The Complexities of Adoption in China

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By JANE LANHEE LEE NAVILLE
In a small coastal town in Guangdong province, a baby was found at a hospital identified only by a birth date -- April 22, 2005 -- written in ballpoint pen on her stomach. She was 3 months old.

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Like most abandoned babies in China, she wasn't well: cherry angioma, benign skin tumors made up of blood vessels, were spreading on her groin. Her parents had most likely left her because they feared her medical bills would crush them, a common cause of financial ruin in China. And she was a girl.

By chance, a month later, Mui Koh, an unmarried Guangdong native who teaches English at a vocational school, started to volunteer her time at the orphanage where the baby had been sent.

"The baby was crying so hard and I felt so bad for her," says Ms. Koh, now 38 years old. "I was told she cried like this each time she urinated because it caused the (pain) to flare up."

Back home in the two-bedroom apartment she shares with her parents, Ms. Koh couldn't stop thinking about the baby. The next day she went back to the orphanage and took the baby to see a doctor at a public hospital nearby. For 300 yuan (about $44), he removed the tumors.

Every evening after that, Ms. Koh visited the orphanage after work to care for the baby. She called her Portia, after the heroine in Shakespeare's "Merchant of Venice." In Chinese, she was Bao-sha -- bao for treasure and sha for the first character in Shakespeare's Chinese name.

Samantha Sin for The Wall Street Journal
Mui Koh and her adopted daughter Portia at home in Guangdong province

Two months went by and Ms. Koh's love for the baby grew. Then the orphanage warned her that unless she adopted Portia -- now perfectly healthy -- the baby would be adopted by someone else.

Ms. Koh was stumped: "I didn't even know the concept of adoption at the time," she says.

No wonder. While China is known overseas as a place many go to adopt babies, until recently adoption was uncommon among Chinese families themselves. That's partly because of limited financial resources, and partly because the country's Confucian culture emphasizes family and filial piety.

"In China, society operates on blood relationships," says Yu Hai, a sociology professor at Fudan University in Shanghai. "So if families can have their own children, they aren't going to adopt."

But change is afoot. Local adoptions are on the rise, thanks to economic progress and evolving social attitudes. Adoption also provides a way around China's family-planning policies, which aim to limit most urban couples to one child.

There aren't any official nationwide data on domestic adoptions. But according to Ji Gang, a director at the central government's Center of Adoption Affairs, they have been "clearly growing" since about 2003 in affluent cities such as Beijing, Shanghai and Guangzhou. In provinces where the economy has grown quickly, says Mr. Ji, "domestic adoption has grown quickly, too."

In China, there are no limits on the number of orphans a person can adopt, he adds, provided the prospective parent can support them financially and passes certain age, health and education requirements. "Once people have the money, they can afford to raise a second or third child."

Samantha Sin for The Wall Street Journal
Ms. Koh plays with Portia, on the bicycle, as the grandparents look on.

The shift toward adoption is also partly due to developments of another kind: Couples are marrying later, and may not be able to conceive. And some women aren't marrying at all. Another factor: Older couples whose only child has died want another.

"Adoption demand created under (these) circumstances is actually quite large," says Zeng Fanlin, a psychologist and associate professor of special education at East China Normal University in Shanghai.

Foster parenting is taking off, too, says Prof. Zeng, also as a result of budding prosperity in bigger Chinese cities -- plus a growing sense of social responsibility. Nodding to the trend, the government implemented nationwide regulations on foster care in 2004.

"Some mothers in their 40s and 50s...they don't have to work and they have time. That's an important precondition," says Mr. Zeng. These financially stable women also want to give back: "People feel that they can help solve a small part of the problems in society," he adds.

Last June, Zhang Min, a 33-year-old Shanghainese, started a small foster home for disabled orphans -- really a three-bedroom apartment in the city's outskirts -- with nine other Shanghai mothers. Ms. Zhang, an administrative worker at a property developer, was moved to action by appeals she read on a Chinese-language Web site that told the stories of sick children. "I never realized that there were so many people in difficult situations. I wanted to find a way to help them," she says.

The mothers -- all middle-class Chinese who can't afford to adopt children, especially those with medical problems, but want to get involved -- take turns helping out at the foster home, called Baobei Zhi Jia, which has six full-time employees (four on hand at a time) and currently shelters eight babies.

Besides the added cost of raising an adopted child, Chinese families typically are expected to donate several thousand yuan (a fortune to most Chinese families) to the orphanage from which they are adopting.

Sharron Lovell for The Wall Street Journal
Zhang Min plays with an orphan at the foster-care center, Baobei Zhi Jia, that she and nine other mothers established in Shanghai.

Because the concept of domestic adoption is relatively new in China, it's still a sensitive topic. Some parents keep the adoptions secret for fear the child might be teased by other children, or treated differently by adults. Others worry that birth parents might locate them and cause trouble or try to take the child away.

For Bao Nan, a pediatric neurosurgeon at Shanghai Children's Medical Center, the sticking point was day care.

Dr. Bao, 41, operates on many orphans with spina bifida, a birth defect that involves the incomplete development of the spinal cord, often resulting in hydrocephalus, in which fluid collects in the brain. It's work he does on behalf of the Baobei Foundation, a Shanghai nonprofit organization (unrelated to Ms. Zhang's group) that helps Chinese orphans suffering from critical neurological or gastrointestinal disorders. With timely surgery, many of these children live normal healthy lives and are adopted internationally when they recover.

Over time, Dr. Bao had an "aha" moment. "I was so touched by the families caring for these orphans, I decided I would also like to adopt one of these babies."

But he and his wife, a cardiovascular surgeon, would have to rely on his mother-in-law to care for any child they adopted. Because the mother-in-law already baby-sits their 9-year-old son, she didn't want the extra responsibility of another child. "We don't have room for a live-in nanny and would need to move to a bigger apartment for that," says Dr. Bao, who hasn't given up on the idea.

For Ms. Koh, there was no choice: She couldn't let Portia go.

With a monthly income of 3,000 yuan (about $440), Ms. Koh had to borrow from one of her brothers to pay the required 5,000 yuan (about $730) "donation" to Portia's orphanage. (That money is used to support the mentally or otherwise handicapped babies left behind.) She didn't tell her brother what the money was for because she feared her family would try to talk her out of the adoption. In fact, she didn't even tell her parents until the day the adoption was finalized.

Ms. Koh made the announcement after dinner that night, as her mother watched TV and her father brewed a pot of tea. "They remained silent. And neither one of them said anything when I finished talking," says Ms. Koh. Their silence was a rebuke.

Two days later, in January 2006, Ms. Koh brought the baby home.

Today, no one in the neighborhood knows Portia is adopted, except the Kohs' next-door neighbors, who keep it a secret. Ms. Koh says if anyone asks, she'll tell them the truth. But nobody has. "I think in the beginning, (the other neighbors) just assumed she was my brother's daughter who came to live with us, or some just assumed I was the godmother."

Finding parents for special-needs children is difficult anywhere. But in China, as in many developing countries, disabled children often carry a social stigma. Plus, the potential of high medical bills make them hard to place outside orphanages.

After last May's massive Sichuan earthquake orphaned more than 600 children, tens of thousands of Chinese families clamored to adopt them. Most, however, were placed with family members; 88 were put up for adoption. But only 12 have been placed with new families so far, according to the Sichuan Civil Affairs Bureau. Many of the kids who haven't been adopted are disabled.

In 1997, the city of Shanghai started China's first official foster-care program after psychological studies showed kids in foster-care were better off than those in orphanages. Of the 2,000-plus orphans who are under the city's care, 60% to 70% are with foster families, according to Prof. Zeng, and many of those children have disabilities or other health problems.

A handful of the foster families in Shanghai are couples who would like to adopt, but can't afford to or aren't ready to. Take Yollanda, a 38-year-old mother in Shanghai who asked that only her English first name be used. In October 2007, on a regular volunteer visit to the pediatric ward of the Shanghai Children's Medical Center, she met Li Yun, a baby with a severe disability who had been sent for treatment from a Guangdong orphanage. The baby had been born with anal atresia, a birth defect in which the rectum is malformed, which requires surgery. She had undergone two unsuccessful operations already. A third one came too late and today she requires a daily enema.

"I saw this baby and she seemed so helpless, so alone," says Yollanda. "I felt I had to help her and take care of her."

With the full support of her husband, who manages the family assets -- Yollanda earns a little over 10,000 yuan (about $1,460) a month as a manager at a mobile-phone parts maker -- she signed a foster-care contract with the Guangdong orphanage and brought the baby home the same day.

These days, Yollanda's 4-year-old daughter and Li Yun, now almost 3, play like sisters -- sharing, and fighting over, toys. The family lives in a small, cramped apartment on the fringes of Shanghai with a cousin who cares for the kids while the couple works.

In Shanghai, foster-care agreements, which can last one month or up to a year, usually come with a monthly stipend of about 700 to 800 yuan (about $102 to $117) for each child to offset food and caretaker costs. Health-care bills are covered, too. The foster family has to apply at a local welfare center, then undergo some training.

In some cases, foster parents are asked to decide after several months whether they will adopt the child they're caring for -- otherwise the orphanage will begin the adoption process and place the baby in the waiting line.

Should she adopt? Yollanda struggled for months with the question as she grew more attached to the child. Her family and friends said no. They worried that Li Yun's health problems would make life difficult for everyone involved. Yollanda fretted about whether she could deal with the child's health issues not just financially but socially: People with disabilities in China aren't yet as well integrated as in other parts of the world.

"In the end, I thought it would be better for her to go to the U.S. because there are good medical programs to help children like her," says Yollanda, as she cradles Li Yun in her arms in her Shanghai apartment.

The orphanage started adoption proceedings for Li Yun and she will most likely be adopted overseas in the next six to 12 months. "But now I am worried that if the adoption process takes too long, it will be hard for Li Yun to adjust...I don't want her to suffer. I don't want her to think I've abandoned her."

As for Ms. Koh, she now teaches English to middle- and high-school students on weekends and most weeknights to make ends meet. Her parents, both 73, are too old to look after Portia full-time. So the talkative, jolly toddler has to live at a local nursery boarding school from Sunday evening to Saturday morning. The care center costs Ms. Koh 13,000 yuan (about $1,900) a year.

"It's not ideal. I hope when she's a little bit older and easier to take care of, she can live at home," says Ms. Koh, who is heartbroken every time she drops off her daughter.

Meanwhile, Ms. Koh's parents, who declined to be interviewed, have come around. They look after Portia on weekends when Ms. Koh has to work. "They give her more attention than they give to my brothers' children," says Ms. Koh.

Her father, a former physical education teacher and educator, initially worried that Ms. Koh would find it difficult to marry with a child. While Ms. Koh says she isn't ruling out marriage, she doesn't need to be married to be happy.

"Portia is part of my heart. She's part of me. Life is rich and meaningful with her," Ms. Koh says.

—Jane Lanhee Lee Naville is a writer based in Shanghai.