"If you say you want a healthy child as young as possible, it's going to be difficult. If you are open to a child with special needs — and that can be all across the map, from severe to something not so difficult — it opens up," she said.
Families that reject the idea of a "special-needs child" are often very amenable to considering a child with a correctable medical condition. Often, it's the same child, Cox said. Special needs means many things. That's why it's important to work with an agency or organization that will learn as much about a child as possible and share it with families so they can make realistic choices. That includes knowing if the group has people in that country who, even if they can't get in to see specific children, know how an orphanage treats the children, whether they have access to medical treatment and more.
Would-be adoptive parents who want a healthy child will be assigned one, if it's even possible. With special-needs children, parents typically get to look at pictures and read profiles and find out about the child's abilities or limitations in order to make decisions about what they can handle and expect, Cox said.
Successful international adoptions start with research, she said. She recommends the State Department's website, Adoption.state.gov, which is neutral and fact-based. It tells what countries are open to adoption by American parents, and what types of children are available, rules and more. Importantly, it provides a list of questions to consider in selecting an agency with which to work.
Cox said the questions you ask an agency are key, from how long they've worked in a country to services they provide the birth mothers, post-adotpion services for adoptive parents, what fees pay for, and more.
She also recommends broadening your search. If you thought you'd adopt in one country, it doesn't hurt to consider other options. Find parents who adopted in different countries. Parents who have been through the process tend to be very outspoken about their experience and supportive of others, she said.
An imperfect system
Despite the new rules and regulations, a number of problems with international adoptions remain.
"We can't come up with solutions until children really are front and center," said Pertman, whose foundation is seeking a different approach than the Hague. "You really have to put kids front and center, and you really have to mean it. That's not easy. Once you start acknowledging these realities, you spend dollars differently. You don't throw out the baby with the bath water, which is what we have done in some countries. The solutions, I think, are less blanket solutions. Blanket solutions are less child-friendly than more tailored solutions."
Cox supports the Hague, which she said highlights and bans abuses in international adoptions. Congress viewed it favorably, too, enacting a law that will in the future mean all international adoptions are held to Hague standards, not whether the country involved has ratified the convention or not.
"That's a very good thing," Cox said. "There will not be two tiers of adoption. All children deserve to have the protections" it provides. But she, too, believes children are not a political or fiscal priority and they should be.
Simmons believes there may be no perfect solution, simply because of the natural dynamics of the adoption process. He recalled filling out his own adoption paperwork, and arriving at the form that interrogated parents about the severity of special needs they were able and willing to provide for. At that moment, he said, he realized that whatever he signed up for was exactly what he was going to get.
As more nations move toward domestic adoption, international adoption trends will move toward serving the children who are traditionally more difficult to adopt because they are older, have special needs or belong to large family groups.
"That's what makes it hard," Simmons said. "That's why it will never be a perfect system."
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