In an Era of Reform

A Review of Social Work Literature on Intercountry Adoption

Karen Smith Rotabi, Kelley McCreery Bunkers


Intercountry adoption (ICA) is a relatively common practice. Since its contemporary conception during the Second World War, approximately one million children have been adopted internationally. Controversy surrounding ICA includes ideas about human rights and notions of child rescue in the context of major reform to prevent child sales and abduction under the Hague Convention on Intercountry Adoption. Social work, as a discipline, is a central player in ICA practices, and at least, one historian asserts that social work academic literature is scant on the topic of problematic practice and reforms. A review of the social work literature was conducted, and four thematic areas emerged in the 87 manuscripts reviewed: (a) social policy; (b) exploitation, social justice, ethics, and human rights; (c) clinical perspectives to include identity, child development, and family transition; and (d) child welfare practices. Results indicate a small but robust body of social work literature, and highlights are presented as well as analysis indicating methodical trends.

  • cultural studies
  • international migration
  • social structure
  • social work
  • sociology of race and ethnicity

This review of social work’s contribution to the literature on intercountry adoption (ICA) was originally developed for the 2010 Ontario Adoption Summit, which brought together a multidisciplinary group of scholars, practitioners, and other stakeholders to focus on the future of ICA, including the “need to reduce corruption and human trafficking while maximizing the best interests of children who are abandoned or relinquished” (Adoption Summit, n.d.). Each discipline presented on the current state of knowledge, and this literature review was conducted for the social work panel. To give some structure to this literature review, we defer to Masson’s (2001) exploration of ICA and her questioning the practice as a “global problem or global solution?” Masson identifies typologies of value-positions or perspectives on ICA: abolitionists, pragmatists, and promoters.

Applying these perspectives, Rotabi and Gibbons (2009) find that there is diversity across the disciplines actively involved in researching ICA with the majority voicing a pragmatic view (Gibbons & Rotabi, in press). Historian Dubinsky (2010), on examination of adoption ethics and the history of adoption from and within the Americas, asserts, “Professional concerns about adoption practice are voiced in relative obscurity of social work journals” (p. 100). We collate social work contributions on the subject of ICA and reform, indicating a small but strong body of work providing critical discourse about the “concerns” and recommendations for change. We begin with exploration of the concept of the best interests of the child as well as the usage of the term orphan across the broad and multidisciplinary literature to provide a context and illustrate the challenges. Then, we review ICA themes in social work literature.

Beginning With an Important Concept: The Best Interests of the Child Defined

The best interest of the child is one of the four principles of the U.N. Convention on the Rights of the Child (CRC) and, more specifically, is mentioned in Article 21 of the CRC as the paramount consideration when considering ICA (United Nations Convention on the Rights of the Child, 1989; Vité & Boéchat, 2008). It is also mentioned in Articles 1, 4, and 16 of the 1993 Hague Convention on Protection of Children and the Cooperation in Relation to Intercountry Adoption (henceforth referred to as the Hague Convention or simply the HCIA; The Hague Conference on Private International Law, 1993). Therefore, it is an overarching principle in ICA policy and practice. However, as important as this principle is to ICA, interpretation is the problem, as understanding and implementation of this principle are greatly influenced by cultural and contextual factors (Alston, 1994).

The inherent challenges related to defining the best interests of the child principle have been explored by academics of all related professional disciplines. Human rights’ expert Phillip Alston (1994) underscores how the principle acts as a bridge or a mediator between cultural beliefs and children’s rights. Legal scholars especially have called on the best interest of the child principle to support and challenge ICA as an intervention (Bartholet & Smolin, in press; Dillon, 2009; McKinney, 2007; Oreskovic & Maskew, 2009). Social work researchers have asserted that protecting the best interests of children within the ICA must be based on a systems approach to ensure universally implemented ethical and legal child welfare practices (Hollingsworth, 2003, 2008; Howe, 2010; Roby, 2007; Rotabi, 2008; Selinske, Naughton, Flanagan, & Pickles, 2001; Triseliotis, 2000). Currently, we lack a formalized definition of the best interests principle as it relates to ICA—one that is empirically tested and agreed on universally—and it is necessary to truly ensure that safeguards for children and families are in place.

Given that the CRC and the Hague Convention fail to provide precise requirements on what must be considered when determining the best interest of the child in ICA, social work professionals can look toward common values shared by social work, the CRC, and the Hague Convention, including ensuring that domestic care options are explored prior to placement in ICA, preserving information about the child’s history and family of origin, soliciting and taking into account the views of the child, and providing professional services by people who place the child’s well-being at the center of all decisions (The Hague Conference on Private International Law, 2008; Wayne, 2006). Attending to all the facets of a balanced determination of a child’s best interests must be tailored to each child and his or her unique family system’s strengths and needs, including empirical evidence when making social service recommendations and selecting interventions. Zermatten, a leading child rights scholar and the recently elected chairperson of the U.N. CRC, acknowledges the need for more empirical evidence to help better inform decision makers about the best interest principle (Zermatten, 2010). This is, in part, due to the misunderstanding of which children are truly orphaned and which children have intact family and kinship systems in need of support rather than ICA as an intervention.

Defining “Orphan”

One of the troubling trends in the general literature and the practice community is the use, misuse, and even occasional abuse of the term orphan. Recognizing the dangers and potential pitfalls of this term is important if social work as a profession aims to improve ICA services. The term orphan has returned to common lexicon in the past decade with the onset of HIV and AIDS and is especially prevalent in the African context (Roby & Shaw, 2006), as it has become a major priority for international aid agencies (Ennew, 2005). Abebe (2009) points out, in the midst of this prioritization, that the term orphan has become extremely politicized, especially by the donor community and mass media, with orphan being defined by different parties and for different reasons, some of those not always in the best interests of children (Abebe, 2009).

Similar to the best interest of the child principle, the concept of orphan is not necessarily understood by all cultures or by all professions the same way. Orphanhood may be defined by death of one or both birth parents, by age of the child, and even by the reasons for parental death, as is the case of AIDS. There are “double orphans” who have lost both parents to death or some other permanent separation, and there are “single orphans” (Abebe, 2009). This latter group would be called children of single parents in industrialized nations; however, in low-resource countries, they are often counted as orphans, illustrating differences of word usages across cultures and economic contexts.

Defining the child as an orphan is frequently done by people who have a vested interest in the final outcome. For example, by referring to the UNICEF statistic of 143 million orphans globally, proponents of ICA may use this statistic to promote their ICA position or perspective (e.g., Bartholet, 2010; Dillon, 2009), in spite of the fact that this inflated number does not at all reflect the true and much smaller number of children in need of and appropriate for ICA as a final placement option (see Bartholet & Smolin, in press; UNAIDS, UNICEF, & USAID, 2004).

Social orphans are those children who may be living in an institution—placed there by parents or close relatives—as a placement option where proper nutrition and education are consistently accessible and are living in a low-resource nation (Roby & Maskew, in press). This was found to be true for most of the children living in institutions in Haiti at the time of the January 2010 earthquake (Balsari, Lemery, Williams, & Nelson, 2010; Selman, in press). Brazil is another nation with many social orphans living as street children in addition to adolescents living in institutions. Of the latter, sometimes institutions are used as a response to juvenile delinquency (Garcia & Fernandez, 2009). These “orphans” have family systems, some more intact than others, and supporting these family resources in an effort to reunify families and deinstitutionalize children is critically important. In these cases, ICA is most likely not the appropriate solution.

Bailey (2009b) discusses the limited attention paid to the issue of orphans in English social work literature. The scarcity of information available leaves practitioners, policy makers, and academics with a very limited view of the issues facing children and social work practitioners outside the borders of high-resource countries (Bailey, 2009b). This limited information allows for common misinterpretations. Ensuring that a commonly understood and appropriate definition of the term orphan is identified and agreed on by social work professionals is an important step in promoting a better understanding of family group structure and the need for social intervention.

Social Work as a Discipline: A Largely Pragmatic Voice Prevails

Generally speaking, when reviewing social work literature, the majority voice is pragmatic, and this is logical given social work’s long-standing commitment to child welfare policy and practice. Literature addressing the social work role is given attention in this review, and because there is a limited literature from social workers in low-resource nations, whenever possible, that literature is included. Also, literature from underrepresented countries and regions is given additional attention. While we emphasize peer-reviewed literature, however, when appropriate, we occasionally include “gray literature” because they are often written by social workers and child rights advocates in child-sending nations (Banks, 2006; McAuley, Pham, Tugwell & Moher, 2000). These reports are early literature indicating poor practice and adoption fraud. When such reports begin to emerge, they are often treated as rumor without enough “evidence” or research rigor to publish in refereed journals, but later, they are cited historically.

As Bailey (2009b) points out, social work literature in the majority of academic journals has been dominated by the perspectives of North American and Western European scholars. Knowledge about social work practice in low- or middle-income countries or global practice in general is inadequate, and it reminds us of repeated commentaries or even challenges for greater global understanding in the profession (Healy & Link, 2011). Rodgers (2009) calls for social work to tackle the challenge of human rights, ethics, and human responsibilities, including exploration of praxis from multiple perspectives. This is particularly relevant to ICA practice given the transactional nature of child welfare extending across geographic borders and the interface of social care systems—social workers and other disciplines like pediatricians and psychologists collaborating on child placement between low- and high-resource nations.

Identifying Social Work Literature and Themes in ICA

To explore existing literature for this review, standard search engines were used, including Academic Search Complete and PsychINFO. Social work authors who have been particularly active in the field were given special consideration, using Google Scholar Internet searches in addition to a review of curriculum vitaés. Also, journals dedicated to international social work, child welfare, and adoption (e.g., Adoption Quarterly) were searched specifically in addition to using Social Work Abstracts for a discipline-specific search. Literature reviewed spans from the late 1970s until 2010, with the exception of adding manuscripts identified as “in press.” Authors were confirmed to be social workers and when there were multiple authors, it was confirmed that at least one of the contributors was a social worker.

While this is a summary of highlights of social work literature with a theme of ICA reform or having implications for human service improvement and/or reform, it is not absolutely exhaustive. Summarized are the contributions of 87 manuscripts with 70 being peer reviewed. By and large, the earliest social work reform literature dates back to the late 1970s and early 1980s, due to the Vietnam Babylift (Joe, 1978; A. S. Ryan, 1983) and cultural identity questions that were being posed about Korean adoptees (e.g., Kim, 1977). Then the early 1990s marked an era of rapid globalization, which eventually emerges into what we call the era of reform. Romanian adoptions were largely the focus in the earliest stages of literature in the era of globalization with a transition to other nations and application of global social policy, practice, and value dilemmas in the era of reform (e.g., Vonk, Simms, & Nackerud, 1999, on China).

The vast majority of publications had a common theme of (a) social policy; (b) exploitation, social justice, ethics, and human rights; (c) clinical perspectives to include identity, child development, and family transition; and (d) child welfare practices. Although all of these areas overlap, the literature review will be reported in this bounded order. We emphasize literature that discusses the role of the social worker in orphan and vulnerable child care and/or ICA practices. Also, literature that is particularly important conceptually and/or should be noted due to empirical rigor also receives greater attention.

Social Policy

Social policy analysis and discussion are prominent in much of the social work literature with examples and/or case studies that are often presented to underscore issues (e.g., Altstein & Simon, 1991). For example, A. S. Ryan (1983), a social work practitioner who was involved in early ICA work, including the Vietnam Babylift, wrote about child rescue efforts. As a promoter, Ryan states that “when increasing numbers of children are confined to refugee camps . . . in many cases intercountry adoption is their best hope for a chance in life, and for life itself” (p. 49). Her discussion concludes with 10 recommendations, including not only government funding for research but also the need for an “international coordinating agency which could set standards for intercountry adoption” (p. 58) in addition to the need for home study authority in the placement state as well as the general development of good policy.

Ten years later, the 1993 Hague Convention was developed and set forth requirements for governance at a central authority level, thereby meeting Ryan’s (1983) suggestion of a coordination approach. Today more than 80 nations are party to the agreement set forth to promote the best interests of the child and prevent child sales, abduction, and child trafficking while providing a framework for ethical adoption and interstate cooperation (The Hague Conference on Private International Law, 1993, 2008). This international agreement has been discussed by Bailey (2009a), Freundlich (2000), Hollingsworth (2003, 2008), Howe (2010), Roby (2007), Rotabi (2008), Rotabi and Gibbons (in press), Triseliotis (2000), and others as they consider issues of commodification of children and social work concerns ranging from social justice to policy and practice at the agency level. A watershed moment for signature countries, the agreement requires that nations meet international child welfare standards not just for ICA as a single practice area but also to provide a range of care and family support that should occur prior to any ratifying nation’s approval of a child for ICA. This continuum of child welfare placement options is based on the subsidiarity principle of the HCIA, which is that biological families should first be supported before alternative care becomes a plan for children. Then, if necessary, children have a right to be placed within a family system (e.g., kinship care/guardianship) and when possible, remain in their country of origin. Once kinship and other appropriate local care approaches are explored, including foster care and/or domestic adoption, then the child or sibling group may be deemed appropriate for consideration of placement into ICA (Rotabi, 2008). Moreover, although social work scholars have long considered the best interests of children and the continuum of child welfare intervention, including adoption, currently there is a lack of empirical literature on the subject as it relates to ICA. This is especially true in regards to the subsidiarity principle of the HCIA and the care practices of orphaned and vulnerable children (Abebe, 2009), specifically interventions that honor subsidiarity rather than fast-tracking desirable children into ICA (Rotabi & Gibbons, in press).

Bergquist’s (2009, in press) policy analysis of the HCIA focuses on its application to disaster and war. Reviewing the history of the Vietnam Babylift and child abduction attempts elsewhere, Bergquist makes important points about the removal of children in the context of emergency and war, including contemporary discourse on child “rescue.” An important consideration is child status either being “orphans” or “refugees.” Bergquist recognizes the HCIA as an important step forward but ultimately concludes that it is inadequate in the context of war and disaster.

This analytical thread of limited HCIA guidance is carried on in the case of disaster by Rotabi and Bergquist (2010), focusing on a U.S. based faith group’s attempt to abduct children for adoption in the aftermath of the 2010 earthquake in Haiti. In this case, the crime and then the lack of will to ultimately prosecute the individuals involved with attempted child trafficking for adoption were explored. This reality underscores, in real terms, the limited consequences for child abduction for adoption. In the case of Haiti, the HCIA did not apply because Haiti was not a party to the agreement at that time. As a result, the capacity to prosecute for human trafficking was ultimately inadequate under legal codes (see Bromfield & Rotabi, in press).

Rotabi and Bergquist (2010) explore the best interests of the child, the differences of opinion, and the ethical dilemmas that arise when making broad generalizations about orphans and extreme poverty, especially when ICA is promoted as a dominant child welfare intervention. ICA in Guatemala became the epicenter of this debate, and there has been a small body of research on the postconflict context and child welfare system of this particularly significant sending nation from 1999 to 2008.

Bunkers, Groza, and Lauer (2009) and Bunkers and Groza (in press) present a historical and policy analysis of Guatemala’s ICA trends, illustrating how the practice became a multimillion-dollar industry. These authors argue that ICA and the financial pressures ultimately undermined the Guatemalan State’s interest in developing a domestic child welfare system and rather relied on ICA as the main response. This supplanted child welfare efforts across a continuum of care ultimately yielding to ICA because of the powerful financial influences at all levels of the system. Among their observations were birth mother payments. The authors asserted that this form of child sales became routine within Guatemalan adoption practices. Gresham, Nackerud, and Risler (2004) also considered this issue and captured the worrisome human rights violations that were documented by the United Nations Economic and Social Council Commission on Human Rights (2000). An important gray report developed by a large group of human rights defenders, lawyers, and social workers titled “Adoptions in Guatemala: Protection or Business?” (Alianza et al., 2007) identified a clear market dynamic with at least 90% of the children departing Guatemala being ages 0 to 2 years and mainly bound to the United States. In an effort to assess the context and problems of Guatemalan adoptions within an ecological perspective, Rotabi, Morris, and Weil (2008) present postconflict social indicators with observations about the role of social workers engaged in a nation notorious for extreme violence against women, including child abduction (Rotabi, 2009). These authors also pose questions about the conception of “client” and the professional role of social workers and others representing the interests of international adoption agencies— frequently distorting the realities of orphaned and vulnerable children to serve the private adoption model. Changes in the Guatemalan system and radical decline in ICA (Bunkers & Groza, in press; Rotabi & Bunkers, 2008) have resulted in shifts to other nations, most notably Ethiopia (Selman, 2009).

Bunkers, Rotabi, and Mezmur (in press) focus on emerging concerns and problems in Ethiopia, including legal codes and processes that undermine the best interests of the child. This includes Ethiopia’s failure to sign and accede to the HCIA thus far, leaving the nation vulnerable to unscrupulous entrepreneurs who are not bound by international standards—it is feared that some of the most unethical adoption agencies have shifted from Guatemala to Ethiopia as a new frontier. Some of the troubling activities include adoptive-birth family visits in villages and gift exchanges (Rotabi, 2010), intersecting with traditional child care models. This includes Gudifecha, a centuries-old practice in which family and kin arrange informal adoption for orphaned and vulnerable children (Bunkers et al., in press).

Including Ethiopia as a significant country of origin, Butterfield and Alemu (2006) as well as Roby and Shaw (2006) explore some of the issues and opportunities of child adoption in their analysis of the larger African region. In this latter analysis, the authors bring the ICA discourse back to local concerns for adoption of African American children from the public child welfare system in the United States, thereby highlighting some of the challenges and contradictions of ICA. Finally, it should be noted that limited information and analysis are also found in the gray literature specifically addressing adoption trends and concerns in the African continent as a whole (United Nations, 2009). However, this is likely to change given the increasing focus on and practice of adoption in this region.

Other countries have contributed significantly to ICA, most notably China. British authors Dowling and Brown (2009) discuss ICA changes in China in the context of globalization such as the shift toward special needs children, also briefly discussing the nation’s efforts toward domestic foster care and adoption. From China itself, Meng and Kai (2009) present a historical perspective, including differing definitions of “orphan” and the one-child policy, children orphaned by AIDS, and children socially orphaned due to parental imprisonment. While noting a huge discrepancy between China’s official government estimates of 573,000 orphans and UNICEF’s estimates of 21 million children, authors integrate economic realities, including a discussion of privileged versus marginalized groups. These authors mention ICA briefly as an intervention, but ultimately, their focal point is different domestic care models, including orphanages, foster care, and kinship care. New and emerging roles of social workers are discussed with the challenges related to the projected increase in children orphaned by HIV/AIDS.

African scholar Maundeni (2009) outlines the definition of “orphans” and their care in Botswana, also considering children orphaned by HIV/AIDS and challenges for social workers. Poverty-reduction programs, social development issues, and a brief discussion of the laws that govern the practice of child care are presented. The subject of child rights frames the discussion, including different forms of assistance to children and their families without any mention of ICA. The author observes that social workers are overwhelmed partly because of inadequate training, specifically in child welfare, as well as their daily function of serving multiple villages in a community development approach. The capacity to care for the needs of individual children or to focus on family support of specific or at-risk families is lacking in this mode of intervention. The importance of kinship care in this traditional society is discussed, and Maundeni points out that 95% of orphans are absorbed in such structures within communities—without social service intervention. Kinship care problems are outlined, such as the separation of orphan siblings across the kin-group for economic reasons or a lack of self-determination on the part of some children for their own care planning. Formalized interventions include fostering and adoption, and these forms of alternative care are found in the Botswana 2008 legal code, but the state has not yet implemented these programs. The family-care approach to institutional care, with house parents, is used in small-scale programs. The author points out that these homes are not like stereotypical inhumane institutions, as this smaller scale approach enables tailored care to address the unique needs of children.

From the Australian perspective, Fronek (2006) offers a theoretical framework for understanding the “emergence, diffusion, and continuance of South Korean intercountry adoption” (p. 22), which is largely based on policy and the global context of both the sending country (South Korea) and receiving countries. Drawing on previous literature on the subject, cited is Sarri, Baik, and Bombyk’s (1998) important observation that South Korea has experienced goal displacement because of the nation’s failure to establish adequate adoption services on a domestic level and deferring to ICA as the intervention of choice for orphaned and vulnerable children. However, Fronek points to inadequate domestic adoption systems as only one factor in the ICA equation in the Asian nation that has been a relatively active country of origin, although declining in recent history. Applying the Actor Network Theory, Fronek develops a framework capturing the complexity of ICA with multiple interactions in the context of globalization. More recently, Fronek and Tilse (2010) carry forth this earlier research into an Australian–Korean case study, exploring the complexities of policy and international practice between two country systems, including a discussion of the use of the Internet in ICA.

From the United States, Roby and Matsumura’s (2002) research provides some insight into historical problems and birth mother issues in another Pacific nation, the Marshall Islands. From interviews with 73 birth mothers in 2001, it was learned that most of the mothers had other children. The reasons for relinquishment were found to be financial, specifically no means of support to care for the child. Also, when the role of grandmothers was explored, it was found that they were often helping with child care, and ultimately, they were a part of the pressure for birth mother relinquishment. Also, in a high birthrate community where abortion was not a legal option for unwanted pregnancy, the problems were further complicated by the fact that temporary child care assistance or services were not available as a government service. Roby and Matsumura also make important observations about cultural ideas related to the continuity of the parent–child relationship and that the conception of adoption does not terminate the relationship. Informal care in the Marshall Islands existed to meet the needs of orphaned and vulnerable children within the extended family and kin group. Authors found that the child was viewed as a link or bridge between two families, or a child could be given as a gift to the new family. In turn, this would provide for and help the birth family and kinship group of the child, a particularly complicated ethical dilemma when this concept is applied to ICA.

In Roby, Wyatt, and Pettys’ (2005) follow-up with a survey research study of open adoptions surveying U.S. families who have adopted from the Marshall Islands, results include motivations to adopt, willingness for openness, and insights gained from their experiences. The results suggest that those surveyed embraced openness but recognized that contact with birth parents is difficult.

Roby and Maskew (in press) present a timely analysis and discussion of child welfare and adoption systems reform in the Marshall Islands as well as Cambodia. Applying the human rights perspective, a historical overview of the development of regulatory controls is useful when considering early stages of reform. This particular analysis further captures the nature of small and impoverished nations and their adoption transactions with far more powerful nations, particularly the United States and Western Europe. Also responding to the need for innovative interventions to support families, Rotabi, Pennell, Roby, and Bunkers (in press) consider Family Group Conferencing (FGC) as a culturally adaptable intervention that has been codified into Marshall Islands law and suggest its application in Guatemala. This particular contribution to the literature exemplifies bridging from social policy analysis to social intervention.

British scholar Dickens (2009), a social policy and child welfare expert, lays out a framework of three ideological and policy approaches of social services and ICA in receiving nations: (a) liberal or neoliberal, (b) conservative corporatist, and (c) social democratic, which he aligns to political philosophies of libertarianism, utilitarianism, and egalitarianism, respectively. The first approach is exemplified by the United States and its private ICA system that has a service for a purchase system within a free-market approach. In this system, the state takes a minimal role in regulation and protection of the most vulnerable.

In keeping with the market-place ideology, there is an emphasis on choice: prospective adopters and birth parent(s) would be free to choose which agency to use, and even to select one another. This leads to a highly competitive market for healthy babies, exemplified by on-line profiles of prospective adopters (effectively advertisements) hoping that a birth parent will choose them. (Dickens, 2009, pp. 597-598)

This leads to inevitable problems and market dynamics in the private U.S. system and has been discussed by a number of social work scholars (e.g., Carstens & Juliá, 1995; Freundlich, 2000, 1998).

In this same discourse about social policy and underlying values, Dickens (1999), who worked for more than 3 years in Romania (Gibbons & Rotabi, in press), presents a case example with historical analysis of the self-imposed moratorium that was a result of multiple factors, including adoption fraud and issues of goal displacement (Sarri et al., 1998) as well as the nation’s entry into the European Union (EU). This particular discourse is important as it highlights the contextual and political nature of ICA policy, illustrating underlying values as well as how international pressure from the EU affected country-specific child care policy, particularly an ICA moratorium.

Dickens (1999) also writes about the emergence of social workers in Romania and some of the challenges, especially in a child welfare system that still heavily relied on both institutional care and ICA. Social workers were often drawn to determine ICA as an appropriate care option because providing family support work and keeping children in their biological families were not valued or prioritized, especially because it frequently involved working closely with the Roma population, which was seen as degrading (Dickens, 1999). Therefore, Dickens argues that social workers could focus on ICA as a way to avoid the discomfort or “low level” work that typifies family support work (Dickens, 1999). Referring a child to be adopted by a foreign family was a task that was clearly defined and easy, and the social worker could feel good about it. In some cases, the social worker could also receive some kind of financial inducement for the referral in a country where the average social worker’s salary was approximately US$55 to US$100 per month at the time. Dickens (2009) shows how this was an understandable choice for the individual social workers involved but was also the “wider result in the weakening of domestic services” (p. 601). Eventually, social workers became more recognized in the child welfare system, and as other alternative means of care such as foster care and domestic adoption became stronger, the legal framework changed to prioritize domestic care options, resulting in social work practice that is more focused on family support and other care options within the continuum. More recently, Nedelcu and Groza (in press) explore the history of ICA and reform in Romania, shedding light on the significant gains in domestic adoptions and other forms of alternative care, such as foster care, in that nation. In sum, the literature focused on Romania provides invaluable insight on legal reform, institutions, foster care, and ICA dating back to the earliest days of concern (Johnson, Edwards, & Puwak, 1993) to later literature that captures changes across a social development continuum.

Focusing on outside social work influence including their own, Dickens and Groza’s (2004) historical review of child “rescue” in Romania poses important considerations for practice and empowerment. These authors present four “shortcomings” and “difficulties” (p. 471) in the response to the orphan crisis in that nation dating back to the early 1990s, as follows: (a) a lack of coordination of voluntary and international aid “helping” activities with Romanian authorities; (b) displacement of Romanian child care/institutional workers with programming developed by outsiders and staffed with volunteers—often passing critical judgment on the Romanian women who had dedicated their careers to working in the institutions; (c) a failure of international organizations to recognize that institutions actually “magnified the general poverty of their local communities” (p. 472), and the problem of Romanian staff becoming resentful of resource donation to “orphans” when their own children and families were without basic necessities (which reportedly led to staff theft of medicines and other donated supplies); and (d) limited training of Romanian institutional staff—much of which was targeted to bilingual staff and ultimately created tensions and an inadequate sustainability plan. These problems contributed to the collapse of the child welfare system, and with changes in the government and EU intervention, new laws were developed—including profoster care legislation for deinstitutionalization of children. This reflective piece is a summary of experiences that considers challenges and ethical issues of power and change with outsider or “expert” influence, concluding with “What is to be the proper place of international agencies, in particular those involved in inter-country adoption; and what are the respective roles and responsibilities of central and local government?” (p. 485).

Exploitation, Ethics, Social Justice, and Human Rights

Altstein and Simon’s (1991) contributions to discourse in social work about adoption practices and ethics were particularly important to beginning critical thinking from multiple and global perspectives. Herrmann and Kasper (1992) sound one of the earliest and most alarming warnings in social work peer review literature about the imbalance of power between sending and receiving nations, focusing on the exploitation of women and families in impoverished environments. Also, in early discourse about morality and ethics, Ngabonziza (1991) of International Social Service observes that ICA

has developed because of modern means of communication, it is north-south and west-east oriented and between rich and poor countries; provides children from a surplus to a deficit area; in many instances functions like a market and according to the laws of a market; and takes place between members of an advanced and well organized society with plenty of social and legal institutions on the one hand and, on the other, ad hoc institutions and or isolated individuals such as lawyers, magistrates, social workers, who act as intermediaries, often motivated only by the gain. (p. 100)

In Ngabonziza’s (1991) discussion of global context, cultural points are considered such as Islamic Shari’ah law that does not recognize adoption and only allows for guardianship (called Kefala)—a form of kinship care that is essentially absent in social work research and literature (an exception is Jaffe, 1991). Ngabonziza discusses “unbearable pressure from adoptive parents and agencies” (p. 78), “child trafficking” (p. 80), and a “lack of social work tradition” (p. 79) in countries of origin. Combining the multiple underlying problems of countries of origin, Ngabonziza uses an admonishing voice of a true abolitionist when he concludes

Given the magnitude of problems facing relinquishing countries, intercountry adoption, even properly conducted, is meaningless. It presents an idealized life for small numbers of children as an alternative for global policy. This is a duty for international cooperation and cannot be solved by intercountry adoption. (p. 80)

From the United States, Hollingsworth (2003) writes about the inherent social justice and exploitation issues, presenting six distinct areas of concern:

(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. (p. 211)

Hollingsworth’s (2003) view of ICA appears abolitionist in approach; however, she pragmatically presents alternative perspectives and acknowledges that ICA is not bad or exploitative for all children and biological families. Also, Hollingsworth notes that there is an alternative view of ICA as an act of social justice itself—saving a child from extreme poverty and life in an institution. It should be noted that this view is shared by many who are promoters of ICA as a social intervention and as promoters of the practice. Hollingsworth (2008) again pragmatically follows up on these ideas in a later commentary on the HCIA and its implications for cultural identity, posing critical questions about just how protective the agreement can be for this important human rights consideration.

From Britain, Triseliotis (2000), a prolific contributor to adoption literature in general, challenges the conceptions of ICA as a humanitarian good with his discussion titled “Intercountry Adoption: Global Trade or Global Gift?” Exploring the problematic dimensions of ICA, he ultimately offers pragmatic and regulatory recommendations about how to “achieve greater legitimacy” (p. 45). Following are five ways in which illegitimacy is manifested:

(1) a disregard for children’s rights as set forth in the UN Convention; (2) the absence of legality; (3) lack of choice for birth parents; (4) disregard of empirically based knowledge of what is known to be the best for children; and (5) absence of an ethical base. (Triseliotis, 2000, p. 45)

Triseliotis (2000) states that, in this period of the late 1990s, ICA is often carried out

in the interests of adults . . . and the trafficking in children that is a characteristic part of it, has set back the clock for the rights of children and has been a bad precedent for countries still struggling to develop child-centered legislation. (p. 49)

Triseliotis (2000) identifies three ways in which ICA can achieve legitimacy: (a) a rights-based approach to children, (b) full international regulation, and (c) the practice of adoption as a global gift. Regulatory controls such as the removal of financial incentives are discussed, and in conclusion Triseliotis critiques the HCIA as it “seems to have had little impact . . . in stemming the trafficking in children . . . because its articles are insufficient or weak or both” (p. 53).

Turning to the idea of an “ethical base” of practice as discussed by Triseliotis (2000), one cannot begin a discussion about adoption ethics and social work without consideration of Madeleine Freundlich’s important and seminal contributions, including conceptions of supply and demand, beneficence, and self-determination (Freundlich, 1998, 2000; Freundlich & Phillips, 2000). In the Year 2000, Freundlich’s book Adoption and Ethics: The Market Forces in Adoption was the most comprehensive social work summary of the issues at hand, making a multidimensional analysis of the supply and demand market model—posing critical questions about rights and responsibilities.

Drawing on ethics and human rights, including Freundlich’s contributions, Roby and White’s (2010) call for regulation of adoption activities on the Internet, highlighting examples of adoption fraud and technology applied to domestic and foreign adoptions. This is an important contribution as it highlights the use of technology for global transactions in the ICA equation, including use of the Internet as a medium for marketing of services and children, some of which crosses the line into unethical and fraudulent practices.

Roby is a prolific contributor to the literature as it relates to legal issues, ethics, and applied knowledge for reform. Her 2007 article “From Rhetoric to Best Practice: Children’s Rights in Intercountry Adoption” pulls together many concepts in this critically important analysis of the human rights dimensions of ICA, providing a holistic overview of the continuum of rights with ICA as an important intervention. This includes conceptions of rights prior to adoption such as the right to a determination of adoptability and a child’s right to be placed with a family that has received appropriate preplacement training and preparation. Also, full family membership is presented as an adoptee’s right of social acceptance in addition to the rights of access to birth and identity records. Importantly, Roby also discusses the child’s right not to become a commodity while being mindful of conditions of poverty and birth family rights, including adoption into the extended family and/or nonrelative adoption within the nation. Roby’s analysis is consistent with the Hague Convention and concepts of the best interests of the child. This discourse is continued in Roby and Ife’s (2009) consideration of human rights and reform and their presentation of a bottom-up approach to change that includes birth family input.

Perspectives on Identity Formation, Family Transition, and Child Development

Social work has made considerable contributions to research about adoptees, identity, and race (Simon & Altstein, 2001; Simon & Roorda, 2000). Important investigations include identity development of Korean adoptees and family life (e.g., Bergquist, 2004; Bergquist, Campbell, & Unrau, 2003; Bergquist, Vonk, Kim, & Feit, 2007; Kim, 1977; McGinnis, in press; Yoon, 2004), including the rarely researched topic of openness in ICA (Hayes & Kim, 2007). Also, there are important research results in the literature related to child transition from country of origin to the new adopted home and child development, including the institutional experience, especially in Romania (e.g., Gavrilovici & Groza, 2007; Groza, 1999; Pearlmutter, Ryan, Johnson, & Groza, 2008; S. D. Ryan & Groza, 2004). Transracial socialization and cultural competence have also received consideration (e.g., Crolley-Simic & Vonk, 2008; Vonk, 2001; Vonk & Angaran, 2001; Vonk & Massatti, 2008), including the testing of instruments for transracial adoption parenting (Massatti, Vonk, & Gregoire, 2004) and ethnic socialization of adoptees (Mohanty, 2010). Later, adult adaptation of adoptees has also been explored (Altstein et al., 1994), and adoptive parental perceptions and satisfaction have been investigated (Bergquist et al., 2003; Paulsen & Merighi, 2009). Reviewing the available literature provides an interesting look into the way that research and recommendations of social workers have evolved as ICA became more prominent. It is impossible to truly give a full overview of all the social work literature in this particularly robust area; however, the selected highlights focused on reform are provided within the following subthemes of cultural identity and child development concerns and caregiving strategies.

Cultural identity

Westhues and Cohen (1998) explore trends in Canada and how changing attitudes have affected adoption-related policy. The authors use ICA as a way to explore the challenges of promoting a national-level policy of multiculturalism and the balance required for accepting the ethnicity and culture of the adopted child while recognizing and respecting the nonminority racial members of the family and community as well. Carstens and Juliá (2000) expand on the importance of adoptive families having an awareness of and sensitivity to the child’s country and culture of origin. Research highlighted that U.S. adoptive families who visited the child’s country of origin prior to the adoption demonstrated ethno-racial awareness that was positively correlated with the adopted child’s sense of security and ethno-cultural awareness. The authors strongly recommend that U.S. adoption agencies should “encourage, support and facilitate a visit to the adoptee’s country of origin” as a means of promoting an ethno-racial awareness of the child’s birth country by members of the adoptive family as well as “encouraging strong ethnic identity formation in adopted children” (Carstens & Juliá, 2000, p. 71). This recommendation is also promoted in Hollingsworth’s (2008) exploration of the HCIA and issues of cultural identity. Social workers involved in adoption work are encouraged to share information, research, and interventions related to cultural identity in an effort to support and promote knowledge about identity development among adoptive parents (Hollingsworth, 2008).

Child development concerns and caregiving strategies

A great deal of social work literature highlighting child development concerns in ICA (e.g., attachment issues) has focused primarily on children being placed into ICA from Romania. The severity of institutional care the majority of Romanian children experienced pre-ICA provided fertile ground for exploring lasting effects of institutionalization. Several studies explore the link between parent–child relationship satisfaction and consistent predictors of child emotional and behavioral strength (Pearlmutter et al., 2008).

Roberson (2006) in her literature review on attachment and caregiving behavior systems in ICA explores what kind of caregiver strategies supported successful adjustment of the adopted child into the family and encouraged secure attachment. Issues related to institutional care prior to placement are explored, and several longitudinal studies on the effect of this type of care on long-term social and health issues are identified (Roberson, 2006). Responsive and flexible parenting is related to attachment security. Roberson recommends that the identification of and knowledge about key protective factors are important for social workers practicing ICA.

This strengths-based perspective is consistently found in Groza’s scholarship, a prolific body of ICA research. For example, Groza and colleagues (Pearlmutter et al., 2008) found that the relationship that adoptive children have with their adoptive parents is the greatest key to understanding parental perception of the current level of executive functioning. The ability to identify these potential strengths in the adoptive family as well as to prepare and support parents regarding their own expectations of the adopted child is an essential trait for social workers to have (Groza, Ryan & Nelson, 2008; Pearlmutter et al., 2008). Cross-national research on Romanian adoptees, explored by S. D. Ryan and Groza (2004), found that although children being placed from institutional care might be traumatized and suffer noticeable developmental and cognitive delays, the strength of the parent–child relationship can positively alter these effects (S. D. Ryan & Groza, 2004). Providing information, helping parents develop strategies to manage and decrease behavior issues or problem areas, and recognizing unrealistic expectations are issues that social workers must address in the home study and preparation phases of adoption. This kind of support and acknowledgment of potential issues in the adoptive placement will help support positive attachment, development, and cognitive outcomes for children (Roberson, 2006; Welsh, Viana, Petrill, & Mathias, 2007). It should be noted that this research is a continuation of Groza’s earlier work in Romania, which found care in institutions to be harmful to children’s development across multiple domains (Groza, 1999).

S. D. Ryan and Groza’s (2004) comparison of adoptees in the United States and Romania is an important study. This large sample of 298 adoptive families incorporated standardized measures including questions about parent–child relationship and child behaviors. Child’s impact on the family was not statistically different between the two groups, and the majority of the families in both countries indicated the child’s addition to be positive. Other findings include the U.S. families having significantly lower levels of trust with their child than was reported by Romanian families. Overall, parent–child satisfaction had similar findings with Romanian families being more satisfied with their relationships. Other findings shed light on the parent–child experience as it relates to their preplacement history, including time spent in hospitals and institutions. In sum, this study not only has important results but it also was constructed holistically with two different cultural contexts. Its design is, in and of itself, an act of social justice, as adoptive families in Romania are considered and even valued as placement options for orphaned and vulnerable children.

Child Welfare Practice

Responding to issues of culture, identity, and family adjustment, U.S. scholar Bailey (2006) pragmatically identifies social workers as critical resources in minimizing the risk of children losing their ethnic heritage in the ICA transition. A practice model is presented to protect ethnic identity while facilitating family formation grounded in the Social Identity Theory. Bailey’s model “promotes assessment of parents’ cultural understanding, education of children’s identity needs, and provision of resources and support for their education of the child’s birth culture” (p. 7). She identifies four principles: (a) knowledgeable and culturally competent adoption agency staff who (b) consistently deliver culturally competent adoption services, and provide (c) support for parents as “cultural vanguards for their internationally adopted children” (p. 7) in an (d) ethical manner that promotes the best interests of the child.

British and U.S. authors Selinske et al. (2001) shed some light on home study practices and the best interests of the child in their analysis. They present case studies that serve as examples of adoption disruptions and dissolutions in which home studies were prepared by a U.K. based individual who claimed social work training and then later was found to be operating as an independent provider without appropriate social work credentials. Because a U.S. citizen infant was inappropriately placed with a British family that resulted in adoption disruption/dissolution ending with repatriation of the infant back to the United States, this case example is provocative. Ultimately, home study policy changes resulted and the U.K. government banned independent contractor assessments, and instead, local social service authorities (where the family resides) are now responsible for home studies. Removing private provider recommendations from the ICA process addresses issues of pay-for-service/private adoption assessments.

In a more recent analysis of home study regulation, Crea (2009, in press) explores the application of the HCIA to home study consistency in the United States. Crea identifies problems of the past (e.g., notorious Russian cases) to illustrate the need for greater oversight of home studies. Reporting on the variability in home study assessment practices, the Structured Analysis Family Evaluation is presented as a promising “means of standardizing the quality of assessments” (p. 675). A high degree of practitioner satisfaction is reported, as identified in previous studies (Crea, Barth, & Chintapalli, 2007).

Turning to practices in countries of origin, Schmidt (2009), based in the Czech Republic, discusses orphan care in Russia, which has historically been one of the most frequent countries of origin of children for ICA in the world (Rotabi & Heine, 2010). This author does not posit ICA as a social intervention while focusing on deinstitutionalization. Schmidt outlines three critical child welfare tasks: (a) prevention of orphanhood through support mechanisms targeting biological families, (b) development of family placement or kinship care, and (c) “humanization of institutions,” which she defines as providing dignified care and child rights–based care while destigmatizing institutionalized children. An important discussion concerns research on Russian views of adopting children from institutions, including a desire for young children and barriers in the decision to actually adopt. Schmidt concludes with a discussion about the role of social workers whom she identifies as key actors in child rights, empowerment practices, and social planning for family support and transformation of child welfare systems in general.

Another important research manuscript focused on practice in sending nations, written by Gibbons, Wilson, and Schnell (2009), and on foster parents in the prereform Guatemalan adoption system. This qualitative research study in which Guatemalan foster mothers were interviewed found that these intermediate families, bridging the time span between child relinquishment and ICA with family-based care, were “critical links” in the adoption process from that particular nation. Findings help us better understand the role or work of foster families in the child development outcomes of the Guatemalan adoptees who benefited from this private care strategy during the height of the ICA years in that nation. Other findings in this study included the report by foster mothers that poverty was the main reason for birth mother relinquishment. This study is an exemplar of interdisciplinary collaboration between two psychologists and a social worker.

Methodological Approaches Employed by Social Work

The majority of social work manuscripts on the subject of ICA were highly conceptual, and analysis was most frequently focused on policy or included policy implications. Case study analyses are presented (e.g., Fronek & Tilse, 2010), and experiences in the ICA process were frequently measured with qualitative methods (e.g., Bailey, 2009a; Crolley-Simic & Vonk, 2008; Roby & Matsumura, 2002; and Gibbons et al., 2009, use of interviews), with some exceptions such as Bergquist et al. (2003). This is not particularly surprising given research ethics and the need for deep exploration of meaning with vulnerable populations, especially with international contexts and cross-cultural research. The exception to this was research in child development and institutionalization, identity formation and adjustment of adoptees, and adoptive parenting (e.g., Groza, 1999; Pearlmutter et al., 2008; S. D. Ryan & Groza, 2004) in which quantitative research incorporated larger data sets and standardized measures in addition to development of scales for measurement (Massatti et al., 2004; Mohanty, 2010).


In the 1990s and into the turn of the millennium, an era of rapid globalization and an expanding adoption market emerged by the Year 2000, and by 2004, there were as many as 45,000 children being adopted annually on a global basis. By 2011, there was at least a 50% decline in ICA placements compared with the peak 2004 numbers (Selman, 2009, in press), and an era of reform emerged as a result of regulation under the Hague Convention and other factors previously discussed.

ICA is an excellent example of the transactional model of social work practice and the global nature of human experiences. It involves multiple dimensions and interactions of human ecology, including social policy, fertility, and access to health care, such as contraception, and human rights, including rights of women, children, and families (Hollingsworth, 2003). Also, economic opportunities on both sides of the equation, including privilege versus poverty, are critical as are other social and environmental problems such as war, natural disaster, and health epidemics such as HIV/AIDS in the context of globalization. Overlying social justice, human rights, and social work ethics, the debates about how to proceed in a conscientious manner, personally and politically (Vonk et al., 1999), are multidimensional and endless. This is especially true when considering the conditions and cultures of each sending nation on a case-by-case basis. Preeminent ethicist Peter Singer (2002) points out that “leaders of smaller nations must . . . consider, in contexts like global warming, trade pacts, foreign aid, and the treatment of refugees, to what extent they are prepared to consider the interests of ‘outsiders’” and “the value of the life of an innocent human being does not vary according to nationality” (p. 4). However, and unfortunately, the industry of ICA has pushed the margins of this idea of human life “value” and, in some cases, taken advantage of vulnerable families and crossed the line into human trafficking under the guise of humanitarianism and ICA (Rotabi & Gibbons, in press).

As ICA has been a highly unregulated and a multimillion-, if not billion, dollar industry over the past 50 to 60 years (Freundlich, 1998, 2000; Riben, 2007), it is in our position that a new dawn has come in the era of globalization (Lyons, 2006) and requirements of the HCIA. Social work has a great deal of insight to offer to prevent commodification of children not just philosophically but also practically with a craftsman’s knowledge of child welfare, social justice, human rights, social policy, and agency administrative practices in combination with the capacity to approach ICA problems with empirical rigor and a commitment to the ethical principle of self-determination and professional competence (Bromfield & Rotabi, in press; Freundlich, 2000; Roby & Maskew, in press; Roby & Matsumura, 2002; Rotabi & Bergquist, 2010; Rotabi & Gibbons, in press).

While we have presented a largely pragmatic position of social workers, it should be noted that British social work scholar Dickens (2009), who has made significant contributions to ICA literature, takes a radical position, challenging the status quo:

The overall message is that even though ICA may offer immediate benefits for some children, it is essential to end it in the longer-term interests of all children. Given the demand for ICA and the challenges faced by families and governments in sending countries, it would be unrealistic to expect a ban by itself to yield instant, unequivocal results. Rather, ending ICA should be seen as a necessary but not sufficient condition for a more equitable globalization for children and families around the world. (p. 605)

This position, in addition to the radical decline in ICA (Selman, 2009), places further urgency on the need for policy and practice research. Fronek and Cuthbert (2011) suggest an alternative paradigm, using a public health prevention perspective, viewing children as “at risk” rather than “available” for ICA (p. 6). Changing notions about ICA does require new lenses and an orientation toward biological family support as we consider the socioecological factors underlying adoption, including structural and gender inequality (Fronek & Cuthbert, 2011; Hollingsworth, 2003).

As authors, we agree with Fronek and Cuthbert’s (2011) and Roby’s (2007) holistic approach as well as Triseliotis (2000) who asserts that decisions about the best interests of children are being made without adequate empirical evidence. Over a decade ago, he called for rigorous monitoring and evaluation of projects related to ICA, and this recommendation continues to stand true today. This is ultimately a call to action for social work researchers who are committed to meeting standards of rigor and inquiry about interventions across the continuum of child welfare and family support, especially in low-resource countries that are typically countries of origin for children being placed into ICA.

In this literature review, it became obvious that the main thrust of research on ICA focused on the child only after adoptive family placement in industrialized nations (see Welsh et al., 2007). This view is limited and even underscores a social justice dimension in the kinds of research questions being posed. It may be said that international adoptees are one of the most overresearched small groups in the world, and conclusions about developmental gains in family context postinstitutional care are not particularly surprising. While the evidence about attachment disorders and other problems related to institutional experiences has been important, much of this research ultimately ignores millions of children left behind in institutions, on the streets of urban centers, or in fragile circumstances with older adults or child-headed households as is frequent in Africa due to HIV/AIDS (Zimmer & Dayton, 2005). In addition, important elements of the child’s entire life, which most likely were of great significance in the overall development and related outcomes of the child, are often treated superficially. We recommend that research provide a more holistic view of the child. This means more research needs to focus on children in their countries of origin, which requires international research collaboration and strengthening schools of social work and other social sciences in countries of origin to develop the capacity of researchers outside of North America and Western Europe. Strengthening capacity at this level is not only right for many reasons, but it will make possible research prior to child placement in ICA.

Related to this, the literature review identified a significant lack of social work literature on birth families, especially for ICA, which has led Wiley and Baden (2005) to acknowledge that birth mothers are “permanently invisible and silent” (p. 14) with some exceptions (e.g., Roby & Matsumura, 2002). This is also true about institutional child caregivers and foster parents and their perspective on alternative care of children, the continuum that may lead to ICA, as they are not heard as key informants in the literature. Also, those social workers who have engaged in ICA in sending nations, such as Russian or Chinese nationals, are also silent. They undoubtedly have important insight.

As supporting birth families/kinship and domestic adoption is critically important, we are left with some important questions. For kinship groups, especially in traditional societies, how may they be supported to retain guardianship of children so that the children may be afforded the opportunity and the right to remain in their families of origin? This question is particularly relevant to grandparent care or sibling care, especially related to children orphaned by HIV/AIDS (Lightfoot & Kalomo, 2010; Maundeni, 2009; Roby & Shaw, 2006; Zimmer & Dayton, 2005). Also, what are the perceptions about domestic adoption and how may we strengthen such an approach, especially in frequent countries of origin such as Russia, China, Guatemala, and Ethiopia? Are traditional care practices such as in traditional societies like Ethiopia (Bunkers et al., in press) being disparaged because they are considered informal? How might large-scale institutions become a model of the past in favor of small-group care models in Botswana or foster care in Romania? In countries with unique dynamics, like South Korea’s use of birth mother homes and shame of illegitimacy, how do particular interventions support or hinder ethical ICA practice? In relation to open adoptions, how may we continue to define this concept as a preference indicated by families in the Marshall Islands? Also, in that nation, how is the important social intervention of FGC affecting practice (Roby & Ife, 2009; Rotabi et al., in press)? And is this intervention adaptable to other contexts? In regards to the Hague Convention, can FGC protect orphaned and vulnerable children and the families who gave birth to them (Rotabi & Gibbons, in press)?

These are just a few of the pressing concerns for social workers around the globe. A multidisciplinary road map for research must be developed. Specifically, research targeting the many aspects of the best interests principle in all stages of the ICA process, across the continuum of child care and family support, is highly recommended given the very limited research available on this most fundamental of child welfare conceptions related to ICA. To integrate these ideas, a stretching of concepts and research boundary spanning is necessary, including greater interdisciplinary collaboration and openness to indigenous social workers and child rights advocates engaged in practice, and deeper analysis that must be holistic with practical considerations for the continuum of care (Fronek & Cuthbert, 2011; Roby, 2007). This is exemplified by Gibbons et al.’s (2009) collaborative exploration of the foster mother role and experience in Guatemalan adoptions. Another example is interdisciplinary collaboration combining social work and law scholarship exemplified by Roby and Maskew’s (in press) analysis of legal reform as a process in the Marshall Islands and Cambodia.

Interdisciplinary partnerships are important for deeper exploration of the best interests of the child and the subsidiarity principle of the Hague Convention to continue to investigate and support improved practices and ultimately promote the human rights of all involved in the ICA equation. We agree with Fronek and Cuthbert’s (2011) assertion that we must move from a child being “available” for ICA to a child “at risk” for ICA perspective to truly implement social interventions oriented toward social justice and human rights. Although some may view this as an abolitionist positioning, it is ultimately a pragmatic perspective as countless children will still remain appropriate for ICA even with a concerted effort toward prevention.


The authors would like to thank doctoral candidate Carmen Mónico for her research assistance and her identification of categories. Also, Jini Roby and Mary Katherine O’Connor provided valuable early feedback, and their guidance is much appreciated.

Article Notes

  • Karen Smith Rotabi is Assistant Professor of social work at Virginia Commonwealth University. Her research agenda is families impacted by war, including intercountry adoption policy, history, and case studies. She has been involved in the implementation of the Hague Convention on Intercountry Adoption in the U.S., serving as an agency evaluator for the Council on Accreditation/U.S. Department of State. Her intercountry adoption focus initially started with Guatemalan adoptions, where she previously worked in the field of child health promotion as a trainer for Peace Corps. She has co-edited, with Judith Gibbons, the forthcoming book (2012) entitled: Intercountry Adoption: Policies, Practices, and Outcomes, Ashgate Press.

  • Kelley McCreery Bunkers is an International Child Protection consultant and she has worked in a number of countries including Romania, Guatemala, and Ethiopia. Focused on child rights, she has published extensively on issues of alternative care of children including informal care of children in traditional societies like Ethiopia. She has also published on intercountry adoption policy and programming with analysis of child rights and ethical practices.

  • The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

  • The author(s) received no financial support for the research and/or authorship of this article.


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