Americans are adopting from other countries in record numbers. Since 1986, more than 125,000 children from other countries have been adopted by Americans. How does a single person, couple or family make the choice to adopt internationally, and how much does it all cost? How do you choose the country from which to adopt? The agency to represent you? And what about all that paperwork? In short, there are myriad issues to consider when looking at international adoption, and a sometimes bewildering array of choices to make

Cost
Cost is something about which almost all adopters are concerned. Because international adoption expenses vary so much from country to country, depending on factors such as agency fees, in-country travel costs and other variables, it’s impossible to state an "average" cost. However, it’s probably safe to say that a range of $14,000 to $21,000 is the norm. The costs involved include:

• agency fees
• a homestudy, if not prepared by the adoption agency
• fees required by the foreign country
• document gathering fees
• travel to and within the country

Choosing a Country
For those who have made the decision to adopt internationally, the choice of a country is often the next step.

In some cases, adopters have an acquaintance, friend or family member who has adopted from a particular country, making adoption from that country seem less daunting. Adopters may be drawn to a particular country’s culture. An individual adopter’s circumstances certainly play a role: While some countries, such Colombia, Equador and Peru, favor younger parents, others, such as China, may prefer older ones (China does not allow anyone younger than 30 years of age to adopt).

Some families may not wish to travel to the country to adopt the child, or may want their time in the country to be limited. The time requirements on in-country travel vary widely -- Korea and India do not require that adoptive parents travel, and escorts may be arranged to bring the child to parents waiting at a major U.S. airport. At the opposite extreme is Colombia, which requires up to seven weeks in country.

Other issues are the ages of adoptable children, the particular health and developmental concerns children from certain geographic areas face and whether the country allows single parent adoption.

Currently the following countries have major adoption programs:

Additionally, adoption may be possible through other countries, but the programs may be informal ones or very few children are adopted.

According to international adoption expert Kay Harper, "Korea is the pioneer in international adoptions. China has a well-defined and predictable process based on the Korean model of adoptions. Vietnam is the wild, wild west of the East." Harper, owner of the international adoption paperwork preparation service Dr. Dossier, explains that China and Korea offer a centralized program (meaning referrals and decisions are made for all of the country at one central location). In contrast, Vietnam’s process is decentralized at the provincial level and although all provinces follow the same procedures, their execution varies from province to province.

Russia is the leader in international adoptions for U.S. adopters -- more children are adopted annually from Russia than any other country. "Of the major international programs, Russia has one of the most streamlined, pragmatic processes," says Harper. "About three or four documents are actually sent to Russia prior to submission of the dossier. Forms are straightforward, and in many cases, just templates. The downside to Russia isn’t the process; it is the concern over health."

Health Concerns
Health is a major concern for international adopters. While the health of adopted children varies from country to country, all internationally adopted children are at risk for nutritional deficiencies, parasitic infections and other conditions. For example, tuberculosis and hepatitis B are fairly common in some areas.

Developmental delays are to be expected of children who have been living in an institution. This sort of delay, sometimes referred to as "orphanage delay," is seldom permanent -- once a child has adequate nutrition, loving care and stimulation, she often catches up to her new peers quickly.

Attachment disorders, which can make it difficult or even impossible for children to bond with adopted parents, are another concern, especially among older children who have spent much of their lives in institutional care.

One of the major concerns voiced from adopters whose children are from Eastern Europe is fetal alcohol syndrome (FAS) and fetal alcohol effect (FAE). "FAS and FAE are a rising concern, as alcoholism is rising in Russia in particular," says Beth Waggenspack, an adoptive parent and expert on Eastern European adoption. She adds that FAS/FAE is not common in Bulgaria or Romania.

"With FAS/FAE, the outcomes really are unknown," says Waggenspack. "That’s why we tell folks to get one of the international doctors familiar with Eastern European referrals to review any medical documents to discuss the potential for alcohol-related issues. Many of our families are dealing with learning disabilities or hyperactivity, for instance, but in many cases, we don’t know if this is because of (prenatal) alcohol use."

International adoption experts suggest that internationally adopted children be examined by a pediatrician who specializes in international adoption medicine. Some children may appear sicker than they are, and others may not exhibit symptoms. One thing to remember is that the sickest children are generally not adopted, as authorities in the child’s home country usually try to ensure that only healthy children are adopted. There are, however, "special needs" children available for adoption in most countries, but these children are adopted by people who specifically request a special needs child. An experienced adoption agency can and should advise prospective adopters on potential health risks.

Choosing the Adoption Agency
"After the selection of the country from which to adopt, the most important task for persons considering international adoption is the choice of an agency," says Harper. "Not unlike the relationship between a birth mother and her obstetrician, the relationship between adoptive parent and his/her agency is very intimate, and requires trust and continual interaction. In essence, the adoption agency is the lifeline to the parent’s child." An adoptive parent herself, Harper founded Dr. Dossier after her own experience adopting internationally.

John Harrah agrees. "We feel that adopters should feel completely comfortable in asking an agency anything at any time," says Harrah. "Communications must be assured before, during and after an adoption. It’s vital that adopters have support for any issue, anywhere, whether at home in the U.S. or in the foreign country. Parents make the leap of faith, and no agency or social worker can do this for them, but an agency or social worker can and should be involved with the parents."

Like Kay Harper, John and his wife Jackie Harrah’s experiences in adopting led them to become professionally involved in international adoption. "A very expensive adoption agency refused to talk with us about adoption from China other than to tell me, "You are too old and China says you are too old." John Harrah was approaching 59 at the time. He soon learned that the agency had given him incorrect information. Not only have the Harrahs successfully adopted two daughters from China, they founded Harrah Family Services, specializing in Chinese adoption. Their program is one of the country’s most respected.

Word of mouth is one way to select any adoption agency, though it’s important to note that just because an agency did a good job for a friend doesn’t mean it’s the right one for you. Adoption professionals advise you to research your options and contact every agency you’re interested in to obtain their information packets. The Internet has a wealth of adoption information; you should be able to do your initial screening from your desk chair! Study the information carefully, and narrow down your search to a few agencies. Interview those agencies to make your final choice. If the agencies you’re interested in aren’t local, the agency should be receptive to a telephone interview.

Want to see more?

• Search a comprehensive list of both domestic and international adoption agencies.
• Get more information on adopting from China, Eastern Europe, India, Korea, Latin America or Vietnam.
• Stay tuned for part II of "International Adoption" to learn what happens after you’ve selected an agency and read about three families’ experiences with international adoption.