Outsourced Children
Orphanage Care and Adoption in Globalizing China
Leslie K. Wang




Children and the Politics of Outsourced Intimacy in China

At the end of a freezing cold January day in 2007, I made my first visit to the infant hospice unit at the Haifeng Children’s Welfare Institute (CWI).1 My breath escaped in white puffs as I ventured tentatively down the dark unheated hallways of the large Chinese state-run orphanage. I had just begun serving as a full-time volunteer for Tomorrow’s Children,2 a Western faith-based organization that provided medical care to abandoned special needs youth. The group had recently opened a large infant hospice, which occupied one full floor of the CWI—a “model” orphanage located in Henan Province, in central China. Tomorrow’s Children used first-world medical practices to care for the institution’s most disabled and ill babies and toddlers until they passed away. Many infants survived and after rehabilitation were returned to the regular state facility, sent out to local foster care, or occasionally even adopted internationally.

I was there to pick up Emma, one of the unit’s young residents. A happy one-year-old girl with a severe bowl haircut, Emma suffered from a rare childhood cancer that had claimed the sight in her left eye. The aggressive disease was threatening her vision in the other eye and possibly even her life. Although it was impossible to know for certain, this illness was most likely the reason she was cast out of her family. As part of my volunteering duties for Tomorrow’s Children, I was given the task of escorting Emma to Beijing on an overnight train. From there, she would fly to Hong Kong for immediate surgery and chemotherapy.

I soon found myself standing nervously on a dark, crowded train platform holding the girl in my arms. Her urgent medical situation filled me with fear, but Emma had the energy of a healthy, rambunctious toddler. She attempted to squirm out of my grasp as several old men rolled past with rattling metal carts, loudly hawking a diverse array of instant noodles, red cellophane-wrapped sausages, and cheap cigarettes. It was late at night when we boarded the train, settling into the bottom bunk of a dimly lit soft-sleeper car filled with businessmen. Emma bounced up and down on the bed and babbled cheerfully as the men snored noisily overhead. Burdened with an overwhelming sense of responsibility, I lay awake anxiously the entire night, terrified to let her out of my sight. When we reached Beijing the following morning, I passed the girl to an American volunteer waiting at the station and heaved an enormous sigh of relief.

Emma spent the next two years in Hong Kong undergoing multiple costly procedures to save her young life. Through the organization’s monthly online newsletters, I learned that her cloudy left eye was removed and that she underwent chemotherapy, laser treatment, and radiation to maintain vision on the other side. In 2009, the group asked its foreign funders for US$20,000 in donations to cover Emma’s latest course of radiation treatment. Against tremendous odds, the child’s cancer went into total remission, and she returned to the Tomorrow’s Children main foster home near Beijing. Then, at the age of four, she was adopted by an American family.

Emma’s uplifting journey of rescue and redemption through international adoption is the type of feel-good story that is often featured in the Western media. However, the positive outcome she enjoyed is rare among abandoned disabled youth. More common are the situations faced by children like Henry, another memorable resident of the Tomorrow’s Children special care unit. Born with severe cerebral palsy, Henry was stick thin, ghostly pale, and nearly catatonic when he first arrived; his dull eyes lacked any sign of awareness, even when you peered directly into them. Without a birth certificate or other identifying information, the doctor estimated that Henry was roughly six years old. Yet after only a few weeks of a specialized nutrition and medical regimen, the boy doubled in weight and grew six inches in height—shocking everyone with his transformation. Facial hair began sprouting from his chin, making clear that he was in fact a teenager. As Henry’s physical health continued to rapidly improve, he blossomed into an intelligent and perceptive adolescent. His Chinese caregiver (ayi) used physical therapy techniques learned from a Western volunteer to stretch his stiff limbs and teach him to grasp objects.

After several months of being nursed back to health, Henry’s hunger for mental stimulation became a source of frustration within his confined surroundings. When volunteers entered the room he howled loudly; using pleading eye contact, he asked to be taken outside in his wheelchair. His ayi believed that he was demanding too much of her time (as she also had two other high-needs children in her care) and ceased his physical therapy. Instead, he was placed in front of the television for hours on end with his back facing the rest of the room. With only three volunteers tending to more than forty children, it was impossible to give Henry the individual attention he craved. In desperation, the boy began to bite his own hands, drawing blood on several occasions. Volunteers attempted to provide him with more one-on-one time, but their efforts could provide only temporary relief.

Both of these children were likely cast out of their families due to their costly life-threatening illnesses. They then embarked on an odyssey of care and rehabilitation within state-run orphanages, and their lives were totally transformed by an intricate set of collaborations between the Chinese government (their official guardian) and the international humanitarian aid groups that assumed full responsibility for their well-being. Within four short years, the vast emotional, medical, and financial resources of global child savers “remade” Emma into a desirable Western adoptee, transporting her from the very bottom of Chinese society to the top of global society. By contrast, Henry’s severe disabilities and long-term dependency limited his chances of adoption. Nonetheless, even though he remained institutionalized, the first-world care and resources he received also remade him into a very different kind of person than he would have otherwise been.

A complex global migration of children is carving an indelible circuit between China and the industrialized world. Since the 1990s, intensive Western investment into certain highly marginalized youth living in the People’s Republic of China (PRC) has been a phenomenon that would have been unimaginable only a few decades earlier when the nation was inaccessible to the outside world. This new predicament raises a number of questions. First, in this time of unprecedented prosperity, why have many Chinese parents abandoned their children to state care? Why have Chinese state authorities allowed foreign humanitarian nongovernmental organizations (NGOs)—whose intentions are often viewed with deep distrust—to become so enmeshed in their nation’s child welfare system?3 And finally, what is the relationship between the international adoption of Chinese children to countries in the global north and the involvement of Western NGOs in domestic state-run orphanages?

The trajectories that Emma and Henry embarked on could not have been more different. Nonetheless, both children participated in the dynamics of what I term outsourced intimacy: the process by which the Chinese state has outsourced the care of locally devalued children to Westerners who, using their own resources, remake them into global citizens. This book highlights the two main ways that outsourced intimacy has operated as an ongoing transnational exchange: (1) through the exportation of mostly healthy girls into Western homes via adoption and (2) through the subsequent importation of first-world actors, resources, and practices into orphanages to care for the mostly special needs youth left behind.

Because of the power inequalities that exist between countries, international adoption typically involves the migration of children from developing areas to advanced industrialized regions. Thus, nations that place their vulnerable children in the care of outsiders are typically perceived as having lower global status. However, I contend that since beginning its international adoption program in the early 1990s, the PRC has been able to further a range of state objectives through outsourced intimacy; these include funding its child welfare system and fostering closer relationships with first-world countries, especially the United States—the destination of most adoptees.4 Moreover, the outflow of healthy girls through adoption has propped open a window of opportunity for international humanitarian aid organizations to enter China and take over the costly care of thousands of other vulnerable, and locally stigmatized, sick and disabled children.

Drawing on a year and a half of ethnographic fieldwork in Chinese state-run orphanages that collaborated with Western NGOs, this book represents the first systematic analysis of the lives of institutionalized youth in the PRC. Outsourced Children considers the cooperation, tensions, and ethical dilemmas that were embedded in these transnational care partnerships to examine China’s changing relationship with the industrialized world and to highlight the key role that children are playing in globalization processes.

This analysis is not meant to condemn practices of international adoption and foreign assistance to institutionalized children. Indeed, I worked closely with vulnerable youth in orphanages and foster homes in the PRC for more than a decade and developed trusting relationships with many of the individuals and organizations that appear throughout these pages. Yet, to provide an honest depiction, I give certain descriptions of orphanage conditions or childcare that may be emotionally distressing to some readers. These observations are not meant to shock but instead are intended to raise awareness and foster an informed dialogue about the lives of the children who exist, largely forgotten, at the edges of the world’s fastest-growing economy.

Children as Symbols of Chinese Modernity

The PRC initiated the process of “reform and opening up” (gaige kaifang) to the outside world in 1978, embracing a capitalist market economy while maintaining an authoritarian political regime headed by the Chinese Communist Party. Since then, the nation has experienced meteoric rates of growth credited with alleviating poverty for more than 600 million people.5 A tidal wave of first-world investment, knowledge, and goods has crashed onto Chinese shores, transforming the country into a global center of manufacturing and consumption.

As the second-largest U.S. trading partner, the PRC is often presented dichotomously in the Western media as either a land of freewheeling opportunity or a dangerous threat to the industrialized world. In 2007 Time Magazine boldly announced that we had entered “the Chinese century,” predicting that the commercial giant would soon surpass the United States as the most powerful national economy.6 Despite this unprecedented prosperity, the PRC remains a developing country with dramatic and escalating inequalities based on gender, class, and geography. Expectations of cradle-to-grave employment security once guaranteed by the government through the socialist “iron rice bowl” (tie fanwan) have completely disappeared, making individual families completely responsible for their own well-being. Rising prosperity has fueled a pervasive sense of anxiety among citizens who engage in a fierce competition over limited resources.

China’s unprecedented economic growth has inspired a flood of research and speculation about the long-term implications of the country’s rapid development and industrialization. Yet few studies have considered the fundamental ways that global capitalism has also transformed the seemingly “private” realm of families or how these macrolevel changes have reshaped individual lives. Children in particular have received inadequate attention, even though many have been acutely affected by socioeconomic transformations.

Studies of contemporary Chinese life that do focus on the family tend to highlight society’s most highly valued youth: urban middle-class only children. Referred to as “little emperors” and “empresses” who are doted on by two parents and four grandparents, these stereotypically spoiled offspring are the outcome of the one-child policy that was first enacted in 1980 and eventually discontinued in early 2016.7 Mocked for their selfishness and rising obesity rates and even labeled by their own government as “wimps . . . with no fighting spirit,”8 these coddled city kids nonetheless shoulder the heavy responsibility of boosting their country’s international reputation and economic productivity.

Parents and state authorities have expended significant effort to mold this group into industrious future workers. Vanessa Fong points out that today’s urban only children, like Chinese emperors of the past, are expected “to bring glory and prosperity to their empire.”9 As the most “modern” of Chinese citizens, little emperors have become the standard against which all other offspring are judged. Indeed, the pervasive sense of insecurity that governs Chinese society has even caused certain children to be “recognized as having more value than others and therefore more deserving of the rights of citizenship.”10

Studies of pampered singletons can tell us solely about the “winners” in the new market economy. In contrast, this book exposes the dark underbelly of modernization by highlighting the experiences of those who were cast out of their families. Within a context of financial insecurity, limited fertility, and an existing cultural preference for sons, Chinese parents now carefully choose which offspring to invest their resources in.

Particularly in the countryside, parental desire to bear at least one healthy male heir who can care for them in old age has negatively impacted two main groups of kids, healthy rural daughters and special needs children. First, in what has been labeled a “gendercide,” parents have turned to sex-selective abortion, abandonment, hiding, or even killing of tens of millions of daughters to protect the possibility of having a son. Of these “missing girls”—so-called because their names are missing from official records—a small fraction have been abandoned to state orphanages. Second, meteoric economic growth has been accompanied by a rapid increase in the number of children born with congenital illnesses and disabilities. Between 2001 and 2006 birth defects jumped by nearly 40 percent, an increase that many have attributed to environmental pollutants, particularly in coal-producing regions.11 The Chinese government estimates that now every year between 800,000 and 1.2 million babies are born with birth defects of which 30 to 40 percent are life threatening.12 With few financial, medical, or social supports available for families with special needs offspring, many of these children have also been abandoned to state care.

The stakes surrounding children in the PRC are high because they “not only represent the future, but their bodies are the site upon which the terms of the national future are being worked out.”13 In the contemporary period, parental preferences for perfect offspring align well with the Chinese government’s goal of producing a new generation of so-called “high quality” (suzhi gao) citizen-workers who can further the country’s global economic and political ambitions. It should be noted that, even though the Chinese government halted the one-child policy in early 2016, many urbanites are deeply ambivalent about bearing a second child due to the high cost of child rearing. An online survey on Sina News that received over 164,000 responses found that 43 percent of individuals were not interested in having two children, while 28 percent said they would have to wait and see. Only 28 percent said that they would definitely do so.14

Hence, in an era defined by stringent restrictions on family size and growing social inequality, the country’s youngest members have been separated into opposing groups with radically different life opportunities. Compared to healthy urban singletons who receive immense parental and state resources, disabled, poor, and/or female children in rural areas are considered less able to support their parents in the future, contributing to their relinquishment to state care. Because individual identity in China is defined in relationship to one’s ancestral lineage, parentless children are deeply stigmatized. Through residing in orphanages, which tend to have little contact with broader society, they are also shut out of civic participation.

Global child rights organizations such as UNICEF (the United Nations Children’s Fund) define orphans as children who have lost either one or both parents (and therefore may still be living with and/or supported by family members).15 However, this book relies on the narrower official Chinese state definition, which refers only to children under age eighteen who have lost their parents through death or abandonment and do not receive support from others.16 The first government survey on orphans in China, which was released in 2005, stated that 573,000 orphans were spread across the country, with the vast majority (86.3 percent) residing in rural areas. Those with special needs constituted 37.3 percent of institutionalized youth in cities and 66.6 percent of the total in rural areas.17

A follow-up study released by UNICEF China in 2010 found that the number of orphans had risen to 712,000, a 24 percent increase in only five years.18 This figure, however, may still exclude more than a quarter of a million children whose parents never officially registered their births to avoid government penalties, thus disqualifying these offspring from state benefits.19 Because most of China’s orphans reside in the countryside, there are fewer children housed in urban welfare institutes—only about 78,000 in 2008.20 Chinese authorities estimate that now up to 98 percent of children in welfare institutes are disabled.21

Within institutions that participate in international adoption, healthy girls converge with mentally and physically disabled youth such as Emma and Henry before being adopted. This situation, which was the norm in most of the orphanages I visited, challenged my own personal assumptions about abandonment and institutional care. Because I had closely followed China’s highly gendered adoption trends for years, when I first began visiting orphanages in 2005 I knew that the majority of the children were abandoned rather than truly orphaned. Like many other Westerners with a surface-level understanding of these issues, I expected to find myself surrounded by countless healthy female babies. Yet, on my first visit to a well-regarded orphanage in the historic port city of Tianjin, I was surprised to discover that most of the young inhabitants had some kind of mental and/or physical disability. Over the course of a week I watched with fascination as a six-month-old infant with the wizened face of an old man sat patiently in a booster seat while a physical therapist fitted tiny, undoubtedly painful, braces onto his severely clubbed feet. During one of these sessions, I asked one of the caregivers in the room where all of the healthy girls were. She responded matter-of-factly, “Dou bei waiguoren shouyang le (They’ve all been adopted by foreigners).”

Between 2005 and 2014, I visited nine different state-run orphanages across the country and seldom ever met a healthy female child. It quickly became apparent that due to their immense desirability for adoption—both internationally and domestically—healthy girls generally leave institutions quite early. Hence, through an ironic twist of globalization, adoption has turned the local disadvantage of being born female into a benefit within orphanages that participate in this practice. This means that nowadays institutions are mostly filled with special needs children and youth, a group that includes a large percentage of boys.22 In other words, orphanages serve as temporary stops for healthy girls on their way to new families and as permanent homes for sick and disabled children. Because special needs youth will likely never be adopted, their stories are rarely told. This book seeks to give voice to their experiences and examine their lives in relation to the unfolding of modernity in the PRC.

Chinese Orphanages in the Global Spotlight

As a volunteer with the faith-based organization Tomorrow’s Children, I spent several months at the Haifeng Children’s Welfare Institute. Located in the primarily agricultural province of Henan, this urban facility cared for about 600 mostly special needs children from the surrounding region. The impressive six-story main structure was covered from top to bottom with thousands of sparkling white square tiles. Inside, the eerily empty lobby was furnished with expensive black leather couches and shiny mounted plaques that attested to the CWI’s reputation as a national exemplar in the field of orphan care.

However, when I ascended the wide cement staircase to the second floor—out of sight of most visitors—the general conditions quickly deteriorated and began to resemble an aging hospital. One day early in my work at the CWI, I learned from another volunteer that the babies in the Tomorrow’s Children unit were sent up from the main orphanage’s “dying room,” the place where infants with the lowest chances of survival were housed. Determined to see this room for myself, I ventured down a long hallway whose walls were gray from years of built-up grime, peeking furtively into rooms lit by naked fluorescent bulbs dangling from wires affixed precariously to the ceiling. As casually as possible, I walked past a worker pushing a dirty mop across the floor and entered a doorway at the end of the hall. Pulling aside a heavy rattling wooden bead curtain, I stepped into the small space and let out a quiet involuntary gasp.

Arrayed in front of me were eighteen extremely dirty, very sick babies and young children who lay in pairs on thin bamboo mats. All were swaddled tightly in thick, festive-looking red cotton quilts that matched the rough, rosy circles the intense cold had painted onto their cheeks. At least half of the babies had their heads shaved on one side—a startling image—indicating their recent arrival from hospitals where they had been given fluids intravenously through their scalps. (I learned later that this was a common treatment in Chinese hospitals.)

The atmosphere in the room was unnervingly quiet as two weary older women in stained white lab coats fed the entire group. All of the babies were drinking powdered formula out of plastic bottles that were propped up on little pillows next to their faces; within seconds several rolled out of their limited reach. After only a few minutes, the ayis quickly circled the room and retrieved all of the bottles, even those that were still half-full. Sparsely furnished, the room noticeably lacked toys, medication, or even toothbrushes for the children. The words of a British volunteer echoed through my head: “This orphanage is a fantastic place to be if you survive to the age of four, but up until that point, it’s definitely survival of the fittest.”

Filled with conflicting emotions, I quietly backed out of the room and continued up the staircase three floors to the brightly lit Tomorrow’s Children unit. Stepping over the threshold into the brand-new facility was like entering a sanitized alternate reality. A host of freshly painted Disney characters smiled down from the walls at chubby, laughing toddlers who raced around the warm, clean space in colorful new plastic baby walkers. Two white Western volunteers sat on the shiny wooden floor helping children play with expensive sensory-enhancing toys that they had brought from home in their luggage. Cradling babies in their arms, Chinese nannies in matching red uniforms rushed by to change diapers, give baths, or retrieve medicine from the British nurse.

In advanced industrialized societies, the term orphanage is generally associated with a bygone era, conjuring up sentimentalized images of Little Orphan Annie or the pitiful coal-smeared street urchins of Charles Dickens’s novels. This type of group-based institutional care was mostly phased out in the United States in the early twentieth century.23 In China, however, state-run institutions have served as the preferred method of caring for parentless children since the founding of the People’s Republic in 1949.24 Even so, Chinese orphanages operated largely unknown to the outside world until the 1990s, when several damning Western media exposés captivated international audiences. The images they showed of deplorable conditions in these facilities continue to inform dominant global perceptions of the PRC today.

In 1995, a television station in the United Kingdom aired “The Dying Rooms: China’s Deepest Secret,” a scathing documentary pieced together from undercover footage shot by British filmmakers in several state-run orphanages. Followed by a sequel in 1996, the films revealed never-before-seen images of severe child neglect in these institutions. Heart-wrenching scenes depicted toddlers strapped down against their will to high chairs or with their legs tightly bound together with rope. The cameras zoomed in on the blank faces of extremely malnourished babies lying ignored on urine-soaked blankets. The films were dedicated to a little girl caregivers referred to as Mei Ming (translated literally as “No Name”), a desperately ill child who was allegedly isolated for ten excruciating days before starving to death in a Guangdong orphanage. These “dying room” documentaries quickly gained global notoriety—reaching their height of pop culture awareness when they were featured on an episode of Oprah—and have reportedly been viewed by over 100 million people around the world.25

In coordination with these films, in 1996 the advocacy group Human Rights Watch/Asia (HRW) released a scathing indictment entitled Death by Default: A Policy of Fatal Neglect in China’s State Orphanages. The report was based on Chinese government documents and eyewitness testimonials of workers at the Shanghai Children’s Welfare Institute in the late 1980s and early 1990s. Within the hidden confines of orphanages, the report charged, death rates among child “inmates” were astonishingly high: up to 50 percent nationwide and 90 percent at the Shanghai CWI. A former orphanage doctor testified that caregivers were occasionally required to implement a macabre process known as “summary resolution,” in which food and water were intentionally withheld from certain children until they succumbed to malnutrition. State-run institutions were described as cruel spaces that operated “as little more than assembly lines for the elimination of unwanted orphans.”26

This unfavorable media exposure directed a global spotlight onto Chinese orphanages, spurring immense international outrage and straining relationships between the PRC and countries in the global north. In response, the People’s Daily—the official mouthpiece of the Chinese Communist Party—took a decidedly defensive tone, claiming that the British documentary was “fabricated” and the human rights report was “distorted and exaggerated.”27 Charging moral hypocrisy, Chinese authorities drew attention to children’s human rights violations in the United States. Using publicly available statistics on guns in American schools, high rates of child poverty, and the large numbers of adolescents involved in violent crimes, one statement charged that “Americans who seem to care about the conditions of Chinese children are totally indifferent to the plight of children in their own country.”28 The damaging publicity stemming from these horrific portrayals led the Chinese government to close off all foreign access to orphanages for several years and to completely revamp the Shanghai CWI, which is now considered a “model” orphanage.

This heated global exchange over purported abuse and neglect in Chinese state orphanages demonstrates how children are deeply interwoven with notions of national autonomy, identity, and global status. All too often their “bodies and minds [are] appropriated as the unprotected terrain upon which cultural battles are fought” at local, national, and global scales.29 As the PRC solidifies its position as an economic leader and fierce competitor to Western democratic states, international discussions about the welfare of its most vulnerable youth have taken on even more acute political connotations. Anne Thurston, a China-based correspondent for The Atlantic who visited a dying room repeatedly in the mid-1990s, confirmed the existence of such spaces but also argued that these types of media depictions reinforce unfair cultural stereotypes that impact international relations. She writes, “The exposés have demonized China just as U.S.–China relations are settling into a more troubled period. American public opinion toward China has typically swung between extremes of admiration and mistrust, as we project our own hopes and fears on a country we have consistently misunderstood.”30

After a chilling period that lasted several years, in the late 1990s state authorities quietly began welcoming more involvement in orphan relief from outside groups such as NGOs and foreign adoption agencies.31 Yet the dearth of empirical data means that the controversial allegations of malign neglect in Chinese welfare institutes have never been resolved. Without other more current representations of these settings, the shocking images remain imprinted on the world’s imagination.

My observations in the dying room of Haifeng CWI, which I visited several more times over the following months, proved that spaces where very sick and disabled children are housed together and given few resources or individualized care still existed more than a decade after the films’ release. But dying rooms cannot be taken as the basis for all institutionalized care in China. This book provides a more accurate perspective by taking into account how the influx of global actors and first-world resources has improved conditions within many orphanages, while at the same time also creating a new set of dilemmas for parentless children.

Outsourced Intimacy through International Adoption

There is an ancient Chinese belief that an invisible, unbreakable red thread connects all those who are destined to be together.32

In the popular children’s book The Red Thread: An Adoptive Fairy Tale, a white king and queen reign over their beautiful, peaceful kingdom. Even though all appears well, something is painfully missing from their lives. Soon a “brilliant red thread” emerges from both of their hearts and leads the couple on an unpredictable journey overseas. Following the thread, the royal pair is led to a small Asian farming village where the inhabitants are poor but welcoming: “The people stared at them; they were so strange, with their clothes ripped to rags, hair tangled, and faces as pale as the moon. But the villagers smiled a greeting, for they were a friendly people.” The couple, still unclear about the purpose of their travels, continues on toward a small bundle left in front of an old house. Inside, they find a smiling Chinese baby girl who has the other end of their red threads looped around her ankles. As the locals look on approvingly, an elderly Asian woman steps forward to tell the king and queen that this adorable infant now “belongs” to them.33

The myth of the red thread is woven throughout Western narratives of adoption from the PRC. Stemming from a Chinese folktale about a matchmaker—the Old Man of the Moon—who ties a red thread between prospective marriage partners from the moment they are born, the story originally justified the centuries-long practice of arranged marriages in premodern China. Since the mid-1990s, however, it has become a dominant theme within the discourse of international adoption and proliferates through a range of consumer items geared toward adoptive families, including bracelets, necklaces, wall hangings, and even a novel of the same title. Because abandonment renders the exact details of children’s early lives largely unknowable, the red thread serves as an open-ended origin story. Symbolizing predestined connections between Western adoptive parents and Chinese babies, the myth helps to “mitigate the unsettling arbitrariness of adoption procedures that initiate a lifelong link between perfect strangers.”34

Primarily white adoptive parents have used this folktale to solidify family bonds that span biological ties, race/ethnicity, and nationality. However, the sense of fatedness that underlies the story altogether bypasses the larger structural inequalities that gave rise to international adoptions in the first place. Outsourced Children aims to show how adoption is a wide-reaching political and economic institution that operates on individual, institutional, and global levels. Specifically, adoption is a key form of outsourced intimacy that has allowed Chinese state authorities to fulfill certain aims. I argue that, for the PRC, sending children abroad to join Western families has served as a form of “soft power,” which refers to a country’s ability to persuade others to do what it wants without force, coercion, or payments.35 Through using globally desirable children as cultural bridges and representatives of soft power, Chinese officials have been able to enhance the nation’s image abroad while also funding the local child welfare system.

The PRC first began its international adoption program in 1992 after sweeping family planning campaigns filled state orphanages with relinquished offspring.36 Since then, over 140,000 children have joined predominantly white middle-class “forever families” throughout the global north.37 The trend has been remarkably gendered, with young healthy girls comprising roughly 90 percent of adoptees.38 These children experience a sudden escalation in social class and status through their global movement, comprising “one of the most privileged forms of diaspora and immigration” in the contemporary era.39

Facilitated and regulated by Chinese state authorities, international adoptions have arguably been motivated by the same market logic that has underlay the PRC’s transition to global capitalism. At approximately US$15,000 to $30,000 per placement (of which nearly US$6,000 is brought over by prospective parents in their luggage, usually in cash, as a mandatory orphanage donation), Chinese adoptions and postadoption services and donations have mushroomed into a lucrative multimillion dollar industry. Although these funds have undoubtedly improved conditions in state orphanages, lax oversight and the vast profitability of international adoption have resulted in many (proven) allegations of baby buying, forced confiscations, and deception of birth families for the sake of sending children abroad.40

Since 2000, the PRC has been ranked the top “sending country” of adoptable children in the world. Although the total population of adoptees pales in comparison to the roughly 20 million babies born in China every year, they have nonetheless garnered a disproportionate amount of attention in Western societies. Readily accepted into mainstream American culture, these girls have been featured in numerous documentaries, New York Times feature articles, Walmart commercials, and even HBO’s Sex and the City when Charlotte, one of the main characters, adopts an adorable, if eerily silent, “Mandarin child” after a series of failed in-vitro treatments.

Researchers have also displayed an intense interest in this relatively homogeneous group, studying topics such as their behavioral adjustment, physiological development, language acquisition, and emotional attachment, as well as racial/ethnic identity formation in white families. Yet even as these mostly healthy girls have been studied extensively within first-world contexts, far less attention has been given to their early experiences in China. Because of this imbalance, international adoption is often viewed too simply as a one-way migration of babies from poor developing countries to rich industrialized regions.

This unidirectional perspective overlooks how this form of migration has established ongoing, crisscrossing transnational flows of people, resources, and knowledge between the PRC and Western countries. Most important for this analysis, adoption has enabled international humanitarians to use their own resources to assist Chinese state orphanages. Hence, adoption simultaneously functions as a means of individual family formation as well as an influential global institution central to the “cultural economy of circulating relationships of power and exchange” between the PRC and Western countries.41

Outsourcing Intimacy to Western Humanitarian NGOs

The involvement of civil society and international actors in caring for China’s marginalized youth is not a new phenomenon. During the late nineteenth and early twentieth centuries, the nongovernmental sector was integral in providing shelter and services to parentless children. Many private individuals, churches, and charitable organizations ran their own orphanages, some of which were founded by Western missionaries or wealthy Chinese philanthropists.42 Early children’s homes sought to instill into young people positive traits of self-sufficiency and self-reliance in the hopes of developing their human capital for the sake of the burgeoning nation-state. Historian Norman Apter explains that, contrary to today, when abandoned children are seen as detrimental to Chinese modernization, early-twentieth-century philanthropists viewed these disadvantaged children as “an untapped resource to be mobilized in the grander project of national construction.”43

After the founding of the PRC in 1949, social welfare services became integral to the state’s political legitimacy. In the early 1950s, private orphanages were either closed down or taken over and reorganized as state welfare institutes by the government, which took sole responsibility for finance and operations. Implementing a new approach toward child welfare, the regime prioritized collective well-being over that of the individual, reinforcing beliefs that orphaned and abandoned children would be best cared for in institutional settings.44

State-run orphanages—both then and now—tended to be located only in urban centers. In rural areas, on the other hand, families and agricultural collectives were responsible for providing for parentless youth. This unequal distribution of services and resources for children mirrored larger regional divides between cities and countryside that have continued to the present day, giving urbanites better education, health care, and material goods while leaving rural residents to fend for themselves. In combination with a rigid household registration system that has prevented peasants from becoming legitimate city residents, the PRC has been “essentially divided into two separate societies: a privileged urban society and a disenfranchised countryside.”45 Today, the government continues to maintain separate rural and urban child welfare provisions. Orphaned and abandoned children in cities are cared for in state-run institutions (the focus of this book) whereas those in the countryside are expected to receive care from informal kin networks; some rural orphans who lack relatives to care for them are eligible to receive a government subsidy known as the “Five Guarantees” system (wu bao) that generally doesn’t include housing.46

Following the shift to a market economy, the Chinese government decentralized social welfare provisions and decreased service funding.47 In turn, the brunt of responsibility for the care, health, and education of parentless children was transferred to local authorities. Although state welfare institutes were long prohibited from accepting outside sources of financial support, in the early 1990s they received permission to pursue a variety of income-generating endeavors and partnerships with private organizations. Nowadays, financing for orphanages operates according to the principle of “multiple levels, multiple channels, and multiple means.”48 International adoptions and involvement with foreign NGOs rank high on this list—pursuits that reflect the increasing globalization of Chinese society.


1. Notes on terminology: In China, the official designation for a state-run facility that cares for parentless children is “Children’s Welfare Institute” (facilities that care only for children) or “Social Welfare Institute” (facilities that usually house the elderly, the disabled, and children in separate buildings). The Chinese Ministry of Civil Affairs manages all of these institutions. Although some scholars object to the negative connotations associated with the Western term orphanage, I use it interchangeably with the other two terms in this book.

2. To protect the identities of individuals and organizations, all proper names have been given pseudonyms unless otherwise specified.

3. Anthony J. Spires, “Contingent Symbiosis and Civil Society in an Authoritarian State: Understanding the Survival of China’s Grassroots NGOs.” American Journal of Sociology 117, 1 (2011): 1–45.

4. Peter Selman, “The Global Decline of Intercountry Adoption: What Lies Ahead?” Social Policy and Society 11 (2012), 381–397.

5. “China Overview,” The World Bank. Retrieved on May 13, 2015, from

6. Michael Elliott, “China Takes on the World,” Time Magazine, January 11, 2007. Available at,9171,1576831,00.html.

7. On October 29, 2015, the Chinese Communist Party officially announced that it will allow all families to have two children, thus ending the one-child policy after thirty-five years. It should be noted, however, that the effects of decades of stringent fertility regulations, including labor shortages, a rapidly aging population, and skewed sex ratios, might not be resolved with the dissolution of this policy. Martin King Whyte, Wang Feng, and Yong Cai, “Challenging Myths about China’s One-Child Policy,” The China Journal 74 (2015), 144–159.

8. Kenji Minemura, “China’s One-Child Policy Creates Wimpy Military Recruits, Deserters.” Asahi Shimbun, February 26, 2013. Available at

9. Vanessa Fong, Only Hope: Coming of Age under China’s One-Child policy. Stanford, CA: Stanford University Press, 2000, 30.

10. Ann Anagnost, “The Corporeal Politics of Quality (Suzhi).” Public Culture 16, 2 (2004): 189–208, 194.

11. Barbara Demick, “China Blames Pollution for Surge in Birth Defects,” Los Angeles Times, February 2, 2009. Available at

12. “Baby with Defects Born Every 30 Seconds in China,” People’s Daily Online, September 13, 2010. Available at

13. Terry Ellen Woronov, “Transforming the Future: ‘Quality’ Children and the Chinese Nation.” ProQuest. Chicago: UMI Dissertations Publishing, 2003, 16.

14. “Would You Choose to Have a Second Child?” (Ni Hui Xuanze Sheng Er Hai Ma?). Retrieved on November 9, 2015, from

15. “Orphans.” UNICEF Press Centre. Retrieved on June 10, 2015, from

16. Liu Meng and Zhu Kai. “Orphan Care in China.” Social Work & Society 7, 1 (2009): 43–57. Rather than taking into account all at-risk or parentless youth in China, I focus on a much smaller subset of children, those who reside in urban welfare institutes that received aid from foreign NGOs. Although a variety of organizations are devoted to caring for street children, HIV/AIDS orphans, and youths with incarcerated parents and deserve detailed investigation, they are not included in this analysis.

17. Xiaoyuan Shang and Jianpeng Cheng, “Analysis of the Situation of China’s Orphans” (“Zhongguo gu’er zhuangkuang fenxi”). Youth Studies 10 (2006): 8–12.

18. Child Welfare in China—Stocktaking Report 2011 ( 2011). Beijing: UNICEF China. Available at

19. Catherine Keyser, “The Role of the State and NGOs in Caring for At-Risk Children: The Case of Orphan Care.” Pages 45–65 in State and Society Responses to Social Welfare Needs in China: Serving the People, edited by Jonathan Schwartz and Shawn Hsieh. New York: Routledge, 2009.

20. Keyser, “The Role of the State and NGOs in Caring for At-Risk Children,” 2009.

21. Nathan Vanderklippe, “The Tragic Tale of China’s Orphanages: 98% of Abandoned Children Have Disabilities,” The Globe and Mail, March 21, 2014. Available at

22. Shang and Fisher, Caring for Orphaned Children in China, 2014.

23. Matthew Crenson, Building the Invisible Orphanage: A Prehistory of the American Welfare System. Cambridge, MA: Harvard University Press, 2009.

24. Norman D. Apter, “All in the Family: New Approaches to Child Relief in Post-Mao China.” Modern China 40, 1 (2014): 3–39.

25. “The Dying Rooms and Return to the Dying Rooms,” True Vision Films. Retrieved on May 14, 2015, from

26. Robin Munro, Jeff Rigsby, and Human Rights Watch Asia, Death by Default: A Policy of Fatal Neglect in China’s State Orphanages. New York: Human Rights Watch, 1996, 3.

27. People’s Daily, “The Description and Accusations about China’s Children’s Welfare Institutions by Britain’s Channel Four and the Human Rights Watch/Asia Do Not Hold Water.” Retrieved on February 29, 2016, from

28. Human Rights Watch/Asia. “Chinese Orphanages: A Follow Up.” Retrieved on May 14, 2015, from

29. Sharon Stephens, Children and the Politics of Culture. Princeton, NJ: Princeton University Press, 1995, 4.

30. Anne Thurston, “In a Chinese Orphanage.” The Atlantic Monthly, April 1996. Available at

31. Keyser, “The Role of the State and NGOs in Caring for At-Risk Children,” 2009.

32. Grace Lin, The Red Thread: An Adoption Fairy Tale. Morton Grove, IL: Albert Whitman and Company, 2007.

33. Lin, The Red Thread, 2007.

34. Gonzalez and Wesseling, “The Stories We Adopt By,” 261.

35. Joseph S. Nye, “Soft Power.” Foreign Policy, 80 (1990): 153–171.

36. For a more detailed explanation of why Chinese orphanages received a large number of children in the 1980s and early 1990s, see Kay Ann Johnson, Wanting a Daughter, Needing a Son: Abandonment, Adoption, and Orphanage Care in China. St. Paul, MN: Yeong & Yeong, 2004.

37. Peter Selman, International Adoptions from the People’s Republic of China, 1992–2012. Working paper, 2014. Newcastle University, UK.

38. Shang and Fisher, Caring for Orphaned Children in China, 2014.

39. David L. Eng, “Transnational Adoption and Queer Diasporas.” Social Text 21, 3 (2003): 1–37.

40. Brian H. Stuy, “Open Secret: Cash and Coercion in China’s International Adoption Program.” Cumberland Law Review 44 (2013): 355.

41. Sara K. Dorow, Transnational Adoption: A Cultural Economy of Race, Gender, and Kinship. Nation of Newcomers. New York: New York University Press, 2006, 25.

42. Michelle King, Between Birth and Death: Female Infanticide in Nineteenth-Century China. Stanford, CA: Stanford University Press, 2014.

43. Norman Apter, “From Charity to Welfare: Restructuring Child Relief in the Early People’s Republic of China.” Paper prepared for Association for Asian Studies Annual Meeting, Chicago, IL, 2009, 6–7.

44. Catherine Keyser, “The Role of the State and NGOs in Caring for At-Risk Children: The Case of Orphan Care.” Pages 45–65 in State and Society Responses to Social Welfare Needs in China: Serving the People, edited by Jonathan Schwartz and Shawn Hsieh. New York: Routledge, 2009.

45. Carolyn Hsu, “Chinese NGOs in Child Welfare: State Pawns or Savvy Partners?” Paper prepared for Association for Asian Studies Annual Meeting, Chicago, 2009, 3.

46. The wu bao protection system provides food, fuel, clothes, and health care to orphaned children, older residents, or disabled people incapable of supporting themselves. Xiaoyuan Shang, Morris Saldov, and Karen R. Fisher, “Informal Kinship Care of Orphans in Rural China.” Social Policy and Society 10, 1 (2011): 103–116.

47. Linda Wong, Marginalization and Social Welfare in China. London: Routledge, 1998.

48. Keyser, “The Role of the State and NGOs in Caring for At-Risk Children,” 2009, 50.