July 28, 2011

Adoption is both a legal event and a lifelong experience that affects birth parents, adoptees, and adoptive parents. The birth family, the adoptee, and the adoptive family are known as the adoption triad. It is estimated that 2-5% of American households include adopted children. This translates into over 100,000 adoptions occurring in the United States each year. Based on a national survey of adoption attitudes reported by the Evan Donaldson Institute for Adoption, in 2002, most Americans (64%) knew a birth parent, someone who is adopted, or an adoptive parent. Adoption is a part of the national fabric of family life in the United States.

Adoption philosophy has changed since the 1970s. The paradigm has changed from finding infants for infertile couples (i.e., parent-centered adoption practice) to finding adoptive families who can meet the needs of children (i.e., child-centered adoption practice)—be they infants, older children, children with special health, developmental, or behavior needs; or children adopted from other countries.

The pool of adoptees has changed over the last few decades. Stepparent adoptions, usually an unrelated man adopting the minor children of a women he marries, represents about half of all adoptions in the United States. Children adopted from the public child welfare system comprise the second largest group of adoptees. These children often have a history of abuse, neglect, and trauma prior to their adoptions. The children from the public system represent about 20% of adoptions. International adoptees represent the next group and have grown over time, reaching to almost 20,000 children adopted from other countries into the United States in 2001. This is about 15% of all adoptions. Infants placed for adoption comprise the last group of children. Many of these children are placed through private attorneys and private agencies. They represent the last 15% of the pool of adoptees.

Adoption practices are undergoing radical changes. Until recently in our culture, adoption has been marked by secrecy and denial. The usual practice in adoption was to seal birth records, amend the birth certificate to reflect as if the child was born to the adoptive parent, and sever all contact with any member of the immediate or extended biological family. Now, adoptions have an option of being more open, including having ongoing contact between adoptees and biological family members.

Adoption is a women’s health issue in several ways. Women are triad members in that they are birth mothers, adoptees, and adoptive mothers. Unique issues emerge for all of the members of the adoption triad, each revolving from loss.

Birth mothers, while an intrinsic member of the adoption triad, are often the least acknowledged and understood member for a variety of reasons. While we have a better understanding of some of the issues encountered by birth mothers who relinquished infants, we have very little knowledge about birth mothers who had parental rights involuntarily terminated or whose children were placed for adoption internationally. The next few paragraphs discuss the issue only from the perspective of the first group of birth mothers.

In the past, there was a greater societal stigma against unmarried women being pregnant. The shame and secrecy that was part of adoption was due, in part, because the pregnancy was a clear indication of women’s sexuality. Social mores attempted to regulate women’s sexuality and having sex outside of marriage resulted in ostracism for many birth mothers. They were often hidden from the community in maternity homes or at family members not living in the same community. These women were often pressured to place their child for adoption.

Birth mothers were encouraged to put the relinquishment of the child behind them emotionally and go on with their life. For many birth mothers, the act of surrendering the baby for adoption was a traumatic experience—a physical, emotional, and psychological loss that had implications for the rest of the mothers’ lives. This loss, complicated by the isolation, shame, and secrecy surrounding the relinquishment of the child, affected self-esteem, sexuality, marital relationships, subsequent childrearing, relationships with the family of origin, and the birth mother’s capacity for trust and intimacy in all relationships. The loss was compounded by the institution of closed adoptions that put legal, social, and emotional barriers on contact between birth mothers and the adoptee or adoptive parents. Today, women who have lost children to adoption have many more avenues to speak openly about and deal with this loss. Some search for their now adult children and others hope to be found. With changing societal attitudes, many birth mothers now reach out for support from family, friends, and organizations that were not available to them in past generations.

One of the biggest issues facing adoptees is the resolution of identity issues. Adoptees experience a variety of issues around identity, varying in intensity and frequency, throughout the life span.

Identity issues are compounded by the lack of information, in closed adoption, about basic physical and mental health information from their biological family members. In closed adoption, unless this information was gathered at the time of adoption and given to the adoptive family, this information is generally inaccessible to the adoptee. The building blocks of identity are basic information. Because they lack information about their biological origins, some adoptees experience identity difficulties in the form of “genealogical bewilderment”—a sense that one’s genetic history is hidden by legal barriers that result in difficulty forming a complete self-identity.

To fill gaps in knowledge, some adoptees make the decision to search for the birth family. Although the decision to search is a multidimensional issue for adoptees, one reason for searching is to resolve identity issues related to developing a healthier and more self-aware sense of self, including seeking answers to questions regarding physical resemblance, genetic health issues, and emotional resolution about relinquishment. In domestic cases of adoption, adoptees have been largely successful at gaining access to previously confidential identifying information. In contrast, the majority of international adoptees often have no identifying information about birth parents due to cultural attitudes about relinquishment and adoption. For example, in China, no formal mechanism exists for parents to relinquish a child for adoption. Birth parents are forced to abandon their children, who are primarily female, in a safe place such as a market, residential area, or factory, where they know their children will be found and placed in a social welfare institution. In turn, adoptive families are encouraged to give their children a cultural and ethnic history since a biological history may never be available to them.

Therefore, the issue of search and identity is more complicated for international adoptees.

Adoptive families, in particular, adoptive mothers, often have gone through a lengthy process of trying to get pregnant before they pursue the option of adoption. One of the most salient health issues for adoptive mothers is dealing with infertility. About 19% of all U.S. couples have a fertility problem. Many adoptive mothers build or add to their families through adoption after multiple unsuccessful attempts at reproductive technologies. These technologies are stressful on the mental and physical health of women and often involve increased physician visits, out-of-pocket costs to families, and time lost from employment; women may experience an emotional rollercoaster each month, especially if pregnancy is not achieved.

Some adoptive parents have been reluctant to have an open adoption. Some fear contact or feel threatened by the presence of the birth mother. With the advent of openness in adoption, a new era in adoptions has begun where both birth parents and adoptive parents can reach an agreement upon the type of disclosure and contact they will share as the adoption continues. Openness is seen to be in the best interest of the child, and is now embraced as a positive trend by the adoption community.

The adoption of a child impacts all members of the adoption triad throughout their lives and for generations to come. The unifying point for all adoptive families is that adoptive parenting has special issues related to adoption and these issues need to be addressed throughout the family life cycle. In each case, differences between adoptive parenting and biologic parenting must be acknowledged, addressed, and celebrated as a unique element specific to each individual family.

In conclusion, while the more difficult issues of adoption are discussed above, it is important to have a balanced view. There are many strengths to be acknowledged about adoption. First, all adoptions are planned and the parents want children. Second, adoptive parents have demonstrated basic competence in motivation, problem-solving skills, and mental health in order to adopt by successfully completing a home study. Third, a broader definition of family through adoption raises awareness that relationships build families, not necessarily biology.

A significant part of the child population is affected by adoption. Adoption is a social arrangement that has more positives than it does negatives and remains the best solution for children who cannot be raised with their biological parents.


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