Analysis Family

Inter-country Adoption: Steep Declines in International Adoptions by U.S. Parents Reflect Mixed Record

Karen Smith Rotabi

For many committed to intercountry adoption, it is unfortunate that since the year 2004 the practice has declined more than 50%. An important question is: what is happening? The answer is complex. To begin with, the unfortunate reality is that intercountry adoption has a mixed history. 

Most Americans have been touched by adoption and many would agree that inter-country adoption is important and even an embodiment of our nation’s commitment to children and humanitarianism. Since World War Two, approximately one million children have been internationally adopted; leaving their country of origin and placed with adoptive families in other nations. Because US families have received at least 50 percent of these children we have been called an “Adoption Nation.” Children have arrived from a variety of countries, including Korea, Vietnam, China, Russia, Cambodia, and Guatemala. Recently, Ethiopia, with at least 5 million orphaned and vulnerable children, has become a popular source for adoptive children.

For many committed to inter-country adoption, it is unfortunate that since the year 2004 the practice has declined more than 50 percent. In sheer numbers, this means that we reached an all-time high of receiving 22,991 children that year and six years later, in 2010, we only had 11,058 children arrive in the US as international adoptees. The 2011 data indicates another decline to 9320 children sent to the US as adoptees.

An important question is: what is happening? The answer is complex. To begin with, the unfortunate reality is that inter-country adoption has a mixed history. On the positive side: many children have impressive developmental gains once they begin living in a family setting rather than a child care institution. Also, medical problems are may be addressed in the US and some children receive life altering if not lifesaving medical care. Overcoming disability and extreme deprivation is one part of the inter-country adoption story.

Even with so much good, there has been a dark side to adoption. It is a practice which has more than its fair share of scandals. The 2010 case of the young boy sent back to Russia unaccompanied with nothing more than a note requesting adoption “annulment” is a good example. Then, there was the Russian girl named Masha Allen who was adopted by a pedophile and he proceeded to sell her sexual abuse photo images into Internet pornography. Her case was eventually heard before US Congress when Masha testified about the abuse and asked “why didn’t anyone come to check on me?” Her question is a direct one for the adoption ‘professionals’ who handled her case. When you look deeper, those involved were anything but professional in practices. They flagrantly disregarded their responsibilty to investigate the adoption placement to determine if it was appropriate and then, in follow-up visits with Masha, to verify her health and safety.

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Other problematic history includes allegations of child abduction. It is hard to forget that during the 2010 aftermath of the Haitian earthquake that a faith or mission group from Idaho attempted to illegally remove or traffic children into the Dominican Republic for the purpose of inter-country adoption. International press eventually identified that most of the children were not ‘orphans’ and their families believed that the children would be cared for and that their families would be able to visit with them and retain relations. When you think about it, families living in extreme poverty could so easily be led to believe such a thing and in a moment of desperation and hope. Allowing your child to leave with a stranger from the U.S. who promises of food and an education may be the only sense of salvation in the moment of disaster chaos. The desperate act eventually plays out as a decision made in haste and with a misrepresentation of intent. Legally such a scenario it fits international child abduction definitions when poor families are unable to retrieve children and then the children enter into adoption schemes.

There have been cases like Cambodia where an American adoption ‘facilitator’ orchestrated child ‘adoptions.’ Rural and mainly illiterate Cambodian families were often given a small sum of money and a bag of rice in exchange for their signature on critical legal documents. Again, these children were not orphans but they were desirable children—relatively young and healthy children who were easily matched with eager US families willing to pay $20,000 or more for the adoption. Investigators found that some of these Cambodian families were led to believe that their children were going to boarding schools overseas. The facilitator was eventually arrested by U.S. Federal Marshalls and she served time in prison for tax evasion, among other charges. Before she was stopped, she earned millions of dollars with her child trafficking scheme and U.S. families were devastated to learn that their children were not orphans.

More recently, the most notorious adoption nation with profound problems has been Guatemala. Approximately 30,000 children departed as inter-country adoptees from 1999-2007. Human rights defenders agree that abuses within this system were profound and while there were legitimate adoptions, there were also an unknown number of adoptions with serious irregularities and illegalities. Problems ranged from birth mother payments to induce adoption arrangements to actual child abduction for adoption. Recently, UN investigators found patterns of organized crime and the highest profile adoption attorney in Guatemala is now serving a 26-year prison sentence. She is linked to a range of problematic cases, including high profile child abduction cases.

Sadly there are three mothers in Guatemala who have taken to hunger protests for their individual daughters return from the U.S. One of those three women now has a Guatemalan court order for her daughter’s repatriation as a victim of abduction. The U.S. family in question, living in Missouri, has thus far ignored the court order with the exception of making a nationally-televised statement that they do not believe such a return to be in the best interests of their daughter. A resulting debate is brewing about rights, responsibilities, and the best interests of the child. No doubt it is difficult to remove a child from a family with which she has lived with for more than three years. In the long run, it may be even more difficult for the U.S. family to one day justify how they became complicit in abduction by ignoring a desperate mother’s search and a Guatemalan court order.

At the end of the day, Interpol has reportedly been contacted and our diplomats have no choice but to get involved because as a nation we have signed the Hague Convention on Inter-country Adoption. This international private law is implemented in the US with the year 2000 Inter-country Adoption Act which requires the US Department of State’s involvement in matters of child sales and abduction under the guise of inter-country adoption. To date, a resolution on this particular abduction case has been fleeting. Internationally recognized Guatemalan human rights defender, Norma Cruz advocates on behalf of this and other cases. Cruz reminds us that child abduction is the cruelest violence of all against a woman as it brings about “eternal suffering.” She has dedicated considerable time and resources to bring a resolution to this case and she reports that she will not rest until justice is served.

While we await resolution on these Guatemalan cases, we are ultimately left with an unfortunate history of inter-country adoption scandals which has led to the decline in the practice. Russian adoptions have slowed down considerably and a moratorium on Cambodian and Guatemalan adoptions is now in place. This is also true for Vietnamese adoptions as that country too has a history of fraud related to questionable child abandonment. Other countries such as China have slowed down considerably due to a variety of factors. And, while Ethiopia has taken off as an adoption nation, there are indications of serious problems in that nation too. In sum, the decline is significant and families who have hoped to adopt internationally are left an uncertain future. And, at the end of the day, this is unfortunate for all who stand to gain from family building via ethical inter-country adoption.

Commentary Sexual Health

Parents, Educators Can Support Pediatricians in Providing Comprehensive Sexuality Education

Nicole Cushman

While medical systems will need to evolve to address the challenges preventing pediatricians from sharing medically accurate and age-appropriate information about sexuality with their patients, there are several things I recommend parents and educators do to reinforce AAP’s guidance.

Last week, the American Academy of Pediatrics (AAP) released a clinical report outlining guidance for pediatricians on providing sexuality education to the children and adolescents in their care. As one of the most influential medical associations in the country, AAP brings, with this report, added weight to longstanding calls for comprehensive sex education.

The report offers guidance for clinicians on incorporating conversations about sexual and reproductive health into routine medical visits and summarizes the research supporting comprehensive sexuality education. It acknowledges the crucial role pediatricians play in supporting their patients’ healthy development, making them key stakeholders in the promotion of young people’s sexual health. Ultimately, the report could bolster efforts by parents and educators to increase access to comprehensive sexuality education and better equip young people to grow into sexually healthy adults.

But, while the guidance provides persuasive, evidence-backed encouragement for pediatricians to speak with parents and children and normalize sexual development, the report does not acknowledge some of the practical challenges to implementing such recommendations—for pediatricians as well as parents and school staff. Articulating these real-world challenges (and strategies for overcoming them) is essential to ensuring the report does not wind up yet another publication collecting proverbial dust on bookshelves.

The AAP report does lay the groundwork for pediatricians to initiate conversations including medically accurate and age-appropriate information about sexuality, and there is plenty in the guidelines to be enthusiastic about. Specifically, the report acknowledges something sexuality educators have long known—that a simple anatomy lesson is not sufficient. According to the AAP, sexuality education should address interpersonal relationships, body image, sexual orientation, gender identity, and reproductive rights as part of a comprehensive conversation about sexual health.

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The report further acknowledges that young people with disabilities, chronic health conditions, and other special needs also need age- and developmentally appropriate sex education, and it suggests resources for providing care to LGBTQ young people. Importantly, the AAP rejects abstinence-only approaches as ineffective and endorses comprehensive sexuality education.

It is clear that such guidance is sorely needed. Previous studies have shown that pediatricians have not been successful at having conversations with their patients about sexuality. One study found that one in three adolescents did not receive any information about sexuality from their pediatrician during health maintenance visits, and those conversations that did occur lasted less than 40 seconds, on average. Another analysis showed that, among sexually experienced adolescents, only a quarter of girls and one-fifth of boys had received information from a health-care provider about sexually transmitted infections or HIV in the last year. 

There are a number of factors at play preventing pediatricians from having these conversations. Beyond parental pushback and anti-choice resistance to comprehensive sex education, which Martha Kempner has covered in depth for Rewire, doctor visits are often limited in time and are not usually scheduled to allow for the kind of discussion needed to build a doctor-patient relationship that would be conducive to providing sexuality education. Doctors also may not get needed in-depth training to initiate and sustain these important, ongoing conversations with patients and their families.

The report notes that children and adolescents prefer a pediatrician who is nonjudgmental and comfortable discussing sexuality, answering questions and addressing concerns, but these interpersonal skills must be developed and honed through clinical training and practice. In order to fully implement the AAP’s recommendations, medical school curricula and residency training programs would need to devote time to building new doctors’ comfort with issues surrounding sexuality, interpersonal skills for navigating tough conversations, and knowledge and skills necessary for providing LGBTQ-friendly care.

As AAP explains in the report, sex education should come from many sources—schools, communities, medical offices, and homes. It lays out what can be a powerful partnership between parents, doctors, and educators in providing the age-appropriate and truly comprehensive sexuality education that young people need and deserve. While medical systems will need to evolve to address the challenges outlined above, there are several things I recommend parents and educators do to reinforce AAP’s guidance.

Parents and Caregivers: 

  • When selecting a pediatrician for your child, ask potential doctors about their approach to sexuality education. Make sure your doctor knows that you want your child to receive comprehensive, medically accurate information about a range of issues pertaining to sexuality and sexual health.
  • Talk with your child at home about sex and sexuality. Before a doctor’s visit, help your child prepare by encouraging them to think about any questions they may have for the doctor about their body, sexual feelings, or personal safety. After the visit, check in with your child to make sure their questions were answered.
  • Find out how your child’s school approaches sexuality education. Make sure school administrators, teachers, and school board members know that you support age-appropriate, comprehensive sex education that will complement the information provided by you and your child’s pediatrician.

School Staff and Educators: 

  • Maintain a referral list of pediatricians for parents to consult. When screening doctors for inclusion on the list, ask them how they approach sexuality education with patients and their families.
  • Involve supportive pediatricians in sex education curriculum review committees. Medical professionals can provide important perspective on what constitutes medically accurate, age- and developmentally-appropriate content when selecting or adapting curriculum materials for sex education classes.
  • Adopt sex-education policies and curricula that are comprehensive and inclusive of all young people, regardless of sexual orientation or gender identity. Ensure that teachers receive the training and support they need to provide high-quality sex education to their students.

The AAP clinical report provides an important step toward ensuring that young people receive sexuality education that supports their healthy sexual development. If adopted widely by pediatricians—in partnership with parents and schools—the report’s recommendations could contribute to a sea change in providing young people with the care and support they need.

Analysis Human Rights

Family Separation, A Natural Byproduct of the U.S. Immigration System

Tina Vasquez

There are millions of children in the United States born into households where one or more of their parents are undocumented—and thousands of these parents are deported each year.

To honor migrant mothers in detention this Mother’s Day, the immigrant rights organization CultureStrike has partnered with Presente.org, NWDC Resistance, and Strong Families. Visitors to MamasDay.org can pick out a card and write a message to a detained mother, and members of CultureStrike will deliver printed cards to detention centers nationwide.

A card from a stranger on the internet is a small gesture, but one that could have been meaningful to Monica Morales’ mother when she was detained at the T. Don Hutto Residential Center late last year. Morales told Rewire her mother, usually a fighter, was depressed and that her morale was at an all-time low. She’d been picked up by Immigration and Customs Enforcement (ICE) at the border while attempting to escape her abusive ex-husband in Mexico and the gang violence that plagued her neighborhood in Chihuahua. After being deported in 2010, she was trying to reenter the United States and reunite with her family in Amarillo, Texas, but the reunion would never happen.

As an adult, Morales is somewhat able to make sense of what occurred, but she worries about what she will tell her three young children about what has happened to their family. These are hard conversations happening all over the country, as there are millions of children in the United States born into households where one or more of their parents are undocumentedand thousands of these parents are deported each year. And, advocates say, there are few, if any, programs available to help immigrant children cope with their trauma.

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“There’s Literally Nothing We Can Do”

On any given day, there are 34,000 people in immigration detention. Prior to the “border crisis” that brought thousands of Central American women to the United States seeking asylum, the Women’s Refugee Commission reported that 10 percent of those in detention were women. Since 2009, that figure has likely increased, but the exact number is unknown.

Morales’ mother was one of them.

Though they were both located in Texas at the time, Morales said getting her mom’s phone calls from Hutto was heartbreaking and that she couldn’t have felt further away or more helpless. Morales hit her breaking point when one day, her mom called sobbing, saying she and seven other women were forced to spend the day in a room covered in urine, blood, and excrement. It was shortly after that Morales’ mom decided to participate in the hunger strike Rewire reported on earlier this year.

“My mom would always tell me that dogs at the pound are treated better than they are in Hutto and other detention centers,” Morales said. “At least at the pound, they try to help the dogs and they want them to get adopted. At places like Hutto, they don’t care what happens to you, they don’t care if you’ll get killed if you get deported. If someone is sick, they don’t care. If someone is suffering, they don’t care.”

Corrections Corporation of America, the nation’s oldest and largest for-profit private prison corporation, runs Hutto. The company has come under fire many times for human rights violations, including at Hutto, which was once used to detain immigrant families, including children. The Obama administration removed families from the facility in 2009 after numerous allegations of human rights abuses, including, according to the Texas Observer, “accounts of children suffering psychological trauma.” In 2010, there were also multiple allegations of sexual assault at the detention center.

Morales’ mother was not aware of Hutto’s history of abuse cases, but Morales told Rewire that after the hunger strike, her mother and other women who participated believed they were being retaliated against by Hutto officers because they had brought more bad publicity to the facility. Morales’ mom was deemed by detention officers a “dangerous detainee” and had to wear a different color uniform to identify her as such, Morales said. She was also placed in solitary confinement for over a month before she was transferred to another detention facility.

Six weeks ago, Morales’ mother was deported back to Chihuahua where she must remain for 20 years, because those who have been deported once before and then attempt to reenter the United States within a period of “inadmissibility” automatically trigger a longer ban.

Advocates have told Rewire that transfers to other facilities and solitary confinement are common tactics used by both detention and ICE officers to retaliate against those who go on strike.

During the time of the hunger strike, ICE denied allegations that it was retaliating against detainees in the form of transfers and solitary confinement. A spokesperson said in a statement to Rewire that it “routinely transfers detainees to other facilities for various reasons, including bed-space availability or to provide greater access to specialized services needed by particular detainees.” The spokesperson added that Hutto “does not have solitary confinement areas.”

As Mother’s Day approaches, Morales told Rewire that her head is heavy with thoughts of her mother. The chance they will be able to see each other anytime soon is slim. If her mom attempts to reenter the United States a third time and is caught, she will be permanently barred. Morales is a DACA recipient, which means she qualified for an immigration policy put into place by President Obama that allows undocumented immigrants who entered the country before their 16th birthday and before June 2007 to receive a work permit and exemption from deportation renewable every two years (but for only as long as the DACA program is in place). It also means Morales is unable to travel outside of the United States unless there is an emergency, and for obvious reasons, those are not the conditions under which she wants to see her mother.

“We can’t see my mom for 20 years and there’s literally nothing we can do,” Morales told Rewire. “I can’t go to Mexico. The only way I can go is if something were to happen to my mom, and I pray I don’t have to go in that situation. And honestly, I would worry if the [Border Patrol] would let me return to the U.S. even though I’d have my paperwork in order. I’ve heard that happens. If you’re in my situation, everything is so risky and I can’t take those risks. I have three children. My youngest child has health issues and he needs medication. My second child suffers from tumors and he needs yearly check-ups. I can’t risk my status in the U.S. to go back.”

Like her mother, Morales is a domestic abuse survivor and she is upset by how immigration laws have impacted her family and offer little recourse to women who are attempting to escape violence. If nothing else, she said, this anger has moved her to be more politically active. Not only has she started a campaign to get Hutto shut down, but she is doing interviews and other activities to shine a light on how the U.S. immigration system further traumatizes survivors of domestic violence, the mental health issues that arise when being forced to navigate such a “horrible” system, and the family separation that has become a natural byproduct of it all.

“I don’t think Americans know what this does to our families or our communities,” Morales said. “I wonder a lot that if people knew what happened to our families, if they would even care. Moms [are] in detention for years just for trying to give their kids a better life. Parents [are] being deported and killed and their children have to be raised by other people. Do people even care?”

The Morales Family

Morales and her sister are working together to pay for bi-weekly psychiatrist sessions in Mexico for their mom, who is struggling with being separated from her only support system and who Morales strongly believes was severely traumatized by her experiences at Hutto.

“She can’t work; she can’t reintegrate herself into society. She can’t leave the house by herself; she can’t be in the house by herself. After being detained, my mom was treated so bad that that I think she started to believe she deserved it. My grandma says my mom can’t sleep at night, she paces. My grandpa asks her what’s wrong and she just says she feels like she’s suffocating. She can’t calm down. She has a lot of anxiety, a lot of depression. She’s different than she used to be,” Morales said.

The Impact of Immigration Policies on Families

Wendy Cervantes is vice president of immigration and child rights at First Focus, one of the few children’s advocacy organizations in the country to focus on immigrant families. Cervantes told Rewire that if adults, much like Morales’ mom, struggle mightily with family separation and symptoms of post-traumatic stress disorder (PTSD) resulting from trauma experienced in their countries of origin and exacerbated by navigating the U.S. immigration system, what must it be like for children?

While it’s certainly true that all immigrant families fear family separation, the challenges faced by mixed-status families like Morales’ are unique. “Mixed status” is in reference to a family comprised of people with different citizenship statuses. A parent, for example, may be undocumented, but their children are American citizens or are “DACA-mented.”

A report from Human Impact Partners, Family Unity, Family Health, found that “nationwide, an estimated 4.5 million children who are U.S. citizens by birth live in families where one or more of their parents are undocumented.” And when deportations occur on the scale that they have under the Obama administration, not only do they separate families, but they have overwhelming an effect on the health and well-being of children. Besides being more apt to suffer poverty, diminished access to food and health care, and limited educational opportunities, children suffer from fear and anxiety about the possible detainment or deportation of their family members. This leads to poor health, behavioral, and educational outcomes, and sometimes results in shorter lifespans, according to Family Unity, Family Health.

In 2012, Colorlines reported that about 90,000 undocumented parents of American citizen children were deported each year. The number has declined since then. In 2013, government data showed it was 72,410, but the Department of Homeland Security (DHS) only documents the number of parents with children who are citizens, not cases in which parents with undocumented children are deported.

“If a kid has to go back to a violent country they’ve never been with their deported parent or if they have to stay behind without a parent or go into the child welfare system, none of it is ideal,” Cervantes told Rewire. “The constant fear your parent will be detained or deported has very large consequences on children, who are showing signs of PTSD at younger and younger ages. The immigration system can really take a kid’s childhood away from them.”

Who Will Address Their Trauma?

The American citizen or DACA-mented children of undocumented parents suffer from things like anxiety and depression because of fears their parents will be detained or deported, Cervantes told Rewire. Furthermore, there are well over one million undocumented children in the United States and to her knowledge, there are no services provided for these children to cope with their trauma.

According to the American Psychological Association, “research indicates that unaccompanied refugee minors experience greater risk of mental illness than general populations.” Based on work she’s done with unaccompanied minors from Central America, Cervantes said the levels of PTSD in these children is “on another level,” which is part of the reason why she said she’s so appalled by the administration’s aggressive approach to the Central American asylum-seeking population, which she said is greatly lacking in empathy.

“I’ve met unaccompanied kids who have told me horrendous stories. They witness horrible things on their journey here, but they were also escaping horrible things in their country of origin. An 8-year-old witnessing a girl he knew from his neighborhood getting gang-raped as part of a gang initiation and seeing his best friend getting beheaded by a gang on his way to school,” Cervantes told Rewire. “How many years of serious counseling and professional help would it take for an adult to be OK after seeing such violence? Now consider we’re talking about a child. It’s so disturbing, and then these same kids get placed in facilities that are like jails. How are they expected to function?”

While counseling is offered in detention, those services have been highly criticized by pediatricians, therapists, and advocates as inadequate at best, especially considering that the counselors in the facilities often only speak English. It’s also important to note, Cervantes said, that these services are only offered while the child or parent is detained. Once they’re released, there isn’t a clear federal program that offer assistance to directly address their trauma.

Rather than sitting around and hoping a program will eventually be created, advocates are currently working on gathering a team of psychiatrists to visit detention centers and assess the mental health services offered. Next week, First Focus will also be launching a TV and radio campaign about family separation spanning eight states, using donated airtime valued at $1 million.

Over the years as she’s worked in immigration, Cervantes is routinely surprised by how little most Americans seem to know about how the immigration system actually works and the very real ways things like detainment and deportation rip families apart, traumatizing people of all ages. She told Rewire that she hopes the upcoming campaign humanizes the issue and helps people understand that family separation isn’t a rarity and that it happens in every community in every state.

“I’m actually very disturbed by so much of the immigration process, especially how we treat families who are seeking asylum and who have risked their lives. I have to believe that if Americans came to understand this, they’d be disturbed too,” Cervantes said. “I just wish I knew why we can’t be compassionate to people who really need our compassion.”

UPDATE: This piece has been updated to include new details about the First Focus program, including that the campaign will span eight states, up from three.

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