International Child Adoptions

Over the past 30 years or so, children have been referred from various countries, initially through an almost-totally unregulated process. Prospective parents were almost entirely dependent on third-party agencies, who ranged from well-intentioned individuals to outright criminals. Problems varied depending on the referring country but, in the main, a paucity of information on the prospective child was compounded by a lack of guidance from any (local) authority together with coercion and unrealistic goals set by the agencies. The whole process was driven by dubious practices, facilitated with ‘sweeteners’, and sometimes dogged by outright corruption and criminal activity.¹

Child adoption has been practiced since Roman² times but really ‘took off’ after the Second World War. The Hague Convention on Inter-County adoptions in 1993 ³ addressed many of the issues that were ‘muddying the waters’ and, together with in-house protocols and legislation ^4,5, eliminated some of the worst abuses. As a result, many of the initiator countries suppling children for adoption, closed or were forced to close this service. Romania was the principal source in the 80s, replaced by Russia and Ethiopia between 2000-2008, then Russia until 2012. By 2013-2016, the process had all but dried up until India started referring children in 2018 and presently, in Malta, India remains the greatest source for intercountry adoptions.

Although most prospective parents request a ‘healthy child’, the vast majority of children offered into an adoption programme usually do have issues, including many health problems. Infectious diseases like Hepatitis B, C and HIV are automatically excluded by almost all countries including Malta, arguably a discriminatory position.⁶ Nevertheless, other medical issues are commonplace, thereby making the accuracy of the pre-adoption medical assessment of each prospective child paramount. Presently, almost 50% of referrals from India are excluded prior to involving any prospective parents on the basis of significant disabilities.¹ The confirmation (or strong suspicion) of severe illness or disability will, in all probability, negate the adoption and condemn that child to a life in an orphanage, destitution, or worse. In contrast, a ‘watered down’ pre-adoption report that disregards a significant medical issue, may result in major psychosocial problems for the parents and, ultimately, failure of the adoption with dire consequences for all involved.

Over the past 30 years, much progress has been achieved in Intercountry Adoptions and the process is now standardized, monitored and regulated. The needs of both the prospective parents and adoptive children are addressed and safeguarded. The process itself has been extended to single parents as well as to non-heterosexual and same-gender couples. For prospective parents, this is usually the most important life-changing decision to-date and, for them, the process needs to be managed carefully and they must be afforded quality time, lengthy counselling, etc. With very few exceptions, for the children this is almost always a win-win situation that will transform their life forever and, in the great majority, for the better!

References

1. S P Attard Montalto, 2025. Personal Data, 2012-2025.
2. Jennifer S Jones. 2019. What is the history of adoption? https://adoption.org/what-is-the-history-of-adoption
3. https://www.hcch.net/en/instruments/conventions/specialised-sections/intercountry-adoption
4. Adoption of Children. Guidelines, Social Regulatory Standards, Malta, 2018. https://scsa.gov.mt/en/Documents/Publications/Adoptions/Adoption%20for%20Children%20-%20EN.pdf
5. S Attard Montalto. Malta Medical Protocol for International Adoptions, 2000.
6. E Chiappini, B Bortone, S Borgi et al. Infectious diseases in internationally adopted children and intercountry discrepancies among screening protocols. A Narrative review. Frontiers Pediatrics 2019; Nov 7: 448.

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