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Adoption: Intercountry

Abstract and Keywords

The practice of intercountry adoption is considered from a historical framework, beginning with World War II to other conflicts and the global dynamics of child circulation for adoption. Significant sources of children are presented, including Russia, China, and Guatemala, as well as moratoriums related to poor practice and fraud. Framed from a social justice perspective, the Hague Convention on Intercountry Adoption is presented with an exploration of child sales and abduction into intercountry adoption. A global market for children creates significant practice challenges for social workers who engage in assessment, both in the country of child origin and in the destination country. Follow-up care includes case management to support families and children in the intercountry adoption process. In conclusion, the significant decline in the practice is reflected upon pragmatically; the need for true reform in the practice is necessary to preserve intercountry adoption for orphaned and vulnerable children.

Keywords: adoption, intercountry, international adoption, historical framework, assessment and case management

The practice of intercountry adoption (ICA) dates back to World War II and the Korean War (Bergquist, Vonk, Kim, & Feit, 2007). What began as a slow or “quiet migration” (Selman, 2002) peaked worldwide in 2004 with 45,000 children being sent from their birth nation to other countries as adoptees (Selman, 2009b, 2012). In the early 21st century, it is estimated that 1 million children worldwide have joined families mainly in Western Europe, the United States, and Canada. Of these destination countries, the United States has received approximately 50% of these children (Selman, 2009b, 2012).

In the United States, the practice of ICA is largely a “nonprofit” activity in terms of adoption agency financial status with regard to tax codes; however, many organizations can be classified as social entrepreneurial (Harding, 1991) and a business model is a reality in the day-to-day organizational practice (O’Connor & Rotabi, 2012). A fee-for-service model is the means of financial solvency and many adoptions cost well over $20,000 US (U.S. Government Accountability Office, 2005). Often, ICA services and related expenses cost $40,000 or more, depending on the adoption agency and country of origin. As follows, some adoption agency director and employee salaries are very high (Rotabi, 2013) and their model of practice has been called a “baby trade” (Kapstein, 2003) that meets a supply-and-demand market (Freundlich, 1998, 2000). On the other hand, it should be noted that in many agencies salaries are commensurate with other social-work practice fields (Rotabi).

In the language of the business model, those who pay for ICA services in the United States are most frequently Caucasian individuals and couples with middle to high incomes who are most likely college educated (Yngvesson, 2010). This privileged group and their facilitating agency typically interface with birth mothers and families who live in poverty without the benefit of opportunities like education, safe housing, adequate nutrition, and quality health care. Birth mothers often cope with the dire circumstances that arise from extreme poverty—minimal or no access to reproductive health and other services, limited opportunities for education, malnutrition of their older children, and familial and societal violence (Bhargava, 2005; Bos, 2007; Hollingsworth, 2003; Roby, Rotabi, & Bunkers, 2013; Siegal, 2011). In essence, ICA is a push and pull between those who “have” opportunity and those who “have not” in terms of resources and power. Frequently, poverty and a history of war are social conditions in ICA nations; these dynamics are a multiplying factor in the creation of social justice issues and ethical dilemmas (Hollingsworth; Roby et al.; Rotabi, 2012a, 2012c).

As Hollingsworth (2003) reminds us, concerns about social justice are considerable. Six core areas are identified:

(1) International adoption may exploit family poverty in developing countries, (2) international adoption may exploit social sanctions directed against disenfranchised children, (3) gender oppression and discrimination may be exploited for the purpose of adopting, (4) children’s rights to knowledge of and access to their birth family may be placed at risk, (5) children’s identification with their racial, ethnic, or national group may be interrupted, and (6) children may be secured in ways that involve abduction, sale, or trafficking. (Hollingsworth, p. 211)

Next, the entry will explore social justice and exploitation concerns in the context of adoption history.

History of ICA

Although adoption in general is a child welfare intervention that has a long-standing history in the United States, Western Europe, and Canada, ICA is a relatively recent phenomenon in contemporary history. Altstein and Simon (1991) have identified five phases in ICA: (a) post World War II, (b) the end of the Korean and Vietnam wars, (c) the civil wars and economic instability in Latin America, (d) the end of the Cold War, and (e) China’s one-child-per-family policy. Additional phases are the (f) rapid globalization and the rise of ICA, the fall of ICA (g) in the era of reform (Rotabi & Bunkers, 2011; Selman, 2009b, 2012), and, finally, the early 21st-century shift into (h) Africa as the final frontier. Because this final phase taking place in Africa is not yet truly history, it is difficult to identify the exact dynamics, and the focus henceforth is primarily on the first seven historical phases, with consideration brief discussion of the issues in Africa.

Seven Major Historical Phases Explored

Post World War II

In the chaos of World War II, orphaned and vulnerable children immigrated across Europe and, in some cases, to other continents as “war orphans.” In the United States, the cause was viewed as a humanitarian solution to postconflict suffering. The issue was compelling enough for First Lady Eleanor Roosevelt to personally involve herself in some of the coordination activities related to medical examinations of children who entered the United States for the purpose of adoption (personal communication, E. Martin, July 2008). Roosevelt carried out this work through her involvement in the U.S. Committee for the Care of European Children; this group responded to the need to move European children as a result of conflict (Teaching Eleanor Roosevelt Glossary, n.d.). From 1948 to 1953, 5,800 European children were adopted by American citizens. European children were also adopted within Europe; for example, 70,000 Finnish children were adopted by Swedes (Selman, 2009b).

End of the Korean and Vietnam Wars

Beginning around 1953, ICA as a response to the orphans of the Korean War began as an evangelical movement, led by Henry and Bertha Holt. Today, well over 100,000 Korean adoptees have joined families in other nations; many of those adoptions were secular in the years following the initial push from the Christian community (Bergquist et al., 2007). In the early 21st century, one of the most respected and longest standing adoption agencies is named after the Holt family and Holt International Children Services has placed thousands of children for adoption with families, children who originated from many different countries (Bergquist et al.).

The first laws crafted to aid in the immigration of orphans were developed in the United States with the assistance of the Holt family and the early push to adopt South Korean children (Bergquist et al., 2007). In contemporary history, the Korean government has also been responsive to policy and social-work practice issues. In the early 21st century, with South Korea’s vibrant economy, what began as a response to war and poverty is now a practice that is largely based on the shame of illegitimacy—a long and persistent problem in Korea as well as other ICA nations (Bergquist et al.; Fronek, 2006). Some Koreans have set a goal to end ICAs in the long term in favor of domestic adoptions and in recent years domestic adoptions in Korea have outnumbered ICAs (Roby & Brown, 2013; Selman, 2012). This is considered an important development in a country that has been criticized in the past as being a dependency model that “exports” child welfare problems rather than increasing the capacity of child protection systems (Fronek; Sarri, Baik, & Bombyk, 1998).

At the end of the Vietnam War, during the fall of Saigon (1975), it is estimated that as many as 3,000 children were removed by airlifts funded by the United States, Canada, Australia, and Europe (Fronek & Cuthbert, 2012a), carried out with military and civilian aircraft authorized by President Ford (U.S. Agency for International Development, 1975). Although many supported the evacuation of the children (Joe, 1978; Ryan, 1983) and it was largely celebrated in the mass media as a rescue mission, there was some outrage both in the general public and among child welfare leaders and scholars (Adoption History Project, 2012; Bergquist, 2009, 2012). Some argued that the children—some of whom were offspring of U.S. soldiers—were spared from almost certain death, whereas one group of religious leaders and academic scholars took the position that the child removal was immoral (Juergensmeyer et al., 1975). This airlift of children was the largest such evacuation in the history of ICA (Bergquist, 2009, 2012).

Civil Wars and Economic Instability in Latin America

The civil wars of Central America and problems of poverty in this region as well as in South America characterize this phase of ICA (Herrmann & Kasper, 1992). El Salvador is one such example; an unknown number of children from that region were sent abroad as adoptees after they were forcibly separated from their families during that civil war. Some of these “living disappeared” children (Rotabi, 2012a) and their biological families have sought reunion in their personal reconciliation of the past. Social workers in El Salvador, working for a search-and-reunion organization called Pro-Búsqueda, have been instrumental in reuniting hundreds of such adoptees (Alvarenga, 2011; Mónico & Rotabi, 2012; Pro-Búsqueda, 2002, 2004, 2009). The search for and reunion of adoptees and their biological families have taken place in Guatemala as well as in other nations where civil conflict led to family–child separation (Rotabi, 2012a).

Although not a conflict country, Brazil at one time sent significant numbers of children into ICA. Fonseca (2002) writes about an adoption system that had many problems, often fueled by large sums of money and facilitated by intermediaries (Abreu, 2009; Cardarello, 2009). In the early 21st century Brazil has regulated ICA and few children leave the nation, largely as a result of reforms stemming from adoption fraud and laws related to child rights (Fonseca, 2009; Garcia & Fernandez, 2009).

End of the Cold War

As the Cold War came to an end, ICA activity in the region became a phenomenon in former Soviet Union nations, including Romania, Russia, and the Ukraine. The first significant rise in adoptions was in Romania, largely because of deplorable conditions in child-care institutions (Nedeclu & Groza, 2012). Documentary-style media attention in the United States and Western Europe led to an outcry for adoption as a social intervention to remove children from desperate circumstances (Groza, Ileana, & Irwin, 1999; Johnson, Edwards, & Puwak, 1993; Nedeclu & Groza).

The underlying issues were not only poverty and a failed state, but also the oppressive reproductive policies of former dictator Ceauşescu, including the prohibition of birth control and the requirement for Romanian women to bear at least five children (Groza et al., 1999). As a result, many families abandoned children in large institutions, rendering them “social orphans.” as their families abandoned children into large institutions as a solution. For Ceauşescu, this was a strategy for building a proletariat of Romanian workers, consistent with his Communist vision. Under oppressive policies, the institutions of Ceauşescu’s era were overcrowded and inhumane (Groza et al.; Johnson et al., 1993; Nedeclu & Groza, 2012).

As the problems of Romania’s social orphans became part of the public consciousness during the fall of the Iron Curtain, there was a huge rush to adopt the orphaned and vulnerable children of Romania. Adoptions numbered approximately 10,000 in 1990 and 1991 alone (Selman, 2009a). However, in haste poor practices prevailed and there were stories of individuals and couples literally walking through institutions and selecting children based on physical characteristics, including skin color and other qualities of appearance. Also, illegal adoptions—removal of children from Romania without appropriate processes and paperwork—began to emerge in the international press as compelling stories (Groza et al., 1999; Johnson et al., 1993; Nedeclu & Groza, 2012; Selman, 2009a). In time, it became clear there were inappropriate adoption placements of children with serious emotional and mental-health problems, including radical attachment disorder (Groza et al.; Johnson et al.; Nedeclu & Groza).

Eventually, 10 years after adoptions began to boom in Romania and approximately thousands of children had left the country as adoptees, a self-imposed adoption moratorium was declared in 2001 (Selman, 2009a). It should be noted that Romania’s moratorium was also related to the nation’s entry into the European Union—there was considerable pressure for Romania to conform to Western European standards of child welfare and adoption practices (Nedeclu & Groza, 2012; Roby & Ife, 2009). Since this time, Romania has remained closed to ICA, except in the case of relative adoption, and the country has undergone significant child welfare reform and development of much needed services for children and families, including foster care and family support initiatives (Nedeclu & Groza).

Although Romania closed as an adoption nation, Russia became a significant source of adopted children globally (Selman, 2009a). More than 50,000 children have been sent to the United States alone (Rotabi, 2012d), and Russian children have had some of the same problems identified in Romania (Ruggiero & Johnson, 2009); many institutionalized children also have suffered from sensory deprivation and other issues of inadequate care (Nelson, Zeanah, Fox, Marshall, Smyke, & Guthrie, 2007). The health problems of Russian adoptees have been investigated, including elevated rates of fetal alcohol syndrome and radical attachment disorder (Miller et al., 2007). Adoptees with such health problems have had challenges adjusting to family life, especially those who were adopted after spending their first few years of life or more in an institution (Hawk & McCall, 2011; Ruggiero & Johnson, 2009).

Sadly, in the United States there have been scandalous cases of child abuse, sometimes related to adoptive parents’ poor adjustment to parenting a special-needs child from Russia (Rotabi, 2012d; Rotabi & Heine, 2010). The problem is so serious that as of early 2013, 20 adoptee deaths have been documented by Russian authorities as a result of child abuse, neglect, or questionable circumstances (Rotabi, 2012d). There were concerted attempts to build a new bilateral agreement, which was eventually passed into law. Many saw this act as a sign that the two nations were collaborating effectively for new adoptions (Rotabi, 2012d). However, at the beginning of 2013, Russia legally ceased ICAs of their citizen children to the United States as a response to these questionable deaths and homicides (de Carbonnel, 2012).

It is important to note that policy changes in Russia parallel the emergent systems of family support, deinstitutionalization of children, foster care, and domestic adoptions (Rotabi, 2012d). Fundamentally, the care of children in Russia and child institutionalization are concerns for many citizens as well as government officials (Schmidt, 2009). It appears that Russia, just as in the case of Korea, is transitioning away from sending their orphaned and vulnerable citizen children abroad (Rotabi, 2012d).

China’s One-Child Policy

Historically, China has been a significant source of ICAs globally. Abandonment of female children into large-scale institutions is a well-known factor in child availability for adoption (Dowling & Brown, 2009; Selman, 2009a). Johnson, who has carried out extensive field research in China, outlines a complex environmental context, pointing out that “the standard discourse of intercountry adoption from China explains that healthy infant girls, the most desirable object in ICA, became available in large numbers in the 1990s because of the clash between an ancient patriarchal Chinese culture and the government’s effort to control runaway population growth through a set of policies commonly referred to as the ‘One Child Policy’” (2012, p. 128). Johnson goes on to explain that only 40% of the population falls under this policy and most of those families live in urban areas. Other areas of China have fewer restrictions, including rural and agricultural regions. As a result, adoptions from China are far more complex than just a policy context (Johnson), like other nations’ dynamics, including issues of opportunity and poverty as well as cultural issues such as the shame of illegitimacy.

China has been historically viewed as a sound nation from which to adopt (Dowling & Brown, 2009). However, the country is not without its own problems of adoption fraud that have intersected with the one-child policy. As Meier and Zhang (2008) present in a legal analysis, a well-documented scandal occurred in the Hunan region. A small ground of government officials forcibly removed infant children from families on the grounds of this policy, although these families were allowed to have more than one child because of their unique status related to regional location and other dynamics (Demick, 2009). The abducted children were found to have been sold into the ICA system—the children’s identities were changed so that they appeared abandoned, as has been the case in other countries.

In the early 21st century, China’s adoption program has undergone a considerable downturn in sending children overseas, with at least a 60% reduction in recent years (Selman, 2012). The policies and practices of ICA have shifted as the Chinese government has placed restrictions on who can adopt from the nation, including a ban on gay couples as well as a limit on the body weight of adopting parents, among other factors (Bellock & Yardley, 2006; Selman, 2009a). Also, domestic adoptions have become a greater priority because Chinese families are now applying to adopt their own citizen children (Johnson, 2012). Now many of the children who are entering into the ICA system are considered “special needs,” ranging from mild problems (for example, cleft palate) to other more serious medical or psychological issues (Dowling & Brown, 2009; Johnson; Selman).

Rapid Globalization and the Rise of ICA During the Millennium Adoption Surge

Globalization and social and economic forces have been interacting with the aid of major technological advances. The Internet and related technologies (Chou, Browne, & Kirkaldy, 2007; Dowling & Brown,2009; Roby & White, 2010) have been the machinery of an ICA surge that coincided with the turn of the millennium. In this time period, the peak in ICAs was notable, with Russia, China, and Guatemala being the lead countries sending their children abroad as adoptees (Selman, 2009b, 2012). This millennium adoption surge ultimately pushed the practice of ICA and social-work practice into a new phase of activity with significant challenges, especially for adoption agencies attempting to meet the supply and demand of the marketplace (Rotabi, 2013).

During this time, thousands of children were circulating globally as intercountry adoptees and there was a parallel rise of ICA agencies, numbering well over 300 in the United States alone (Rotabi, 2008). Some organizations were better than others, employing social workers and developing standards of practice that were consistent with child and family rights. However, the unfortunate reality was that the poverty of many of the sending nations, combined with graft and corruption, made the practice difficult to regulate, even by the most well-intentioned agencies. Other agencies were poorly managed and even served as fronts for illegal activities, as was the case in Cambodia (Maskew, 2004–2005; Smolin, 2004, 2006).

Cambodia warrants special attention as a country where U.S. federal criminal investigation took place; entitled Operation Broken Hearts, this investigation led to the arrest and conviction of adoption facilitator Lauryn Galindo (Cross, 2005; Maskew, 2004–2005; Roby & Maskew, 2012; Smolin, 2004, 2006). Working for Seattle Adoptions International, directed by Galindo’s sister Lynn Devin, Galindo orchestrated a large-scale adoption fraud scheme to include at least 700 children and millions of dollars in “fees” (Cross). Unethical and illegal activities included a variety of offenses such as bribery, money laundering, and immigration visa fraud. Many of the tactics used by Galindo and the individuals with whom she collaborated in Cambodia were consistent with organized crime activities. According to the investigating officer, prosecution and the eventual plea bargain were based on financial crimes, including tax evasion (Cross).

The Fall of ICA in the Era of Major ICA Reform

Since its peak year in 2004, the practice of ICA has decreased significantly around the globe (Selman, 2009b, 2012). The United States alone has experienced a more than 60% decrease in ICA (Roby et al., 2013), largely as a result of the aforementioned ICA fraud and illicit activities in the practice of ICA. Selman (2012) has conducted extensive analysis of ICA trends and concludes, “Faced with the clear evidence of declining numbers and the growing criticism of a system so open to abuse . . . many feel that this may indeed be the ‘beginning of the end of wide-scale ICA’ ” (p. 44).

As Selman points out, the future of ICA is uncertain and the changes related to the decline are linked to a number of factors, including a new international policy context that interfaces with serious ethical dilemmas and illegal acts outlined previously. For this overview of ICA, both policy and practice will be reviewed and applied to Guatemala as a case example.

Policy as a Catalyzing Force for Reform

Social policy has historically been basic and lacking of social protections for orphans and vulnerable children, as well as their families, who interact with the ICA system (Rotabi & Gibbons, 2012). Laws and policies related to ICA practices have been based on inadequate legal frameworks, often within immigration law and policy, such as the domestic laws of Vietnam interfacing with laws in the United States, Canada, and Western European countries. However, the 1993 Hague Convention on Protection of Children and Co-operation in Respect to Intercountry Adoption (henceforth simply referred to as the HCIA) was a catalyst for change.

The Hague Convention on Intercountry Adoption

Agreed upon by over 80 countries, the HCIA holds the best interests of the child to be a paramount value, as identified in the preamble. The subsidiarity principle of the HCIA requires that a child’s birth country provide family support services to birth families to help preserve the child’s biological roots, including extended family. Kinship care is valued and when these child-care opportunities are exhausted, in-country options are to be explored, including domestic adoptions. If and when these social interventions are not possible, then the child may be identified as appropriate to be sent overseas as an adoptee with careful controls for ethical transactions, such as appropriate birth parent counseling or ethically grounded procedures for identifying that a child is truly abandoned. This continuum of care has been developed and prescribed to prevent child sales, abduction, and ultimately trafficking into ICA.

Guatemala: A Case Example of HCIA Policy Implementation

Guatemala serves as a good example for application of the HCIA in the era of reform because it represents is a particularly difficult context for policy implementation. Guatemala is one of the most impoverished countries in the Western Hemisphere, with a history of a 36-year civil conflict (1960–1996) in which an unknown number of illegal adoptions were orchestrated by military officials and lawyers (Dubinsky, 2010).

In the postconflict environment, beginning with the Peace Accords in 1996, Guatemala saw a rise in ICA. During this time, there was a child protection law that included adoption (Rotabi, Morris, & Weil, 2008), but in reality the practice was largely unregulated. Although there were legitimate ICAs from Guatemala, there were gross human rights abuses, including child sales and abduction, which have been documented extensively (Bunkers & Groza, 2012; Bunkers, Groza, & Lauer, 2009; Casa Alianza et al., 2007; Comisión Internacional Contra la Impunidad en Guatemala, 2010; Gresham, Nackerud, & Risler, 2004; Mónico, 2013; Rotabi, 2009, 2011, 2012a, 2012b; Rotabi & Bunkers, 2008; Rotabi et al., 2008; Siegal, 2011). To gain control over illegal practices and human rights abuses in the era of reform, in 2008 Guatemala began to implement a new law to regulate ICAs. This law, developed after years of controversy, was the Guatemalan legal domestication of the Hague Convention on Intercountry Adoption (Bunkers & Groza, 2012; Bunkers et. al, 2009; Comisión Internacional Contra la Impunidad en Guatemala, 2010; Hague Conference on Private International Law, 1993, 2007; Rotabi & Bunkers; Rotabi et al., 2008).

The combination of gross human rights abuses and implementation of the HCIA resulted in a self-imposed ICA moratorium in Guatemala, which began on the first day of the year 2008 (Bunkers & Groza, 2012; Bunkers et al., 2009). In the early 21st century, the Guatemalan Central Adoption Authority is building a domestic child adoption system to meet the requirements of the subsidiarity principle (Bunkers & Groza; Rotabi, Pennell, Roby, & Bunkers, 2012; Rotabi, Roby, & Pennell, 2013). Guatemalan children have been placed in domestic adoptions in small numbers and there is an emergent child foster-care system in the country (Bunkers & Groza; Rotabi & Gibbons, 2012). In a parallel process, social-work education is now focusing more on child protection, including evidenced-based models of practice (Rotabi, Pennell, et al.).

The U.S. Intercountry Adoption Act

Just as Guatemala developed a domestic law that was consistent with the HCIA, the United States had done the same with the year 2000 Intercountry Adoption Act (IAA). This federal law defines some of the previously discussed activities as child trafficking. However, in 2013, the law has not been used successfully to prosecute any individuals (Bromfield & Rotabi, 2012; Roby & Brown, 2013). One key area impacted by the law is adoption agency day-to-day practices as those organizations interface with other HCIA countries. Specifically, agencies must now be approved as “accredited” adoption service providers and a range of administrative standards guide that practice (Council on Accreditation, 2007; Rotabi & Gibbons, 2012). The idea of “approved” or accredited adoption providers is related to the requirements of the HCIA (Hague Conference on Private International Law, 1993).

The Policy Exception of Africa

At the time of this writing in 2013, many countries in Africa are exceptions to the HCIA and the IAA. The issue is complicated, but because many African nations have not signed the HCIA, the IAA does not apply—the IAA only applies to ICA transactions between two HCIA nations. As a result, some adoption agencies in the United States have continued to practice ICA without agency accreditation, focusing their programming on non-HCIA countries in Africa (Bunkers, Rotabi, & Mezmur, 2012). Mónico (2013) calls this the “African loop hole” and this problem has been criticized in the analysis of the HCIA’s implementation (Rotabi & Gibbons, 2012).

This dynamic is particularly concerning given Africa’s history of human trafficking and known problems related to ICA systems (Mezmur, 2009a, 2009b). Ethiopia has been of greatest concern in recent history; the country has one of the world’s largest populations of orphaned and vulnerable children and a traditional family care structure that is now interfacing with a highly aggressive ICA system (Bunkers et al., 2012), reaching into Africa as the final frontier. Other countries where ICAs are emerging include the Democratic Republic of Congo and South Africa, which appear to be becoming more active (Hogbácka, 2012; Mezmur, 2009a, 2009b).

To respond to these issues, the Intercountry Adoption Universal Accreditation Act was signed by President Obama on January 14, 2013 (U.S. Department of State, 2013). This law, which will go into effect in July 2014, will require all U.S.-based adoption agencies to be accredited, regardless of the HCIA status of the country of origin. This law will at least close the Africa loophole in the United States (Mónico, 2013).

Social-Work Practice for ICA

Multiple practice tasks are carried out for ICAs, including assessment, case management, and supportive service referrals. These areas will be considered briefly as they relate to the unique social-work practice area of ICA.


Social workers carry out assessments in both countries. In countries of origin, birth parent and family histories are documented when possible, including known medical conditions. If the child is found to be abandoned, social workers do their best to determine any historical facts and document them in a social history report.

In the destination or receiving country, home study investigations determine whether a prospective family meets the social and legal criteria for ICA. Areas of assessment range from motivation to adopt and the ability to parent to the financial resources necessary to carry out the process itself as well as raise a child (Crea, 2009). Medical evaluations and other documentation of adoption readiness are considered as documentary evidence as reviewed by investigating social workers (Rotabi, 2011).

Social workers acting as “brokers” comprise a recognized task area of practice (Hepworth, Rooney, Rooney, Strom-Gottfried, & Larsen, 2010). Frequently ICA agencies in destination nations act as brokers in the ICA process—often managing significant paperwork and the large sums of money necessary to complete the ICA transaction. Interfacing with child welfare and adoption authorities in the second nation, ICA agencies are expected to follow laws and protocol related to each nation’s legal code and the guidance of the HCIA as well as child immigration requirements. Knowledge of these legal and policy dimensions is a specialist area of ICA practice.

Case Management

Case management is a critical function on both sides of the ICA adoption system—case management for prospective parents in the destination country as well as case management for the child’s country of origin. As such, social-work practices intersect with the highly sensitive issues of ethical termination of parental rights, child relinquishment, or determination of child abandonment, as mentioned previously (O’Connor & Rotabi, 2012).

Once a child is placed in an adoptive family, case management includes follow-up care for families who are parenting children with unique histories, including institutionalized children. Often case management includes referral to services that have been developed to support families who adopt children internationally, including specialized medical and mental-health programming. Again, making referrals is a classic area of social-work case management (Hepworth et al., 2010).


There is no more controversial area of social-work practice than ICA. One certainty in the future of ICA is that its practice has decreased profoundly and the consequences will come to bear upon orphaned and vulnerable children in need of parenting. This fact, combined with the evidence of impressive developmental gains in children post-ICA (Juffer & Van IJzendoorn, 2009, 2012), requires the social-work profession to consider how to strengthen the practice to ultimately preserve ICA.

Social work’s commitment to child welfare, social justice, and human rights must guide any future thinking. The obligation of social work is to proceed with caution grounded in the discipline’s deep commitment to child protection and the development of culturally relevant interventions (Healy, 2008; Hollingsworth, 2003; Roby, 2007; Rotabi et al., 2012) with the professional wisdom and knowledge of evidence-based practices (Roby et al., 2013). Further, the entire continuum of care must be considered before, during, and after a child’s placement into ICA (Fronek & Cuthbert, 2012b; Roby, 2007). Particular attention must be paid to birth mothers because research and practice guidance in this area, as related to ICA, is scant (Rotabi & Bunkers, 2011; Wiley & Baden, 2005)

It is impossible for social work to make significant changes without global coordination and collaboration among practitioners engaged in ICA activities and scholars carrying out useful research (Roby et al., 2013; Rotabi & Bunkers, 2011). Many of the underlying issues are macrostructural and related to social inequality, as pointed out by Hollingsworth (2003), a condition that will continue to persist given the current conditions in an unjust world. As such, ICA fraud and unethical practices will continue to be a problematic area for the profession of social work as the population of orphaned and vulnerable children continues to expand with the HIV/AIDS epidemic and other social problems, including conflict in Africa and elsewhere.

This summary highlights the issues and underscores the ever-changing landscape of ICA social work. It is intended as a documentation of the historical practice as well as policy ranging from international private law to the resulting legal frameworks and adoption agency accreditation. The discussion is offered as a pragmatic analysis and consideration for the future so that ICA may continue to be a viable social intervention and social-work practice area.


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