Adoption in Romania illustrates both the best and worst aspects of intercountry adoption and has led to the most comprehensive British study on outcomes of early deprivation. Since 1990, 30 000 Romanian children have been adopted abroad, 1200 within Britain.18 The English and Romanian Adoptees Study Team (ERA) followed up 165 of these children, adopted before 42 months, comparing them with 52 non‐deprived UK adoptees placed before 6 months.
The Romanian children had been confined to their cots in impersonal unsanitary institutions with insufficient food and no opportunities for play.19 Although initially 50% were malnourished and 60% were severely developmentally delayed, by the age of 4 most had caught up with their British counterparts.20 However, further studies at the ages of 6 and 11 showed that severe institutional privation was particularly associated with attachment disorders, inattention/over‐activity and quasi‐autistic behaviours. There were no discernable effects if the institutionalisation occurred before the age of 6 months. Thereafter, the marked adverse effects persisted at the age of 11 for many of the children who were over 6 months on arrival.21,22
Although there is marked heterogeneity in the outcomes, it seems that after the first critical 6 months of life, severe deprivation can lead to long‐term psychological impairment. It is also clear that the effects are neither universal nor fixed and there is no significant “dose–response” relationship between the duration of deprivation and the outcome. Profound deprivation is also compatible with normal psychological functioning. One-fifth of the children who had spent the longest time in institutions showed normal functioning. The behavioural outcomes were unaffected by the quality of the adoptive home.21,22
Today Romania is making strenuous efforts to rehabilitate children and 170 orphanages have closed. Spending on antenatal care and family planning has increased. Foster families and volunteers have been recruited to work with abandoned children. The government has spent heavily on public education to stamp out the idea that children are a saleable commodity, a viewpoint encouraged by the vast sums made from child trafficking in the 1990s.
In 2005, Romania banned international adoptions. Government officials claim that the ban has helped them to concentrate on proper substitute childcare. Opponents claim it is denying children the chance of a family. Powerful American adoption agencies, backed by Italy and France, continue to lobby hard for repeal. However, the European Union strongly supported the adoption ban and even insisted on continuing childcare reform as a condition of Romania's bid for EU membership.18
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The long‐term outcomes
Growing up is challenging for children from stable backgrounds. Intercountry adopted children have had a sharply defined historical, geographical, and social break in their life histories. They grow up looking different from their parents, family, and friends. Unlike immigrants, they do not grow up in bilingual households in contact with their extended family and culture. Whether this has damaging long‐term effects on identity and self‐esteem is an unresolved issue.
Many adoptees are now reaching adolescence in Western Europe and the USA. Research studies, which are almost exclusively Scandinavian, Dutch and American, into the mental health and social adjustment of these young adults have produced conflicting results. Some suggested that substantial numbers became increasingly maladjusted as they grew older, with higher than average rates of suicide and mental health problems,23,24 while others suggested a more favourable outcome.25 An overview of the Scandinavian experience concluded that although 75% were managing well, 25% of adolescents were experiencing problems linked to learning, identity and ethnicity.26 American research suggests that the best outcomes are found in a nurturing environment, where a willingness to acknowledge physical differences, openness about the child's origins and help in dealing with the potential conflict of cultures exists.27
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So what is all the fuss about?
Intercountry adoption is not going to stop. The number of children involved is increasing. Intercountry adoption must, therefore, be a service driven by the needs of children. It is not the solution to child abandonment. It does not empty orphanages nor address child poverty in developing countries. It rescues one child but many are left behind. Driven by a powerful demand for babies, it is unlikely to provide families for older children, sibling groups, special needs or disabled children. Only governments can permanently change the lives of all a nation's children by prioritising maternal and child welfare.
All children have the right to be cared for by their parents within the traditions of their family and land of birth. Any alternative should be considered a last resort. Children are a nation's most precious resource and few countries should want to let them go easily. All governments could do more to ensure that they have firm control over intercountry adoption and practice it with integrity.
Globally, there is a pressing need for basic data and further research into outcomes. Virtually nothing is known about the fate of the children adopted into the UK. Very little international attention has been paid to the plight of birth parents or siblings left behind. British paediatricians and child psychiatrists need to become more knowledgeable about the unique health and psychological problems of intercountry adoption. Above all, more research is needed on the long‐term outcomes for children who have grown up far from home and their issues of identity, culture, belonging, and loss. Children transplanted from one culture to another deserve to have their chances of rejection reduced to a minimum.
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Footnotes
Competing interests: None.
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References
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