Not long ago, the choices facing Robert and Julie Garrett would have been simpler. Once they set their hearts on adopting a child from China, the odds were high they could soon bring home a healthy infant girl.
It's different now.
Faced with a long wait and a smaller pool of healthy orphans available to foreigners, the Garretts have decided after much soul-searching to adopt one of the special-needs children who now abound in China's orphanages.
"It's really hard, and we want to make the right choice," said Julie Garrett, of Gainesville, Ga.
The children's conditions range widely. Some are correctable, some not: cleft lips and palates, congenital heart disease, missing or malformed limbs, impaired vision or hearing.
"It's important for us to not take on more than we can handle," Garrett said. "That process takes time - praying over it, discussing what medical needs you think you could take on. It's a journey in itself just to decide if that's the right direction to go."
Starting in the early 1990s and as recently as a few years ago, the large majority of Chinese children adopted by foreigners were healthy baby girls abandoned by their parents, often because of a preference for a son in a country rigidly enforcing a one-child policy.
Between 1995 and 2005, Americans adopted more than 60,000 children from China. The peak was 7,903 in 2005.
Circumstances have changed dramatically since. China has eased its one-child policy, fewer baby girls are abandoned, domestic adoptions of healthy orphans have increased, and the waiting time for foreigners to adopt a healthy infant has tripled to roughly four years.
As a result, U.S. adoptions from China have dropped more than 60 percent, to 3,001 last year. And of the children now adopted, roughly three of every five have special medical needs.
One contributing factor is China's rate of birth defects, which a government family planning commission said increased by nearly 50 percent between 2001-06.
Amy Eldridge of the Oklahoma-based Love Without Boundaries Foundation, which oversees several programs to aid Chinese orphans, says many children with birth defects, boys as well as girls, are abandoned, and they now comprise a majority of the orphan population.
"Some parents feel the child will bring bad luck to their family," said Eldridge. "And we're seeing many poor families abandon children with medical needs in hopes they will get care."
The Garretts have decided they're not ready to take a child with a severe medical problem. They're seeking one with a correctable condition.
Bethany and Kevin Durkin, who live in Westchester County, went through a similar decision process and are now parents of two girls adopted through the Waiting Child program.
Olivia, 7, had a weak, underused right arm when she was adopted in 2004, while Lucy, 5, had a cleft palate that was repaired soon after her adoption in November 2007.
Both girls undergo therapy regularly - Lucy for speech, Olivia to improve the mobility of her arm and right hand.
"She does cartwheels, jump-rope - people don't even know she has an issue," Bethany Durkin said of Olivia. "She just can't open her hand by itself." As for Lucy, "she's a total social butterfly," her mother said. "A really happy kid."