ADOPTION IN A HOSPITAL SETTING LEELA NARANG The study of 76 adopted...
ADOPTION IN A HOSPITAL SETTING
The study of 76 adopted cases is based on the factual information collected over
a period of 10 years i.e. from 1971 to 1980. It was undertaken with a view to have a
systematic and organised effort to find out a suitable and permanent home for the aban-
doned babies, also to have a proper and realistic coordination with various child welfare
The scope of the study is mainly limited to eligibility requirement of adoptive parents,
hospital procedure followed for unwanted pregnancies and abandoned babies and subse-
quently some suggestions based on experience of the Social Worker.
Mrs. Leela Narang is Medico-Social Worker at Smt. Sucheta Kriplani Hospital,
The Social Welfare Department of Smt.
Initially the number of cases dealt with
Sucheta Kriplani Hospital, New Delhi was very small. The Social Worker found
came across the problem of abandoned it very difficult to find suitable homes for the
children as far back as twenty-five years children because in Indian Society there is
ago and since then the search for suitable a negative and prejudiced attitude towards
adoptive parents, the permanent placement the abandoned child. However, within a span
of children in homes where they could get of 25 years, a lot of change has taken place
love and care, became one of the main in this attitude, and more adoptive parents
objectives of this Department. In the with good educational background and pro-
absence of any well-organised agency for fessional status have started coming to the
adoption in the city, the job was undertaken
department. Thus the service was in keep-
as one of the various duties by the pro-
ing with the U.N. Declaration of (the right
fessionally trained medico-social worker in of the child) 1959 that the child shall enjoy
the medical setting.
special protection to be able to develop in
Smt. Sucheta Kriplani Hospital is one of every way in a condition of freedom and
the oldest hospitals attached to Lady Hard-
dignity. An attempt is being made to pro-
inge Medical College for women in India vide a home for each abandoned homeless
which was established in 1916. Being ex-
parentless child, a home and parents full
clusively for women, patients come to this of love and care. Thus, an adoptive service
hospital not only from Delhi and nearby has come into being in the hospital.
villages but from all over India.
This hospital being a free Government
In this context only those patients who hospital, no fee is charged from the parents
came to the hospital to deliver the child for registration and therefore the number
in utmost secrecy and those who came to of applicants for registeration has increased
avail the medical termination of pregnancy over the years and the medico-social worker
services but were found to be beyond the had to follow certain procedures keeping
period of termination, were referred to the in mind the legal aspects of adoption. In
Social Welfare Department for guidance the absence of any uniform secular adop-
tion Act children are placed under two
In the field of child welfare, especially separate Acts — for Hindus, the Hindu
that of abandoned and neglected children, Adoption and Maintenance Act 1956, and
the Social Welfare Department of this for Christians, Muslims, Parsis the Guar-
hospital could be counted amongst the first dianship and Ward Act, 1980.
to start adoption service in right earnest.
The ultimate responsibility of placing a
child is with the social worker. Therefore, have in mind, their faith in the doctor who
careful selection of adoptive parents is certifies that the child is fit for adoption
done on the basis of eligibility requirement helps in direct and early placement of the
and, wherever necessary, help was taken child.
from other agencies in placing the children
Another objective of the study is to have
in suitable families.
a proper and realistic co-ordination with
The study of 76 adopted cases was various child welfare organisations and
undertaken with a view to having more agencies.
systematic and organised efforts to find out
It is not always possible to deal with
a suitable and permanent home for the various problems confronting the welfare of
unwanted babies left abandoned in the abandoned babies single handed, e.g., deal-
hospital. This is also to help those adoptive ing with handicapped and mentally retarded
parents who want direct and early place-
children, children born with congenital
ment from the hospital itself due to the abnormalities and sick babies who need
special care. These are some of the areas
(1) Adoptive parents wanted to adopt a where complete and effective coordination
child immediately after birth or a few days with other agencies is necessary.
after birth so that they can bring up the
This study is based on the factual infor-
child like their natural born child.
mation collected over a period of ten years,
(2) The social history of the natural from 1971 to 1980. During this period, 116
parent is known to the medical social babies were given for adoption and 76 of
worker and the adoptive parents' faith in these cases have been selected for the study.
the social worker helps in early placement In 40 cases information was not complete
of the child.
and therefore had to be dropped.
(3) The medical history of the birth of
With the emergence of various child
the child is known to the doctors of the welfare agencies in Delhi, their help was
hospital and the worker. Adoptive parents sought from time to time in placing chil-
are free to discuss the fears and doubts they dren in suitable families.
T A B L E 1
Y E A R - W I S E DISTRIBUTION OF CHILDREN G I V E N FOR ADOPTION THROUGH VARIOUS AGENCIES
F R O M 1971 — 1980
Total No. of
Reg. Homes s. o. s.
ADOPTION IN A HOSPITAL SETTING
Year-wise distribution of children given
The hospital staff constitutes the largest
for adoption through various agencies from number of referrals, i.e. 43.4 per cent. This
1971-1980, is shown in table 1.
shows the awareness on the part of medical
Table 1 indicates that 19 children were and para-medical personnel about the adop-
placed in 1978. The increase in number can tion facility available in the hospital itself.
be attributed to the interest of attending Those who were known to the social wor-
doctors in referring the cases to the depart-
kers are 21.1 per cent. They are mostly pro-
ment well in time whereas the number fell to
fessionals working in other organisations
8 children in 1976. This could be a mere and some are known to the workers through
relations and friends. Four per cent were
Whenever help from other agencies was referred from private practitioners who were
required, the medical social worker never former doctors of the hospital. Referrals
hesitated to contact them. The largest num-
from Foster Care Home and Indian Council
ber of children were placed through Foster of Child Welfare were 17.1 per cent and 11.8
Care Home in the last 10 years. Direct per cent respectively. Even lawyers and
placement from the hospital were 39. These registered organisations referred cases to the
adoptive parents did not want the adoption Department. From the sources of referrals
to be through other adoption agencies be-
it is evident that all the 76 cases referred to
cause of the lengthy procedure of the the Department came through those people
agencies and the cost involved in going who are either connected with the natural
through the agencies. Moreover, complete parents or working for the welfare of chil-
and full information can be given to them dren. This shows their understanding of
about the birth of the child. Adoption human problems and an helping attitude on
through the Indian Council of Child Wel-
fare were 17, followed by 8 through regis-
Once the adoptive parents are referred to
tered Welfare Homes for children, two the Department they are interviewed and
through Udyan and one through the Hospi-
screened on the basis of their age, health,
tal Welfare Society. In all 116 children were medical history, income, profession, educa-
given for adoption.
tion number of living (natural) children,
Adoptive parents were referred to the number of children already adopted, prefe-
Social Welfare Department from various rence for the sex of the child etc.
Age being the most important eligibility
requirement of the adoptive parents, it was
T A B L E 2
carefully considered not in terms of years
REFERRAL-WISE DISTRIBUTION OF C A S E S
alone, but on the basis of health, energy
and maturity of these parents. The mean
Sources of Referral N o . of
age of the adoptive father was 38.71;
whereas in the case of the adoptive mother
I. Hospital Staff:
it was 34.34. Taking a late decision in
Doctors, Nurses, Tech.
adopting a child is mainly due to the fact
Staff, Office staff
2. Known to the worker
that there is a strong desire to have their
3. Foster Care H o m e
own child. After waiting and giving a fair
4. Indian Council of Child
trial to various types of treatment, it beco-
5. Private Practitioner
mes clear that the only way of overcoming
7. Regd. Organisations of
childlessness is adoption. Those who adopt-
ed a child after 6 to 10 years of married
life were 35.5 per cent followed by 22.4
Health of the parents was considered
per cent of those who adopted after 11 to with a view to protect the child against the
15 years of married life. Ten (13.2%) possible loss of adoptive parents during the
thought of adoption quite late, i.e. after 16 growing years of the child. So, health cer-
to 20 years of waiting. Six (7.9%) had their tification of the parents was a primary re-
own daughters so decided very late when quirement of the department.
they did not get a son of their own. Two
Financial stability was taken as another
(2.6%) adoptive parents thought of adopt-
important factor to assure adequate provi-
ing a child after 27 years of married life. sion for the care of the child. Though there
Two (2.6%) were single, unmarried ladies, are no set incomes presented, yet it is be-
well educated and well settled who took lieved that a family should have a stable
an independent decision. It is very rare source of income.
that unmarried ladies come for adoption.
Table 3 indicates that 58 (76.3%) adop-
Both these ladies adopted a female child. tive parents settled in India are from diffe-
One was Hindu of 32 years of age and rent income brackets. The highest number of
another was a foreign national 42 years of parents, i.e. 19 per cent were in the (20000-
age posted in India on foreign assignment. 25000) per annum bracket, 18 (23.7%) are
Both of them expressed their desire to get settled abroad with foreign currency in-
married. In 9 cases, i.e. 11.8 per cent, years comes. Of those settled abroad, 12 were
of marriage were not specified.
Indians and 6 were foreign nationals. By
and large, the table shows that all the
adopting parents had an income which
would help them to fulfil the basic needs
INCOME DISTRIBUTION P E R ANNUM OF ADOPTIVE
PARENTS IN INDIA
of the child, besides giving it good educa-
tion and proper care.
No. of Adoptive
Along with the income the closely link-
ed factors are profession and education of
Less than 5
adoptive parents. Out of 76 cases, 72, i.e.
94.7 per cent men were employed in profes-
sions such as engineers, doctors, army and
police officers, business executives, teachers,
lecturers, advocates, journalists, technicians,
film producers, clerks, businessmen and
farmers. In four cases the occupation was
Education of adoptive parents was given
equal importance so that the concept of
adoption can be understood in the broader
perspective. So far as adoptive fathers were
concerned, 63 (82.9%) were educated, 31
were graduates and 23 postgraduates. Edu-
cation of adoptive mothers was considered
55 - Above
to be a favourable point in placing the
children with them irrespective of the fact
whether they are working or non-working
ADOPTION IN A HOSPITAL SETTING
mothers, as it helps them to understand the
Preference was given to adoptive parents
child, his special needs and problems in a residing in Delhi or outside Delhi. It is
better way as he grows up.
only when no suitable family is available
in India that children were placed outside
Among adoptive mothers, 86.8 per cent India either with Indians settled abroad or
were educated, 50 per cent were educated with foreign nationals. This has happened
working mothers and 36.8 per cent were on various occasions when the child offered
educated housewives who could devote their for adoption was underweight or suffered
full time for the proper upbringing of the from congenital abnormality or was reject-
children. Twenty two were graduates and ed because of its dark complexion.
24 were postgraduates. Working mothers
were employed in a variety of fields the
Because of the need to follow-up and
most common being teaching, business exe-
place the children early with adoptive pa-
cutive, clerical, medical and para medical rents, only those who were residing in
Delhi were considered first. Babies placed in
Delhi were 49 (64.4%), 9 (11.8%) were
placed outside Delhi but in India, and 18
EDUCATION-WISE DISTRIBUTION OF WORKING AND (23.6%) were settled abroad, 11 in U.S.A.
NON-WORKING A D O P T I V E M O T H E R S
and one each in Australia, Sweden, Nor-
way, Denmark, Belgium, Thailand and
Canada. Out of these 18 foster parents, 12
were Indians and 6 foreign nationals.
During the course of case study adop-
ters are allowed to express themselves
freely, their views are elicited on many sen-
sitive topics of adoption. To begin with,
adoptive parents are told that the majority
of children who are given for adoption are
born out of wedlock. In Indian social and
cultural setting unmarried motherhood is
considered unacceptable behaviour, there-
fore the views of adoptive parents are to
be considered on this important point.
Sex preference is another pertinent ques-
Religious composition of the adoptive tion. This is again related to Indian culture
parents shows that 62 (81.6%) were adopt-
were preference is always for boys. From
ed by Hindus, 6 (7.9%) by Sikhs covered the data it will be seen that 45 (59.2%)
under the Hindu Adoption and Maintena-
were male babies and 31 (40.7%) were
nce Act of 1956, and 8 (10.5%) babies were female babies.
placed in Christian families under the Guar-
The reaction of near relations is also
dianship and Ward Act of 1890.
given due importance, but 26.3 per cent of
Out of the 8 cases given under Guardian-
adoptive parents wanted to keep the adop-
ship and Ward Act of 1890, 6 were given tion secret due to various factors, such as
to foreign nationals through registered Wel-
fears about social acceptance of the child
fare Homes for children and two were given and fear of in-laws who may force the
to Indian nationals.
husband into a second marriage on account
of infertility on the part of the woman. them in relation to the facility of medical
Those who had three or four daughters termination of pregnancy available in the
wanted to adopt a son and pass him off hospital and accordingly they are advised
as their own, so that the right of inheri-
to get themselves registered at other adop-
tance is maintained without relations know-
ing about the adoption.
During the course of interviews, many
Some intimate aspects of their married doubts and apprehensions, myths and pre-
life, their personal life and their relations judices, are discussed and clarified to the
with the rest of the family members are satisfaction of adoptive parents. For exam-
also taken into consideration.
ple, adoptive parents are advised not to
Confidentiality of natural as well as adop-
adopt children from their near relations as
tive parents is maintained in the interest of they will live in constant fear of losing the
both the parties. Neither parents are told child at a later stage of child development
anything except the medical history of na-
and at times be subjected to blackmail like
tural parents to adoptive parents in rela-
natural parents forcing the adoptive parents
tion to the child.
to transfer all the property in the name of
a minor child. Thus independent adoption
Adoptive parents are very positively told is discouraged in favour of agency adoption.
about legal protection to the child and its
importance is explained to them. Adoption
Definite negative bias toward illegitimacy
Acts and court procedures are explained to by adoptive parents was observed by the
them to the extent that they should not be worker. The adopters feel that the undesir-
scared of going to the court
able characteristics of natural parents will
The motive for adoption is also discuss-
be reflected in the child as a hereditary
ed at length. The strongest motive observed factor when the child grows up. Therefore,
is a desire to have a male child. Six cases most of the adoptive parents express their
had daughters already but wanted a son. desire to have a beautiful, fair complexion-
Other motives generally expressed are infer-
ed and intelligent child from educated and
tility, a child to carry on the name of the well-to-do natural parents.
family etc. One adoptive parent reported a
After giving them all the relevant infor-
rivalry with other members of the family mation regarding adoption — adopters have
who have children of their own. One want-
to be mentally prepared to accept a child
ed a child to replace a dead child. Twenty-
who is not their own child still more than
nine per cent husbands had been treated for their own, and their ability to accept and
sterility and 14.4 per cent wives had history live with a difference as they will be under-
of repeated abortions and miscarriages.
going an entirely different preparatory ex-
Some adoptive parents are dissuaded perience of parenthood than the normal
from adoption in view of their age, health biological phenomenon of pregnancy and
and mental makeup. Either they are ad-
vised to wait for some time if they are very
The role of a social worker in adoption
young and nothing is medically wrong, or, is that of an intermediary, especially in a
if the adopters are too old and not keep-
hospital setting where both the parents,
ing good health they are advised to adopt adoptive as well as natural, come for pro-
a four to five years old child.
fessional advice. Natural mothers, whether
The limitations regarding the availability married or unmarried, who want to aban-
of babies in the hospital are explained to don their unwanted babies in the hospital
ADOPTION IN A HOSPITAL SETTING
are offered the kind of services that are tion. Early placement of the child is desired
most helpful and understanding in establish-
because of cross-infection in the nursery
ing rapport with the client.
and for the sake of individual maternal care
Out of 76 placements, 57 (75%) were which the child needs at the tender age.
children born out of wedlock. Eighteen
(23.6%) were of married parents. Unmarri-
T A B L E 5
ed mothers had to abandon their babies DAY-WISE DISTRIBUTION OF BABIES AT THE
irrespective of the sex of the child because
T I M E OF PLACEMENT
of the social stigma attached to unmarried
motherhood in Indian culture. Among the No. of Days
No. of Babies
children of married mothers, 11 were fema-
les and 7 males which shows that it is not
2 - 5
always the case that married mothers aban-
doned their female babies only. Four mar-
6 - 9
ried mothers left their female babies because
the child born was the third or fourth
daughter in the family and parents were
expecting a son. Their disappointment in not
getting a son compelled them to abandon
their daughters in the hospital. Seven were
widows — this includes those who were
already pregnant when they become widows
and were already having children to look
after and those who became pregnant after
several years of widowhood. Culturally
there is a deep seated attitude of disappro-
Table 5 shows that 31.5 per cent of
val in Indian Society regarding extra mari-
children were placed with families as early
tal relationships and widows becoming as 2 to 5 days after birth. Twentyone per
pregnant after the death of their husbands. cent were held up for 6-9 days because of
One was physically handicapped and could some important medical examination and
not look after her newly born child. Two observation, 27.6 per cent cases stayed for
were already pregnant when they got mar-
18 days and above due to prolonged illness,
ried. Their husbands agreed to give the Four per cent were born outside the hospi-
babies in adoption because their behaviour tal and left abandoned in the hospital,
was not in conformity with the accepted
Placement of girls took longer time and
norms of society. Four had extra-marital babies whose mothers could not take a deci-
relationships when husbands were away for sion also took longer time for placement.
a long time. One mother was picked up This is more so with married women.
from the roadside and was severely retard-
Some were told very late about the adop-
ed; her marital status could not be ascer-
tion facilities in the hospital.
Adopting parents were explained the me-
As soon as a child is left abandoned in dical history of the birth of the child. Risks
the hospital it is taken care of by the pae-
in relation to birth history were clearly
diatrician of the hospital. Thorough medi-
explained, but at the early stage no absolute
cal check-up is done before the child is and specific prediction could be made as
declared medically fit to be given for adop-
to how the child would grow.
Observations and Suggestions
be a social stigma and an unacceptable
behaviour in Indian society. That was the
Adoption in a broader sense is a rela-
main reason for not telling the social his-
tively new concept in Indian Society, which tory of natural parents to adoptive parents.
needs a more comprehensive approach for The percentage of married women who left
the total development of the child's perso-
their babies under economical and social
nality. The real meaning of adoption lies pressure was 23.6. All these mothers need
in restoring to the child the security of a counselling and skilful handling of their pro-
permanent home — thus adoption is a two blems at the hands of qualified, mature and
way process, a home for the child and a experienced personnel.
child for the home.
In 1955, at the National Conference on
Mean age of adoptive fathers was 38.71 Adoption in the United States, the desira-
per cent and that of adoptive mothers bility of early placement was viewed from
34.34 per cent. Along with age, the health, social and psychological angles, i.e. to mini-
vitality and maturity of the parents were mise the effect of separation from natural
also taken into consideration. There should parents, to establish the relation with adop-
be a maximum age beyond which children tive parents as early as possible and to
should not be placed with adoptive parents. allow greater integration into the family
Educational standard and profession of through love and care.
adoptive parents were given more emphasis
Early placement of the child, as pointed
than income, though financial stability was out in this study, was done mainly to avoid
given due importance. As preference was cross-infection in the hospital nursery. Thus,
given to the education of both the parents, a need for team-work approach from all
82.9 per cent and 86.8 per cent respectively disciplines is essential. The role of experts
were well educated. The underlying idea such as paediatricians, psychiatrist, psycho-
was the higher the learning, the better the logist, social workers, lawyers and other
outlook of parents towards adoption.
child welfare agencies should be more com-
Those adoptive parents who preferred to municative and well co-ordinated.
keep adoption secret were 20 (26.3%), des-
Agencies through which children were
pite being told that adoption can never re-
placed for adoption never supplied the full
main a secret. In all the cases, adoption was information to the Department about adop-
with mutual consent though in some cases tive parents. They never thought it obliga-
it was kept a secret from in-laws and other tory on their part to furnish the full infor-
mation to the department even about the
Significantly large number of babies given welfare of the child once the child was taken
in adoption were male 45 (59.2%). This is away from the hospital. The hospital should
in confirmity with the age-old custom of not be considered a supplier of babies to
Hindus where the son will become heir to other agencies. However, parents who want
the property and will carry on the name of to adopt direct from the hospital should
the family after the father's death. In spite be helped.
of this, highly educated couples preferred
According to the Child Welfare League
to take girls in adoption. In many cases of America, adoptive parents should be
counselling intervention was necessary on given information regarding natural parents.
behalf of female babies to change the mind They also emphasise that the child should
of adoptive parents.
be helped to understand adoption. A frank
Unmarried motherhood is considered to handling of the child's adoptive status at
ADOPTION IN A HOSPITAL SETTING
an early age is desirable. The child should the old record permanently sealed and at
not learn it in a traumatic way from his the direction of the court a new birth cer-
friends and relations.
tificate should be issued by the Directorate
In the absence of any factual data it may of Vital Statistics. This recommendation
be stated that Indian parents want to keep can hold good in the Indian setting also.
silent on this subjects. Only one adoptive
So far as follow-up services are concern-
mother in the study told her son about ed, adoptive parents are advised to bring
adoption. The rest of the educated adoptive the child to the hospital or keep the worker
parents when advised by the social worker informed about the welfare of the child by
felt they should tell the child but hesitations writing letters and sending photographs.
and reservations were expressed in com-
Although implementation of follow-up ser-
municating with children on this topic.
vices are desired, home visits cannot be
Legal protection to the child is a must. undertaken in the absence of conveyance
Adoptive parents who expressed reluctance facilities.
to undergo court formalities were altoge-
Court orders on adoption should be made
ther rejected. In this study 89.5 per cent part of the hospital record of the baby. On
of children were given in adoption through the basis of long work experience the
Hindu Adoption and Maintenance Act of worker has felt that adoptive parents need
1956 and 10.5 per cent through Guardian-
services in terms of guidance and coun-
ship and Ward Act of 1890.
selling long after legal adoption is done.
Children are given in adoption through Explanation and discussion on various
the court of the Districts Sessions Judge. kinds of topics are needed as the child
During court hearing no confidentiality is grows older, especially his questions regard-
maintained. Many adopters while attending ing his natural parents, his adoptive status,
the court, felt that adoption cases should interference from other near relations, dis-
be heard in a separate chamber.
pute over property are some of the delicate
A common problem confronting all adop-
problems over which adoptive parents
tive parents is a birth certificate. The re-
would like to consult the worker. For this
quirement of the birth certificate is a must purpose, proper record has to be main-
when the child starts going to school and tained.
parents are in a fix how to get it. Adoptive
Adoption is a "Special Situation" where
parents do not want the school authorities all efforts should be concentrated to make
to know that the child is an adopted one. it a success, its value lies in restoring to
As per recommendation of the 1955 Na-
the child all that he had lost immediately
tional Conference on Adoption in America, after his birth. Thus a comprehensive secu-
a new birth certificate should be issued at lar law on adoption is an urgent need for
the time of the final court order showing the welfare of abandoned children to make
the adoptive parent as natural parent with adoption effective and meaningful.
R E F E R E N C E S
Ali Baig, Tara
"Steeped in Myth and Prejudice," The Hindustan Times Weekly
We Adopted it.
"Born to others", The Hindustan Times Sunday,
"Evaluation Report on Foster Care Services in Delhi" Indian
Council of Child Welfare News Bulletin,
March 1980, Vol. 28.
N o . 10: 102.
"Adoption Facts and Fallacies Problem of Rootless Children's
Welfare," The Hindustan Times,
December 26, 1980 (P.T.I.
Adoption of Non-white Children,
A British Adoption Project.
The study of Adoption Practice,
child welfare league of America.
The Placement of Adoptive children