Giving up a helpless newborn to strangers is not very easy to do, and even during the worst of the times, only about 2% of women volutarily surrender their infants for adoption. Adoption is a great solution *for the child* when the parents are dead or too dangerous and there is no other family to care for the child, but it is terrible as a means of distributing consumer goods (ie, living human beings) to people who want babies. Wanting something is not a good enough to reason to have the want satisfied, especially when it comes at such a high cost to the women who surender their infants and the children themselves. Additionally, relinquishing mothers tend be the youngest and poorest women being used by older, wealthier couples to obtain a baby.
J Obstet Gynecol Neonatal Nurs. 1999 Jul-Aug;28(4):395-400.
Postadoptive reactions of the relinquishing mother: a review.
Askren HA, Bloom KC.
Deer Valley OB/GYN, Mesa, AZ, USA.
OBJECTIVE: To review the literature addressing the process of relinquishment as it relates to the birth mother. DATA SOURCES: Computerized searches in CINAHL; Article 1 st, PsycFIRST, and SocioAbs databases, using the keywords adoption and relinquishment; and ancestral bibliographies. STUDY SELECTION: Articles from indexed journals in the English language relevant to the keywords were evaluated. No studies were located before 1978. Studies that sampled only an adolescent population were excluded. Twelve studies met the inclusion criteria and were included in the analysis. DATA EXTRACTION: Data were extracted and information was organized under the following headings: grief reaction, long-term effects, efforts to resolve, and influences on the relinquishment experience. DATA SYNTHESIS: A grief reaction unique to the relinquishing mother was identified. Although this reaction consists of features characteristic of the normal grief reaction, these features persist and often lead to chronic, unresolved grief. CONCLUSIONS: The relinquishing mother is at risk for long-term physical, psychologic, and social repercussions. Although interventions have been proposed, little is known about their effectiveness in preventing or alleviating these repercussions.
Med J Aust. 1986 Feb 3;144(3):117-9.
Psychological disability in women who relinquish a baby for adoption.
Condon JT.
During 1986, approximately 2000 women in Australia are likely to relinquish a baby for adoption. A study is presented of 20 relinquishing mothers that demonstrates a very high incidence of pathological grief reactions which have failed to resolve although many years have elapsed since the relinquishment. This group had abnormally high scores for depression and psychosomatic symptoms on the Middlesex Hospital questionnaire. Factors that militate against the resolution of grief after relinquishment are discussed. Guidelines for the medical profession that are aimed at preventing psychological disability in relinquishing mothers are outlined.
Community Health Stud. 1990;14(2):180-9.
Social factors associated with the decision to relinquish a baby for adoption.
Najman JM, Morrison J, Keeping JD, Andersen MJ, Williams GM.
Department of Social and Preventive Medicine, University of Queensland.
Little is known about the characteristics, social circumstances and mental health of women who give a child up for adoption. This paper reports data from a longitudinal study of 8556 women interviewed initially at their first obstetrical visit. In total, 7668 proceeded to give birth to a live singleton baby, of which 64 then relinquished the baby for adoption. Relinquishing mothers were predominantly 18 years of age or younger, in the lowest family income group, single, having an unplanned and/or unwanted baby and reported that they were not living with a partner. These women were somewhat more likely to manifest symptoms of anxiety and depression both prior, and subsequent to, the adoption, but the majority of relinquishing mothers were of 'normal' mental health. The decision to relinquish a baby appears to be a consequence of an unwanted pregnancy experienced by an economically deprived single mother rather than the result of emotional or psychological/psychiatric considerations. These findings document a particular dimension of the impact of poverty on health.
Pediatrics. 2001 Aug;108(2):E30. Adoption as a risk factor for attempted suicide during adolescence.
Slap G, Goodman E, Huang B.
Division of Adolescent Medicine, Department of Pediatrics, Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio 45229-3039, USA. slap@chmcc.org
OBJECTIVE: Depression, impulsivity, and aggression during adolescence have been associated with both adoption and suicidal behavior. Studies of adopted adults suggest that impulsivity, even more than depression, may be an inherited factor that mediates suicidal behavior. However, the association between adoption and adolescent suicide attempts and the mechanisms that might explain it remain unknown. The objective of this study was to determine the following: 1) whether suicide attempts are more common among adolescents who live with adoptive parents rather than biological parents; 2) whether the association is mediated by impulsivity, and 3) whether family connectedness decreases the risk of suicide attempt regardless of adoptive or biological status. METHODS: A secondary analysis of Wave I data from the National Longitudinal Study of Adolescent Health was conducted, which used a school-based, clustered sampling design to identify a nationally representative sample of 7th- to 12th-grade students, with oversampling of underrepresented groups. Of the 90 118 adolescents who completed the National Longitudinal Study of Adolescent Health in-school survey, 17 125 completed the in-home interview and had parents of identified gender who completed separate in-home questionnaire. The subset of adolescents for this study was drawn from the in-home sampling according to the following criteria: 1) adolescent living with adoptive or biological mother at the time of the interview, 2) adolescent had never been separated from mother for more than 6 months, 3) mother was in first marriage at the time of the interview, and 4) the adoptive mother had never been married to the adolescent's biological father. Of the 6577 adolescents in the final study sample, 214 (3.3%) were living with adoptive mothers and 6363 (96.7%) were living with biological mothers. Variables. The primary outcome measured was adolescent report of suicide attempt(s) in the past year. Other variables included in the analyses were sociodemographics characteristics (gender, age, race/ethnicity, family income, parental education), general health (self-rated health, routine examination in the past year, need for medical care in the past year that was not obtained), mental health (depressive symptoms, self-image, trouble relaxing in the past year, bad temper, psychological or emotional counseling in the past year), risk behaviors (cigarettes, alcohol, marijuana, sexual intercourse ever, delinquency, physical fighting in the past year, impulsive decision making), school-related characteristics (grade point average, school connectedness), and family interaction (family connectedness, parental presence, maternal satisfaction with parent-adolescent relationship). Data Analysis. Univariate analyses were used to compare adoptees versus nonadoptees, suicide attempters versus nonsuicide attempters, and adopted suicide attempters versus nonadopted suicide attempters on all variables. Variables that were associated with attempted suicide were entered into a forward stepwise logistic regression procedure, and variables that were associated with the log odds of attempt were retained in the model. The area under the model's receiver operating characteristic curve was calculated as a measure of its overall performance. After the association of adoption with attempted suicide was demonstrated, the potential mediating effect of impulsivity was explored by adding it to the model. The same procedure was followed for any variable that was associated with adoption in the full sample or the subsample of suicide attempters. To determine whether any variable in the model moderated the association between adoption and suicide attempt, the interaction term for that variable x adoption was forced into the model. RESULTS:
Adoptees differed significantly from nonadoptees on 4 of 26 variables. They were more likely to have attempted suicide (7.6% vs 3.1%) and to have received psychological or emotional counseling in the past year (16.9% vs 8.2%), and their mothers reported higher parental education and family income. Attempters differed significantly from nonattempters on all variables except for age, race/ethnicity, parental education, family income, and routine examination in the past year. On logistic regression, 9 variables were independently associated with attempted suicide: depression (adjusted odds ratio
: 3.41), counseling (AOR: 2.83), female gender (AOR: 2.31), cigarette use (AOR: 2.31), delinquency (AOR: 2.17), adoption (AOR: 1.98), low self-image (AOR: 1.78), aggression (AOR: 1.48), and high family connectedness (AOR: 0.60). The receiver operating characteristic curve for the model had an area of 0.834, indicating performance significantly better than chance. The AOR for adoption did not change when parental education, family income, and impulsivity were forced into the model. None of the interaction terms (adoption × another risk factor) demonstrated a significant effect.
CONCLUSIONS. Attempted suicide is more common among adolescents who live with adoptive parents than among adolescents who live with biological parents. The association persists after adjusting for depression and aggression and is not explained by impulsivity as measured by a self-reported tendency to make decisions quickly. Although the mechanism underlying the association remains unclear, recognizing the adoptive status may help health care providers to identify youths who are at risk and to intervene before a suicide attempt occurs. It is important to note, however, that the great majority of adopted youths do not attempt suicide and that adopted and nonadopted youths in this study did not differ in other aspects of emotional and behavioral health. Furthermore, high family connectedness decreases the likelihood of suicide attempts regardless of adoptive status and represents a protective factor for all adolescents. 
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