The impact of the COVID-19 pandemic on intercountry adoption and international commercial surrogacy

ICA and ICS

ICS has gained popularity as a means of building families alongside a global decline in ICAs related to ethical concerns and illicit practices (Cuthbert and Fronek, 2014). Abuses and ethical problems in ICA and ICS are well documented (Davies, 2017; Fronek, 2018; Gibbons and Rotabi, 2012; Quartly et al., 2013; Rotabi and Bromfield, 2017). These vulnerabilities are being further exacerbated during this global health crisis.

For ICA, the business model of private adoptions serves to find children for families rather than families for children (Fronek and Cuthbert, 2012; Rotabi and Bromfield, 2017). Fraudulent and illegal adoptions have been documented in all countries that have participated in the practice, with significant attention paid to Latin America, Africa and Asia (Dubinsky, 2010; Rotabi and Bromfield, 2017). Fundamentally, in traditional societies like Ethiopia and Cambodia, vulnerable families have been exploited as the Western concept of adoption is not typically understood. Adoptive parents have also been defrauded. Today, many cases are either in a moratorium or under strict rules to protect children. The Hague Convention on Protection of Children and Co-operation in Respect of Intercountry Adoption (HCCH, 1993) has been critical in reforming practice to prevent child sales into adoption, address force, fraud and coercion (Fronek and Cuthbert, 2012; Gibbons and Rotabi, 2012).

A profit-driven model has resulted in the commercialisation of children in ICS. When children are not deemed desirable (e.g. children with disabilities), they have been left stateless, abandoned and trafficked (Trimmings and Beaumont, 2013). Opaque practices have made it is impossible to estimate how many children are affected. However, the risks for human rights abuses of poor surrogate mothers are profound due to the unregulated nature of ICS businesses (Davies, 2017; Fronek, 2018; Rotabi and Bromfield, 2017). When surrogacy is practised in countries like the Ukraine and Kenya with limited surrogacy regulation, abuses against women and children do occur. However, risks also exist in the United States, especially in California, a popular destination for Chinese customers who pay upwards of US$75,000 (Rotabi and Bromfield, 2017).

COVID-19

COVID-19, first identified in Wuhan, China, in December 2019, is having a marked impact on both practices (Park et al., 2020). By mid-February, the virus had killed more people than SARS and MERS combined (Mahase, 2020). On the 11th March 2020, the World Health Organization (WHO) announced pandemic status (WHO, 2020c). At the time of writing this article, there were no scientifically validated pharmacological treatments, and vaccines were predicted to be at minimum 18 months away (WHO, 2020a). Despite guidelines from WHO, countries have taken divergent approaches to the pandemic. Some have been ill-prepared; Australia, the United States and United Kingdom have taken different approaches to mitigation, while other countries such as China and New Zealand adopted suppression which aims to contain its spread (Ferguson et al., 2020).

The virus disproportionally affects older people, people with comorbidities and vulnerable populations who have greater potential for serious illness and death (Park et al., 2020). Children can be infected and transmit the virus, and some children are developing multi-system inflammatory disease resulting in chronic disease or death (Hong et al., 2020; Lee et al., 2020; WHO, 2020b). Knowledge about pregnancy complications and risk of vertical transmission to newborns is still developing. Two cases of infected newborns have been reported in China (Qiao, 2020). Surrogacy-born children, often premature or with other health conditions, may be at greater risk. All actors in ICA and ICS and the systems that support them are threatened by this pandemic. COVID-19 has the potential to intensify present vulnerabilities and create new ones.

The impact on ICA

International flights have ceased. Countries have closed their borders to non-citizens and restricted the internal movement of citizens for an undefined period, likely to be months. Many countries hardest hit by COVID-19, such as the United States, China, South Korea, Italy and Spain, are key actors in ICA as either countries of origin or countries of destination.

Children already matched with prospective parents but still in countries of origin are facing delays due to travel restrictions. Initially, adoption cases were given priority where possible, for example in the China–United States programme, consistent with earlier responses to natural and man-made crises (US Department of State, 2020a). Children will remain in institutions and other care situations longer than planned. Countries that have moved rapidly towards adoption as a solution to de-institutionalisation to meet national targets may be forced to seek alternatives. Although a risk to ICA, benefits may be that governments and donors are forced to turn attention to enhancing family preservation, tracing and reintegration, which are neglected where adoption is prioritised. Exploring family strengthening and preservation is an ethical and cautionary approach that is protective against fraud and more consistent with the rights of children than pursuing adoption as the first priority in the care of children. The health of institutional and foster carers is of concern. For example, foster carers in South Korea who care for children to be adopted are usually older, at risk of infection and reliant on income from fostering. In countries such as China, institutions supply the demand for adopted children. There is currently no data on how carers in institutional or foster care or children are faring in the pandemic.

Adoption practitioners are all too familiar with the anxieties and frustration of prospective parents and their eagerness for a quick, problem-free process under normal circumstances (Quartly et al., 2013). In most receiving countries of children, considerable political pressure is exerted to fast-track these processes. A prime example is the 2010 earthquake in Haiti (Rotabi and Bromfield, 2017). Today, strategies are needed to support practitioners to deal with increased anxiety over delays without compromising ethical standards such as organisational support that remains focused on the well-being and rights of children rather than succumbing to pressure that displaces these interests.

Private agencies allowed in some countries such as the United States have already felt the impact of decreasing numbers of ICAs. Many have already closed, unable to sustain financial viability. Many more will close in the coming months due to the economic downturn (Neville and Rotabi, 2020). Processes in place to protect the best interests of children may be compromised to progress adoptions, for example, reducing the 14-day socialisation period that requires American prospective parents to be in Haiti and to hire proxies instead (US Department of State, 2020b). Agencies must make decisions about not accepting new applications which would create significant uncertainty for all parties. Historically, adoption agencies have pushed on more vigorously during times of crisis. An official cessation of new applications to adopt internationally is the right strategy, while recognising that a global call to respond to ‘orphans’ of the pandemic will likely be loud and dramatic, demanding ICA as a humanitarian solution. Caution is based on history and the facts at hand. Global orphanhood is overstated, with 80–90 percent of institutionalised children having at least one living parent and extended families who could care for them with appropriate services and resources (Rotabi and Bromfield, 2017).

The impact on ICS

In the ICS marketplace, multiple tiers of actors work to bring together commissioning parents, surrogate mothers and donors, often in less regulated environments. Similar to adoption, pregnancies are in process and children have been born. Transmission of COVID-19, travel restrictions and potential financial consequences for commissioning parents have negative implications. The fate of surrogate mothers and children born are uncertain if financial support is withdrawn, if handovers of infants are stalled for long periods, or if commissioning parents change their minds. Fundamentally, it is an expensive process and the predicted recession and unemployment has jeopardised planned surrogacies, leaving children and vulnerable surrogate mothers in uncertain circumstances, especially as payments are often made in instalments across the course of fertility procedures and pregnancy. For example, over 500 babies have been left stranded in the Ukraine (Górny, 2020). Consequently, the Children’s Ombudsman in the Ukraine has proposed banning the practice (Ukrinform, 2020). These are businesses not renowned for transparency and accountability, and efforts are being made to ensure financial viability through continued advertising. Entering into new surrogacy arrangements when there is no guaranteed stable outcome for the children born is inherently unethical. In addition, provisions must be made for the one-to-one care of children already born from surrogacy until travel, legal custody and parentage can be resolved. False promises and financial abuse are already existing vulnerabilities (Fronek, 2018). As it is more difficult to coordinate the necessary processes in challenging times, telehealth will be used to advance new arrangements even when uncertainty about completing transactions exist. Known risks will be exacerbated for all parties, particularly children.

Conclusion

The long-term impact, like the virus itself, is speculative depending on how long restrictions are in place, but with certainty, the pandemic is having negative effects on ICA and ICS. Some may herald the demise of these practices, while others predict a mere hiatus. Be that as it may, the long history of ICA and the short history of ICS has shown that as sources of children are blocked, those with vested interests work around obstacles to find new solutions. Unfortunately, these sometimes involve eroding safeguards, resorting to unethical or criminal practices which jeopardise the well-being of children and vulnerable adults involved, especially pertinent where money and children come together. However, this crisis also brings opportunities to review practices and processes in a way that encompasses contemporary knowledge and addresses social injustice and the needs of the vulnerable and disempowered, rather than simply ensuring that pre-existing practices continue as they once were. All indications suggest the health, social and economic impacts will be of greater significance than first expected. Social workers must be poised to respond ethically, making critical decisions related to the best interests of children by ensuring parties do not enter into new arrangements that cannot be fulfilled and that children ‘stuck’ in countries due to travel restrictions are cared for properly.