Celebrity adoption was one of the media sensations of 2006, the year every British newspaper suddenly had an opinion about intercountry adoption. What some praised as the altruistic rescue of a child from poverty and early death, others criticised as an adult-driven, largely commercial transaction. Few editorials considered the consequences for the child growing up in a “rainbow family” far from home or the plight of those children for whom rescue was not an option.

Unlike newspaper editors, paediatricians instinctively support policies that are in the best interests of children. However, forming an opinion about intercountry adoption can be an ethical minefield. While adopters are often driven by humanitarian motives, the children they crave are potentially very saleable items in unscrupulous hands. Few would wish to insult the good intentions of adoptive parents. However, it would be naive to deny that corruption and criminality can exploit the desperation of parents caring for children they can ill afford and the yearnings of those with none.

In a perfect world without war and gross inequities in living conditions, intercountry adoption would not exist. To leave the country of one’s birth and culture is to undertake an uncertain and hazardous journey which, given a free choice, few would attempt. For a child, this is also a risky and disempowering process. The decision to move is normally made for a child rather than by the child. Children move from the familiar to the different and from fitting in to standing out. While the change is often from poverty to relative wealth, wealth alone cannot guarantee a better life.

THE DEMOGRAPHICS OF INTERCOUNTRY ADOPTION

Intercountry adoption started in North America primarily as a philanthropic response to the devastation following World War II and initially involved children …