The practice of intercountry adoption is first considered from a historical framework, beginning with World War II, to other conflicts throughout the 20th and 21st centuries. In this historical overview, factors that contributed to the rise of the global circulation of children for adoption in the 20th century are discussed, as well as efforts for reform in the 21st century in response to problems of abuse, fraud, and exploitation and the development of policies to regulate intercountry adoption and ultimately protect children. Specifically, The Hague Convention on Intercountry Adoption is presented from a social justice perspective, using Guatemala as a case example, as well as relevant U.S. policies regulating intercountry adoption practices. Finally, direct practice considerations for social workers are discussed. These include pre- and post-adoption issues to support families and children through the intercountry adoption process and across the child’s lifespan with considerations for trans-racial adoptions and the unique child-family support issues. 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.