Europe's cultural makeover marked a period of significant innovation for adoption. Without support from the nobility, the practice gradually shifted toward abandoned children. Abandonment levels rose with the fall of the empire and many of the foundlings were left on the doorstep of the Church.[18] Initially, the clergy reacted by drafting rules to govern the exposing, selling, and rearing of abandoned children. The Church's innovation, however, was the practice of oblation, whereby children were dedicated to lay life within monastic institutions and reared within a monastery. This created the first system in European history in which abandoned children did not have legal, social, or moral disadvantages. As a result, many of Europe's abandoned and orphaned children became alumni of the Church, which in turn took the role of adopter. Oblation marks the beginning of a shift toward institutionalization, eventually bringing about the establishment of the foundling hospital and orphanage.[18]
In the 1970s, as adoption search and support organizations developed, there were challenges to the language in common use at the time. As books like Adoption Triangle by Sorosky, Pannor and Baran were published, and support groups formed like CUB (Concerned United Birthparents), a major shift from "natural parent" to "birthparent"[182][183] occurred. Along with the change in times and social attitudes came additional examination of the language used in adoption.
There is limited research on the consequences of adoption for the original parents, and the findings have been mixed. One study found that those who released their babies for adoption were less comfortable with their decision than those who kept their babies. However, levels of comfort over both groups were high, and those who released their child were similar to those who kept their child in ratings of life satisfaction, relationship satisfaction, and positive future outlook for schooling, employment, finances, and marriage.[121] Subsequent research found that adolescent mothers who chose to release their babies for adoption were more likely to experience feelings of sorrow and regret over their decision than those who kept their babies. However, these feelings decreased significantly from one year after birth to the end of the second year.[122]
Several factors affect the decision to release or raise the child. White adolescents tend to give up their babies to non-relatives, whereas black adolescents are more likely to receive support from their own community in raising the child and also in the form of informal adoption by relatives.[118] Studies by Leynes and by Festinger and Young, Berkman, and Rehr found that for pregnant adolescents, the decision to release the child for adoption depended on the attitude toward adoption held by the adolescent's mother.[119] Another study found that pregnant adolescents whose mothers had a higher level of education were more likely to release their babies for adoption. Research suggests that women who choose to release their babies for adoption are more likely to be younger, enrolled in school, and have lived in a two-parent household at age 10, than those who kept and raised their babies.[120]
The American model of adoption eventually proliferated globally. England and Wales established their first formal adoption law in 1926. The Netherlands passed its law in 1956. Sweden made adoptees full members of the family in 1959. West Germany enacted its first laws in 1977.[49] Additionally, the Asian powers opened their orphanage systems to adoption, influenced as they were by Western ideas following colonial rule and military occupation.[50] In France, local public institutions accredit candidates for adoption, who can then contact orphanages abroad, or ask for the support of NGOs. The system does not involve fees, but gives considerable power to social workers whose decisions may restrict adoption to standardized families (middle-age, medium to high income, heterosexual, Caucasian).[51]
"Honest Adoption Language" refers to a set of terms that proponents say reflect the point of view that: (1) family relationships (social, emotional, psychological or physical) that existed prior to the legal adoption often continue past this point or endure in some form despite long periods of separation, and that (2) mothers who have "voluntarily surrendered" children to adoption (as opposed to involuntary terminations through court-authorized child-welfare proceedings) seldom view it as a choice that was freely made, but instead describe scenarios of powerlessness, lack of resources, and overall lack of choice.[187][188] It also reflects the point of view that the term "birth mother" is derogatory in implying that the woman has ceased being a mother after the physical act of giving birth. Proponents of HAL liken this to the mother being treated as a "breeder" or "incubator".[189] Terms included in HAL include terms that were used before PAL, including "natural mother," "first mother," and "surrendered for adoption."
Reform and family preservation efforts have also been strongly associated with the perceived misuse of adoption. In some cases, parents' rights have been terminated when their ethnic or socio-economic group has been deemed unfit by society. Some of these practices were generally accepted but have later been considered abusive; others were uncontroversially reprehensible.

Some adoptees reject the idea of reunion. It is unclear, though, what differentiates adoptees who search from those who do not. One paper summarizes the research, stating, "...attempts to draw distinctions between the searcher and non-searcher are no more conclusive or generalizable than attempts to substantiate...differences between adoptees and nonadoptees."[169]
The next stage of adoption's evolution fell to the emerging nation of the United States. Rapid immigration and the American Civil War resulted in unprecedented overcrowding of orphanages and foundling homes in the mid-nineteenth century. Charles Loring Brace, a Protestant minister became appalled by the legions of homeless waifs roaming the streets of New York City. Brace considered the abandoned youth, particularly Catholics, to be the most dangerous element challenging the city's order.[26][27]
International adoption: involves the placing of a child for adoption outside that child's country of birth. This can occur through both public and private agencies. In some countries, such as Sweden, these adoptions account for the majority of cases (see above Table). The U.S. example, however, indicates there is wide variation by country since adoptions from abroad account for less than 15% of its cases.[83] More than 60,000 Russian children have been adopted in the United States since 1992,[85] and a similar number of Chinese children were adopted from 1995 to 2005.[86] The laws of different countries vary in their willingness to allow international adoptions. Recognizing the difficulties and challenges associated with international adoption, and in an effort to protect those involved from the corruption and exploitation which sometimes accompanies it, the Hague Conference on Private International Law developed the Hague Adoption Convention, which came into force on 1 May 1995 and has been ratified by 85 countries as of November 2011.[87]

In Spain under Francisco Franco’s 1939–75 dictatorship the newborns of some left-wing opponents of the regime, or unmarried or poor couples, were removed from their mothers and adopted. New mothers were frequently told their babies had died suddenly after birth and the hospital had taken care of their burials, when in fact they were given or sold to another family. It is believed that up to 300,000 babies were involved. These system – which allegedly involved doctors, nurses, nuns and priests – outlived Franco’s death in 1975 and carried on as an illegal baby trafficking network until 1987 when a new law regulating adoption was introduced.[180][181]
During the same period, the Progressive movement swept the United States with a critical goal of ending the prevailing orphanage system. The culmination of such efforts came with the First White House Conference on the Care of Dependent Children called by President Theodore Roosevelt in 1909,[33] where it was declared that the nuclear family represented "the highest and finest product of civilization" and was best able to serve as primary caretaker for the abandoned and orphaned.[34][35] Anti-institutional forces gathered momentum. As late as 1923, only two percent of children without parental care were in adoptive homes, with the balance in foster arrangements and orphanages. Less than forty years later, nearly one-third were in an adoptive home.[36]
Similar mechanisms appear to be at work in the physical development of adoptees. Danish and American researchers conducting studies on the genetic contribution to body mass index found correlations between an adoptee's weight class and his biological parents' BMI while finding no relationship with the adoptive family environment. Moreover, about one-half of inter-individual differences were due to individual non-shared influences.[115][116]
This system of apprenticeship and informal adoption extended into the 19th century, today seen as a transitional phase for adoption history. Under the direction of social welfare activists, orphan asylums began to promote adoptions based on sentiment rather than work; children were placed out under agreements to provide care for them as family members instead of under contracts for apprenticeship.[21] The growth of this model is believed to have contributed to the enactment of the first modern adoption law in 1851 by the Commonwealth of Massachusetts, unique in that it codified the ideal of the "best interests of the child."[22][23] Despite its intent, though, in practice, the system operated much the same as earlier incarnations. The experience of the Boston Female Asylum (BFA) is a good example, which had up to 30% of its charges adopted out by 1888.[24] Officials of the BFA noted that, although the asylum promoted otherwise, adoptive parents did not distinguish between indenture and adoption; "We believe," the asylum officials said, "that often, when children of a younger age are taken to be adopted, the adoption is only another name for service."[25]
The majority of people state that their primary source of information about adoption comes from friends and family and the news media. Nevertheless, most people report the media provides them a favorable view of adoption; 72% indicated receiving positive impressions.[145] There is, however, still substantial criticism of the media's adoption coverage. Some adoption blogs, for example, criticized Meet the Robinsons for using outdated orphanage imagery[146][147] as did advocacy non-profit The Evan B. Donaldson Adoption Institute.[148]
The practice of closed adoption (aka confidential or secret adoption),[74] which has not been the norm for most of modern history,[75] seals all identifying information, maintaining it as secret and preventing disclosure of the adoptive parents', biological kins', and adoptees' identities. Nevertheless, closed adoption may allow the transmittal of non-identifying information such as medical history and religious and ethnic background.[76] Today, as a result of safe haven laws passed by some U.S. states, secret adoption is seeing renewed influence. In so-called "safe-haven" states, infants can be left, anonymously, at hospitals, fire departments, or police stations within a few days of birth, a practice criticized by some adoption advocacy organizations as being retrograde and dangerous.[77]
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Unlike guardianship or other systems designed for the care of the young, adoption is intended to effect a permanent change in status and as such requires societal recognition, either through legal or religious sanction. Historically, some societies have enacted specific laws governing adoption; where others have tried to achieve adoption through less formal means, notably via contracts that specified inheritance rights and parental responsibilities without an accompanying transfer of filiation. Modern systems of adoption, arising in the 20th century, tend to be governed by comprehensive statutes and regulations.

This system of apprenticeship and informal adoption extended into the 19th century, today seen as a transitional phase for adoption history. Under the direction of social welfare activists, orphan asylums began to promote adoptions based on sentiment rather than work; children were placed out under agreements to provide care for them as family members instead of under contracts for apprenticeship.[21] The growth of this model is believed to have contributed to the enactment of the first modern adoption law in 1851 by the Commonwealth of Massachusetts, unique in that it codified the ideal of the "best interests of the child."[22][23] Despite its intent, though, in practice, the system operated much the same as earlier incarnations. The experience of the Boston Female Asylum (BFA) is a good example, which had up to 30% of its charges adopted out by 1888.[24] Officials of the BFA noted that, although the asylum promoted otherwise, adoptive parents did not distinguish between indenture and adoption; "We believe," the asylum officials said, "that often, when children of a younger age are taken to be adopted, the adoption is only another name for service."[25]
In Spain under Francisco Franco’s 1939–75 dictatorship the newborns of some left-wing opponents of the regime, or unmarried or poor couples, were removed from their mothers and adopted. New mothers were frequently told their babies had died suddenly after birth and the hospital had taken care of their burials, when in fact they were given or sold to another family. It is believed that up to 300,000 babies were involved. These system – which allegedly involved doctors, nurses, nuns and priests – outlived Franco’s death in 1975 and carried on as an illegal baby trafficking network until 1987 when a new law regulating adoption was introduced.[180][181]

The adoptee population does, however, seem to be more at risk for certain behavioral issues. Researchers from the University of Minnesota studied adolescents who had been adopted and found that adoptees were twice as likely as non-adopted people to suffer from oppositional defiant disorder and attention-deficit/hyperactivity disorder (with an 8% rate in the general population).[135] Suicide risks were also significantly greater than the general population. Swedish researchers found both international and domestic adoptees undertook suicide at much higher rates than non-adopted peers; with international adoptees and female international adoptees, in particular, at highest risk.[136]
As the idea of institutional care gained acceptance, formal rules appeared about how to place children into families: boys could become apprenticed to an artisan and girls might be married off under the institution's authority.[19] Institutions informally adopted out children as well, a mechanism treated as a way to obtain cheap labor, demonstrated by the fact that when the adopted died, their bodies were returned by the family to the institution for burial.[20] 
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