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FACTSHEETS FOR FAMILIES | SEPTEMBER 2020

Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov

Intercountry Adoption: What 

Do I Need to Know?

WHAT'S INSIDE

Working with an adoption service provider

The Hague Adoption Convention

Intercountry adoption can be a rewarding but 

complex process. It is subject to U.S. Federal 

and State laws as well as the laws in the country 

from which you wish to adopt. If you would 

like to build your family by adopting a child 

from abroad, an overview of the requirements, 

decisions, and steps and a list of resources will 

help you on that journey.

This factsheet provides a guide to intercountry 

adoption, including information on requirements 

and processes you may need before and after 

you are matched with a child; how to select the 

adoption service provider that is right for you; 

and eligibility, immigration, and citizenship 

requirements. You'll also find information about 

how to prepare for parenting an internationally 

adopted child, bringing your child home, and tips 

for adjusting to a new family structure for you 

and your new child. 

Eligibility requirements and important 

considerations

Deciding where to adopt from

Additional resources

Adopting a child 

Adjusting to a new family structure

Conclusion

References
Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 2

The U.S. Department of State is responsible 

for overseeing intercountry adoption to 

and from the United States, and you will 

find helpful information on its Intercountry 

Adoption website. The U.S. Department of 

Homeland Security's U.S. Citizenship and 

Immigration Services (USCIS) has jurisdiction 

over the suitability of the prospective 

adoptive parent(s) and the child's immigration 

requirements. USCIS's Adoption website also 

has helpful background information.

THE HAGUE ADOPTION 

CONVENTION

The Hague Convention on Protection of 

Children and Co-Operation in Respect of 

Intercountry Adoption (the Convention) went 

into effect in the United States on April 1, 

2008. This international treaty is designed to 

promote the best interests of children, birth 

families, and adoptive families in adoptions 

between participating countries. It provides 

necessary and important protections to 

prevent the abduction, sale, and trafficking 

of children. In the United States, the 

Department of State is the designated Central 

Authority for the Convention, and the Office 

of Children's Issues in the Department's 

Bureau of Consular Affairs is responsible for 

executing the day-to-day functions required 

under the Convention. 

USCIS also plays a significant role in 

determining the suitability of prospective 

adoptive parents and the child's eligibility 

to immigrate to the United States. For more 

information, visit the U.S. Department of 

State's Understanding the Hague Convention

webpage. 

Note: Some resources or organizations 

refer to the Convention as "the Hague" and 

therefore use terminology such as "Hague 

adoption" or "non-Hague process" rather than 

"Convention adoption" or "non-Convention 

process." Although the terms are different, the 

meaning is the same.

ADOPTING FROM HAGUE CONVENTION 

AND NON-CONVENTION COUNTRIES

There are two different intercountry adoption 

processes. One guides adoptions from 

countries that are party to the Convention. 

The other guides non-Convention countries. 

Adoption and immigration processes usually 

occur in tandem, but each has its own 

elements and requirements. Your adoption 

service provider will guide you through the 

entire process specific to the country from 

which you decide to adopt. Websites from the 

U.S. Department of State and USCIS provide 

a general overview of the adoption and 

immigration processes for each of these:

U.S. Department of State

 Hague Adoption Process

 Non-Hague Adoption Process

USCIS 

 Hague Process

 Orphan Process

Over 100 nations, including the United States, 

are party to the Convention. In addition to 

providing important safeguards for children 

and families involved in the intercountry 

adoption process, the Convention dictates 

that countries must first consider national 
Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 3

adoption solutions for placement of children 

domestically; ensure the child is legally 

eligible for adoption; preserve information 

about the child and their family of origin; 

work to match the child with a suitable 

adoptive family; and thoroughly evaluate the 

suitability of the prospective adoptive family. 

The Intercountry Adoption Act of 2000 

(IAA) implemented the Convention in the 

United States. An important requirement 

under the IAA is that adoption services in 

Convention cases could only be provided by 

accredited agencies or approved persons, 

adoption service providers supervised by 

such accredited, or approved providers or 

by an exempted provider, unless all adoption 

services are provided by a public domestic 

authority.

The Intercountry Adoption Universal 

Accreditation Act of 2012 extends the 

safeguards provided by accreditation to 

orphans who are being adopted from 

countries that are not party to the Hague 

Adoption Convention, to their adoptive 

parents, and to their birth parents. This 

ensures that adoption service providers are all 

held to the same Federal standards, no matter 

from which country a child is adopted.

IMMIGRANT VISA PROCESSES: 

CONVENTION AND NON-CONVENTION 

DIFFERENCES

Children adopted from other countries must 

obtain U.S. visas (IH-3, IH-4, IR-3, or IR-4) 

before they can travel or move to the United 

States. Because of the safeguards in place 

through the Convention, the immigration 

process is generally more streamlined in 

Convention adoptions. In non-Convention 

countries, there may be additional steps 

required of the U.S. Embassy responsible for 

adjudicating the immigrant visa application 

and confirming the child's eligibility to 

immigrate. One key difference is that if the 

child is from a non-Convention country, 

the U.S. Embassy processes the I-604 form 

(Determination on Child for Adoption), 

commonly referred to as an "orphan 

determination." It generally takes several 

weeks or, in some cases, months, to complete 

the orphan determination. Refer to the U.S. 

Department of State's Non-Convention 

Adoption Cases: Form I-604 Determination 

and Immigrant Visa Appointment Scheduling

webpage for more detailed information.

The U.S. Department of State provides an 

overview of the visa processes:

 Hague Visa Process

 Non-Hague Visa Process

ELIGIBILITY REQUIREMENTS AND 

IMPORTANT CONSIDERATIONS

If you're interested in intercountry adoption, 

you'll need to become familiar with the 

adoption regulations and guidelines of the 

U.S. Department of State. Additionally, you 

should be aware of USCIS's adoption eligibility 

requirements, your home State's laws on 

immigration and citizenship, and the laws of 

the prospective child's country of origin. It's 

also important to learn about the social and 

cultural context in which your prospective 

child was born and assess whether you can 

meet the child's needs. 
Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 4

ADOPTIVE PARENT ELIGIBILITY 

REQUIREMENTS 

Eligibility requirements are subject to Federal 

and State laws and the laws of the country 

from which you wish to adopt.

 Federal eligibility. USCIS determines the 

suitability and eligibility of prospective 

adoptive parents to adopt and the eligibility 

of the child to immigrate to the United 

States. In general, USCIS has two basic 

eligibility requirements for prospective 

parents:

1. Unmarried applicants must be U.S. 

citizens and at least 25 years old when 

they file the petition to adopt. 

2. Married couples must jointly adopt the 

child, but only one spouse must be a U.S. 

citizen. 

U.S. requirements are addressed in more 

detail on the USCIS webpages for the 

Hague and orphan (non-Convention) 

processes.

 State eligibility. For State-specific 

information, visit Child Welfare Information 

Gateway's State Laws on Intercountry 

Adoption webpage. 

 Foreign country eligibility. For countryspecific information about foreign 

governments' eligibility requirements 

for prospective adoptive parents and the 

children they may adopt, visit the U.S. 

Department of State's Country Information

webpage. For general information about 

eligibility, visit its Who Can Adopt and 

Eligibility to Adopt webpages. 

IMPORTANT CONSIDERATIONS 

Prospective adoptive parents may also want to 

think about these additional considerations:

 Timeframe. It generally takes 1 to 5 years 

to complete an intercountry adoption. The 

length and predictability of the process 

depend on the country, the adoption 

service provider, and the individual child 

involved. It can also depend on your 

background, including complex family 

issues and mental health or financial 

concerns that may affect the length to 

navigate the home study process. 

 Reasons the child needs a permanent 

family. As with children in the United 

States, the main reasons children in other 

countries need adoptive families include 

maltreatment, parental illness or death, 

and abandonment. Factors in the child's 

country of origin, such as the economy, 

policies on population control, famine, and 

natural disasters, may also play a role in 

why the child is eligible for adoption. It is 

important to understand how these factors 

may have affected the life of the child you 

are considering adopting. 

 Ages of eligible children. The international 

adoption of children less than 1 year of age 

has become increasingly less likely than in 

the past due, in part, to the Convention's 

commitment to the principle of subsidiarity. 

According to this principle, it's in the child's 

best interests to remain with their birth 

or extended family whenever possible and 

domestic placements are prioritized before 

intercountry adoption may be considered. 
Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 5

Consequently, the ages of children eligible 

for adoption vary widely depending on the 

country. In general, the ages of children 

adopted from other countries ranges from 

6 months to 16 years (although intercountry 

adoptions at the latter age are less 

common). 

 Lack of information on the child: It is also

very important for parents to understand

that information provided about the child

will likely be incomplete or inadequate.

Parents need to be comfortable with

missing and possibly incorrect information

regarding the child. As a result, it is critical

for parents to prepare for the unexpected.

 Needs of the children: Very often, these

children are also in need of treatment to

provide thorough nutritional, medical, and

developmentally appropriate care. Also,

some countries have regulations prohibiting

the separation of siblings.

DECIDING WHERE TO ADOPT 

FROM

You may have a variety of reasons for why 

you want to adopt from a particular country. 

Because agencies have different country 

programs, it is recommended that you choose 

where to adopt from before choosing your 

adoption service provider. If you are in the 

process of deciding where to adopt from, the 

following information may help you narrow 

your search. 

 Racial and cultural diversity. Depending on

the country you select, your child's racial

and cultural background might be different

from your own. Resources about racially

and culturally diverse families are available

from Information Gateway on its Adoption 

by Family Type: Racially and Culturally 

Diverse Families webpage. The National 

Council For Adoption also has helpful 

information on its website.

 Age of child requested. As part of the home

study process, you will be approved to

adopt a child within a specific age range.

However, knowing in advance the age range

you want to request allows you to choose a 

country that places children within that

range. The majority of children waiting for

adoption internationally are in an older

range. Though infant adoptions used to be 

frequent, they are now quite rare in

intercountry adoption.

 Special needs. The majority of children

placed for adoption have some type of

medical, developmental, behavioral, and/or 

mental health related special need. It can be 

helpful to understand the profiles of

children available for intercountry adoption

from a particular country to determine

if it is a good match for the prospective

adoptive family.

 Institution or foster care placements.

In many countries, children who need

permanent families are cared for in

institutions or orphanages, which may

increase their risk of exposure to serious

trauma. Spending time in institutions early

in life can cause harmful and sometimes

permanent effects in children, such as

developmental delays and behavioral and/

or attachment concerns (McCall

& Groark, 2015). The age when a child

enters an institution, the length of time in

institutional care, and the quality of the

institution or foster family are important 
Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 6

factors to consider when adopting. 

Children adopted from institutions or 

foster care may require additional medical, 

educational, and mental health support as 

well as families who understand their needs 

and how to help them. 

 Travel requirements. Most countries 

require prospective parents to travel to the 

child's country to complete the adoption 

process. The number of trips required 

varies, as does the required lengths of stay. 

Traveling to your child's country of origin 

may offer the added benefit of learning 

about their culture. For more information 

on the benefits, refer to "The Top 10 Secrets 

of Successful Adoption Travel" and "Family 

Travel."

 Processing time. The length of time it 

takes to complete an adoption ranges from 

country to country—and often within a 

country depending upon the child request 

(e.g., age of child, openness to medical 

special needs, etc.). Adoption service 

providers can often provide estimates based 

on the previous cases they have processed 

for families.

 Fees. Fees also vary depending on the 

country, service provider, and needs of 

the adoptive child. They typically range 

from $25,000 to $40,000 and cover agency 

and foreign fees, a home study, and travel 

(R. Hanlon, personal communication, 

September 21, 2020). Accredited adoption 

service providers are required by law 

to provide a comprehensive schedule 

of expected fees. For more about the 

financial aspects of intercountry adoption, 

read Information Gateway's Planning for 

Adoption: Knowing the Costs and Resources.

WORKING WITH AN ADOPTION 

SERVICE PROVIDER

Per the accreditation regulations of the IAA, 

all agencies or persons providing any of the 

six specific intercountry adoption services 

listed below must be accredited or approved 

per the U.S. Federal regulations 22 CFR §96, 

§97, and §98, regardless of whether the 

adoption will fall under Convention or nonConvention processes. 

According to the IAA, the following are the 

six intercountry adoption services (22 CFR 

§ 96.2):

1. Identifying a child eligible for adoption and 

arranging an adoption 

2. Securing the necessary consent to 

termination of parental rights and to 

adoption 

3. Performing a background study on a child 

or a home study on a prospective adoptive 

parent and reporting on such a study 

4. Making nonjudicial determinations of 

the best interests of a child and the 

appropriateness of an adoptive placement 

for the child 

5. Monitoring a case after a child has been 

placed with prospective adoptive parents 

until final adoption

6. Assuming custody and providing (including 

facilitating the provision of) child care 

or any other social service pending an 

alternative placement when necessary 

because of a disruption before final 

adoption 
Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 7

In addition to the six adoption services, 

an accredited adoption service provider 

will assist you to obtain a home study, 

and complete required training and other 

preparation for an intercountry adoption. 

To be approved or accredited, adoption 

service providers must meet eligibility 

requirements in nine areas, including ethical 

practices, information disclosure, and service 

planning. In addition, each Convention 

country may have its own accreditation 

requirements. Accredited providers generally 

handle intercountry adoptions from specific 

countries, and the country where you 

plan to adopt may also have authorization 

requirements that limit which provider you 

are able to use. To find an accredited and 

approved provider, visit the U.S. Department 

of State's Adoption Service Provider Search

webpage. 

It's normal to work with a primary provider—

the accredited agency or approved person 

responsible for ensuring that all six adoption 

services are provided—who is not in your 

State and partner with a local home study 

agency. If you do not locate an accredited 

provider with a program that meets your 

needs or works in the country where 

you wish to adopt, please see Finding a 

Primary Provider on the Intercountry 

Adoption Accreditation and Maintenance 

Entity (IAAME) website. (IAAME is the U.S. 

Department of State-designated accrediting 

entity. If you have additional questions, you 

may contact IAAME for assistance.)

Many adoption service providers have detailed 

websites with helpful information for your 

search. A reputable provider will walk you 

through the adoption process and help you 

with the following:

 Prepare you to become an adoptive parent 

through classes on parenting and adoption 

issues or referrals to such programs 

 Contact USCIS about immigration laws and 

forms

 Handle or help troubleshoot problems 

along the way 

 Provide information or direct services 

for postadoption reporting, citizenship 

acquisition, and postadoption supports.

You should look for a provider who 

understands your values and priorities 

and will help you throughout the entire 

intercountry adoption and immigration 

processes. To decide on an adoption service 

provider who is right for you, research 

providers who have specific experience 

in your country(ies) of interest. Review 

providers' websites and contact them 

directly to learn more about the services 

they offer. Experienced providers will offer 

in-person or virtual sessions to answer your 

questions openly, including those about fees. 

These sessions are usually free. Researching 

different providers may help you find the one 

that best meets your needs (Refer to Choosing 

an Adoption Professional for guidance on 

selecting one.) You can also ask to speak to 

adoptive families who used the provider's 

services or check with your local Better 

Business Bureau. 
Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 8

For a list of agencies denied accreditation, 

visit the Department of State's Agencies 

Denied or Subject to Adverse Action webpage. 

You may review information about complaints 

and adverse actions against all accredited 

adoption service providers on the IAAME

website by clicking on "Substantiated 

Complaints and Adverse Action Report" to 

download the most up-to-date report.

QUESTIONS TO ASK ADOPTION SERVICE 

PROVIDERS

The following questions can help you 

determine which provider may best meet your 

family's needs:

 By which State is the provider licensed? Is 

the license in good standing? 

 Has the provider had any complaints filed 

against them, and if so, what were they 

about and what was the outcome?

 Has the provider ever been denied 

accreditation? Why? 

 Does the provider offer all adoption 

services? What other organizations may be 

involved in providing some of these services 

in a specific case? (For example, if your 

adoption services provider is only helping 

to conduct your home study, ask which 

other providers may help identify a child 

for adoption, obtain the termination of the 

birth parents' parental rights, or monitor 

the case until the adoption is finalized.) 

 Does the provider offer a written contract 

that outlines the services offered, fees, and 

expectations of the client and provider? 

 What are the provider's minimum 

requirements for prospective parents? 

 In which countries does the provider have 

intercountry adoption programs? How long 

has the provider had programs in those 

countries? 

 How long has the provider been involved in 

intercountry adoptions? 

 Can you speak with other families who have 

adopted a child with similar circumstances? 

 How many children has the provider placed 

(both from the country of interest and 

overall)? 

 How does the adoption service provider 

receive referrals (the packet of information 

about a potential adoptive child)?

 What training or support does the provider 

offer to help parents prepare to adopt and 

then parent a child with special needs?

 What training or support does the provider 

offer to help parents prepare to adopt and 

then parent a child who is culturally or 

racially different from them? 

 Does the provider have overseas staff or use 

the services of facilitators or lawyers? How 

does the provider monitor or supervise the 

work of those individuals?

 How do the provider's contacts who work 

in other countries (such as staff, facilitators, 

or lawyers) identify children needing 

families? Does the provider travel regularly 

to the countries of origin?

 What services are provided after your child 

comes home? How long are they available? 

 What happens if you change your mind and 

decide not to adopt? 
Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 9

 What, if any, is the refund policy if an 

adoption does not occur or if the country 

closes to adoptions? Can they provide that 

policy in writing? 

 Does the provider offer services in 

the unlikely event that the adoption is 

dissolved? 

 How many past clients have disrupted 

a placement or dissolved an adoption? 

What supports did the provider offer such 

families, and what were the reasons the 

families made their decisions?

ADOPTING A CHILD

Whether you adopt a child from a Convention 

or non-Convention country, this section 

provides information on the general steps you 

will need to complete before and after the 

adoption is finalized. It includes health and 

mental health concerns to consider before 

you bring your child home, support services 

to help after your child is home, and how to 

complete the citizenship acquisition process 

for your child. 

PREPARING AND TRAINING FOR 

ADOPTION

Like all prospective adoptive parents, you 

will need to complete a home study; submit 

immigration forms; and put together a 

dossier, which is a collection of your family's 

personal records (e.g., proof of identity, 

finances, health, other children in the home, 

fingerprints for clearance checks) required 

by the legal system of the child's country of 

origin to process the adoption. While the 

agency that conducts your home study must 

be licensed in your State of residence, the 

accredited adoption service provider that 

serves as the primary provider (or placing 

agency) may operate from anywhere in the 

United States. You also must complete at 

least 10 hours of training before the adoption 

in addition to any other requirements of 

your State of residence. Your child's country 

of origin may have additional training 

requirements for prospective adoptive 

parents. You may be exempted from training 

by the primary provider if you already have 

completed other sufficient training. 

Investing in Training and 

Development for Foster/Adoptive 

Families

In 2017, the Children’s Bureau awarded 

a 5-year grant to Spaulding for Children 

to develop the National Training and 

Development Curriculum for Foster and 

Adoptive Parents (NTDC). NTDC provides 

foster and adoptive parents with the 

training, knowledge, and ongoing skills 

they need to effectively parent children and 

youth. The curriculum addresses medical, 

psychological, developmental, emotional, 

and mental health considerations for 

prospective adoptive parents. The 

curriculum also includes several areas 

of knowledge and skills specifically for 

parents interested in intercountry adoption 

to help them support the children they 

adopt and help themselves understand 

the intercountry adoption process. It is also 

critical for prospective adoptive parents 

to get child-specific and country-specific 

training before traveling to the child’s 

country of origin.
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MATCHING AND PLACEMENT PROCESS

A few months to a year or more after 

completing the required paperwork, your 

family may be chosen for a specific child for 

possible placement, or you may receive a 

specific child profile for consideration. The 

specific referral or matching process may 

vary depending on the country and adoption 

service provider involved. 

A few countries may allow families to be 

directly involved in this step by viewing 

photolistings of waiting children. Many 

adoption service providers and some private 

advocacy organizations offer their own 

photolistings you can view that include 

pictures and brief descriptions of children 

eligible for intercountry adoption. 

When a specific child is identified, you will 

receive a referral (a packet of information 

about the child). This packet usually includes 

the child's picture and information on their 

health and history, if available. Medical 

information, however, may be inaccurate or 

limited. You will likely have a minimum of 2 

weeks to consider the available information 

and decide whether you can meet this child's 

needs. Ask questions of your provider or a 

doctor who specializes in internationally 

adopted children before you accept the 

placement. Some clinics specialize in 

intercountry adoptions, so you can use them 

to have the medical information reviewed 

by a doctor who is trained in this area. Pay 

particular attention to the information 

related to the child's health, prenatal health 

(if known), placement history, any exposure 

to trauma, and expected emotional or 

mental health needs. Do not be afraid to 

ask for additional information, particularly 

if a professional raises issues that concern 

you (See the section belon on physical 

and behavioral health considerations for 

additional information and resources.) 

Adoption of Relatives

If you are interested in adopting a child to 

whom you are related, you are required 

to follow the same steps as you would 

for a nonrelative adoption. A prospective 

adoptive child who is related to you must 

qualify for intercountry adoption and 

immigration to the United States under 

the same criteria as unrelated children 

under the Convention or non-Convention 

processes. The specific requirements 

depend on the country in which your 

relative lives.

The adoption of a stepchild is not generally 

handled as an intercountry adoption.

For the most up-to-date information on 

adopting a relative through intercountry 

adoption, visit the U.S. Department of 

State’s Adopting a Relative for Immigration

to the United States webpage and USCIS’ 

Other Adoption-Related Immigration

webpage.
Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 11

If you are unsure about whether you can 

make the changes necessary to incorporate 

the child into your family, it is better to stop 

the process before meeting them than to 

later risk a possible disruption (ending the 

adoption process after legal placement but 

before finalization) or dissolution (ending 

the adoption after finalization). Children 

who experience disruptions or dissolutions 

face new grief, rejection, and compounded 

trauma. More information on this topic is on 

Information Gateway's Adoption Disruption/

Dissolution webpage and in Adoption 

Disruption and Dissolution.

Children adopted through intercountry 

adoption may be at risk for unregulated 

custody transfer, sometimes referred to as 

"rehoming," which occurs when adoptive 

parents informally (i.e., without involving 

child welfare professionals or courts) place 

their child in a home other than theirs with 

the intention of permanently transferring 

custody. (Child Welfare Information Gateway, 

2018b; U.S. Government Accountability Office, 

2015). Unregulated custody transfer puts the 

child at risk of abuse, neglect, and other poor 

outcomes, and many State laws attempt to 

prevent it. (Refer to Information Gateway's 

Unregulated Custody Transfers of Adopted 

Children for more information.)

It is critical that families be as prepared 

as possible to move into this journey with 

commitment and a full understanding of 

the challenges that they may encounter. 

To reduce the likelihood of relational 

breakdowns, families should obtain support 

prior to being matched, during the process of 

being matched, and after the child has been 

placed in the home. This could be through 

a formal or informal support group, mental 

health services, other adoptive families, 

books and trainings on topics specific to your 

adoption process, and through the support of 

your adoption agency.

PHYSICAL AND BEHAVIORAL HEALTH 

CONSIDERATIONS

Although there is a very wide diversity among 

children awaiting adoption in terms of their 

age, gender, skin color, religion, ethnicity, 

and other personal and socio-demographical 

aspects, there are some general factors that 

they share:

 They are primarily residing in orphanages, 

with some in foster care or other child 

welfare settings.

 Many children placed for intercountry 

adoption have known medical special 

needs. The needs can cover a wide range of 

issues—from minor, medically correctible 

needs to more profound needs that impact 

a child's daily independent functioning.

 Children without a diagnosed or suspected 

medical or cognitive special need may 

still have unreported short- or long-term 

special needs that could impact their health 

and development.

 Sibling groups often await adoption as a 

unit. 

Children eligible for intercountry adoption 

often have special needs and health 

conditions that may be treated in the 

United States more easily than in the child's 

country of origin. These challenges may be 
Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 12

accompanied by trauma from their early life 

experience as well as deep feelings of loss 

and grief for their birth families, culture, 

community, friends, food, and language. 

Refer to Information Gateway's The Impact 

of Adoption to learn more about core issues 

experienced in adoption. 

Also, children who live in institutions are 

sometimes exposed to physical or sexual 

abuse and/or neglect, which can contribute 

to physical and behavioral health concerns. 

Sometimes children may not feel safe to share 

information, particularly about sexual abuse, 

until they feel comfortable with their adoptive 

families, who may be the first people to learn 

about the maltreatment. 

Given the possible lack of health and other 

life history information about the child, you 

may learn of your child's special needs after 

placement, whether or not you had planned 

and prepared to adopt a child with special 

needs. Refer to Information Gateway's 

Obtaining Background Information on Your 

Prospective Adopted Child for details on how 

to find personal information about your 

prospective adoptive child.

The American Academy of Pediatrics 

recommends a comprehensive health 

evaluation for all children who are adopted, 

including those adopted internationally (Jones 

et al., 2019). Reputable providers will give you 

as much medical information as possible from 

your child's country of origin, including the 

child's background. But they cannot guarantee 

the information is accurate or complete. 

The type and quality of available information 

will vary depending on the country and the 

child's situation. Health records will be in the 

language of the child's country of origin and 

may need to be translated, and translated 

records sometimes are not complete or 

accurate. Parents should consider requesting 

copies of the original medical records so that 

U.S. health professionals who are fluent in 

that language can review and translate them. 

When reviewing the medical information of a 

child with whom you are matched, consider 

that child's expected health and behavioral 

health needs so you can have realistic shortand long-term expectations. A doctor familiar 

with intercountry adoption can help you 

understand the information you receive about 

your child's health and development. 

Visit the following resources for general 

information on the health needs and concerns 

commonly associated with adopting a child 

from another country:

 Health Considerations (U.S. Department of 

State)

 Medical Examination (U.S. Department of 

State)

 Adopting a Child From Another Country 

(Intercountry Adoption) (Centers for 

Disease Control and Prevention)

 Internationally Adopted Children: Important 

Information for Parents (American Academy 

of Pediatrics)

 The Role of Pre-Placement Medical Review 

in Contemporary Adoptions: Setting 

Expectations, Assessing a Child's Needs, and 

Supporting Successful Family Formation

(National Council For Adoption)

Arrange for your adopted child to have a 

medical exam with a pediatrician specializing 

in adoption health soon after you bring your 

child home.
Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 13

OBTAINING LEGAL CUSTODY AND 

ADDITIONAL ACTIONS

Your adoption service provider will guide you 

through the appropriate and required steps 

in the legal adoption process, which typically 

begins after you accept a referral for a specific 

child. Some countries may require you to 

finalize the adoption in their jurisdiction. 

Other countries may only transfer legal 

custody/guardianship to you or your adoption 

service provider and not complete a final 

adoption. In that case, you must finalize the 

adoption in a U.S. court to establish the child's 

U.S. citizenship. 

For a child from a Convention country, do not 

adopt or accept legal custody of the child until 

the following have occurred:

 USCIS has provisionally approved your 

petition to classify the Convention adoptee 

as an immediate relative (Form I-800).

 The U.S. Department of State has advised 

the central authority in the child's country 

of origin that you have been found suitable 

and that the child appears eligible to come 

to the United States if adopted or if legal 

custody for the purpose of adoption is 

granted. This is often referred to as the 

"Article 5 letter."

Additional actions may be required by 

U.S. immigration law, State law, the law 

or regulations of your child's country of 

origin, or your adoption service provider 

before or after you bring your child home. 

Requirements vary depending on the type 

of immigrant visa your child received. Your 

adoption service provider can tell you about 

what must be done in your specific case, but 

the following are possible other steps: 

 Finalize your child's adoption or readopt 

your child in a U.S. court. If your child 

received an IR-4 or IH-4 category visa, 

which are generally issued when the foreign 

court issues a guardianship order instead 

of an adoption order, you must finalize 

the adoption in a U.S. State court before 

your child can acquire U.S. citizenship. It 

is recommended to readopt your child in 

the United States if your child is not from 

a Convention country. If your child is from 

a Convention country, readoption is not 

typically required. For more information 

on State laws and why readopting in the 

United States may be beneficial in some 

cases, visit Information Gateway's Meeting 

Citizenship Requirements webpage, which 

covers readoption.

 Obtain documentation of your child's U.S. 

Citizenship. USCIS will automatically issue 

a Certificate of Citizenship to children 

who enter the United States with an IR-3 

or IH-3 category visa to reside with the 

adoptive parents. For children who do not 

automatically acquire citizenship and who 

parents must take additional steps in the 

State of residence, the parents may apply to 

USCIS for a Certificate of Citizenship or to 

the Department of State for a U.S. passport.
Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 14

 Obtain a Social Security number for 

your child. The U.S. Social Security 

Administration will assign your child 

a Social Security number before you 

obtain proof of U.S. citizenship. If your 

child entered the United States on an 

IR-4 or IH-4 visa and was granted Lawful 

Permanent Resident status but did not 

acquire U.S. citizenship automatically, you 

will need to provide proof that your child 

subsequently acquired citizenship after 

you completed a full and final adoption 

and satisfied any remaining requirements. 

Records will not show your child is a U.S. 

citizen until you provide this proof with 

either a Certificate of Citizenship or a U.S. 

passport. For more information, refer to 

Social Security Numbers for Children.

The following Information Gateway 

publications may be helpful in determining 

what additional actions may be required in 

your case: 

 State Recognition of Intercountry Adoptions 

Finalized Abroad

 Completing Intercountry Adoptions Not 

Finalized Abroad

SERVICES FOR AFTER AN ADOPTION IS 

FINALIZED

Your family will likely need some level of 

support and services after the adoption is 

finalized. This need may arise years after the 

adoption is finalized. Work with your adoption 

service provider before your child's adoption 

is finalized to ensure you know where and 

how to access services if the need arises. The 

following are examples of adoption support 

and preservation services (Child Welfare 

Information Gateway, 2018a):

 Support groups

 Therapy or counseling

 Respite care

 Camps, social events, and heritage activities

 Information resources

 Support in maintaining relationships with 

birth families, including search and reunion 

Although the availability of services may 

vary depending on your State or locality, the 

Federal Government encourages States to 

provide services to any adoptive family that 

needs them (Children's Bureau, 2014). To 

view information on services by State, visit 

Information Gateway's Adoption Assistance 

by State webpage. It is important to note that 

adoption services may be offered by the child 

welfare agency but open to any family who 

has adopted. 

The following are additional resources about 

adoption support and preservation services: 

 What to Expect After Adoption (U.S. 

Department of State)

 Accessing Adoption Support and 

Preservation Services (Information Gateway)

 Finding and Working With AdoptionCompetent Therapists (Information 

Gateway)
Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 15

ACQUIRING AND DOCUMENTING U.S. 

CITIZENSHIP

Acquiring and documenting your child's U.S. 

citizenship is important to ensure they are 

able to enjoy certain rights and privileges, 

including applying to colleges for financial 

aid, being eligible for certain types of 

employment, or registering to vote. Most 

children adopted from abroad acquire U.S. 

citizenship automatically when they enter the 

United States under the terms of the Child 

Citizenship Act of 2000. In general, a child 

whose adoption is finalized abroad acquires 

citizenship automatically if the child meets 

the following conditions:

 Is under the age of 18;

 Enters the United States as a permanent 

resident; and

 Resides in the United States and is in the 

legal and physical custody of at least one 

parent who is a U.S. citizen 

For many internationally adopted children, 

citizenship is acquired automatically, 

but documentation of citizenship is not. 

Therefore, obtaining documentation for them 

is important. A Certificate of Citizenship 

issued by USCIS, or a U.S. passport issued 

by the U.S. Department of State, provides 

proof of U.S. citizenship for children who 

become citizens through adoption. This is 

different than the certificate provided with 

Convention adoptions that states the adoption 

complies with the Convention. The process 

for obtaining the Certificate of Citizenship 

depends on the type of visa your child was 

issued. Check the stamp on your child's 

passport to determine the type of visa issued. 

You may be able to obtain a passport for 

your child from the U.S. Department of State 

before receiving the Certificate of Citizenship, 

but the adoption must be full and final 

according to U.S. Federal law. The "full effect" 

of a foreign adoption decree means that 

you and your child have the same rights and 

obligations as you would have if a State court 

had issued the adoption decree. Even if you 

have obtained a passport for your child, the 

Certificate of Citizenship is still recommended 

as the best proof of citizenship as it does not 

expire and is issued from USCIS.

Submitting Postadoption Reports 

and Pictures

Many countries require parents to submit 

reports on the progress and welfare 

of their child after the adoption has 

been finalized. Postadoption reporting 

requirements vary by country. For 

example, some may require annual reports 

for 5 years or perhaps until the child is 18 

years old. Ensuring these reports are filed 

in a timely manner is an important factor 

in fostering positive relationships between 

the United States and your child's country 

of origin, paving the way for future 

intercountry adoptions. Failure to submit 

these reports to foreign countries has 

caused adoption programs to shut down, 

so it's important that you are aware of 

reporting requirements and adhere to 

them. Visit the U.S. Department of State's 

Post-Adoption Reporting Overview

webpage for additional information.
Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 16

Your child will not acquire citizenship 

automatically if they enter the United States 

as a permanent resident with either an IR-4 or 

IH-4 visa. For example, one common scenario 

for issuance of this category of visa is if both 

adoptive parents do not travel to the child's 

country of origin, and both do not appear 

for the visa interview with the child. In this 

case, it is essential that you first finalize your 

child's adoption in the appropriate State court 

and meet other State-specific requirements 

before your child can acquire citizenship. 

Some individuals who were legally adopted 

and have been U.S. residents for most of their 

lives learn later that they do not hold U.S. 

citizenship because their adoptive parents 

did not fulfill citizenship requirements. Some 

adoptees may discover this as young adults 

when applying for certain jobs, registering to 

vote, or applying for a U.S. passport. 

Visit the following webpages for more 

information on obtaining and documenting 

citizenship for your child:

U.S. Department of State

 Obtaining Citizenship or Documenting

Acquired Citizenship for Adopted Children

 Documenting U.S. Citizenship for Your

Child Adopted Abroad

USCIS

 U.S. Citizenship for an Adopted Child

 After Your Child Enters the United States

 Certificate of Citizenship for Your

Internationally Adopted Child

ADJUSTING TO A NEW FAMILY 

STRUCTURE

Parents are often unprepared for the 

emotional challenges they and their children 

face when their family grows through 

adoption. Information Gateway provides 

several factsheets and webpages to help you 

and your child adjust:

 Parenting Your Adopted Preschooler, 

Parenting Your Adopted School-Age Child, 

and Parenting Your Adopted Teenager offer 

tips for helping your child adjust to a new 

home and family and explore common 

parenting considerations, including 

adoption and child development, gaps 

in developmental stages, discipline, and 

improving your child's school experience. 

 After Intercountry Adoption provides 

resources to help in a variety of 

areas, including understanding health 

assessments and evaluations, obtaining 

documents, and helping your child 

reconnect with their cultural roots.

 The Impact of Adoption provides an 

overview of the seven core issues in 

adoption and how they may affect children 

and adults who have been adopted, birth 

parents, and adoptive parents.

The National Council For Adoption also 

provides an Intercountry Adoption webpage 

as another helpful resource for adoptive 

families.

During this transition and throughout your 

lives as an adoptive family, staff from the 

adoption service provider may be a valuable 
Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 17

source of support. Your adoption agency may 

provide services that last from 6 months to 

several years after placement. You can locate 

resources and referrals for additional services 

from a variety of sources, such as the internet 

or the local library. For more information 

about support and services for after adoption, 

refer to Information Gateway's Accessing 

Adoption Support and Preservation Services.

CONCLUSION

Navigating the laws and process of 

intercountry adoption is challenging, but an 

accredited adoption service provider can 

guide you through a successful journey, from 

arranging a home study to documenting 

your child's citizenship. If you decide that 

intercountry adoption is right for you, actively 

preparing for your child's needs and your 

own will smooth the transition for you and 

your growing family. Children who have 

endured potentially traumatic experiences 

before they join your family deserve parents 

who know their needs and how to care for 

them. Preparing for your child's physical 

and behavioral health and considering your 

family's adjustments will help ready you 

for the complex and exciting journey of 

welcoming a child from another country into 

your home.

ADDITIONAL RESOURCES

Information Gateway: Includes several 

publications and web sections on intercountry 

adoptions: 

 Adoption Options: Where Do I Start?

 Obtaining Background Information on Your 

Prospective Adopted Child

 Adopting Children From Another Country

 After Intercountry Adoption

 Adoption by Family Type: Racially and 

Culturally Diverse Families

U.S. Department of State: Provides 

information on a wide range of intercountry 

adoption topics, such as the Hague 

Convention, the adoption process, and 

country-specific notes

Contact With Birth Families

With the enormous amount of information 

available online throughout the world, 

more people are finding each other 

through online searches. Children and 

youth who are adopted frequently search 

for their birth families and vice versa. Feel 

free to ask your adoption service provider 

about how you can support your child 

in safely using the internet and social 

media and how to navigate newly formed 

relationships with the child’s birth family. It 

is important for adoptive families to share 

information they have about the birth 

family with the child and to be supportive 

in acknowledging and honoring not only 

the child’s birth family but their culture, 

race and community. This supportive 

atmosphere will help the child to develop 

their full identity. For more information 

about maintaining connections 

and contact with birth families, visit 

Information Gateway’s Ongoing Contact 

With Birth Families in Adoption webpage 

and Helping Your Adopted Children 

Maintain Important Relationships With 

Family factsheet.
Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 18

USCIS: Details Convention and nonConvention process for intercountry 

adoptions

University of Minnesota Adoption Medicine

Clinic: Addresses health issues related to 

children adopted from other countries

American Academy of Pediatrics: Includes a 

listing of pediatricians by State who specialize 

in providing services to adopted children and 

information about health-related adoption 

issues

ComeUnity: Highlights information on health 

issues related to intercountry and domestic 

adoptions, including a list of clinics and 

doctors that specialize intercountry adoption

International Adoption Help: Lists adoption 

clinics that specialize in international medical 

and health information

National Council For Adoption: Offers a 

Convention-compliant training, "Intercountry 

Adoption Journey," that prepares prospective 

adoptive parents for the unique challenges 

of parenting a child adopted from another 

country 

REFERENCES

Children's Bureau. (2014). Re-homing of 

adopted children: Responsibilities for States 

and opportunities in the provision of postadoption services (ACYF-CB-IM-14-02). U.S. 

Department of Health and Human Services, 

Administration for Children and Families. 

https://www.acf.hhs.gov/cb/resource/

im1402

Child Welfare Information Gateway. 

(2018a). Accessing Adoption Support and 

Preservation Services. Washington, DC: U.S. 

Department of Health and Human Services, 

Children's Bureau. 

Child Welfare Information Gateway. (2018b). 

Unregulated custody transfers of adopted 

children. Washington, DC: U.S. Department 

of Health and Human Services, Children's 

Bureau. 

Jones, V. F., Schulte, E. E., & Council on Foster 

Care, Adoption, and Kinship Care. (2019). 

Comprehensive health evaluation of the 

newly adopted child. Pediatrics, 143(5), 

e20190657. https://doi.org/10.1542/

peds.2019-0657

McCall, R. B., & Groark, C. J. (2015). Research 

on institutionalized children: Implications 

for international child welfare practitioners 

and policymakers. International 

Perspectives in Psychology: Research, 

Practice, Consultation, 4(2), 142–159. 

https://doi.org/10.1037/ipp0000033
Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 19

U.S. Government Accountability Office. 

(2015). Steps have been taken to address 

unregulated custody transfers of adopted 

children (GAO-15-733). https://www.gao.

gov/assets/680/672575.pdf

SUGGESTED CITATION:

Child Welfare Information Gateway. (2020). 

Intercountry adoption: What do I need to 

know? Washington, DC: U.S. Department of 

Health and Human Services, Administration 

for Children and Families, Children's Bureau.

This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information 

Gateway. This publication is available online at https://www.childwelfare.gov/pubs/factsheets-families-intercountry/.

U.S. Department of Health and Human 

Services Administration for Children and 

Families Administration on Children, 

Youth and Families Children’s Bureau