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]
The most recent adoption attitudes survey completed by the Evan Donaldson Institute provides further evidence of this stigma. Nearly one-third of the surveyed population believed adoptees are less-well adjusted, more prone to medical issues, and predisposed to drug and alcohol problems. Additionally, 40–45% thought adoptees were more likely to have behavior problems and trouble at school. In contrast, the same study indicated adoptive parents were viewed favorably, with nearly 90% describing them as "lucky, advantaged, and unselfish."[144]
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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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.
Attitudes and laws regarding adoption vary greatly. Whereas all cultures make arrangements whereby children whose birth parents are unavailable to rear them can be brought up by others, not all cultures have the concept of adoption, that is treating unrelated children as equivalent to biological children of the adoptive parents. Under Islamic Law, for example, adopted children must keep their original surname to be identified with blood relations,[194] and, traditionally, women wear a hijab in the presence of males in their adoptive households. In Egypt, these cultural distinctions have led to making adoption illegal.[195]
By 1979, representatives of 32 organizations from 33 states, Canada and Mexico gathered in Washington, DC to establish the American Adoption Congress (AAC) passing a unanimous resolution: "Open Records complete with all identifying information for all members of the adoption triad, birthparents, adoptive parents and adoptee at the adoptee's age of majority (18 or 19, depending on state) or earlier if all members of the triad agree."[161] Later years saw the evolution of more militant organizations such as Bastard Nation (founded in 1996), groups that helped overturn sealed records in Alabama, Delaware, New Hampshire, Oregon, Tennessee, and Maine.[162][163] Simultaneously, groups such as Origins USA (founded in 1997) started to actively speak about family preservation and the rights of mothers.[164] The intellectual tone of these recent reform movements was influenced by the publishing of The Primal Wound by Nancy Verrier. "Primal wound" is described as the "devastation which the infant feels because of separation from its birth mother. It is the deep and consequential feeling of abandonment which the baby adoptee feels after the adoption and which may continue for the rest of his life."[153]
His solution was outlined in The Best Method of Disposing of Our Pauper and Vagrant Children (1859) which started the Orphan Train movement. The orphan trains eventually shipped an estimated 200,000 children from the urban centers of the East to the nation's rural regions.[28] The children were generally indentured, rather than adopted, to families who took them in.[29] As in times past, some children were raised as members of the family while others were used as farm laborers and household servants.[30] The sheer size of the displacement—the largest migration of children in history—and the degree of exploitation that occurred, gave rise to new agencies and a series of laws that promoted adoption arrangements rather than indenture. The hallmark of the period is Minnesota's adoption law of 1917 which mandated investigation of all placements and limited record access to those involved in the adoption.[31][32]