Adoption
Adoption is a rich, complex legal and social process with a long history in the United States. Adoption refers to an incredibly broad range of experiences, which can make it difficult to discuss. However, there are common threads no matter the type of adoption.
This page will provide a brief, non-exhaustive background on adoption in the United States including a brief timeline, adoption numbers, and the many types of adoption. Continue learning about adoption by visiting our distinct pages:
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1) for clinicians: to learn about common but underrecognized adoption stereotypes and explore our recommendations for best practices around adoption in the clinic and the chart
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2) for adopted patients: to learn about how adoption may affect health and how to advocate for yourself in healthcare settings.
Introduction
Adoption is a legal and social process through which a person becomes the permanent, legal parent of a child who is not biologically related to them. To become available for adoption, a child must first be legally orphaned with the dissolution of legal ties between them and their biological (often called "birth") family. In contrast, guardianship functions similarly, although the parents retain their legal right of parenthood and custody can be reclaimed.
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Adoption in the United States has a long, complex, and evolving history, reflecting broader societal changes in family structures, cultural values, and child welfare practices. From informal arrangements in US colonial times to the establishment of formal legal frameworks in the 20th century, the practice of adoption has been shaped by shifting attitudes toward children, parenthood, race, societal norms as well as by U.S. militarism, diplomatic relations, and humanitarian disasters. Adoption thus encompasses a huge variety of experiences. It's important to recognize that no adoption experience nor adopted person is exactly the same.
Adoption by the Numbers*
7.8 million
estimated adult adoptees live in the United States.
64%
of Americans report knowing someone in their family or close friends who adopted or is an adopted person.
80,000
the number of adoptions in the US each year.
Adoptions: By the Numbers 2021 & 2022, National Council For Adoption.
Finding accurate numbers to describe adoption is difficult as there is not one US government body that tracks all adoptions. The U.S. State Department tracks international adoptions though only data from 2000-2017 is publically available on their website. Individual US states track the numbers of adoptions of Indigenous children and from foster care. However, private, independently brokered domestic adoptions and informal adoption arrangements are largely unknown. The US Census began collecting information about adopted minors in 2000 for the first time. However, adoptees “disappear" in the Census as adults. In 2022, the National Council for Adoption painstakingly compiled and tallied various sources about adoption in the United States and released the most comprehensive report to date. However, the report only includes domestic adoption data from 2019-2022 (est. 1851) and intercountry adoptions (est. 1948) from the year 2000.
U.S. Adoption Timeline
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1851: first “modern” adoption law passed in MA
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1854-1927: “orphan trains” move children to the East Coast for inspection”
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1912: US Children’s Bureau is founded
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1917: MN makes adoption records confidential - other states follow suit
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1944: RI seals original birth certificate (OBC) access
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1945: Majority of states have strict adoption confidentiality laws
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1948: the first intercountry adoptees arrive from Hong Kong, Greece, World War II Allies in the U.S. as refugees
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1948: the first transracial adoption
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1950: Indian Child Adoption Project begins, beginning the transfer of ~25% of all Native children into non-Native families
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1953: Korean War adoptions make intercountry adoption more visible
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1961: international adoption is codified in US law
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1966: Bastard Nation, adoptee rights group, forms around access to sealed adoption records
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1967: Loving v. Virginia legalizes interracial marriage and families across the United States
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1970: Adoption peaks at an estimated 175,000 annually
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1970s - ongoing: adoption reform movement criticizes closed adoption practices; state activism for OBC laws
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1972: National Black Social Workers Union denounces transracial adoption and discrimination against Black families seeking to adopt
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1973: Roe v. Wade legalizes abortion prior to fetal viability
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1978: Indian Child Welfare Act (ICWA)
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1993: The Hague Convention on the Protection of Children and Co-operation in Respect of Intercountry Adoption establishes international standards for international adoptions.
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1994 & 1996: Multiethnic Placement Act prohibits adoption agencies from federal funding that consider race, color, and national origin of foster or adoptive parents from delaying a child's placement from foster care and to increase recruitment of foster and adoptive parents that reflect the race and ethnicity of children awaiting placement.
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1997: Adoption and Safe Families Act
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2008: Hague Convention goes into effect in the United States
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2015: Obergefell v. Hodges legalizes same-sex marriage, partially eases the adoption process for same-sex couples
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2022: Dobbs v. Jackson Women's Health Organization overturns Roe v. Wade and ends federally affirmed right to abortion prior to fetal viability
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2023: Challenges to ICWA
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2024: China ends its international adoption, allowing only biological relative adoptions
There is no one adoption experience
Types of Adoption
Below are a few common terms that can describe adoption (all independent of one another).
For example, in the case of a white American couple adopting a Black child from foster care, this could be described as a public, domestic, transracial and transcultural adoption. A Chinese American person adopting a child from South Korea through an adoption agency could be described as private, international, same-race and transcultural adoption. A Mexican American person who adopts their Mexican American nephew could be categorized as a kinship adoption.
Of course, racial and cultural identity can also be multi-faceted and infinitely more complicated. Remember that even with the same exact "type" of adoption in these 7 categories, the experience of adoption can vary widely.
Public vs Private
Public adoption refers to those arranged through US state child welfare agencies (e.g., from foster care). Private adoption can include those arranged through adoption agencies or by private adoption brokers and lawyers.
Kinship vs Non-relative
Kinship adoption refers to the adoption of a child by relatives while non-relative or "stranger adoption" refers to that by non-relatives.
Formal vs Informal
For a variety of reasons, including accessibility of the legal system, an adoption may not be a formally recognized by the law. Caring for the children of extended family or community in times of illness, financial instability, or other strain is culturally expected in different contexts.
Domestic vs. International vs. American Indian
The nationalities of the child and adopting parent determines which laws govern adoption. International (also called intercountry, transnational) adoption refers to the adoption of a child by a person of a different nationality while domestic adoption refers to the adoption of a child by a person of the same nationality. After the passage of the Indian Child Welfare Act of 1978, the adoptions of American Indian (Native American, Indigenous, or First Nation) children have been regulated distinctly from domestic or international adoptions.
Transracial v. Same-race
Although race is socially-defined concept created to justify specific power and economic structures, it continues to have ongoing relevance to our inequitable society today. Since the 1970s, "transracial" is a term that has described adoptions between children and a parent of a different racial background. Due to structural racism that has allocated resources and stability differently, most transracial adoptions feature white parents adopting children of color. Same-race describes when the child and adopting parent belong to the same racial background. We note that racial identity is far more complex than encompassed by this terminology.
Transcultural vs Same-cultural
This describes an adoption that occurs when the adopting parent belongs to a different cultural background than the child. This is independent of race. For example, Chinese American parents adopting a child from South Korea could be characterized as an international, same-race, transcultural adoption.
Closed vs open
These terms describe a continuum of contact between adoptive and biological families after adoption. Prior to the 1990s, adoptions in the U.S. were typically "closed," meaning that adoptions were supposed to be a "clean break" with no further communication (often accompanied by the promise of confidentiality regarding the adoption). However, open adoptions have become more common and are now in the majority. It's important to note that what counts as an "open adoption" varies significantly (e.g., annual exchange of photos, emails, calls, visits) and is not legally enforceable. For example, an open adoption may be "closed" by adoptive parents after the adoption and there is often little recourse.
Learn More
Adoption: For Patients
For adopted patients, we know that you've already been advocating for yourself as a patient your whole life. We invite you to explore our page with a few resources to help explain the nuances of what adoption can mean for you in the clinical setting.
Adoption: For Clinicians
We invite you to explore our page for clinicians on adoption issues to better assist your patients and contribute positively to their experiences. Here, you will find valuable resources insights designed to enhance your knowledge, including notes on specific phrasing, principles, and further resources.