights to their child by the time he or she arrives at an orphanage. By the time you finalize your adoption on foreign soil, the relinquishment is irreversible. This means the adoption is final.

Your family's privacy is protected from inquiry. For example, in Russia, a child's adoption file is sealed by law. In China, most orphaned girls have been abandoned with little information on the birth mother. (The bad news is if you change your mind later about connecting with the birth mother, you're probably out of luck.)

If you have suffered disappointment with infertility or failed domestic placements, choosing international adoption may allow you to reassert control over your adoption journey by establishing a more concrete time frame. The sheer number of children available — in the tens of thousands — makes the outcome virtually certain for qualified parents. You will be parents of a child if you can pass the foreign government's requirements. You can count on that happening usually within 12 to 18 months.

With so many orphans available for adoption, you can state your preferences on the child's age, race, health and gender. If you want a larger family, sibling groups are available faster because they are harder to place. Some governments might reduce certain fees and waive mandatory waiting periods to place physically disabled kids.

However, you should not consider international adoption if you are not ready to parent a child with special needs or developmental delays. Many children adopted internationally have at least mild developmental delays.

The Risks

What are the risks unique to international adoption? You must accept that information on your child will be scarce ... very scarce. Health and developmental status should be paramount on the scale of your concerns. You will have to accept opinions from sources whose reliability cannot be documented — hardly comforting for Americans who are used to cutting-edge information.

Orphanages do not have automated record-keeping systems. What you may receive are head, weight and length measurements at birth and at intervals thereafter ... or maybe not. And you may get test results for hepatitis, AIDS, venereal disease at various intervals ... or maybe not. If you hit the jackpot, you may receive a video lasting ... oh, maybe 2 or 3 or even 4 minutes long, showing how the child sits, crawls, stands, speaks and/or interacts with caretakers, hardly enough footage on which to base a lifetime decision. Or you may not get a video at all.

Historically, foreign countries hate to give up healthy children due to national pride. In some countries, medical reports are totally bogus and include fabricated or exaggerated medical diagnoses (water on the brain and stroke at birth are common in Russia) to help qualify a child to be adopted internationally. You may not have a clue which diagnoses are real.

It's critical you find an expert pediatrician who has vast experience evaluating institutionalized children. Look for them at international adoption clinics. These pediatricians have screened thousands of medical documents from orphanages worldwide and understand fully the risks inherent to your decision. Some doctors charge for this service; some offer their opinions at no charge in exchange for a donation to their clinic.

What Health Problems Do Internationally Adopted Children Experience?

We most commonly see five health problems with internationally adopted children: hepatitis, AIDS, fetal alcohol syndrome or effect (FAS/FAE), attachment deficit disorder (ADD) and sensory integration dysfunction (SID). There are lots of other risks as well, including prematurity, undisclosed birth defects, cerebral palsy, autism, hyperactivity, malnutrition and rickets, to name a few. However, there are no conclusive tests for FAS/FAE, ADD or SID, which can be diagnosed as key developmental milestones are missed, sometimes up to age 2 or after.

You should become well-acquainted with these risks by doing a lot of homework and working closely with your licensed adoption agency.

In contrast to domestic adoption, Americans rarely arrange private adoptions through foreign attorneys. There are many advantages to employing an agency rather than a foreign attorney in international adoption. Most agencies have established track records and all must meet standards for conduct by licensing authorities. Some are seasoned enough to be recognized by highly regarded experts such as the Council on Accreditation (COA) or the reputable Joint Commission on International Children's Services ( The Adoption Guide of 2002 ( provides comprehensive listings of international adoption agencies.

Not every domestic agency is good at international adoption (and vice versa). The skill sets differ greatly. Domestic social workers counsel birth mothers throughout their pregnancies, help obtain appropriate medical care, negotiate adoption plans, and facilitate the child's first meeting with the new parents.

International agencies have virtually no contact with birth parents. The more thorough agencies talk directly to orphanage doctors and directors. They gather whatever scarce information they can about your referral. They translate documents, arrange your air travel and lodging, and hire foreign coordinators, drivers, translators and tour guides. They try to ensure that your appearances in front of foreign officials proceed smoothly. International specialists may speak multiple languages and have foreign government connections.

It's important to comparison shop. Agencies commonly offer informational meetings to educate potential clients about their philosophies and styles. Attend as many informational meetings as you can and ask a lot of questions. Ask about the agencies' length and variety of experience with international adoption. It's not important to go with the oldest agency because the overseas landscape changes rapidly and agencies must be nimble and informed to keep pace. But if the agency is just a few years old, you should be asking some hard questions about its ability to deliver. It's not always best to go with the biggest agency measured by number of annual placements. You don't want to get lost in the system because you have people waiting ahead of you in line. Ask if the agency is not for profit. Does it have 501(c)(3) tax-exempt status from the IRS? Ask how the adoption professionals are compensated. Does the agency have a humanitarian mandate?

Every agency should provide a list of references, including past adoptive families, licensing authorities and even international adoption clinics. Be sure to ask for names of families that had problems. Agencies usually will give you names of folks who will praise them to the moon. Find out what went wrong in the process and what the agency did to fix it.

Inquire about the agency's parent training requirements, which vary from agency to agency. Some require up to 20 hours of classes. Others require that you thoroughly read a few books and be ready to discuss them at the home study. Some require that you obtain a foster care license. Some do not. Each agency's expectation for the time you will spend becoming educated before adopting will differ, so do your homework.

Can I Adopt If I'm Single? Divorced? Gay? Disabled? Have Been Convicted Of A Crime Or Offense?

Some foreign governments will exclude you if you are single, divorced, gay or disabled. In addition, agencies are free to decide who they will and won't represent. Some have religious affiliations or lifestyle philosophies they expect you to share. Each agency can decide who it will represent as suitable parents to the foreign government. So, you may have to do a lot of extra agency shopping and be open to alternative country programs.

Whether you will be able to adopt if you have been convicted of a crime or offense depends on many factors: the nature of the crime or offense, your state's laws, your agency's rules and the foreign countries' requirements. If you have been convicted of a crime or offense and wish to adopt, consult an attorney early in the process for further information.

You may be tempted to hide or not disclose certain information to increase your chances of adopting. I cannot caution you enough to be completely honest and truthful with your agency and your attorney. If you are not perfectly honest with your agency and attorney, not only will you run the risk of a failed adoption, but you may never be able to adopt.

The Costs

Why is international adoption so expensive?

It doesn't make sense that international adoption should cost so much. After all, there's a child in an orphanage who clearly needs a home, food, medicine and a loving family. Why does it cost $20,000 to $35,000 to get that child to his or her new parents? Why can't governments lessen the financial burden of adopting one of their needy children?

Here are some of the reasons that international adoption costs so much. Private in-country legal fees can cost well into the thousands; it can be tough to find qualified, highly reputable people to prepare the child's legal documents in the foreign country. Travel costs can be astronomical because you may be asked to travel at the last minute and be unable to use frequent flyer miles or discount fares. (If you don't have a frequent flyer account, be sure to set one up before you leave!) Part of your total cost may be an "orphanage donation" to help feed and clothe the children who remain in the orphanage.

Don't be afraid to shop around because agency and country program fees can vary dramatically. There is no standard way in the industry of presenting agency fees so you may be comparing apples and oranges. For example, travel fees may or may not be included in the published program cost, making one agency look cheaper when it's really the other way around. Every agency you interview should readily disclose all future fees in detail.

The Process

How long does it take to adopt internationally?

A typical time from is 12 to 18 months, minimum. The dossier (or "paperwork") phase takes two to four months if you're organized about setting deadlines for yourself. Once you have completed your dossier, the journey becomes highly variable depending upon the country and the agency. Next comes the time when you will be asked to consider specific children who are presented to you (the "referral" phase). An agency may take anywhere from six to twelve months to present you with a child who is available for adoption. Finally you are ready to travel. You may take one trip, two trips or, yes, maybe even three trips to get your child, again depending on the program. The "travel phase" can last from one week to several months.

1. The Paperwork Phase

Hopefully, you are a methodical paper pusher who can build a dossier in two to four months. If not, it could be a year before you receive a referral. Those of you who are unorganized might consider hiring a document specialist who will order all your birth and marriage certificates, divorce decrees, etc., and affix the appropriate seals. Agencies may include this service for an extra fee or refer you to an outside consultant for assistance.

What is a dossier?

A dossier is a collection of documents that are required to adopt a foreign child. It will include an IR4 form approved by the Department of State, a home study, recently issued originals of birth and marriage certificates and divorce decrees, police clearances, letters of reference and affidavits by your doctor and bank attesting to your physical and financial well-being. Usually, there are 15 to 20 documents in a typical dossier. Every foreign country has its own checklist of required documents and authoritative seals. This checklist should be considered a moving target because the country can change its mind at any time, even when you are on the airplane. What is required today may be entirely different from what is required tomorrow.

What is a Department of State Form IR4? Do I have to file it right away?

The IR4 is a form published by the Department of State. The IR4 is a "petition to classify an orphan as an immediate relative." The function of the IR4 is to classify a foreign-born orphan as your child to allow her to enter the U.S. without a U.S. passport.

Is a home study different for international adoption than for domestic adoption?

Yes and no. A social worker still comes to the house and interviews you just as in domestic adoption. However, you will be asked questions like "How do you intend to keep the child's culture alive in your home?" Or "How do you feel about adopting a child from a different ethnic heritage?" Foreign adoption officials want to make sure this child will know and respect the rich traditions of its proud country and will look for language to that effect in an international home study.

Before your home study, take a deep breath. This is not the inquisition! The social workers who perform home studies generally are warm, caring people who are deeply committed to the cause of international adoption. They take great satisfaction knowing they have helped a needy orphan find a home. So relax and be yourself.

What else do I need?

Some agencies require a photo album of family pictures to show foreign officials. Pictures might include siblings, Grandma and Grandpa, aunts and uncles, cousins and friends to demonstrate that the child will be welcomed into a warm, supportive extended family. Show pictures of your house, the nursery, your local playground and school to assure officials that you have a loving and stable environment to bring your child into.

Do you really need a foster care license?

Technically no, because foreign countries don't mandate it. However, many agencies have chosen to require a foster care license to ensure an extra layer of parental training. It does give you some advantages if both parents can't travel at the last minute. For example, it's possible that an adoption could be finalized without both parents present. Ask your agency upfront if you need to go to the extra time and expense to get one.

2. The Referral Phase

This phase can last anywhere from a few weeks to months depending upon how the child meets your expectations. After the dossier is done and before the actual referral, you should identify a fully qualified international adoption pediatrician who has experience reviewing information on thousands of institutionalized children.

What is a referral?

A referral is made when you are formally presented with a child. What's in a referral package and who makes the referral differ by agency and by country. For example, in China the government selects and refers the child to you. In Eastern Europe, your agency selects and refers the child to you. You may receive a video lasting a few minutes, some photographs at different ages, and a translation of the medical record.

What information do I receive about the birth parents?

None or almost none. If you receive a great deal of information, consider yourself lucky. Maybe you'll get a name. Maybe you'll receive evidence on paper about the birth mother's test results for hepatitis, AIDS, CVS and venereal disease. Maybe not. Maybe you'll even receive information on the birth father, but don't count on it. So unlike the domestic process, you will not meet the birth mother or be able to monitor her standard of obstetric care. You probably will not know if she drank alcohol or did drugs during her pregnancy (you may not know this about a domestic birth mother either).

Will I know specifically why my child was placed for adoption?

You may never find out your child's early history. Orphanages exist in Third World countries because a significant part of the population cannot afford to take care of their children. Birth mothers in some countries have access to abortion, but choose instead to give life and a shot at a better future to their babies, however small the odds may be. In other countries, birth control isn't readily available. Some children become wards of the state if their parents die and their relatives can't take them in. Some parents have debilitating problems with drugs or alcohol. You may never know.

Baby Versus Toddler: The Age Decision

It is rare that you will adopt an infant under 4 months of age from a foreign country. Generally, it takes several months for a newborn to become eligible for an international adoption.

There's a tradeoff between adopting a baby from 3 to 12 months and a toddler over the age of 1 year. It's a dilemma, and one you need to talk to your agency about in some depth before you accept a referral. Some professionals believe that adopting under 12 months is the only way to go because there is less developmental damage from being institutionalized. The other view is your agency will have gathered more developmental information on a child who is over 12 months of age. Recognize that children who will have permanent disabilities such as FAS/FAE, cerebral palsy and autism are diagnosed as late as 2 years of age. So, with the benefit of more information, you may learn that your referral presents above average health risk.

Adopting An Older Child

An older child will almost certainly present with developmental issues. Before you leave U.S. soil, be fully prepared to address the child's undetermined special needs. Explore the special education services offered by your school district. They can be outstanding or legally minimal, depending upon your district's financial commitment to special education. Learn about Individual Education Plans (IEPs), which legally entitle a special-needs child to special therapies at school (

Call your insurance company to find out what outside therapies may be covered. In the absence of good insurance coverage, you will rely on your school's ability to deliver a package that can help your child catch up. This may include speech and language therapy, occupational therapy for fine motor skills, physical therapy for gross motor delays, vision therapy, tutoring help, and extra attention from a psychologist or social worker to help your child assimilate.

Call An International Adoption Clinic Right Away!

This is the third time I've stressed the importance of finding a fully qualified pediatrician at an international adoption clinic to review your referral. IT BEARS REPEATING. These doctors are used to looking at what is intrinsically a high-risk population and sifting out the gems of information that point to risks you and your local pediatrician may not pick up. Many have traveled extensively to observe and train orphanage staff and are passionately devoted to the cause. They have a mandate to spell out all the possible risks so you can make a rational judgment on a child before you fall in love with the pictures. You can find these specialists through your agency and on the web.

Saying 'No' To A Referral

There may come a time when you just do not feel comfortable with the referral you've received from your agency. This can be the hardest moment along the international journey because you may have to grapple with saying no to a living, breathing child. All I can say is that if in your heart of hearts, you can't envision yourself being a fully committed parent to this child, you owe it him or her to say no. Every kid deserves a parent who is willing to put that child first. If your agency has a lot of waiting families, there may be yet another possible home for him or her in the future.

3. The Travel Phase

Why do I have to take two or three trips to get a child? Country programs differ in many ways, such as the age, gender, health and race of the children available. The travel requirements can also differ greatly. Quite frankly, these countries set guidelines to ensure the safety of their children; they are not concerned about making your journey to parenthood as easy as possible.

Few countries offer escort service, so you should be prepared to travel overseas. Some Latin American countries require one trip, but perhaps an extended stay of up to several weeks or months. In Eastern Europe, two trips are usually the status quo.

The First Trip — You See The Child

Don't expect a storybook rendezvous. The first encounter may be rocky because the child is asked to separate from a trusted worker and play with complete strangers. Separation anxiety can be viewed as a healthy sign that the child has learned to attach with someone. Your second visit on this trip probably will proceed more smoothly once the child warms up to you.

Men, be prepared for a cool reception. Most kids have only been around female caregivers and may balk when they see you. Give it time. Adoptive Families Magazine ( published an article that recommended "therapeutic holding" as described by author Martha Welch in the book "Holding Time."

Prepare yourself for the emotionally draining orphanage visit. It's a sobering realization that you'll be leaving children behind, and you may wish to bring them all home, too. You are witnessing a very sad reality.

The Second Or Third Trip — Count On The Airplane Trip From Hell

Imagine you think you have been kidnapped. You have been swept up in the arms of strangers who sound and smell different from the caretakers who have held and fed you throughout your whole short life. These strangers don't even understand the basics of the only language you've managed to pick up in your first year. You have a bad cold and probably an ear infection. You are being offered weird food and you have diarrhea. And to top it off, your favorite caregiver is nowhere to be found. NOW these strangers strap you to a chair, the plane lifts off and your ears start to ache. You are angry, scared, confused and grieving the loss of the only existence you have ever known.

As parents, you will have to demonstrate great patience and endurance on the return flight home. Count on a tough trip and be pleasantly surprised when it's really not too bad. Your child may not sleep for the entire plane ride and you will have to count on the kindness of strangers to go to the bathroom if you're traveling alone. First-time parents, be careful to keep your children well-hydrated, but do not overdo the juice ... or you will be sorry!

Plan the airport scene before your return. You may dream about 100 friends and family members wildly cheering, waving signs and bearing flowers. However, remember your child has just flown thousands of miles for the first time in his or her life. Your new child is probably exhausted and sick. (One little girl burst into tears the minute she saw family and friends at customs!) None of you may be ready for a raucous welcome home party. Your child's needs should take priority during this stressful time.

After The Homecoming

First things first: the visit to the pediatrician

Before you leave home on your last trip to bring your child home, get an appointment with your pediatrician for just after your projected return date. You want to have your child examined right away in case he or she needs medicine to combat common orphanage problems: ear infections, bronchitis, colds, chest congestion, flu, fevers, etc. A post-institutionalized child usually has a compromised immune system due to lack of vitamins and proper nutrition. Choose a pediatric practice that offers same-day visits for sick children.

Next, the lab tests

Your child's pediatrician will likely order a battery of blood tests to rule out conditions or infectious diseases that the child may have acquired in the orphanage.

Start your immunizations ... and reimmunizations

There is no guarantee that if your child's medical record shows he or she has been vaccinated for various diseases that the immunizations actually worked. Adoptive Families Magazine quotes a study by Dr. Dana Johnson's clinic that 60 percent of tested children showed no immunity to DTP (diphtheria, tetanus and polio) even though their medical records showed evidence of the shots. Sometimes the quality of immunizations overseas pales by comparison to the standard of care in the U.S. So don't be surprised if your pediatrician recommends starting from scratch with your child's immunization schedule.

Post-Placement Visits By Home Study Agency

Expect your home study worker to visit you a few times after your homecoming. Remember that, by law, your agency is required to look out for the best interest of your child, so the home study worker will ask many questions about your child's adjustment, health and impact on the rest of the family. Don't forget the follow-up reports you must file with your agency. If you don't file these, a foreign judge could decide to reject someone else's adoption because your paperwork isn't done. (It's happened.)

Do I really need to readopt in Illinois?

While it isn't mandatory that you readopt your child in Illinois, it is HIGHLY recommended. The readoption process is simple and relatively inexpensive. Upon completion of the readoption, you will have an Illinois judgment order for adoption and will no longer need to produce the foreign judgment and translation. You will also receive an Illinois "birth certificate" or record of foreign birth listing you as the birth parent of your child and listing the name of your child as the name you have chosen, not his or her birth name. With those two documents, you can also obtain a Social Security card for your child.

What about American citizenship?

All adopted foreign-born kids automatically are American citizens if they meet certain requirements. But proof of citizenship isn't given, so I highly recommend that you apply for a certificate of citizenship or a passport with the U.S. State Department upon your return to the U.S. Learn about passports on the U.S. State Department's website (