| Authors | S Attard Montalto Edwina Gouder Laura Agius Tony Mifsud |
| Abstract | The increasing problem of infertility and the low availability of suitable children for local adoption in Malta has resulted in a significant demand for adoptions from overseas, amounting to 550 adoptions in 502 families from 1987-2002 (compared with 205 local adoptions in the same time period). Undoubtedly, these international adoptions have resulted in much happiness. However, they have also been associated with significant problems mostly involving legal, beaurocratic, financial and, not least, medical difficulties. The latter have included absence/incomplete/false medical data, erroneous medical examination, diagnosis and investigative reports, some of which have had significant implications for the child, the prospective family and public health at large. Indeed, in 1999, an internal audit confirmed an incidence of hepatitis B in up to 16% of adoptive children from particular countries (including those with HbeAg positivity and chronic active hepatitis on biopsy), as well as relatively high rates of other problems such as pervasive disorders (3%), HIV and others. In most cases prospective parents were completely uninformed and, in some cases misled, as to the implications of the medical problem in question. Since 2000, the issue of parent education has been addressed in an ongoing course of instruction based at the Family Welfare Unit (FWU). Concurrently, in an attempt to curtail the high incidence of associated medical problems in this cohort, a custom-designed questionnaire is sent to all international adoption agencies once a prospective child has been identified. This requests basic medical and personal details, as well as details of previous and current health, growth measurements, developmental milestones and immunisation. A list of investigative results including hepatitis B and HIV status (as mandatory) are required. The questionnaire is given legal weighting and the adoption process does not proceed until a satisfactory return is obtained by the FWU. Prospective parents are informed of the results and allowed to decide freely whether to proceed or not, except in those problem cases with public health implications whereby the FWU instructs the Commissioner of Police not to issue an entry visa. Since its inception, five couples did not wish to proceed in lieu of a neurodisability (2 cases), severe growth retardation (2), and potential metabolic disorder (1) flagged up by the questionnaire. The number of problems decreased significantly from 23 medical and 12 misinformation problems out of 453 cases before the questionnaire, to 1 misinformation issue from 97 cases afterwards (p=0.021 for medical problems and p=0.028 combined). This exercise has therefore had a significant impact on the prospective families as well as on public health resources, and it is now part of the normal modus operandi for all international adoptions to Malta. Its routine acceptance is particularly timely as previous sources of adoptions from former east bloc countries have dried up, and couples are now seeking openings in sub-Sahara Africa where HIV infection is rife. |
Published in: | |
| Journal | Malta Medical Journal |
| Volume | 15 Issue 1-2/suppl. 2003 |
| Pages | - |
| Date | |
| Link to journal | |
| Key words | adoption, medical data |