One unforgettable winter day in 2002, I knocked on the door of A3 and found a friendly couple waiting for me. The husband, a bank executive, was tall and well dressed. His wife, an elementary school teacher, didn’t look anywhere near the age listed on her chart, thirty-nine. Classy and attractive, even in a hospital gown, she smiled and nodded as I introduced myself. Studying her chart, I could see that the patient, Mrs. Givens, was experiencing vaginal bleeding and abdominal cramps. I assumed she was pregnant, since the chart stated that her last menstrual period had been nine weeks earlier.
It didn’t take long to discover that she was the more outspoken of the couple.
“Doctor, we are hardworking people,” she began, sitting upright on the examining table. “We pay our tithes and rarely question God’s reason for our failure to have a baby.”
She was dry-eyed and calm.
“This is my sixth pregnancy, but I have no children,” she continued. “There is nothing that I want more than to have a child. I’ve read books, attended seminars on parenting; I’m ready to be a mom.”
But repeatedly she had miscarried. Her doctors could give her no explanation. That morning had started out fine, she said, but her heart sank when she got to work and discovered she was bleeding. She left work immediately and went home to lie down and pray. Unfortunately, though, soon she started feeling stomach cramps. She called her husband, who came home and rushed her to the hospital.
“Here, you should take a look at this,” Mrs. Givens said, handing me a worn brown book—a journal, organized by dates, describing every detail of this and her previous pregnancies. She’d highlighted everything from her last menstrual period to prayer services. The journal provided an extraordinarily thorough look at her medical history. As I read some of the entries, Mr. Givens stood behind his wife like a bodyguard. The two of them seemed to have a close and loving relationship.
I noticed that Mrs. Givens had starred the date of a previous positive pregnancy test, and then I skipped to an entry six weeks later: “I prayed and prayed that it wouldn’t happen,” I read. “The bleeding started this morning. I rushed to the emergency department. This is our fourth time. I knew that I was miscarrying, but hoped maybe the doctors could save this one. I did everything I was told. I don’t know if I can do this again.”
I was still thumbing through the journal when Mrs. Givens interrupted. “Doctor, last time, the doctor told me they couldn’t do anything. That was two years ago. My husband and I have been married for eight years. I can’t lose another pregnancy. This is our last try. I said I would try until I’m forty, then no more.”
She repeated it firmly: “After my fortieth birthday, no more tries.”
I tried to sound optimistic. “Mrs. Givens, before making assumptions, let’s finish your history and perform a physical exam. We’ll order some lab work and perform an ultrasound to see where we are with this pregnancy.”
“What was your name again?” she asked.
“Dr. Davis,” I reminded her.
Mrs. Givens wasn’t done with her story yet. “Dr. Davis, we have relatives and friends who are now on their second and third children. Every time I visit my cousins and friends, I wonder why—why can’t we have the same joy?”
She had truly believed God would see her through, but I could see her faith starting to bend. “What’s wrong with me? If only I could make it past the twenty-sixth week,” she said.
Clearly she knew that at twenty-six weeks most premature babies have a decent chance at survival. But on this day, she was only seven weeks pregnant, eight at best.
“Today isn’t happening,” she said dully.
She quizzed me about whether she could have a “cervical cerclage,” a medical procedure in which the cervix is practically sewn shut to keep it from opening prematurely and expelling the growing fetus. I could see that Mrs. Givens knew her stuff, had collected a ton of information. I explained that while the cerclage is a great option in some cases, she wasn’t advanced enough in her pregnancy to consider it. A normal pregnancy lasts thirty-seven to forty-two weeks. Every week is a necessary phase in the development of an organ or body part, I said. Science has yet to discover a way to shorten the pregnancy process.
“At an early stage the body miscarries for many reasons, whether it’s anatomical, your body structure, or something wrong with the fetus, like genetic abnormalities,” I told her. “It’s the body’s way of handling such situations.”
I sensed that she felt somehow to blame, and so I assured her she had not done anything wrong and that, in fact, from what I read in her journal, I could tell she’d been one of the most careful and deliberate pregnant women I’d seen. But Mrs. Givens seemed to be devolving right in front of me, suddenly becoming withdrawn, wrapping her arms around herself, and slowly rocking back and forth.
I glanced down at my watch and realized I had to move things along. Calling for a nurse to assist me, I wheeled my stool over so I could perform a pelvic exam. Once I placed the speculum, I could see a steady flow of maroon blood rushing out of Mrs. Givens’s cervix. Not good. The bleeding likely meant she was shedding her uterine lining, fetus included. Probing with my hands, I could tell the cervix was closed. At least that was a good sign. An open cervix would have certainly signified an impending miscarriage. Perhaps bed rest could save the baby. A small chance, but a chance nonetheless.
Now I needed a more detailed look inside. I called for an orderly to take Mrs. Givens for an ultrasound. I could have performed the test myself but decided to spare her the indignity of possibly having to undergo the same test twice in one day: If she had indeed miscarried, hospital rules required her to have an ultrasound in the radiology suite. Since the Givenses would be busy for a while, I left to continue my rounds.
I picked up the chart for my next patient and knocked on A4’s door, waited for a positive response, then stepped inside. A twenty-one-year-old woman, Ms. Harris, was pacing the small exam room. She was wearing a hospital gown, and I could easily see her behind, as she had failed to tie the gown in back. She was not happy; that much was plain.
“About time,” she said, by way of introduction.
“Hi, I’m Dr. Davis,” I said, pointing to my identification badge.
“I know who you are. I saw you running around the department last time I was here. I got a female doctor then. Is there one here today?”
I informed her that the female physician on staff would not be in until later. “At midnight—just another four hours, if you’re willing to wait,” I said, pretty sure what her response would be.
She made a hissing sound. “I guess you’ll have to do. I was here a week ago. That doctor, she told me I was miscarrying.”
I glanced down at the nurse’s triage sheet and saw that the patient indeed was pregnant. An ultrasound performed a week earlier showed her at about seven weeks.
“She said I had a fifty-fifty chance of miscarrying,” Ms. Harris continued. “That my ultrasound was abnormal, and then something about me having a threatened pregnancy. She told me to stay in bed and follow up with the clinic across the street from me.”
“Well, have you made an appointment there?” I asked.
“No,” she quipped. “I don’t have time to show up at nobody’s clinic.”
She explained that she was too busy for a full doctor’s appointment. “This is my sixth pregnancy,” she said. She had three children at home and had undergone two abortions. “I only decided to come back today because I didn’t miscarry. That doctor, she told me the baby would be gone by now.”
She couldn’t afford an abortion, she said, so she’d come back to the emergency room to get the procedure done. “After all, you guys told me it would happen, and it didn’t,” she added belligerently. “This is malpractice to me, and I want you to be the first to know that you guys lied to me and if I have to, I will get a lawyer.”
I could barely believe her; I just hoped my facial expression didn’t give away my thoughts. The memory of what had just happened next door was too fresh in my mind. It certainly affected my reaction to Ms. Harris—she was almost too much to take. My many encounters with young women like her sometimes left me feeling defeated, frustrated, as it seems impossible to stamp out all the reproductive ignorance and sexual carelessness in the world.
Looking back, I wish I’d taken a deep breath, ignored her rant, and talked to her about responsible methods of birth control to prevent unwanted pregnancies. I also wish I hadn’t made any knee-jerk assumptions. I think we doctors sometimes assume too much. We assume that young women know what to do for their bodies and are just behaving irresponsibly. Unfortunately, I’m too often reminded that, in fact, they don’t have the information they need to make responsible choices, and that their sexual decisions are sometimes not just spontaneous but also based on myths and half-truths.
“Ms. Harris, I’m sorry to hear what happened, and I assure you we will find out what’s going on,” I said. “Now, to make sure I understand: You were hoping to lose this pregnancy and were under the impression that was going to happen.”
“You got it,” she said. “But since the bleeding stopped and I didn’t see any clots, I’m sure it is still inside of me … Doc, I need this thing to happen, like, yesterday. I didn’t want to come back here.”
She continued: “You got to understand, I love my man, and he doesn’t want any more kids.” He already had six, she said, including her three, and they definitely didn’t need any more mouths to feed.
I rubbed my suddenly tired eyes. “Ms. Harris, let’s first see if you’re still pregnant. You may have already miscarried, and the stopping of the vaginal bleeding may simply be a sign that the fetus has passed. I’ll need to perform a full examination, which includes a pelvic. A nurse will be in the room with me.”
“Oh, no, Dr. Davis, they did that exam last week. You don’t have to repeat it. Besides, my man isn’t going to allow no dude to look up inside of me.”
As crazy as it sounds, this kind of response isn’t rare. I’ve had patients demand to be examined only by a female doctor, and I’ve seen boyfriends and husbands act out, as though I was invading their personal Fort Knox. Usually, I can calm the situation by remaining professional, assuring the couple that I’ve performed thousands of pelvic exams and that a nurse (most assuredly a woman in these circumstances) would be present the entire time. Still, I’d seen grown men storm out of the room, slamming the door behind them.
“Ms. Harris, you’re here for help. Let me do my job. The nurse will be in the room. You will be safe,” I said more sharply than I’d intended.
“Okay, but if he comes in here and sees you doing this thing, he’s going to get you,” she threatened. I wanted to laugh out loud, even though it was obvious she was dead serious. Instead, I said calmly: “Let me worry about that, Ms. Harris.”
I had her climb on the exam table and moved to listen to her lungs, which were clear. Her heart rate was regular, with no murmur. Her abdomen was soft, she had regular bowel sounds, there were no abnormal masses and no tenderness. “Okay, Ms. Harris, your exam thus far is fine. I’ll go grab a nurse and be right back.”
As I made my way to the door, she said, “Hey, Doctor, if you can’t perform the abortion, do you have a department that’ll do it for me? I really want to get it done today.”
“Let’s just get through the exam,” I said, opening the door. “I’ll also bring back the ultrasound machine.”
As soon as I shut the door behind me, I couldn’t contain my disbelief. Linda, one of my favorite nurses, was standing near the door. Her expression told me she could tell something was wrong.
“I’m going to need you as a chaperone in A4,” I explained. “You won’t believe what’s going on in there. I’ve got an irate patient blaming us because she didn’t miscarry.”
Rolling the ultrasound machine toward the room, I explained the two stories unfolding simultaneously. “What’s crazy is that the couple in A3 would kill for the opportunity to have a baby, and here we have Ms. Harris, who can’t wait to abort her fetus.”
I wasn’t judging either family, I told Linda. Ms. Harris had every right to get an abortion, just not in the emergency room. I wished these young couples thought more about birth control before it came to this. And I wished I had the power to grant both parties their desires: If only I could take Ms. Harris’s unwanted pregnancy and give it to Mr. and Mrs. Givens.
“That would be a miracle,” Linda said.
Well, it was definitely pure fantasy. And this here was as real as life got. I completed Ms. Harris’s ultrasound, which showed that she was indeed still pregnant. There was even fetal heart activity.
“Ms. Harris, the fetus is still present. As you can see from the image on the ultrasound machine, the heart is beating.”
“I don’t want to see it. I want it out of me.”
“Ms. Harris, we don’t perform abortions in the emergency department. You’ll have to follow up with the obstetrics clinic.”
There wasn’t much left for me to say to her, although silently a million thoughts were spinning in my mind. I usually wouldn’t have gotten so worked up, but the side-by-side contrast was just so stark. Though I was taken aback by Ms. Harris’s irritation, part of me understood. To her, this fetus represented one thing: more struggle in a young life already heaped with so much of it. I got it. I really did. I just wanted her to see the other side, and before I could bite it back, a non-medical opinion slipped out of my mouth: “You know, there are people out there who wish they were in your position.”
“What do you mean?” she snapped.
I chose my words carefully. “Well, some women can’t have kids and want more than anything else to be a mom.”
Immediately, I wished I’d kept my mouth shut. She looked shocked at first, and then her face contorted to anger: “Dr. Davis, you have some nerve. You are not the judge of me. It’s none of your business what I decide to do.”
I apologized right away. I hadn’t intended to offend her. I’m not sure she heard me, though, because by then her voice had reached a full screech: “I’m going to sue this hospital! I hope it burns to the ground!”
I left the room, stood outside for a moment, and took a deep breath. The Givenses were waiting to hear the results of the ultrasound, so I retrieved their chart and headed back to A3. The hour it had taken for me to get the ultrasound results had given the couple some good time together, apparently. Mrs. Givens seemed more at peace. Her husband sat on the bed beside her and held her hand. I felt like a judge about to render a disappointing verdict. My words would redefine their lives somehow and determine the road they would take from here.
Sweat began beading on my forehead. I had removed my white coat earlier so that I would look less formal, less callous. I only hoped my scrubs didn’t smell, since I hadn’t had time to wash them the night before.
“Mr. and Mrs. Givens, the ultrasound results show a low-lying fetus close to the cervix,” I began.
“What does that mean?” Mrs. Givens asked.
I knew beforehand that they wouldn’t understand the medical terminology. I guess I was just trying to buy more time. I didn’t want to steal their dreams. This part of my job sucked.
“Mrs. Givens, you are miscarrying. The fetus is moving toward the vagina, and eventually you will pass it.”
The husband and wife reached for each other, crying. For me, it was bad enough being the bearer of bad news, but I especially hated that this couple’s strong faith had not been rewarded—at least, not yet. I searched my brain for comforting words.
“I read your journal,” I told them. “The two of you are believers and an inspiration to me. Please don’t blame yourselves. All the right steps were taken. Your journal tells it all, from your battle with morning sickness to the fact that Mr. Givens slept in the guest room when he had the flu so that you wouldn’t get sick. So many sacrifices. You are going to be great parents, even if you have to adopt.”
I had no idea whether Mr. and Mrs. Givens had ever even considered adoption or would in the future, but I hoped so. I’d seen far too many children come into the world unwanted, and—as far as I could see—this husband and wife were a loving couple who wanted nothing more than to become parents.
For many couples, the desire for a blood connection to a child, to create someone who carries part of their unique genetic makeup, is so strong that they don’t even want to hear about adoption. Many are afraid. They wonder: Can I love a child who has no biological part of me? How will I know for sure what the child is like? What if I end up with a problem child? Those fears are real, and unfortunately a few highly visible stories about adoptions gone wrong contribute to broad misperceptions. But adoption, much like having a child the natural way, is full of wonder and mystery. There is no 100 percent guarantee that a family who adopts will wind up with a perfect child and a perfect life, just as there is no guarantee that a natural birth will result in these things. But the 2007 National Survey of Adoptive Parents, the first large national survey of families across all adoption types—the foster care system, private domestic adoptions, and international adoptions—offers some assurance.
Conducted by the U.S. Department of Health and Human Services, the study—which included interviews with more than 2,000 families—shows that the overwhelming majority of adoptive families are happy with their choice: 93 percent of those who adopted through private agencies reported that they would definitely make the same decision again; 87 percent of those who had adopted internationally also said they would do so again; and 81 percent of those who had gone through the foster care system would repeat their decision as well.
Likewise, a large majority—85 percent—of the adopted children were reported by their parents to have been in excellent or very good health. Eighty-eight percent of the school-aged children demonstrated positive social behaviors. Only a small minority had been diagnosed with disorders such as attachment disorder, depression, attention deficit disorder, attention deficit/hyperactivity disorder, conduct disorder, Fetal Alcohol Syndrome, or drug issues. That’s the happy side of the adoption coin, the side that the public rarely sees.
The need for more African American families to adopt is tremendous, given the disproportionate numbers of our children in the nation’s foster care system waiting to find a permanent family. As of the end of September 2010, there were a total of 107,011 children in foster care available for adoption—30,812 of whom were African American and another 6,771 of mixed race.
The process for becoming an adoptive parent varies, depending on the type of adoption. But all adoptions generally require some type of home study, in which an investigator, usually a social worker, conducts a series of home visits and interviews with family members and collects pertinent data to determine a family’s fitness to become adoptive parents. Of the three adoption types, the foster care system is the most affordable, with fees that generally don’t exceed $2,500. A private adoption can cost upward from $5,000 to $40,000, and an international adoption from $15,000 to $30,000. The push in recent decades to increase the number of African American adoptive families has spawned an industry of agencies and programs dedicated to that purpose. Since faith plays such an important role in the lives of many black families, one of the most visible programs is connected to the Catholic Church. One Church One Child dates back to the 1980s, when Father George Clements, a civil rights activist and African American Roman Catholic priest, adopted a boy and formed the organization to encourage churches to help find stable homes for black children. Dozens of state and local chapters of the organization have since been formed throughout the country. For families of faith, like Mr. and Mrs. Givens, the support of their church in adopting a child would add an extra layer of comfort.
I’ve always heard that God works in mysterious ways. I couldn’t give Mr. and Mrs. Givens the news they wanted in the emergency room that day. But maybe my role was broader: to plant the seed of possibility.
This means not having sex (vaginal, anal, or oral) at any time. It is the only sure way to prevent pregnancy and protect against sexually transmitted infections (STIs), including HIV.
This method means either you do not have sex or you use a barrier method on the days you are most fertile (most likely to become pregnant). It also involves checking your cervical mucus and recording your body temperature each day. Cervical mucus is the discharge from your vagina. You are most fertile when it is clear and slippery like raw egg whites. Use a basal thermometer to take your temperature and record it on a chart: Your temperature will rise 0.4 to 0.8°F on the first day of ovulation. You can talk with your doctor or a natural family planning instructor to learn how to record and understand this information.
Contraceptive sponge
This barrier method is a soft, disk-shaped device with a loop for removal. It is made out of polyurethane foam and contains nonoxynol-9, which kills sperm (spermicide). Before having sex, wet the sponge and place it, loop side down, inside your vagina to cover the cervix. The sponge is effective for up to twenty-four hours, including more than one act of intercourse. It needs to be left in for at least six hours after having sex to prevent pregnancy. It must then be taken out within thirty hours after it is inserted.
Only one kind of contraceptive sponge is sold in the United States: the Today Sponge. Women who are sensitive to the spermicide nonoxynol-9 should not use the sponge.
Diaphragm, cervical cap, and cervical shield
These barrier methods block the sperm from entering the cervix (the opening to your womb) and reaching the egg. Before having sex, add spermicide (to block or kill sperm) to the device. (You can buy spermicide gel or foam at a drugstore.) Then place it inside your vagina to cover your cervix. All three of these barrier methods must be left in place for six to eight hours after having sex to prevent pregnancy. The diaphragm should be taken out within twenty-four hours. The cap and shield should be taken out within forty-eight hours.
Female condom
This condom is worn by the woman inside her vagina. It keeps sperm from getting into her body. It is made of thin, flexible, man-made rubber and is packaged with a lubricant. It can be inserted up to eight hours before having sex. Use a new condom each time you have intercourse. And don’t use it and a male condom at the same time. Condoms, both male and female, are the only methods listed here that also offer protection from STIs.
Male condom
A male condom is a thin sheath placed over an erect penis to keep sperm from entering a woman’s body. Condoms can be made of latex, polyurethane, or “natural lambskin.” The natural kind do not protect against STIs. Condoms work best when used with a vaginal spermicide, which kills the sperm. You need to use a new condom with each sex act.
Oral contraceptives—combined pill (“the pill”)
The pill contains the hormones estrogen and progestin. It is taken daily to keep the ovaries from releasing an egg. The pill also causes changes in the lining of the uterus and the cervical mucus to keep the sperm from joining the egg.
Many types of oral contraceptives are available. Talk with your doctor about which is best for you.
The patch
Also called by its brand name, Ortho Evra, this skin patch is worn on the lower abdomen, buttocks, outer arm, or upper body. It releases the hormones progestin and estrogen into the bloodstream to stop the ovaries from releasing eggs in most women. It also thickens the cervical mucus, which keeps the sperm from joining with the egg. You put on a new patch once a week for three weeks. The fourth week you don’t use a patch in order to have a period.
Shot/injection
The birth control shot often is called by its brand name, Depo-Provera. With this method you get injections, or shots, of the hormone progestin in the buttocks or arm every three months. A new type is injected under the skin. The birth control shot stops the ovaries from releasing an egg in most women. It also causes changes in the cervix that keep the sperm from joining with the egg. The shot should not be used more than two years in a row because it can cause a temporary loss of bone density.
This is a thin, flexible ring that releases the hormones progestin and estrogen. It works by stopping the ovaries from releasing eggs. It also thickens the cervical mucus, which keeps the sperm from joining the egg. It is commonly referred to by its brand name, NuvaRing. You squeeze the ring between your thumb and index finger and insert it into your vagina. You wear the ring for three weeks, take it out for the week that you have your period, and then put in a new ring.
Implantable rod
This is a matchstick-sized, flexible rod that is put under the skin of the upper arm. It is often called by its brand name, Implanon. The rod releases progestin, which causes changes in the lining of the uterus and the cervical mucus to keep the sperm from joining an egg. Less often, it stops the ovaries from releasing eggs. It is effective for up to three years.
Intrauterine devices or IUDs
An IUD is a small device shaped like a T that goes in your uterus. There are two types:
• Copper IUD—The copper IUD goes by the brand name ParaGard. It releases a small amount of copper into the uterus, which prevents the sperm from reaching and fertilizing the egg. If fertilization does occur, the IUD keeps the fertilized egg from implanting in the lining of the uterus. A doctor needs to put in your copper IUD. It can stay in your uterus for five to ten years.
• Hormonal IUD—The hormonal IUD goes by the brand name Mirena. It is sometimes called an “intrauterine system,” or IUS. It releases progestin into the uterus, which keeps the ovaries from releasing an egg and causes the cervical mucus to thicken so sperm can’t reach the egg. It also affects the ability of a fertilized egg to successfully implant in the uterus. A doctor needs to put in a hormonal IUD. It can stay in your uterus for up to five years.
Sterilization implant (Essure)
Essure is the first non-surgical method of sterilizing women. A thin tube is used to thread a tiny spring-like device through the vagina and uterus into each fallopian tube. The device works by causing scar tissue to form around the coil. This blocks the fallopian tubes and stops the egg and sperm from joining. It can take about three months for the scar tissue to grow, so it’s important to use another form of birth control during this time. Then you will have to return to your doctor for a test to see if scar tissue has fully blocked your tubes.
Surgical sterilization
For women, surgical sterilization closes the fallopian tubes by cutting, tying, or sealing them. This stops the eggs from going down to the uterus where they can be fertilized. The surgery can be done a number of ways. Sometimes, a woman having cesarean birth has the procedure done at the same time, so as to avoid having additional surgery later.
For men, having a vasectomy keeps sperm from going to his penis, so his ejaculate never has any sperm in it. Sperm stays in the system after surgery for about three months. During that time, use a backup form of birth control to prevent pregnancy. A simple test can be done to check if all the sperm is gone; it is called a “semen analysis.”
Plan B One-Step or Next Choice. It is also called “the morning after pill.”
Emergency contraception keeps a woman from getting pregnant when she has had unprotected vaginal intercourse. Emergency contraception can be taken as a single pill treatment or in two doses. A single dose treatment works as well as two doses and does not have more side effects. It works by stopping the ovaries from releasing an egg or keeping the sperm from joining with the egg. For the best chances for it to work, take the pill as soon as possible after unprotected sex. It should be taken within seventy-two hours after having unprotected sex. A single-pill dose or two-pill dose of emergency contraception is available over-the-counter (OTC) for women ages seventeen and older.
All birth control methods work best if used correctly and every time you have sex. Be sure you know the right way to use them. Sometimes doctors don’t explain how to use a method because they assume you already know. Talk with your doctor if you have questions. They are used to talking about birth control. For more information about birth control methods, call womens+health.+gov at 800-994-9662 (TDD: 888-220-5446) or contact the following organizations:
• American College of Obstetricians and Gynecologists
Phone: 800-762-2264 × 349 (for publications requests only)
• Food and Drug Administration
Phone: 888-463-6332
• Planned Parenthood Federation of America
Phone: 800-230-7526
• Population Council
Phone: 212-339-0500*
Adoption Types†
There are four basic types of adoption:
• public agency adoption
• domestic private agency adoption
• international adoption
• independent adoption
As the chart below shows, requirements, costs, and timing vary between and within the different types of adoption. To decide which is best for you, think seriously about the type of child you would like to adopt (for example, an infant, an older child or group of siblings, a child from another country, a child who has special needs, etc.).
Type of Adoption
Public agency adoption
Definition
an adoption directed and supervised by a state or local Department of Human Services (or Social Services, or Human Resources, or Health and Welfare, or Child and Family Services, etc.)
Children Available
children with special needs (kids who are harder to place due to emotional or physical disorders, age, race, membership in a sibling group, backgrounds); rarely infants
Approximate Cost
from $0 to $2,500 (depending on the state, up to $2,000 of “nonrecurring” adoption costs for eligible special needs children may be reimbursed)
Who Can Adopt
flexible eligibility requirements for adoptive parents; on a case-by-case basis, will consider single parents, parents over the age of forty, parents who have other children, parents with low incomes, etc.
How Long It Takes
starts slowly, but for those who have an updated home study, placement can occur as soon as a few months after selecting a child
Type of Adoption
Private agency adoption
Definition
an adoption directed and supervised by a privately funded, licensed adoption agency
Children Available
sometimes handle special needs children; more commonly associated with younger children and infants
Approximate Cost
$5,000 to $40,000; lower for special needs children; some agencies have sliding fee scales
Who Can Adopt
agencies may recruit parents based on race, religious affiliation, etc.; for infant adoptions, birth mother often chooses
How Long It Takes
a few months to a few years (sometimes longer for infant adoption)
International adoption
(not legal in all states; also known as “private adoption”)
Definition
process of adopting a child who is not a U.S. citizen, which may be accomplished privately through an attorney or through an international adoption agency
Children Available
nearly seventy countries allow their children to be adopted by U.S. citizens; ages range from infants to teens; health conditions vary
Approximate Cost
$15,000 to $30,000 (varies by country; travel and travel-related expenses may be additional)
Who Can Adopt
depends on agency and country requirements; some countries will accept single parents; most prospective parents are between ages twenty-five and forty-five
How Long It Takes
six months to several years depending on the child’s age and health and the country’s political climate
Type of Adoption
Independent adoption
Definition
an adoption initiated by prospective parents and completed with help from an attorney or adoption counselor
Children Available
generally infants
Approximate Cost
$8,000 to $40,000+ (includes prospective parents’ cost of finding a birth mother, certain birth mother expenses, and attorney’s fees)
Who Can Adopt
birth mothers typically choose the adoptive parent—preferences tend to run toward younger, affluent, married couples
How Long It Takes
varies; as long as it takes to find a birth mother who will see the process through to finalization
African American Adoption Agency
2356 University Ave. W
St. Paul, MN 55114-1850
888-840-4084 or 651-659-0460
African American Adoptions, Inc.
8471 Canyon Oak Drive
Springfield, VA 22153
703-829-5641
Another Choice for Black Children, Inc.
2340 Beatties Ford Road
Charlotte, NC 28216
800-774-3534 or 704-394-1124
Ardythe and Gale Sayers Center for African American Adoption
2049 Ridge Ave.
Evanston, IL 60201
847-733-3209
www.+cradle.+org/+adoption-+agency/+adopt_+aa.+html
The Black Adoption Placement and Research Center
2332 Merced St.
San Leandro, CA 94577
510-430-3600
Black Adoption Services Three Rivers Adoption Council
307 Fourth Ave., Ste. 310
Pittsburgh, PA 15222
412-471-8722
Children’s Bureau, Inc.
615 N. Alabama St.
Indianapolis, IN 46204
317-264-2700
Dallas Minority Adoption Council
P.O. Box 764058
Dallas, TX 75376-4058
214-371-5280
Dunbar Association, Inc.
1453 S. State St.
Syracuse, NY 13205
315-476-4269
Families First
1105 W. Peachtree St., NE
P.O. Box 7948, Stn. C
Atlanta, GA 30357-0948
404-853-2800
Family Matters of Greater Washington, D.C.
1509 16th St. NW
Washington, DC 20036
202-289-1510
http://+family+mattersdc.+org/
Harlem Dowling-West Side Center
2090 Adam Clayton
Powell Jr. Blvd.
New York, NY 10027
212-749-3656
Homes for Black Children
511 E. Larned St.
Detroit, MI 48226
313-961-4777
www.+homes4+black+children.+org
1299 E. Artesia Blvd.
Carson, CA 90746
877-367-8858 or 310-900-0930
www.+blackparenting.+org/+services.+html
Institute for Family & Child Well-Being
P.O. Box 7845
Upper Marlboro, MD 20792
info@familyandchildwellbeing.com
www.+familyand+child+wellbeing.+com
Minority Adoption Program Child Saving Institute
4545 Dodge St.
Omaha, NE 68132
402-553-6000 or 866-400-4274
Mississippi Families for Kids
407 Briarwood Drive, Ste. 209
Jackson, MS 39206
601-957-7670
National Network of Adoption Advocacy Programs (NNAAP)
5601 Chamberlayne Road
Richmond, VA 23227
804-377-1627
The New York Chapter Association of Black Social Workers’ Child Adoption Counseling and Referral Service
1969 Madison Ave.
New York, NY 10035
212-831-5181
New York Council on Adoptable Children
589 Eighth Ave., 15th Fl.
New York, NY 10018
212-475-0222
One Church One Child of North/North Central Texas
2860 Evans Ave.
Fort Worth, TX 76104
866-42-ADOPT (866-422-3678)
Rejoice! Inc.
1820 Linglestown Rd.
Harrisburg, PA 17110
717-221-0722
Tabor Children’s Services
57 E. Armat St.
Philadelphia, PA 19144
215-842-4800
Women’s Christian Alliance
1722 Cecil B. Moore Ave.
Philadelphia, PA 19121-3405
215-236-9911
* Source: All of the birth control information in the preceding pages was reprinted from womens+health.+gov, a federal government website managed by the U.S. Department of Health and Human Services Office on Women’s Health.
† Note: It is also possible to adopt children by first becoming a foster parent; many children who have special needs are adopted by their foster parents. Drawback: There is no guarantee that foster parents will be able to adopt either the child in their care or any other child. Most children in foster care return to their birth families, and some are placed in the custody of relatives or adopted by parents the agency feels are best able to meet the child’s particular needs. Advantages: Children who enter foster care are, on average, younger than children who become legally free for adoption after spending years in care. In addition, parents who take in foster children have time to get fully acquainted with a child before committing to adoption. The more parents know about a child, the better their chances are for a successful adoption.
Source: North American Council on Adoptable Children, 970 Raymond Ave., Suite 106, St. Paul, MN 55114, 651-644-3036, www.+nacac.+org. For a more comprehensive list of adoption agencies, go to: www.+child+welfare.+gov/+nfcad/.