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There are many myths surrounding child adoption. And yet adoption is all around us, even though we may not recognize this fact. Every day, there are children being adopted into loving families across the world. The advent of Assisted Reproductive Technologies (ARTs) has now enabled intending mothers to carry adopted embryos in their wombs. NATHAN KIWERE explores this growing phenomenon and how it is fostering love and humanity among families attempting to overcome childlessness.

Forty one-year-old high school teacher Amanda (identity protected) has lived with her husband Ian for nearly 19 years. After getting married in 2000, they began trying to have children the natural way. In the beginning, it was quite exciting to plan for an impending conception.

They spent many nights reading baby name books and discussing ideal nursery schools. When months turned into years of failed attempts to conceive, the excitement turned into sadness and hopelessness.

Seeking help from the medical field was trying and lacked the romance and surprise of creating a child with candlelight and soft music. But they soldiered on because in the end, having children was more important to them than the conception procedure. After many failed Intrauterine Inseminations, In Vitro Fertilization (IVF), several miscarriages, and an almost decade-long wait list for adoption, they were at a standstill.

“We were told by two prominent doctors that our next course of action would be to use donor eggs,” they intimated. In 2008, they came across a nonprofi t organisation which connects couples that have completed their families (yet still have frozen embryos in storage) with couples who are in need of healthy embryos to complete a family.

Eventually, they adopted embryos, and now have four and a halfyear-old twins. Amanda and Ian are a microcosm of countless couples struggling with severe diminished ovarian reserve or a host of other conditions that make them unable to have genetic children.

The widely known method employed by those that seek to have non-biological children is through child adoption. This article highlights embryo and child adoption methods as alternatives to the natural way of siring children.

Conditions for adopting a child

But only those that are ready to meet the minimum requirements can adopt a child. Information available at Ugandans Adopt indicates that to qualify, one must be a Ugandan citizen, a non-national with proof of residence in Uganda and willing to stay for at least one year to foster the child until an adoption order is obtained.

Other conditions include: one has to be 25 years or older, and at
least 21 years older than the child he or she wishes to adopt; married or single (single applicants can only adopt children of the same sex as themselves); willing to undergo assessment by a social worker and probation offi cer; able to meet the needs of a child; and adoptive parents need to be in good health and willing to undertake a medical assessment.

But the stringent regulation of child adoption, particularly the requirement of fostering the child for one year, has made it extremely difficult for foreign adoptive families to take on children. Allen Kizito, the managing director of Oasis Children’s Home in Lweza, says this requirement has always knocked out foreign adoptive parents who happen to constitute the majority.

“The culture of adoption in Uganda is still very poor,” she said. “The only options we are left with are either resettling the children in their biological families or simply continue taking care of them, something that is not easy at all.”

Embryo adoption

Cognizant of the innumerable challenges posed by the conventional child adoption that involves families taking on already born children, science has devised other ARTs that can enable an adoptive mother to carry the baby in her own womb.

One of the few fertility clinics that carry out this relatively new technology is the Women’s Hospital International and Fertility Centre (WHI&FC) in Bukoto, Kampala.

They have been carrying out the practice for the last three years. Arnold Sali, an embryologist at WHI&FC, says: “When couples go through in-vitro fertilization, sometimes there are fertilised eggs (embryos) that remain and are frozen for later use. When couples decide that their family is complete but still have embryos remaining, there are a few options: they can donate them to a couple who is unable to conceive.”

Sali adds that at WHI&FC, in most cases the embryo donors get to choose the recipients and thus have to give their express legal consent or release of liability. The process of embryo adoption requires highly professional and specilised handling and equipment, which are not easily available at your average clinic. The services are scarcely available outside of Kampala, and not many people are aware of them. According to Dr Edward Tamale-Sali, director and founder WHI&FC, embryos are mostly adopted by women who fail to fi nd a marriage partner or those who do not want to have a sexual relationship.

Embryos are also adopted by women who do not want to adopt babies from adoption houses. The adoptive mother is subjected to psychiatric assessment to prepare her psychologically before adopting the embryo, and she must also be fi nancially stable to look after the baby. “The policy of our clinic stipulates that the woman should reveal her sexuality.

For example, we do not entertain lesbians or LGBT people. Once they reveal, we do not accept to give them embryos because we believe this child will be abused,” Dr Sali says. He adds that the father of the embryo (sperm donor) usually consents and his identity is documented because at one point in time a child might want to know who his/her father is.

“Some fathers consent, but don’t want to be involved in supporting the child fi nancially. That is why we insist the mother must have fi nances to support this child,” he says

Understanding adoption

Child adoption, in the conventional sense, is a way of providing security, permanency and love of a new family when it is not possible for a child to be raised by his/her birth parents or within the birth family.

According to a 2014 study on legal guardianship and adoption practices in Uganda by the Ministry of Gender, Labour and Social Development, Uganda was among the top 20 countries of origin for inter-country adoptions to the USA. Bernados, UK’s
largest adoption agency, defi nes adoption as the social, emotional, and legal process in which children who will not be raised by their birth parents become full and permanent legal members of another family while maintaining genetic and psychological connections to their birth family.

Adoption has many facets and touches people in different ways –depending on their role and perspective. If a child can’t be looked after by his or her birth parents, they will be fostered or adopted. Fostering a child is temporary whereas adoption is permanent transfer of rights. Adoption transfers all legal parental rights and responsibilities to the adoptive parents.

The birth parents lose all legal access to their child once an adoption order is approved by the authorities. The child becomes a new member of the adoptive family and receives the same rights as if he or she were born into that family.
Only on very rare occasions have adoption placements been reversed. According to Ugandans Adopt, a government campaign to promote domestic adoption in Uganda, currently over 50,000 children are growing up in institutions and every week a child is abandoned.

The campaign is working with the Ministry of Gender to fi nd adoptive parents in Uganda willing to provide loving and permanent homes for abandoned children.

Legal provision

However, just as in the case of the traditional child adoption, embryo adoption also has its ethics that must be observed. At the moment there is no clear guiding legal framework in Uganda, but there are strict regulations in other countries where embryo adoption has been practiced for long.

For instance in the USA, couples must be a genetic male and a genetic female married for a minimum of three years; wife must be 45 years old or younger; wife’s body mass index
(BMI) must be below 40 at the time of the frozen embryo transfer; the combined age of applicant couple must not exceed 100 years. The adopting mother must also be healthy and able to carry a child to full term.

Surrogates are not an option for carrying the pregnancy. The wife must not smoke during the application process, embryo transfer preparation and procedure process, or during pregnancy. For intended parents, embryo donation allows them the experience of a pregnancy. They are able to control the prenatal environment and don’t run the risk of a donation falling through at the last second.

Available information indicates that the average pregnancy success rate using embryo donation is 40 per cent. Like many statistics, this varies by programme and fertility clinic. This number is slightly higher than standard IVF success rates, generally because the donated or adopted embryos have undergone pre-implantation genetic testing. Embryo adoption has its own fl ipside that the donor has to deal with.

According to Conceive Abilities, a Chicago-based global egg donor and surrogacy agency, while the parents who have successfully built their families through IVF have spent much time, energy and money to create the embryos, it is an emotionally complex decision.

They must come to terms with the fact that their genetic offspring – a full genetic sibling to their children – will be born into and raised in an entirely different family. It is important to consider the implications of this decision, both for themselves and their children.

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