Paediatrics: Legal aspects of international adoption

Legal aspects of international adoption

The Adoption and Children Act 2002 and the Family Procedure (Adoption) Rules 2005 have comprehensively reformed the law on adoption. A new process called ‘placement’ has replaced the process of ‘freeing for adop-tion’. The following notes cover some basic information for UK citizens wishing to bring an adopted child from another country.

·  In general anyone over 21 can legally adopt a child.

·  The UK does not have a statutory upper age limit, but each local authority has the power to determine if a prospective adoptive parent is above its acceptable age limit.

·  Married couples must adopt ‘jointly’, unless one partner cannot be found, is incapable of making an application, or if a separation is likely to be permanent.

·  Unmarried couples may not adopt ‘jointly’, although one partner in that couple may adopt.

UK requirements for adoption

It is a criminal offence if a parent adopts a child overseas with the intention of bringing the child to the UK without having been approved.

·  A person must be approved for adoption by their local social services department before a child can be identified.

·  A detailed ‘home study’ will be conducted by local social services or an ‘approved adoption society’. A list of approved societies can be obtained from the British Association for Adoption and Fostering (M www.baaf.org.uk).

·  A medical clearance and full police background check are also required.

·  Once the approval for adoption has been granted, the prospective parent(s) should then contact the following departments for advice: the UK Border Agency—Inter-country adoption and immigration rules (M www.bia.homeoffice.gov.uk/sitecontent/documents/residency/ intercountryadoption.pdf

·  The prospective parent(s) must also apply to the nearest British Embassy or Consulate to obtain clearance for the child to enter the UK. The Home Office Immigration service has an information package (RON117) that explains the procedures.

The UK has now ratified the Hague Convention on Protection of Children and Co-operation in respect of Intercountry Adoption 1993. This means that, in many cases, provided an adoption order is obtained in the child’s country of origin, it will not be necessary for the applicant to obtain an order in the UK as well. However, where the child’s country of origin has not ratified the Hague Convention, the procedures are more stringent. Applications for adoption in the UK are still necessary and may be trans-ferred to the High Court.

Medical care

There is now a growing literature on the medical problems encountered by some internationally adopted children, albeit in predominantly US jour-nals.

It should be remembered that many internationally adopted children have come from institutions in countries with many endemic diseases. In the USA, international adopted children have been reported to have the following conditions identified on arrival:

·Hepatitis B.

·Intestinal parasites.

·Congenital syphilis.

·Anaemia

·Lead poisoning.

·Deficient immunization.

·Emotional and behavioural problems.

·Unsuspected medical problems.

·Developmental delay.

·Microcephaly.

In some instances, parents now consult an expert in adoption-medicine to review the information given by the adoption agency. The American Academy of Pediatrics has recommendations on pre-adoption review and screening on arrival. The pre-adoption review will include the following:

·The specialist should be able to advise on the medical summary, the risk of foetal alcohol syndrome, and explain the meaning of Russian diagnoses, such as ‘perinatal encephalopathy’, ‘hypertensive– hydrocephalic syndrome’, and ‘pyramidal insufficiency’.

·Assessment of growth and development charts, and any photographs and videos.

Once the child has arrived, it is advisable to document the adequacy of immunity gained from any immunizations. In addition to considering and testing for the diseases noted above, the child will require testing for the following infections on arrival and 4–6mths later.

·Hepatitis B.

·Hepatitis C.

·HIV (note that very few internationally adopted children arrive with this infection).

Last, the adoptive parents should consider long-term developmental follow-up.