NEW YORK — Not long ago, the choices facing Robert and Julie Garrett would have been simpler. Once they set their hearts on adopting a child from China, the odds were high they could soon bring home a healthy infant girl.
It's different now.
Faced with a long wait — and a smaller pool of healthy orphans available to foreigners — the Garretts have decided after much soul-searching to adopt one of the special-needs children who now abound in China's orphanages.
"It's really hard, and we want to make the right choice," said Julie Garrett, of Gainesville, Ga.
The children's conditions range widely. Some are correctible, some not: cleft lips and palates, congenital heart disease, missing or malformed limbs, impaired vision or hearing.
"It's important for us to not take on more than we can handle," Garrett said. "That process takes time — praying over it, discussing what medical needs you think you could take on.
"It's a journey in itself just to decide if that's the right direction to go."
Starting in the early 1990s, and as recently as a few years ago, the large majority of Chinese children adopted by foreigners were healthy baby girls abandoned by their parents, often because of a preference for a son in a country rigidly enforcing a one-child policy.
Between 1995 and 2005, Americans adopted more than 60,000 children from China. The peak was 7,903 in 2005.
Circumstances have changed dramatically since then. China has eased its one-child policy, fewer baby girls are abandoned, domestic adoptions of healthy orphans have increased, and the waiting time for foreigners to adopt a healthy infant has tripled to roughly four years.
As a result, U.S. adoptions from China have plummeted more than 60 percent, to 3,001 last year. And of the children now adopted, roughly three of every five have special medical needs.
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Birth defects common
One contributing factor is China's rate of birth defects, which a government family planning commission said increased by nearly 50 percent between 2001-2006.
Amy Eldridge of the Oklahoma-based Love Without Boundaries Foundation, which oversees several programs to aid Chinese orphans, says many children with birth defects — boys as well as girls — are abandoned, and they now comprise a majority of the orphan population.
"Some parents feel the child will bring bad luck to their family," said Eldridge, who has traveled often to China. "And we're seeing many poor families abandon children with medical needs in hopes they will get care."
The Garretts, in their 30s and without children, signed up in December 2008 for the traditional program that might lead to adoption of a healthy infant. But facing a long wait, they later entered the Waiting Child program, which features special-needs children and can complete an adoption in less than one year.
The Garretts — he's an aluminum plant worker, she's an office manager — have decided they're not ready to take a child with a severe or incurable medical problem, so they're seeking one with a correctible condition.
"We have reviewed a couple of children," Julie Garrett said. "It's grueling to look at their faces and try to make a decision if you could care for them, and come to the realization you're not the best fit to be able to care for them the best they should be."
Level of comfort
Bethany and Kevin Durkin, who live in the Westchester County suburbs of New York City, went through a similar decision process and are now parents of two girls adopted through the Waiting Child program.
"They ask what you're comfortable with," said Bethany Durkin. "I wasn't with hepatitis B or heart surgery, but we were comfortable with cleft palate."
Both girls undergo therapy regularly — Lucy for speech, Olivia to improve the mobility of her arm and right hand.
"She does cartwheels, jump-rope — people don't even know she has an issue," Durkin said of Olivia. "She just can't open her hand by itself."
As for Lucy, "she's a total social butterfly," her mother said. "A really happy kid."
What it takes
Agencies focusing on adoptions from China now find that a major part of their work is preparing families to take on special-needs cases.
"We don't want a family to join this program just because it's faster — that's the wrong way to go," said Snow Wu, president of Great Wall China Adoptions.
"We want them because in every aspect they're ready — we screen them very carefully, financially, emotionally, physically," she said. "This is not for everyone."
Wu's agency, based in Austin, Texas, has placed roughly 8,000 children in U.S. homes since 1996. Special-needs adoptions now comprise about half its caseload.
"We've not heard a single family say they shouldn't have done it," Wu said. "If they decide not to do it, it's before they bring the child home. Once they do that, none have complained."
Eldridge, of Love Without Boundaries, said advance education is crucial to the success of special-needs adoption.
"Some families get cold feet when they get to China," she said. "We receive one or two calls a month from parents who feel overwhelmed while they are on their adoption trip, but often, once they have someone to talk with, they realize they can continue."
She cited calls from parents who hadn't been fully aware of the speech and eating problems faced by children with cleft palates. In other cases, she said, parents panicked because the child they were adopting seemed too frail — not realizing that this was due to living in a crowded orphanage, and not a result of a chronic medical problem.
Eldridge, who has five biological children, also is the mother of two orphans from China, a 10-year-old daughter adopted as a healthy infant and a 5-year-old son, T.J., who is missing the lower half of his right arm.
"I was one of the people who, on the first adoption, never would have considered special needs," she said. "I had a great fear that I could never do that. I thought people who took that path had white robes and halos."
Her outlook evolved as she started meeting special-needs children, and she's grateful.
T.J "can do everything," she said. "I don't even look at him as special needs."
A lifetime decision
Since it began encouraging international adoptions in the 1990s, China has won praise for striving to provide accurate information about the children in its orphanages. But as more children with complex medical conditions are put up for adoption, experts say there's often less certainty about their prognosis.
"A lot of people are having to make lifetime decisions based on less information," said Dr. Jennifer Chambers, who counsels many parents as director of an international adoption clinic in Birmingham, Ala.
"There is more risk being taken because there's more unknowns," she said. "I don't see false information, but I see lack of information, and different medical systems from ours."
America offers so many opportunities to these children, Chambers said.
"They could have ended up at 18 after bouncing from one state-run institution to another — they wouldn't have a chance," she said. "Over here, they have surgeries, life-changing therapies."
She told of a recently adopted 1-year-old blind girl who suffered neglect at her understaffed orphanage in China.
"Here she will get every specialist she needs," Chambers said. "She's starting to talk and babble. She's coming alive, she's going to meet her potential. There, she might have died."
Another pediatrician specializing in foreign adoptions, Dr. Jane Aronson of New York City, said she remains concerned that some parents consider special-needs adoptions primarily because the wait is shorter than for a healthy child.
"The problem then is they're not realistic about the complexity of special needs," she said. "They're often not a good match and may end out doing more harm to the child."
However, Aronson said she relishes the challenges of helping special-needs adoptions succeed. "What I love is providing the families with recommendations when the child comes home, setting them up with specialists, seeing how the child goes through surgeries, and then the child is happy and the family is happy," she said. "When it's done properly it's so wonderful — it's win-win. But I get crazy when people go into it as a lark."
Many of the U.S. agencies involved in overseas adoption belong to the Joint Council on International Children's Services. Its president, Tom DeFilipo, expects the ongoing changes to be permanent and broad-based — with fewer international adoptions of healthy infants and a larger share involving special-needs and older children.
The council conducted a survey of its members last year, covering adoptions from all foreign countries, and found that 27 percent were special-needs cases and 29 percent involved children 3 or older.
"Surprisingly enough, recruiting families is not the biggest challenge," DeFilipo said. "It's ensuring they're adequately prepared and that they have post-placement services for medical and psychological needs."
High cost of care
Most families have insurance to cover the medical bills, he said, but often psychological counseling is not covered or hard to obtain.
"That's a huge problem," he said. "A shortage of qualified service providers, and difficulty of paying for it."
For some special-needs children, medical costs can be enormous — placing a premium on generous health insurance.
Susan and Richard Moore of Orlando, Fla., estimate they've incurred more than $200,000 in medical bills for their daughter, Hannah, since they adopted her in December 2007 through Great Wall China Adoption. Hannah has had several operations, and scores of visits to doctors, to deal with hydrocephalus, also known as water on the brain, and spina bifida, a birth defect on her spinal cord.
The bulk of the cost has been covered by Richard's medical benefits with his employer, Hilton Grand Vacations. He also works a 7 a.m.-2 p.m. schedule so he can spend afternoons with Hannah, now 7, and her brother Harrison, an autistic, U.S.-born 12-year-old who was adopted as an infant.
"We thought if we can handle autism, we can handle anything else they threw at us," said Susan Moore. "We figured we had a lot of stamina."
The Moores say Hannah is doing well, but they closely monitor her progress at school to be sure she doesn't fall behind her first-grade classmates.
"You worry about her with physical activity," her father said. "You don't want her head to get hit, for her to get bumped. ... If she's on a bike, make sure she has her helmet on."
The Moores encourage other families to consider special-needs adoption, which they describe as immensely fulfilling, but also urge careful deliberations.
"Don't make a decision because you're falling in love with a picture and you want that beautiful face looking up at you at the end of the day," Susan said. "You have to put the effort in, do your research, and know that not every day is going to be as good as the other days."
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