“WHY DON’T YOU JUST ADOPT?”
A lot of people pursuing fertility treatments get that question, and people who are worried about whether they can have children after cancer treatment are no exception. And it’s a good question—except for the “just” part. Whether or not you’re a cancer survivor, you don’t “just” adopt. It’s not a simple solution, any more than fertility treatments are simple.
But it’s also not out of your reach if you’re a cancer survivor, contrary to what a lot of people think. You may fear that agencies will turn you away or that a pregnant woman considering placing her child for adoption will never pick you or that you won’t even pass a home study. In most cases, you’d be wrong. Nobody keeps any statistics on this, but just based on conversations with agencies and cancer survivors, and reading posts to cancer websites and adoption mailing lists, I’d venture to bet that hundreds, if not thousands, of cancer survivors have been able to adopt children. You could be one of them—if it’s right for you.
This is a book about having children after cancer, not about adoption itself, so I’m not going to delve too far into the fine details of the adoption process. There are other books designed to do just that, and you can find a list of some of them in the Resources section at the end of this book. Still, when you’re thinking about whether or not you can, should, and want to adopt as a cancer survivor, it’s important to know the basics.
There are three general ways to adopt in the United States: private domestic adoption, international adoption, and foster-adoption. When I say “private domestic adoption,” I’m talking about any and all adoptions of a child from the United States, in which the state has not already taken temporary or permanent custody of the child away from the birth parents. That can mean adopting through an agency or using an attorney. (Four states—Colorado, Connecticut, Delaware, and Massachusetts—require you to use an agency for adoptions and do not permit attorney-managed adoptions.)
Domestic adoptions can be open (birth parents have direct contact with the adoptive family through letters, emails, phone calls, and often even visits); semi-open (birth parents have more limited contact with the adoptive family, sometimes only through an intermediary like an agency or attorney); or closed (neither the birth family nor the adoptive family has any information about each other, and there is no contact). The trend in domestic adoption has been away from fully closed adoptions, since many professionals now believe that, in most cases, at least some degree of openness is good for everyone involved.
International adoption means just what it says: adopting a child from another country. For virtually all international adoptions to the United States, you have to go through an accredited agency. Most international adoptions used to be closed, since it was often difficult to locate the birth parents of a child adopted from another country, but that has changed in recent years. Many parents adopting children internationally strive to maintain some kind of relationship with their child’s birth family, if they are known and can be located.
Adoption from foster care means that the child (or children) you are adopting has been taken from the birth parents’ custody by some state authority—usually your state’s version of a family services agency. With foster-adoption, the child is sometimes placed in your care as a foster child while the state is still considering whether or not the birth parents can eventually parent him or her again. Sometimes, on the other hand, foster children are already free for adoption because their birth parents’ rights have already been severed. Usually, these are older children.
Cancer survivors can, and have, adopted children using all of these options. Which is right for you? It depends on a lot of factors, some having to do with your cancer diagnosis and some that you’d have to consider whether or not you were a cancer survivor.
Answering the questions below can help you to further define your expectations and pinpoint what type of adoption might be right for you and your family.
Before we talk more about what kind of adoption might be right for you, let’s talk about your “golden ticket” for any kind of adoption: your doctor’s letter.
All prospective adoptive parents, no matter how they plan to adopt, must go through a process called the home study, where a social worker or other professional visits your home and interviews you and your partner (and anyone else who lives with you) about your lives, your parenting philosophies, and all kinds of other nitty-gritty details that help the adoption professional decide if you’re a safe person to entrust with the life of a child. Usually, going from the beginning of a home study to the point at which you get officially approved to adopt can take anywhere from a month to six months or more; if you’re adopting from foster care, you will likely also have to go through a series of classes before you can be approved to adopt. (Some domestic adoption agencies require classes as well, but most do not.)
Usually, by the time you get your home study approved, you’ve already decided on what kind of adoption to pursue—because the home study process is generally supervised by the agency you’ll be adopting through, by an independent licensed home study agency or social worker if you’re using an attorney, or by the state itself if you’re adopting from foster care. But since the doctor’s letter is so important to getting approved for adoption, we’ll talk about what it needs to say before we talk about how you choose an adoption professional and move forward with the kind of adoption you think is best for you.
One part of every home study is the medical form. It differs from state to state and program to program, but pretty much all home studies ask whether you have had a life-threatening illness such as cancer.
First rule: Don’t lie. If it comes out that you’ve lied in your home study—about a cancer history or anything else—it can completely put an end to your chances for adopting. And most of the time, you will have to get a doctor to either fill out a medical history form or sign off on the one you’ve filled out, so it’s not as if you can leave this information out or expect your doctor to do so. Answer the Big C question completely and truthfully. For example, you could write: “Successfully treated for testicular cancer in 2005. My physician states that there is no evidence of any remaining cancer and that my life expectancy is normal.”
But what you really need is your doctor to say that him- or herself. That gives you the best chance of having your home study approved and of having an agency give you the go-ahead to adopt. Don’t just hand your doctor the form and ask that it be filled out; tell your doctor what you need it to say. If the form is general and brief (some are), ask your doctor to write a more detailed letter.
“Letters from doctors are a big challenge,” says Beth Friedberg, associate director of international adoptions at Spence-Chapin in New York, a highly respected adoption agency that oversees both domestic and international adoptions. “Many times, doctors will write a very cursory letter, and we have to keep asking for more details. You want a very, very supportive letter from a doctor, explaining your diagnosis, how you were treated, and how you responded.”
Make sure your doctor doesn’t write the letter as if he or she is writing to another doctor. The people at adoption agencies in the United States, and adoption programs in other countries, are professionals, but they’re not doctors. Don’t give them jargon. The key words that most agencies will look for are “cancer free” and “normal life expectancy.”
“It’s best if the doctor can state that you have a normal life span, that the cancer has been fully treated and is not expected to recur, and that you are fully able to parent a child,” says Vicki Peterson, executive director of external affairs for Wide Horizons for Children (WHFC), an agency with offices on the East Coast that handles both domestic and international adoptions. “It helps if [doctors] can include any statistics that they have that can support that, depending on the type of cancer and response to treatment. No doctor can guarantee anything, but the stronger [doctors] can be in terms of their expectations, the better.”
Many doctors, particularly oncologists, are so busy that requests to sign forms and write letters can fall through the cracks. One way to make sure you get the letter you need promptly is to draft it yourself and save it to a flash or thumb drive. Then bring it along to your next appointment, and go over the letter with your doctor then and there. He or she can make corrections, print it out on letterhead, and sign the letter for you to take along with you.
What if you had cancer when you were fifteen, and now you’re thirty-five and want to adopt? Do you still need to disclose that twenty-year-old diagnosis, even if the cancer hasn’t made a peep since then? Talk with your doctor, says Peterson. “If he or she feels it’s an important part of your medical history and must go on the report [he or she is] going to fill out, you need to know that,” she says. “If it’s something that happened in childhood, long ago, and hasn’t recurred since then, it’s probably a medical decision rather than an agency decision to include it. But if there’s any chance at all it could show up in your home study in some other way, you don’t want to leave it out and then have it surprise you.”
If you get that “golden ticket”—a good doctor’s letter—and you’re at least a year out from cancer treatment (the precise length of time depends on what agency you’re working with and what countries you’re considering adopting from, if you go the international route), it’s likely that your home study will be approved. Assuming, that is, that you don’t have any other red flags. “We don’t just look at health in a vacuum,” says Friedberg. “The other parts of your life will be looked at as strengths or problems as well, by the agency, the state, and/or the country you’re adopting from.”
Today, a lot of cancer survivors who choose adoption are opting to pursue private domestic adoption, either using an agency or an attorney. At the time of this writing, at least, it’s much easier for a cancer survivor to adopt domestically than internationally. This doesn’t mean you can’t adopt internationally; it just means that fewer countries than in the past are open to approving adoptions for people with a cancer history. (More on that in “Country Codes: International Adoption,” this page.)
So, if you decide that domestic adoption is right for you, how do you move forward? How do you choose an agency or attorney? How do you get “matched” with an expectant mother considering adoption? And when and how do you bring up your cancer history with her? Or do you?
Finding a good adoption agency, or good adoption attorney, is a lot like finding a good apple in a huge bin at the grocery store. A lot of them look good on the surface, but when you turn them over, there are worms, bruises, brown spots, and other flaws. The problem is that it’s a lot easier to inspect an apple at the supermarket than it is to get the inside scoop on adoption agencies or attorneys. It’s important to make sure that your agency has its state license and to check out whether or not it has any complaints with the Better Business Bureau, but those are bare minimums. Similarly, your adoption attorney should be a member in good standing of the American Academy of Adoption Attorneys (Quad-A), but that alone won’t tell you if you’re dealing with a reputable professional.
All I can say is, take your time and do your homework—a lot of homework. Start by making a list of agencies or attorneys you’re interested in. To get the names of agencies or attorneys who work in your state, search the online databases provided by Adoptive Families magazine in their Adoption Guide website:
You can also mine theadoptionguide.com for a lot of other key resources in your agency or attorney search, including essential questions to ask any agency or attorney before signing on with them, and other sources of information for getting the scoop on agencies or attorneys you’re considering.
One good source for feedback on particular adoption agencies is the Yahoo mailing list Adoption Agency Research (http://groups.yahoo.com/group/Adoption_Agency_Research/). Technically, it’s focused on international adoption, but as it’s evolved, there’s been a lot of discussion about agencies that are involved with domestic adoptions as well (and many agencies do both). There are also agency reviews online at adoptionagencyratings.com, although it can be a bit hard to search. The Evan B. Donaldson Institute (www.adoptioninstitute.org) doesn’t provide specific guidelines or questions for choosing an agency, but the wealth of resources on issues like transracial adoption, ethics and adoption, open adoption, and more make this an important stop in your adoption journey and can give you insights into what you do and don’t want in an agency.
One question that’s not on many standard lists of “what to ask an agency,” not surprisingly, is “What is your policy on working with cancer survivors?” Technically, the Americans with Disabilities Act (ADA) prevents domestic adoption agencies from establishing blanket policies to screen out cancer survivors. Madelyn Freundlich of the Evan B. Donaldson Adoption Institute writes, “The law … requires individualized assessments based on actual risks and the use of reasonable judgment, based on current medical knowledge or on the best available objective evidence, in determining the risks involved and the actual abilities and disabilities of the individual.” (Read more here: www.adoptioninstitute.org/policy/ada.html.)
But ADA or no ADA, when I first started calling adoption agencies, literally within a month or so of my breast cancer diagnosis, I expected most of them to hang up on me or at least put me off with vague politeness. Much to my surprise, not a single agency I spoke with said they would not work with cancer survivors or that they required some long posttreatment cancer-free period of three or more years. Five years later, interviewing agencies for this book, their responses were much the same. Most reputable adoption agencies will work with cancer survivors, although each one may have slightly different requirements for how long you need to have been cancer free before beginning the process.
One domestic adoption agency that’s particularly cancer friendly is Abrazo, which is based in Texas but works with families all over the United States. That’s because executive director Elizabeth Jurenovich is herself a breast cancer survivor. “Over the years, we’ve worked with a number of families where the adoptive father or adoptive mother has survived cancer, and we’ve found them to be wonderful parents,” Jurenovich says. Abrazo usually asks prospective adoptive parents to wait a full year after completing treatment before beginning the process. “I think there’s not just a physical, but an emotional healing that has to go on after dealing with cancer—just as with infertility. Our program does require documented infertility to adopt, and families coming out of the infertility treatment process are also asked to wait at least six months after concluding treatment before starting the adoption process.”
The Cradle, an Illinois agency, takes a more case-by-case approach. “What we’re looking for is completion of treatment. We’ve had people come to us who wanted to start the adoption process while in treatment, and we’ve asked them to wait until they’ve completed it, because we know that active cancer treatment takes a physical and emotional toll on you and your family,” says Linda Hagemann, director of social work. “But there’s a lot of research, reading, and preparing you can do during that time. And after that, we’re really not looking for any specific length of time that someone is postcancer, but more what’s involved in staying healthy, and treating it as any other medical condition.” (Hagemann notes that follow-up treatments—like a five-year Tamoxifen regimen after initial breast cancer treatment—wouldn’t prevent someone from starting the adoption process with The Cradle.)
It’s difficult to create a comprehensive list of cancer-friendly domestic adoption agencies and their policies, but what follows is a short list of nine agencies that have either directly told me that they work with cancer survivors or that have been used by other cancer survivors to adopt. Mentioning an agency on this list doesn’t mean I do or do not endorse the agency, just that I know that they work with cancer survivors. (In other words, check them out yourself!) Many, but not all, of these agencies work with adoptive parents throughout the country, not just those in their state or region.
Attorneys are usually even more flexible when it comes to working with cancer survivors. Many cancer survivors I know have adopted using an attorney and have had good experiences. Scott Greenberg and his wife, Rachel—you read about their inability to conceive using banked sperm in chapter 2—eventually decided to go this route after first signing up with a small, semiprivate California agency.
“Within a week after hiring our attorney, we got a phone call about two situations. In the first one, the baby had already been born and the birth mom hadn’t picked us yet, but the attorney thought she would,” Scott recalls. “In the second situation, the woman was pregnant and had picked us, and would be ready to sign papers when the baby was born. We decided to hold out for the baby who was already born and hope that the mom would pick us, and she did. And that was our son, Bailey—he’s seven now.” The Greenbergs went through a similar process to adopt daughter Peyton two-and-a-half years later.
Courtney Zinzser, also in California, used private attorneys to adopt three times. She’d been a single mom when initially diagnosed with breast cancer in 1996 at thirty-three. A year later, when the cancer returned, she managed to freeze just one embryo using donor sperm before starting chemotherapy. But she feared trying to get pregnant again after breast cancer, especially since hers was the kind fed by hormones (hormone receptor positive). Courtney initially considered using a surrogate but eventually ruled that out too.
As Courtney began to focus on adoption, she had some specific concerns. “I’m a special needs teacher and deal with special needs kids all day, so I felt like I couldn’t handle having a special needs child at home too,” says Zinzser, founder of Pink Wings 4 Breast Cancer. “I wanted domestic newborn adoption. I actually wanted twins. For months we heard nothing from our attorney, and I was getting really frustrated. Then, within two weeks, we heard from two different people—a friend of a friend, and one of the patients of my sister, who’s a pediatrician—that they were looking to place babies for adoption. Both girls, both due in June.”
Although some agencies caution against “artificial twinning,” Courtney wanted to adopt both girls. “We were ready for two, but we thought it would probably turn out that one wouldn’t go through,” she says. She told one of the prospective birth moms right away about the other one, and waited a little to tell the other—but both were comfortable with the situation. Courtney’s daughters, Sage and Sienna, were born within two weeks of each other.
A few years later, Courtney felt ready to adopt again. “I always wanted the Brady Bunch,” she says. She went through one heartbreaking situation in which the birth mother of one of her daughters insisted that she wanted Courtney to adopt the new baby she was carrying, only to decide to parent after giving birth. Several weeks later, Courtney’s attorney called her with news of a baby being born that same day. “ ‘He’s adorable, and they picked you—come in and see him tomorrow,’ she said. That’s how we found out about our little guy, Slayton, who’s now four.”
If you’re adopting domestically, chances are pretty good that the birth mother will play some role in choosing you to adopt her child—as happened for Scott Greenberg and his wife. There are still quite a few cases in which women either tell the agency to choose adoptive parents for them, or relinquish the baby to an agency at the hospital after birth and don’t want to be involved in the process at all. But that’s less and less common today, so it’s pretty likely that at some point, you’ll need to convince a woman considering adoption that you are the right family for her baby.
Once you’ve signed on with your agency or attorney, the next step is usually to put together a profile of your family. Sometimes this is a one-page letter with a few photos, sometimes it’s a multipage document or scrapbook. Either way, it’s the next point in the journey where you will probably wonder, “What do I do about the cancer thing?”
Deciding when to disclose your cancer history to a woman who’s considering you to adopt her child is kind of like deciding when to tell a new boyfriend you’ve had a mastectomy. The first date? Maybe too soon. Any time later? Maybe too late. It feels like there’s no “good time” to make a big disclosure like that. But that’s not a good reason to conceal it altogether.
Scott Greenberg took the plunge right away. “I knew my cancer would have to make its way into the profile that the birth mom would read,” he recalls. “If you’re concerned about who’s going to raise your kid, do you want to give it to some guy who might die of cancer? There haven’t been too many occasions where I felt ‘disabled’ or ‘tainted’ from the cancer, but I did then.”
Now a professional motivational speaker, Scott decided to make something most people would perceive as a weakness into a strength. In their profile, the couple wrote, “Scott survived cancer as a young man, and it inspired him to become a motivational speaker to help other people overcome problems in their own lives.”
“I basically explained that because of what I’d been through, I could better understand adversity,” he says. “I was hoping that a birth mom would connect with that and think that maybe I could help their child become a stronger person.”
Scott took exactly the right approach, says The Cradle’s Linda Hagemann. “We do ask families to put medical conditions in their profile,” she explains. “We practice open adoption, and as part of forming a relationship and disclosing backgrounds to each other, we ask adoptive parents to be honest about health conditions just as they want birth parents to be honest.”
Like Scott, says Hagemann, you should position your cancer experience as positively as possible: “This was a challenge we faced a few years ago, but it’s brought us closer together and helped make us stronger and be more resolved about our desire to be parents.” Of course, you’ll want to include information that the cancer has been successfully treated and you have a favorable prognosis. “Just a couple of sentences about it, and then in a meeting you could talk more,” says Hagemann. “Introducing it in a letter ensures that the mother isn’t caught off guard with the information later.”
Many adoption professionals say that women considering adoption react with surprising equanimity to the idea that the adoptive parents they’re considering have cancer in their background. “Most of the moms we work with, they’re not strangers to hard knocks, to life. They realize that life has its ups and downs and they’re pretty realistic about it,” says Hagemann. “I don’t think they’re under any illusion that adoption is just going to be all perfection. We’ve had families with prior marriages, families with a health issue or something difficult in their background, parents who are recovering alcoholics. Birth parents typically are grateful for the honesty and the fact that this is somebody who has been successful in dealing with a challenge.”
That’s not to say that families with a cancer history haven’t sometimes been skipped over for that reason. But Hagemann says that most of the time, prospective birth parents are looking for specific things in a family: a particular religious background, a home in the country or in the city, a stay-at-home parent, a childless couple or older siblings, particular educational opportunities. In other words, you’re just as likely to be chosen, or not chosen, because of how many other kids you have as because you had thyroid cancer three years ago. It’s about the whole you, not just the “cancer you.”
What if you’re not comfortable with putting your cancer diagnosis in the profile? Is it okay to wait until a prospective birth mom shows interest in you and share the information as you’re getting to know each other? That’s fine, says Abrazo’s Elizabeth Jurenovich—as long as you do use the “C word” before the expectant mom has made any commitments to you. “There are a whole host of details about a family that are not necessarily appropriate for a profile. To some extent it depends on how relevant it is to who you are as a couple and how recent it is,” she says. “But remember that birth parents are expected to be truthful and forthright, and we owe them the same level of honesty.”
When we adopted our daughter in 2006, I was less than two years out from my 2004 cancer diagnosis. We’d just been on the classic adoption roller coaster: two failed matches with one agency, including one where we’d flown hundreds of miles to await the birth only to find out after the baby was born that her mom decided to parent—a few weeks before Christmas. This was followed by a bad “breakup” with that agency, and then a situation with an unscrupulous lawyer who promoted a match with an expectant seventeen-year-old, only to do a 180 when our own lawyer told her that her fees were beyond the limits allowed by New Jersey law. The other attorney then revealed that the girl’s mother was supposedly very leery of my cancer history and had been planning to put the kibosh on the match anyway.
So with our second agency, I shied away from putting anything about my cancer diagnosis in writing. It wasn’t in our profile, and it wasn’t in the letter we wrote directly to our daughter’s birth mother, when the agency told us there was a young woman in Georgia due in a month who wanted to hear more about us.
Instead, I think we took the coward’s way out. We told K. about my cancer history on a visit to her hometown, during dinner at a big, loud, festive Mexican restaurant. I didn’t exactly mumble, “GreatnachospassthesalsabythewayIhadcancer,” but I didn’t say, “Look, there’s something important you should know,” either. I tried to slip it into the conversation as unobtrusively as possible while still being able to tell myself that I’d told her. As it turned out, she really didn’t have much of a concern about it—but I don’t like how we handled it. If we had it to do over again, we would have put the cancer history in our profile because I think that Linda Hagemann is right on all counts. Prospective adoptive parents owe the people who are going to entrust them with their children the whole truth, and we often sell people short. I believe having battled cancer makes me a stronger person and a better mom, so why not say that in a profile?
If you choose to adopt from another country, your big question won’t be “How do I explain my cancer history in a profile for a woman considering adoption to read?” Instead, it will be, “What country or countries will allow me to adopt as a cancer survivor?” Because although you may pass a home study done by your adoption agency, that doesn’t mean that you will be approved by the authorities of the country you wish to adopt from. Each country has its own policies about what kind of health history they’re willing to consider in prospective adoption parents—policies that aren’t always quite clear, but that U.S. adoption agencies have little, if any ability to change.
If I were writing this book six or seven years ago, this section would be much different. When I was diagnosed with breast cancer in 2004 and made the conscious decision to forego fertility preservation, I almost immediately began exploring adoption possibilities, both international and domestic. At that time, agencies I spoke with reassured me that there were a number of cancer-friendly countries, chief among them being China and Guatemala.
That was then; this is now. Today, the picture has changed drastically. “In general, most countries have become more restrictive about what mental and physical health conditions they will accept in adoptive parents,” says WHFC’s Vicki Peterson.
Several years ago, China introduced restrictive new guidelines as to who can adopt from that country; one of the new requirements is that if you’ve ever been diagnosed with cancer, you must be at least ten years cancer free. Even for prospective adoptive parents with no health issues at all, the wait for Chinese adoptions has slowed to such a trickle that, as a practical matter, it makes almost no sense to start the process of adopting from China today unless you are open to adopting a child with significant special needs—or you’re fine with waiting four, five, or more years to bring home your child.
Adoptions from Guatemala to the United States, meanwhile, have been shut down entirely since the United States became a signatory to the Hague Adoption Convention, an intercountry agreement designed to protect child trafficking and exploitation and ensure that adoptions are in the best interests of the children involved. Guatemala is technically a signatory to the Hague Convention, but there have been major concerns raised about the ethics of adoption practices in Guatemala, and the United States has suspended all adoptions from that country until it achieves compliance with the Convention’s requirements. Guatemalan adoptions may reopen someday, but it’s unlikely to be very soon.
Dawn Davenport, who writes the Creating a Family adoption blog, has called the current situation a “perfect storm” of international adoption delays, not just for cancer survivors but for everyone. With Guatemala (and Vietnam) shutting down to U.S. adoptions, and many people turning away from China due to its delays and restrictions, the timeline for adoptions from other countries—like Russia and Ethiopia—is slowing down as more prospective adoptive parents seek out these programs.
So where does that leave you as a cancer survivor? When I first started thinking about this book, I expected to include a clear and specific chart listing which countries were cancer friendly and which were not. But it’s more complicated than that. The problem is that the international adoption picture is an ever-changing one. Some countries close down to international adoptions; others open or reopen; still others change their rules.
“Every country has a different policy on how long ago a cancer history needs to be,” says Jessica Palmer, social work coordinator with Holt International, one of the best-known international agencies. “I can keep track of what countries say when I ask something about a client’s cancer history on a case-by-case basis, and then I can ask a week later and get a different answer. It’s almost impossible to have a hard-and-fast rule.”
So I have a chart for you—but it’s a lot vaguer than I wanted it to be. This chart includes a list of most of the countries from which U.S. citizens can currently adopt, the children generally available for adoption, the countries’ basic requirements of adoptive parents (age requirements, income, etc.), their stance on a cancer history and other health issues, and some of the larger and better-known agencies that currently work in those countries. This is not an exhaustive chart of all the requirements, issues, paperwork, travel required, and timeline for each country—just basic info that should give you an idea of whether you’d want to explore a particular country further. The information comes from the State Department’s public information on adoption from these countries, as well as the public websites of reputable agencies working in these countries. Just keep in mind that a lot can change very fast in international adoption, so use this information only as a jumping-off point, and verify everything you read here with current State Department and agency information!
Burundi adoptions to the United States are relatively new, and programs are in development at a couple of major American agencies. Some other pilot programs are in different stages at various agencies as well, in countries including the Democratic Republic of Congo, Lesotho, and Rwanda. Pilot programs such as these can often move very quickly; they can also shut down just as quickly. While they may be more open to cancer survivors, they may also be more vulnerable to ethical violations, so proceed with your eyes wide open.
REQUIREMENTS The program is open to married couples and heterosexual women, ages thirty to fifty-five. Couples should have been married and living together for at least five years prior to beginning the process.
CHILDREN Children are older infants to teenagers. They are cared for in private orphanages.
CANCER? The program asks for no major medical history. So early on with a new program, it’s hard to know how a cancer history will be viewed, but adoption professionals recommend presenting a cancer history in context, as part of a family’s overall dossier, for the most favorable case-by-case consideration.
AGENCIES Wide Horizons for Children
Practically speaking, China has become almost exclusively a special-needs program for any new adoption applicants. The new requirements instituted in 2007, plus a general slowdown of the process, means that there is usually a more than three-year wait from beginning the process to bringing a child home. U.S. adoptions from China are down significantly from their peak of more than 7,000 in 2004 to just under 5,500 in 2007.
REQUIREMENTS Parents must be a legally married heterosexual couple, ages thirty to forty-nine, with no more than four children already in the household and an income of at least $10,000 per family member (including the child to be adopted).
CHILDREN Children are at least seven months old at time of placement, usually over a year. There are more girls than boys. Children awaiting adoption live in Chinese orphanages.
CANCER? In most cases, China requires that you be ten years cancer free before you can adopt. But if you are willing to adopt a child of three or older with significant special needs, such as a heart defect, you may be able to get a medical exemption. Such adoptions can also sometimes move much more quickly.
AGENCIES Alliance for Children, Children’s Home Society and Family Services, Holt, Spence-Chapin, WACAP, Wide Horizons for Children
Colombian adoptions are among the more stable and long-standing adoption programs offered by many U.S. adoption agencies today.
REQUIREMENTS Parents must be married and each should be between twenty-five and thirty-eight years old to adopt babies and younger children. Older parents and single men and women may adopt older children and those with special needs and must have no more than two children already at home.
CHILDREN About half of all children placed from Colombia are under one year of age. The wait is usually about eighteen months to three years, with longer time frames for younger infants. Children live in both private orphanages and foster care.
CANCER? Eligibility is limited to applicants without physical health issues that impair their daily lives or life span. Colombia tends to be conservative in its health requirements, but depending on the type of cancer and long-term prognosis, they may be willing to consider cancer survivors on a case-by-case basis.
AGENCIES Alliance for Children, Children’s Home Society and Family Services, Spence-Chapin, Wide Horizons for Children
In 2006, 731 immigrant visas for adoption were issued to children from Ethiopia; this number nearly tripled, to 2,277, by 2009. The sharp spike in interest in Ethiopian adoption has also led to concerns about ethics and accountability, as often happens when a country becomes “popular” for adoptions, so choose your agency carefully. Some agencies say that cancer survivors meet with more understanding in Ethiopian adoptions; others have a specific five-year cancer-free rule for Ethiopia. As of this writing, that is a requirement of some agencies, not the country itself, and I know of multiple cancer survivors who have completed Ethiopian adoptions well before reaching the “five-year cancer-free” mark.
REQUIREMENTS Parents should be couples married at least one year, both over twenty-five and under fifty-six, with no more than a fifty-year age difference between youngest parent and child.
CHILDREN Children are infants, toddlers, children, and sibling groups. You must be open to a child up to thirty-six months of age; some babies do arrive home as young as six months, but this is rare. Children awaiting adoption live in group care centers.
CANCER? It is required that you have no chronic medical conditions that would impact the parenting of a child. Conditions like cancer are considered on a case-by-case basis; at present, most agencies will tell you that at this time, Ethiopia is one of the best prospects for cancer survivors considering international adoption.
AGENCIES Alliance for Children, Children’s Home Society and Family Services, Holt, Spence-Chapin, Wide Horizons for Children, WACAP
All U.S. adoption programs in Guatemala are suspended indefinitely. Guatemala is not a signatory to the Hague Adoption Convention.
The devastating earthquake of January 2010 left Haitian adoption programs in turmoil. Many adoptions were expedited for children already in the process of being adopted, but much of the adoption system in place in Haiti—staff, records, facilities—was lost in the earthquake. In May 2010, Haiti’s adoption authority began accepting new applications for children who either were documented as orphans before the quake or had been formally relinquished by their birth parents since January 12. But most U.S. agencies continue to proceed with caution in Haiti.
The process for adopting from India can be volatile, and many agencies that work in India encourage adoptive families to “double apply” or have a backup country in the event that the process is disrupted.
REQUIREMENTS Parents should be couples aged twenty-eight to forty, with no more than fifteen years’ age difference between them. There should be at least twenty-one and no more than forty-five years between parent and child. If at least one parent is not of documented Indian heritage/citizenship status (nonresident Indian or Overseas Citizen of India), then you will be matched with a child of thirty-six months or older. Sometimes India will consider single women up to age forty-five who have not been married previously.
CHILDREN Children are toddlers, school-aged children, and sibling groups.
CANCER? India requires adoptive parents to have no serious health concerns. As with other countries that have broad statements like this, cancer survivors may be able to adopt from India on a case-by-case basis.
AGENCIES Children’s Home Society and Family Services, Wide Horizons for Children
Kazakhstan temporarily put adoptions to the United States on hold in 2008, with little explanation, but has recently begun to process them again. Some agencies are working again in Kazakhstan on a pilot basis. WACAP and Wide Horizons are among those agencies.
REQUIREMENTS Parent(s) should be married couples and single women no more than forty-five years of age.
CHILDREN Children are usually between six months and three years old at the time of referral, but children up to fifteen years old need families. They generally reside in “baby homes” (orphanages) and represent a variety of ethnicities, including Asian, Eurasian, and Caucasian.
CANCER? WACAP reports that Kazakhstan is one of the countries that it considers “more flexible” on cancer than others.
AGENCIES Alliance for Children, WACAP, Wide Horizons for Children
Korea has some of the most strict and specific standards for adoptive parents of any country. There are also far fewer agencies working in Korea than in many other countries; they are very restrictive as to whom they work with. Some agencies have slowed down their Korea adoption processes lately.
REQUIREMENTS Parents should be couples over twenty-five and under forty-three at time of submission, married at least three years. There should be no more than five children (including the prospective adopted child) under eighteen in the family. There are strict health requirements, including a BMI of less than 30.
CHILDREN Children are infants of both genders, and there are many more boys than girls. They usually arrive home between eight and twelve months of age and live in small nurseries before entering foster care while awaiting adoption.
CANCER? Korea generally requires a five-year cancer-free period before cancer survivors can adopt. If you’ve cleared the five-year hurdle, though, the process is otherwise considered to be fairly smooth and predictable.
AGENCIES Children’s Home Society and Family Services, Holt, Spence-Chapin, WACAP (only in certain states), Wide Horizons for Children
As of August 2010, the United States has suspended adoption from Nepal because of concerns about unreliable and fabricated documents. (Technically, the suspension applies only to adoptions of children reported abandoned, but in practice, this applies to all Nepali adoptions.) It’s unknown when and whether these adoptions will resume.
Wide Horizons for Children calls the Philippine adoption program one of its most stable. All adoptions in the Philippines are overseen by a government body, the Intercountry Adoption Board.
REQUIREMENTS Parent(s) should be couples with a formal legal relationship of at least three years, ages twenty-seven to forty-five. Parents over forty-five may adopt a slightly older child. Single applicants are allowed to adopt children six or older or with special needs. Same-gender couples may not adopt from the Philippines. Documented infertility is required.
CHILDREN As of May 1, 2009, the Philippines instituted a temporary moratorium on the adoption of children aged two and younger, because of a large backlog of prospective adoptive parents awaiting adoption of babies and young toddlers. Adoptions of children aged three and older are still proceeding. Preschool and school-aged children, and sibling groups are available for adoption; they live in both foster care and orphanage settings.
CANCER? Parents should have no serious medical issues—but the requirements do not specify whether there is a problem with medical issues, such as cancer, that have been successfully treated in the past. Cancer is generally handled on a case-by-case basis.
AGENCIES Holt, Wide Horizons for Children
Almost everyone has heard of the case of seven-year-old Artyom Savelyev, who was returned to Russia on a plane by himself in April 2010, after his adoptive mother claimed she could no longer parent him. This case has thrown Russian adoptions to the United States into turmoil. These adoptions are apparently still proceeding, and American and Russian officials have reached accord on an adoption pact. Russia’s parliament has rejected a motion to halt all American adoptions. But Russian officials themselves differ on whether they want to suspend adoptions to the United States or allow the program to continue. This is definitely a “stay tuned” matter that can change day by day. At the end of July 2010, the Joint Council on International Children’s Services reported that although the status hasn’t officially changed, prospective adoptive parents should be prepared for possible delays.
REQUIREMENTS Parent(s) should be couples married at least one year, and single women. Russia prefers no more than forty-five years between the youngest parent and child.
CHILDREN Children are both genders and all ages; there are more boys than girls. Many parents bring home toddlers under two, but adoption of infants under one year is almost unheard of. Children generally live in orphanages, but foster care is becoming more available.
CANCER? Some agencies consider Russia very cancer friendly, while others say just the opposite. A lot depends on the region or regions in which the agency works. In general, Russia considers health issues like a cancer history on a case-by-case basis. Some regions may require the parent with a cancer history to have a medical examination in Russia.
AGENCIES Alliance for Children, Children’s Home Society and Family Services, Holt, Spence-Chapin, WACAP, Wide Horizons for Children
Rwanda, one of the newest international adoption pilot programs in the United States, has been temporarily suspended while they work on implementing the Hague process. As with all newer and pilot programs, it’s still hard to predict exactly how the process will work in the future.
REQUIREMENTS Parent(s) should be couples married at least five years with no more than one divorce each, aged thirty to fifty, or single, heterosexual females aged thirty-five to fifty. You can have no more than two children in the home already.
CHILDREN Children are boys and girls of all ages, especially infants to two years.
CANCER? Applicants should have no major medical history. It’s hard to know exactly how Rwanda’s new pilot program will respond to parents with a cancer history, but some adoption professionals think that, like Ethiopia, they will be more flexible.
AGENCIES Wide Horizons for Children
Taiwan essentially has two adoption programs: one for parents interested in adopting a non–special needs baby or young child, and the other for those open to special needs or older children. Some agencies offer programs in which the birth parents select the adoptive parents, although traditional closed adoptions are also available. Taiwan requires adoptive parents to complete post-placement reports for five years.
REQUIREMENTS Applicants must be between twenty-five and fifty-five years of age and at least twenty years older than the child they wish to adopt. Applicants over forty will be considered for older children and those with special needs. There can be no more than three children already in the home; you may only have one child if you want to adopt a healthy child under five.
CHILDREN Most children are at least a year old when they come home, and many have some minor to significant special needs.
CANCER? Taiwan requires that applicants be in good mental and physical health, but what exactly that may mean is vague. WHFC’s Vicki Peterson suggests that the country may be willing to work with applicants who are at least two years out from successful treatment.
AGENCIES Alliance for Children, Wide Horizons for Children
Adoptions from Vietnam to the United States were shut down in 2005, reopened in 2006, and shut down again in 2008 after allegations of corruption. While open, the Vietnam adoption process was considered fairly welcoming for cancer survivors, but there’s no way to know when things will start up again.
Here are some tips for thinking about adopting internationally as a cancer survivors:
Look for a well-known agency with a long track record in international adoption. This is important for any prospective adoptive parents, but even more so for cancer survivors, who may be more vulnerable to the come-on tactics of more fly-by-night agencies. Here is a short list of some well-known agencies with long track records, who have told me that they work with cancer survivor:
Adoption Associates, Michigan
Alliance for Children, Massachusetts
Children’s Home Society and Family Services, Minnesota
Spence-Chapin, New York
WACAP, Oregon
Wide Horizons for Children, multiple East Coast offices
Even countries that seem entirely closed off to cancer survivors may not always be so unwelcoming. Anne Eastbourne (names of this family changed upon request) had adopted her daughter Jie Jie from China in February 2007, when the little girl was four and a half. She’d been home just eight months when Anne was diagnosed with stage I breast cancer. After a lumpectomy, four rounds of chemotherapy, and radiation, Anne and her husband, Mike, were ready to adopt again.
“Because our daughter was older coming home, we feel that God gave us the ability to care for older children, and we very much want to adopt older kids,” Anne says. “We knew that China had changed their rules in May 2007 and was much more strict about a cancer history, so we figured they were out. We called at least thirty agencies, and I think we looked at every country in the world.”
The family went through a changing list of countries and options—Nepal? Krygyzstan? Bulgaria? Domestic foster care? Then one day in August 2009, Jie Jie, then seven, confronted her mother. “Mommy, why aren’t we adopting from China?” she asked.
“Darling, we can’t,” Anne answered.
“Mommy, did you try? Did you just try? Did you call China and ask them?” Jie Jie demanded.
“We had a whole long discussion about why we can’t adopt from China because Mommy had cancer,” Anne says. When Jie Jie wouldn’t take no for an answer, Anne decided to show her the website of Chinese Children Adoption International, a large agency that posts a clear, detailed online description of the country’s rules. “I go down the list and say, ‘See here? Rule #7. No cancer survivors,’ ” she says. “But then I see that it doesn’t say that anymore. It says, ‘Cancer survivors on a case-by-case basis.’ ” (Today, CCAI’s website reads, “If an applicant has a history of any cancer, please contact CCAI before completing the Application for Adoption.”)
Stunned, Anne called the agency. “They told us that in just the last week, China had indicated they were open to considering cancer survivors for the waiting child program,” she says. “On August 5, we submitted a request for an exception, and ten days later we got the exception straight from the medical board: we could try to adopt a child three or older with special needs, like a heart defect.”
Since Jie Jie had come to them with a heart defect of her own, Anne felt more than ready for that challenge. Anne went back to the agency she’d been working with and said, “See if you can match us.” The very next day, they got a phone call. “We have a referral for a four-year-old boy—would you like to look at his file?” They would. They did. And in May 2010, they traveled to China to bring home their son, then nearly five. “If it hadn’t been for my daughter insisting, we would have completely given up on China,” Anne says. “Keep calling and calling and do your research.”
That’s perfect advice, says Rebecca Carter (name changed at her request), who was diagnosed with breast cancer at the age of forty-four in 2006. Carter and her husband both had grown children from a previous marriage, but they yearned to have a baby together. They had gone through IVF and miscarriages before Rebecca’s diagnosis, and they knew that after cancer and chemotherapy, adoption was probably their only chance to be parents again.
After rejecting domestic adoption, the Carters thought of Russia, where Rebecca’s husband had been born. But the first few agencies they spoke with told them they couldn’t adopt from Russia so soon after cancer treatment (she was just six months out when she began the process), and that when enough time had passed, they’d be too old. “When I heard a few agencies tell me it was impossible, I thought that there was no way of doing it,” Rebecca says. “But then I went through the list of agencies that were accredited to work in Russia at the time and called each and every one of them. Every one had a different story.”
One accredited agency, Alliance for Children, didn’t just tell Rebecca a blanket policy. “They asked about my history and what my doctors thought and if I could get a positive medical report about my condition,” Rebecca recalls. “It was a really detailed interview about my whole history. Then they said, okay, go ahead and submit your application. They assigned me to a region [that] is more flexible about certain things. Some regions, for example, require that you go to a doctor in Russia to be examined. We didn’t have to do that.”
By the end of September 2007, when Rebecca was barely a year out of treatment, they had received the referral for their son. They traveled to Russia to meet him in November and returned to bring him home in January. “He’s changed our lives. He just turned three, and he’s the cutest, the sweetest,” she says.
Susan Nichols, the founder of the adoption-after-cancer Yahoo email group, has adopted twice internationally after her breast cancer diagnosis in 2001. Just two years out of treatment, she and her husband started pursuing a Russian adoption to add to their family—they have a daughter, Haeli, who was then nine years old. “I did a lot of research while in treatment and met another family who’d adopted a daughter from China and three girls from Kazakhstan. Even though I got my periods back very quickly after chemo—I was thirty-one at the time—we decided that maybe adoption was our little calling.”
The family chose Russia because they wanted to adopt two children at once, something that was difficult to do at the time in other countries. Susan was very careful with the way she described her cancer in documents for the Russian authorities. “I didn’t say, ‘cancer’—I said that I had ‘a little lump.’ I couldn’t make the cancer who I was for the home study,” she says. “Fortunately, I had a social worker who had a family member who’d had breast cancer and understood what the terms meant. She said she could write a positive home study if the doctor gave me a letter saying I was free of cancer and that I could have a reasonable chance at a normal life expectancy. So that’s what he wrote. And then she called their regional connections and found a region that was open to working with someone with a history of cancer.”
In December 2003, Susan and her husband brought home their two sons, Ethan and Zachary, then eighteen months and thirteen months. In the summer of 2010, they adopted two brothers from Ethiopia who are now six and eight, and shortly afterward began the process to bring home the boys’ sister, whom they had just found out about. They have also adopted a teenage daughter who was their foster child for several years. “That would be six children adopted after stage 2b breast cancer, adopted from three different countries, including the U.S. foster system. They are all wonderful,” Nichols says. “I rarely talk about the cancer to any adoption officials, social workers, agencies, and so on. It doesn’t define who I am. It was an episode in my life.”
When people say, “There are so many children who need homes,” they’re generally talking about children in foster care, whether they realize it or not. Every year, about 50,000 children are adopted from foster care in the United States, while about 125,000 are still awaiting adoption. According to the Department of Health and Human Services, children in foster care are more likely to be older, members of a minority group, members of a sibling group, or survivors of abuse or neglect.
Deciding whether foster parenting is right for you—either with the goal of eventually adopting a child that you foster, or not—is a very complex question, in many ways beyond the scope of this book. There are some excellent books on foster parenting and foster-adoption listed in the Resources section at the end of this book. Here I’ll give you the basics and then talk about what your prospects are to foster-adopt as a cancer survivor.
Foster parenting and foster-adoption can be very different depending on what state you live in. To become a foster parent, you must first go through a state-run process for becoming licensed, which usually includes
In some ways, becoming a foster parent may sound easier than successfully adopting internationally or through domestic private adoption. After all, as long as you’re twenty-one and have your own income, you can often still qualify as a foster parent in most states even if you’re older, single, don’t own your home, already have multiple children, and/or rely on some government assistance. But there’s much more to it than that.
Each state has different training requirements for foster parents, ranging from as few as six hours of classroom training to as many as forty-five. You can find more specific information about how the foster parenting process works in your state at www.adoptuskids.org. This training is important. Children who are in foster care are there for a reason; they have been separated from their birth family because the child protection authorities think their home is not a safe or appropriate environment for them. That means that they may have been abused or neglected. At minimum, they have undergone the traumatic experience of being separated from their parents. Foster parents need to be prepared to cope with the unique needs of these children and with the fact that they will be parenting under the state’s supervision. That may mean regular meetings with social workers and other professionals, visits with birth parents, and not being able to make ordinary family decisions—like traveling out of state for the holidays—without clearing it with your child’s caseworker or the court.
Children’s Sake of Virginia, a child placing agency, suggests that you ask yourself the following questions before you decide whether or not to become a foster parent:
States have different names for the agencies that supervise foster care. For example, in New Jersey, it’s the Department of Youth and Family Services; in Texas, it’s the Department of Family and Protective Services. In many states, there are also private nonprofit agencies that work in partnership with these state agencies to license and supervise foster parents. You can find state and private foster care agencies near you by searching the Child Welfare Information Gateway’s directory at www.childwelfare.gov/nfcad/.
Sometimes, it can be easier to find out about foster care opportunities in your area by talking to one of the private agencies than by calling an overworked and underfunded state agency. Google “foster care agency” and add the name of your state, and you should be able to find agencies near you.
What will the state, or the private agency, say when they find out you’re a cancer survivor? In many cases, not much. States generally require that prospective foster parents be in “good physical and mental health” and not have any current medical conditions that would affect their ability to parent a child—so unless you’re currently in treatment and it has substantially impaired you, you’ll often find that your cancer history presents no problem at all.
In Michigan, for example, “So long as their doctor says it’s okay, there isn’t any restriction,” says Carol Slottke, a child welfare licensing consultant at the Department of Human Services. “We have some people who are foster parents who have gone through cancer treatment and continued to foster while being treated, in fact. If there’s a medical condition that arises while they’re fostering, the agency can request another doctor’s statement, but unless it’s a major impairment, there’s no problem.”
Casey Family Services, a private agency that licenses foster parents in Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont, as well as Baltimore, Maryland, is similarly flexible with cancer survivors. “The parents need not to have had a ‘life-changing experience or trauma’ within the past year, which I would think would include cancer,” says Roye Anastasio Bourke, Casey’s public affairs manager. “But if someone had gone through their final cancer treatment a little less than a year before, and had been well and functioning and able to participate in life full-time for a year, I can’t imagine that they would turn anybody away. I think that the concern with our agency would be to know that the person was strong enough and felt healthy enough to parent a child. We have to consider, first and foremost, the needs of the child—many of them have been removed from their homes and have behavioral issues and attachment issues. We need to be sure a foster parent has enough support to meet these challenges.”
Social workers and other foster care professionals in several other states, including North Carolina, expressed much the same sentiments. In fact, I haven’t yet talked to anyone working with the foster care system in any state who has said that it might be difficult for a cancer survivor—assuming that their condition has been successfully treated—to become a foster parent or adopt through foster care.
Jim and Joy DeLaere, who had daughter Lillian and son Lincoln via IVF using sperm frozen before Jim’s cancer treatment, had also long considered becoming foster parents. “Growing up I had a foster brother, and we’d heard some ads for sibling groups who needed to be adopted together. I went to an adoption conference, and the Illinois Department of Children and Family Services was there, saying how much they need foster parents,” Joy recalls.
The DeLaeres went through an eighteen-month process to become foster parents—with delays not because of Jim’s cancer, but because of state budget problems. “They didn’t bat an eye at his cancer history,” Joy says. They received their foster care license in June 2009, and in February 2010 began fostering brother-and-sister siblings, ages eleven and thirteen.
Christa Michael, a real estate agent in Georgia, was first diagnosed with breast cancer in 2004, shortly before she turned forty. She had a grown son from a previous marriage and had lost another son in infancy, and then decided after the cancer recurred that she wasn’t done with parenting. Her sister’s two young children, then just three months and four years old, were in need of a foster home, and Christa immediately volunteered.
“They did ask for all my medical records, but they were much less focused on the cancer than on home evaluations and drug tests,” Christa says. She’s since gone through additional recurrences and had a scare when a broker with a real estate company she then worked with called the child services agency because she thought Christa couldn’t parent the children since she had cancer again. “I spent the next two weeks in terror with emergency hearings, fearful that they were going to come and get my kids,” she says. “But eventually we resolved it.” Ultimately, her sister’s parental rights were terminated, and Christa finalized the children’s adoption in early 2010.
She’s now planning on fostering more children—two siblings, close to the ages her two are now. “No more adoptions—although I say that now …” she laughs.
Carly Chandler, who was diagnosed with stage III breast cancer in 2003, also didn’t find her cancer history any barrier to foster care and adoption. Initially diagnosed when she was pregnant with her second son, Carly went through the works: an induced early delivery, chemotherapy, a double mastectomy, and eventually, a hysterectomy and oophorectomy (removal of her ovaries) when she was diagnosed with the BRCA2 mutation that increases risk for multiple gynecological cancers.
At first, her own fears about her health and her future—never mind anyone else’s—kept Carly from even considering having more children. “But once I was alive for a couple of years, I realized I might stay healthy, and my husband and I started to talk about foster-adopt,” she says. “That was always something we’d wanted to do, adopt. And even if I hadn’t had cancer, private and overseas adoption were just too expensive. This was our only option, and that was fine. It was kind of a hard path, but private adoption can be too.”
The Chandlers began going through the licensing process in Oceanside, California, where they then lived (Carly’s husband is in the Marine Corps, and they have moved frequently), in February 2007. “We got licensed and got our foster son within a few weeks,” she says. “We only did foster-adopt and asked to only foster children who were most likely to be adoptable.” Their little boy was four months old, but as a preemie, he was more like a one-month-old. When he was almost a year old, the boy’s biological mother gave birth again, and the Chandlers began fostering his little sister when she was seven months old. They recently finalized the adoptions of both children, now one and two years old.
Throughout the process, her cancer never posed an issue. “That was one of our first questions—is this going to affect anything? They said no—in fact, they’d had foster parents and adoptive parents where both members of the couple had had cancer,” Carly says. “As long as my doctor could say I was able to take care of children twenty-four hours a day, that was pretty much it.”
What if the cancer comes back while you’re in the process of adoption? Usually, your agency will ask that you put your application on hold until your condition is stable—but it doesn’t have to derail your adoption plans completely.
Pam Staples actually found out she had stage I endometrial cancer while in the process of fertility testing, when something looked “not quite right” on her ultrasound. At the time, she opted to skip a hysterectomy, still hoping to have biological children. She took a drug called Megace (megestrol) for several months, after which tests revealed the cancer had apparently been eradicated. Pam and her husband continued pursuing fertility treatments, and went from fertility drugs to intrauterine insemination to in vitro fertilization, with no success. Finally, in early 2008, they decided to pursue adoption instead.
They chose domestic adoption, thinking that lengthy overseas travel would be difficult with Pam’s husband’s new job. They researched agencies, talking to other people who had had cancer and to adoption attorneys in an effort to find one that was cancer friendly.
“Since my cancer was very early stage I, my doctors said, ‘Don’t worry, we can work around it,’ ” Pam says. “They were very supportive of our family-building efforts.” Ultimately, the couple chose a local agency in North Carolina. “They said, ‘With cancer, we work around it, we listen to what your doctor has to say.’ My doctor had already said that I have a full life expectancy and I just need to continue to take follow-up measures.”
But as they were making plans for their home study, in August 2008, Pam was diagnosed with thyroid cancer. That fall was grueling: she had her thyroid removed and went through a week of intensive pill-form radiation therapy, using radioactive iodine, that put her in seclusion for eight days. “I had to have at least ten feet between me and the nearest adult,” she says. “All my bedsheets had to be washed separately. Our cats and dog couldn’t be anywhere near me. I couldn’t touch anyone else’s food.”
In mid-November 2008, her full body scan came back clean, and she’s been cancer free ever since. “In the meantime, I was informing the agency what we were doing. They said that the key item they needed was regular updates from both my doctors while going through this process. They wanted something from my doctor that said this would not kill me, that I had a full life expectancy,” Pam says. “My doctor wrote a really nice letter and included a bunch of studies on thyroid cancer and life expectancy. The agency asked for some additional information about treatments and how often I would have to go for follow-up. The home study was completed in December, and we got the formal notice of approval in January.”
Eight months later, in August 2009, the agency called. There was a baby due in mid-September—would Pam and her husband be willing to have their profile shown to the mother? They would. They met her in early September, and their son was born September 21. “We hadn’t done a thing! We really thought we’d have a match and have two or three months to get ready,” she says. The adoption was finalized in April 2010.
Like fertility preservation and IVF, adoption can be costly. Unlike fertility preservation and IVF, adoption isn’t covered by your health insurance. Once a child is legally in your custody—even before an adoption is finalized—your health insurance is required to cover their health care just as it would a child born to you, but that doesn’t mean it has to pay for the adoption itself.
Costs of adoption vary widely. Some private domestic adoptions can be completed for less than $10,000, but that’s rare. A 2009 survey done by Adoptive Families magazine found that over 50 percent of domestic newborn adoptions were completed with fees of less than $25,000, but 12 percent cost more than $30,000. A recent post to an adoption mailing list mentioned an agency seeking a family on the West Coast for twins soon to be born; fees were $45,000.1
International adoption is even more expensive because you pay all the same fees you usually pay in domestic adoption—agency fees for advertising and operations cost, legal fees, and so on—in addition to specific fees mandated by the country you’re adopting from, as well as the costs of travel, sometimes multiple trips. Cost may be a big factor in terms of choosing a country—Russia, for example, can be particularly costly to adopt from given that it requires adoptive parents to take two separate trips. In Adoptive Families’ 2009 survey, virtually everyone who adopted from Russia said their expenses had totaled more than $35,000. Nearly 70 percent of those adopting from Ethiopia, however, had costs totaling less than $25,000.2
Adopting from foster care is much less costly. In fact, in most cases, it ultimately costs parents nothing to adopt from foster care, and until you officially adopt your child, you will likely receive a monthly stipend from the state to cover some of their expenses. Their health care will also be paid for by Medicaid. If you adopt a child with special needs or a medically fragile child, there’s additional support. Some states may even continue the support after the adoption is finalized. Many states have Subsidized Adoption Programs for special-needs children (this may merely mean that they are older, part of a sibling group that can’t be separated, or from a minority group), which provide regular monthly support and Medicaid coverage until the adopted child turns eighteen or finishes high school.
If you’re pursuing private domestic adoption or intercountry adoption, how do you go about affording it? There’s no such thing as adoption insurance, and very few people have tens of thousands of dollars just sitting around waiting to be put to good use.
If your adjusted gross income (AGI) is less than $122,000, you can receive a tax credit of $12,150 (as of 2009) for adoption. That means you can subtract up to $12,150 of documented adoption expenses (including travel) from your tax liability. You can split the credit into multiple years—for example, if you incur some agency expenses in 2010 and then more costs in 2011, when you finalize the adoption, you can take part of the credit on your 2010 tax bill and the rest in 2011. But if you’re adopting internationally, you cannot take any part of the credit until the tax year that your adoption is finalized and your child becomes a U.S. citizen. You can find out more at www.irs.gov/taxtopics/tc607.html.
Many larger employers—and even some not-so-large ones—offer some kind of support to their employees who adopt. My husband’s company, a financial services firm in New York, paid $5,000 toward the cost of our daughter’s adoption. AstraZeneca, Bank of America, Capital One, Honeywell, KPMG, McGraw-Hill, MetLife, Microsoft, Patagonia, Warner Music Group, and several others have been praised by their employees for offering adoption assistance ranging from $5,000 to $10,000 per adoption.
Wheaton College of Illinois has a great policy—they provide equivalent benefits for adoptive families as if they were having children biologically. In terms of subsidies, that means they provide an approximation of the insurance costs for a normal, healthy delivery—about $10,000.
If your company hasn’t caught on yet, you can make the case to them yourself that it’s a great way to attract and retain excellent employees. Download the Adoptive Families’ sample letter here: www.adoptivefamilies.com/articles.php?aid=1480.
The U.S. military provides up to $2,000 per child, or $5,000 per year, in support to military families who adopt, provided that they use a qualified adoption agency. These benefits aren’t paid until the adoption is complete. You can find out more at www.childwelfare.gov/pubs/f_milita.cfm.
Many adoption agencies, and some private funds and charities, provide grants or loans to parents who adopt a waiting child or a child with special needs. You can find lists of these organizations at http://www.affordingadoption.com/grants.php. This organization has also just begun forming its own foundation that will offer adoption grants.
The National Adoption Foundation (www.nafadopt.org) uses a combination of corporate and private funds to offer grants, unsecured loans, and an “adoption credit card,” open to all adoptive families, regardless of income and where you are adopting from. Grants range from $500 to $2,500.
If you own your home, you might also consider a Home Equity Line of Credit (HELOC) to help finance adoption costs. The interest on the loan is tax-deductible, and you can usually write checks on the loan for just the amount you need. For example, if you’re approved for a $20,000 HELOC, you can pay your individual bills using the loan rather than taking the whole amount out in one lump sum.
If you’ve definitely chosen adoption, you can probably skip the next chapter—on having a healthy pregnancy—and jump ahead to the following one on special parenting concerns after cancer. But if there’s any chance that a postcancer pregnancy might be in the cards for you, don’t miss chapter 6!