The Baby Trade
Each year, Massachusetts families adopt some 3,000 children. One Harvard Business School professor asks if these babies shoul have price tags and if the market begs for more regulation.
The home page for Rainbow Kids is designed to rip your heart out. When you log on to www.rainbowkids.com, you see color photographs of beautiful, usually somber-looking children. There are some babies, some older kids. Most are toddlers, clasping toys or sporting huge bows in their hair. All these children are available - waiting, you quickly learn, for their "forever families." As you scroll farther, you learn how to search: by country, gender, age. The toughest one is "date added," which shows, in reverse order, how long some children have been waiting. On a recent visit, for example, you could find 6-year-old Bulat, who had been on the list for three and a half years. "He is described as quiet and gentle," the site reports, "and really enjoys playing sports." Ten-year-old Yamile "likes to write and draw ... and dreams of being a doctor when she grows up." At precious.org, another adoption photo listing, you can learn about Sofia - "sweet and smart, sparkly and fun, polite and inquisitive" - or Rafael, an "A+ student" who "is dreaming to have a family." All these children, like all the Rainbow Kids, are orphans. And, essentially, they are all for sale.
Officially, of course, selling babies is illegal. The parents who visit Rainbow Kids aren't looking to buy their children; they're hoping to adopt them. In practice, though, adoption is indeed a market, particularly in its international dimension. There is a huge and unsatiated demand for children, the same demand that propels would-be parents to seek out fertility clinics and surrogacy brokers. There is a tragically large supply of "waiting" children and a panoply of intermediaries - adoption agencies, social workers, lawyers - working to match the two sides. There are prices, too, in the adoption trade, differentiated "fees" that clearly distinguish one child from another. Little Anita from Eastern Europe, for example, is a "sweet, affectionate girl" who suffers from fetal alcohol syndrome. Her adoption fees are reduced. Yi-Wei of Korea, an 11-year-old boy found abandoned on the street, comes with a $7,500 private grant.
In purely economic terms, Anita and Yi-Wei are only tiny bits of the global baby trade. Although some parents choose adoption instead of (or in addition to) old-fashioned reproduction, many wander onto the Rainbow Kids site after they've exhausted all other channels of child production. In these cases, the market for existing children functions as a nearly perfect substitute for the nonexistent ones, for the children who weren't born as a result of artificial insemination, in vitro fertilization (IVF), or sex. As with the more mechanical forms of reproduction, adoption carries a price tag, ranging from virtually nothing - the cost of adopting a teenager from the US foster system - to more than $35,000, the fully loaded cost for a healthy white Russian infant.
What separates adoption from other aspects of the baby trade, however, is the obvious difference in "product." In assisted reproduction, the parent is purchasing the potential of a child, the hope that technological intervention will lead to a live birth. The producers, meanwhile, are selling eggs and sperm, services and promises, along with the probability that their high-tech tinkering will create a child. In adoption, by contrast, the child already exists. He or she is a little person, shorn of parents but fully equipped with the rights, dreams, and memories of a human being. Accordingly, the politics and practices of adoption are even more complex than those that surround the more usual forms of reproduction. It's one thing (and bad enough, some would say) to sell sperm or an egg. It's quite another to sell a child.
NORMATIVE VIEWS ON ADOPTION SPLIT sharply into two camps. On one side are those who see adoption as a purely social interaction: It is about building families and rescuing children. In this view, there is no overlap at all between adoption and commerce, and no notion of putting prices on children. On the other side, however, adoption is not only a market but a market of the worst possible sort. It is a market that sells innocent children, putting a price on their heads without any concern for their well-being or for the toll imposed by being treated as trade. Moreover, opponents also charge that the very possibility of adoption, and particularly of international adoption, raises the stakes for poor, pregnant women. If these women know that they can place their children for adoption, and if they can perhaps receive some payment for their labors, they will be tempted or tricked into choosing adoption - to sell their babies for profit, in the harshest version of this critique, and expand an inherently illicit market. Less dramatically, critics of international adoption also argue that it compromises the human rights of the children involved by thrusting them into a cultural context different from their own.
The debates in this field are passionate, with adoptive families and adoption agencies pitted against those who condemn the process. In the United States, the proponents of adoption have tended to win: US families adopt more than 100,000 children each year, roughly 15 percent from abroad and nearly all under the confines of a wide-ranging, government-sanctioned system. In Massachusetts, 3,259 children were adopted in 2001 (the latest year for which figures are available).
In some respects, the debate over adoption is both small and highly personal. Those who paint adoption as an intimate, admirable, non-commercial activity tend to be either adoptive parents or adoption agencies. Those who scorn it as illicit trade tend to be neither. There is little public attention paid to the world of adoption (aside from the occasional fluff piece or horror story), yet the questions that surround it are both fundamental and far-reaching, because in adoption there is an awkward imbalance between market forces and public perception, between what is happening on the ground and how we choose to describe it.
One look at Rainbow Kids, for example, suggests that something close to commerce is indeed taking place. The same can be said of the seminars that adoption agencies regularly hold to describe their trade and the stories of "available children" profiled in glossy magazines. Yet such hints of trade need not imply that adoption is illicit or immoral or that children are being treated as commodities. Instead, market forces could be exactly what make adoption work in many cases, what allows a vast supply of children to be matched with the equally vast demand for them.
IT'S TEMPTING TO SAY THAT MONEY SHOULD never enter the relationship between parent and child. Indeed, on moral grounds, one can argue that the prohibition against selling children is so deep and so crucial that nothing - not even the fate of these children themselves - can violate it.
If one sees adoption as part of a broader baby trade, however, such sweeping pronouncements are more difficult to make. Because, clearly, profits are being made in other parts of the trade: in infertility treatments, in sperm sales, in surrogacy. By what logic can we argue that a fertility clinic can charge its clients $44,800 for a gestational surrogate cycle, but an adoption agency can't charge $8,000 to place a war orphan from Ethiopia?
Perhaps one can draw a hard and fast line at the child himself, distinguishing between the components of conception and the product of that conception. In other words, one can say that from the moment the child is born, he or she can no longer be traded or treated as part of a market transaction. This is a legitimate position. It also, however, often runs contrary to the interests of the child at hand. Because it takes money to bring a little boy from Ethiopia to Boston; it takes money to care for that little boy in a local orphanage and to ensure that his prospective parents can raise him in an appropriate manner. If this money does not change hands - if the market for international adoption were to disappear - that little boy would almost certainly spend his childhood in an institution. And only a tiny handful of sociologists and child welfare advocates would still maintain that any child is better served by institutional life.
Alternatively, one could allow the transaction to occur but insist it remain apart from any market influence. Practically, such a position would mean ceding adoption entirely to the government. It would mean expending government resources and replacing market structures with government bureaucracies. But government-based adoption would clash head-on with a deeply seated preference for choice. It would thrust family making into bureaucratic hands and would likely engender the kinds of delays and inefficiencies that currently cloud the US foster system. Moreover, a government-based adoption system would stand in even sharper contrast with other elements of the baby market; it would mean creating a sharp dichotomy between reproductive options that could be purchased (eggs, embryos, preimplantation genetic diagnosis, IVF) and those that could not.
Such a system is indeed possible, and if we take the moment of conception as a clear dividing line, then it may be the best we can do. But taking adoption out of the market would lessen the efficiencies that now exist. It would reduce the number of children available for adoption and increase the amount of time involved. It would also impose older-era guidelines on parenting, leaving government agencies to determine who is suitable to form a family, and how.
Once again, the trade-offs of such a system become most evident when compared with other means of baby making. At a societal level, adoption almost certainly provides a better option than assisted reproduction. It draws upon the existing supply of children rather than creating new ones. It conserves financial resources that would otherwise be spent on foster care or institutional arrangements. And it avoids the cost of new, higher-tech children.
Admittedly, one wouldn't want childless couples to bear sole responsibility - or indeed any real responsibility - for solving the problem of parentless children. By the same token, though, it also seems foolhardy to put adoption at a relative disadvantage to assisted reproduction. If we let people donate eggs and sperm and embryos, how can we insist that infants be handed to the state? If we let an unmarried 52-year-old woman pay $100,000 for the IVF treatment that will provide her with newborn twins, why should we prevent that same woman from paying, say, $25,000 to adopt Sofia or Rafael?
THE FUNNY THING ABOUT THE ADOPTION market is that it works. It doesn't work in every case, of course, and it works better for some kids and parents than others. Yet the history of adoption provides a surprisingly consistent picture of success. Whether they adopt through public agencies or private, through friends or foreign lawyers, and whether they adopt infants who look "just like them" or distant toddlers of a different race, most adoptive parents subsequently assess their experiences in rather glowing terms. They embrace their adopted children as theirs and don't seem to harbor any lingering doubts about the nature of the original transaction. The only prevalent complaints revolve around shortages and bureaucratic delays: too few children, too much red tape.
For adopted children and birth parents, the picture is murkier, but not for reasons that relate directly to commerce. Some limited evidence suggests, for example, that adult adoptees resent the transactions that surrounded their placement. Some studies argue that adoptees bear the lingering pain of their birth mother's "rejection" or that they face a lifelong quest to discover their genetic origins. Most adoption experts currently argue that open adoption is better than closed and that adoptees have a right to know the circumstances of their birth. None of these complaints, however, has anything to do with the business of adoption. On the contrary, critics reserve their sharpest bile for the old model of state-based or licensed-agency adoption, where all transactions were secret and power rested with a handful of social workers.
Similar complaints are voiced by, or on behalf of, birth mothers, now commonly regarded as the most vulnerable element in the adoption triad. During adoption's heyday in the middle of the 20th century, young, unmarried birth mothers were routinely denied any say in their child's destiny, or even their own. They were routed into unsavory maternity homes by parents or boyfriends, where their children were frequently taken before the mothers even awoke after the birth.
Yet again, the tragedy of adoption in these cases has little or nothing to do with the market. Women didn't relinquish their children in the 1950s and 1960s because they had a financial incentive to do so; they relinquished them because they didn't have the means or social standing to raise them on their own. Circumstances changed somewhat after the advent of birth control and legalized abortion, because the sudden dearth of adoptable infants made brokers more willing to offer enticements to birth mothers, and birth mothers more ready to accept them. A far more important change, though, was that birth mothers began to exercise choice and discretion, deciding whether to place their children and, increasingly, with whom.
Again, therefore, the introduction of market forces actually enhanced the options that birth mothers were offered. At the extreme, market forces have put birth mothers into the buyer's position, enabling them to select from a catalog of potential parents. Such options do not imply that the decision to relinquish a child has become easy or that birth mothers see their choices as representing some kind of pleasant parental supermarket. By the same token, though, it is difficult to argue that market forces have worsened the plight of birth mothers.
Those who do advance accusations along these lines generally focus on the less-developed world, where, they contend, women are coerced by their own poverty to relinquish children they would prefer to raise. But, again, it is hard to blame the market for causing these women's undeniable pain or to believe that halting cross-border adoption would do anything to alleviate their situation. Instead, the adoption market sends capital flowing in precisely the direction that adoption's opponents desire: from rich countries to poor, from wealthy parents to abandoned, neglected, or relinquished kids. And if a little more commerce were injected into this field, more of the waiting Yamiles and Bulats might leave the world of Rainbow Kids and finally head for home.
Debora L. Spar is the Spangler Family Professor and senior associate dean at Harvard Business School. She lives outside Boston with her husband and three children, one of whom was adopted from Russia three years ago. Send e-mail to email@example.com.
FINDING A HOME
US families adopted 127,407 children in 2001, the latest year for which data are available. These New England states saw the following numbers of adoptions:
New Hampshire 630
Rhode Island 617
SOURCE: 2004 NATIONAL ADOPTION INFORMATION CLEARINGHOUSE REPORT; MAINE FIGURES ARE FROM 2000
COMING FROM ABROAD
In 2005, the following ranked as the top countries of origin for orphans bound for the United States and issued immigrant visas:
China (mainland) 7,906
South Korea 1,630
SOURCE: US DEPARTMENT OF STATE