Outsourced Children is the “first systematic analysis of the lives of institutionalized youth in the PRC” (p. 4), particularly those orphaned due to parental death or abandonment. Leslie Wang's in-depth study is an important counterweight to the sensational exposés in Western media in the 1990s about infant neglect in China's state-run orphanages epitomized by “dying rooms,” whose continued existence Wang does not deny but demonstrates to be unrepresentative of China's entire child welfare system (pp. 9–12).
After the damning news coverage and international approbation, the Chinese government gradually opened to investment by foreign charitable organizations and international adoption agencies. Wang thus rightly situates her study of China's child welfare system—inclusive of orphanages and adoptions—within a global framework that highlights the multidirectional, transnational exchanges of “people, resources, and knowledge” and objectively assesses the consequences (p. 15). For example, healthy girls are most desirable for adoption by Western couples and so pass quickly through China's orphanages and foster homes. In turn, profits generated by China's multibillion-dollar international adoption industry, including large cash payments direct from adopting parents, are reinvested into the institutions to help those less likely to be adopted—98 percent of children in China's state orphanages have an illness or disability (p. 8). Wang argues that “outsourced intimacy”—global adoption—is also a form of “soft power” that enables the Chinese state to project a positive image abroad while funding the domestic child welfare system (p. 14). Further, the state views it as forging global connections over the long term through the active cultivation of adoptees’ ethnic and racial ties to the motherland, such as through returnee tours. Along with financial support, China's child welfare institutions receive technology, expertise, and volunteer labor from the West. However, with these donations come “universal” ideologies and protocols for “good care” that, Wang observes, reinforce specifically Western and Christian notions of moral superiority even as they clash with local realities and norms of care.
Chapter 2, “Survival of the Fittest,” pairs well with chapter 3, “From ‘Missing Girls’ to America's Sweethearts.” Wang explains how China's concern with improving “population quality” through mandatory birth planning to achieve the small family ideal conducive to national development goals, when combined with son preference and eugenics, has unintentionally resulted in a skewed gender ratio and abandonment of both healthy girls and babies of either sex who have congenital mental or physical impairments. The latter are especially pitiable: traditional society viewed them as cursed and morally deficient, while modern society views them as burdensome and useless because they appear to lack the human capital necessary for citizens to contribute productively to economic and national development. Moreover, the state has privatized health insurance, making it nearly unaffordable for poor households, and offers no financial support for families raising special needs children. Cultural attitudes and structural inequality together account for the disproportionate abandonment of special needs infants to institutional care, often via state-sanctioned, hence controversial, drop-off centers known as “baby hatches” (p. 39). The plight of such children is ethically concerning and especially critical to address; Wang presents research indicating that congenital abnormalities are escalating in China, possibly due to environmental factors.
In contrast to the children with disabilities, healthy girls are considered valuable in a profitable global adoption business, which Wang explores in chapter 3. In China, more girls than boys are available for adoption, largely due to son preference and a strict fertility policy that until recent years limited urban families to just one child, and rural families to two only if the first child was not a healthy boy. Healthy boys available for adoption are often the offspring of unmarried mothers, whose best option is abandonment in face of the social stigma and legal difficulty of registering a child born out of wedlock. During the 1990s, China promoted international adoptions, which peaked in 2005; most adoptions were of girls by white, middle-class, American or other Western couples (and a small percentage of single parents). In the United States, gender, racial, and patriarchal ideologies and hierarchies shape (white, middle-class) Americans’ preference for adopting Chinese girls. Policy shifts since 1998 have served to limit international adoptions and encourage more domestic adoptions, reflecting China's growing economic and political clout. Due to patrilineal kinship and related beliefs about ancestry, Chinese families likewise favor (healthy) girls for adoption. The recent policy shifts also responded to proven allegations of child trafficking; high demand and potential to profit from the large sums of cash required of international adopting parents by the agencies incentivized the abduction (and possibly also the abandonment) of healthy “orphan” girls. The desirability of healthy girls in the international and domestic adoption market explains why Wang found more healthy, able-bodied boys than girls remaining in the orphanages over the long term.
In chapters 4 and 5, Wang draws upon several months of fieldwork when she volunteered as a caregiver in two foreign-funded, voluntary organizations operating within and under China's state-run child welfare institutes (CWI). Located in a provincial city, Tomorrow's Children (profiled in chapter 4) provided rehabilitation—often expensive medical procedures conducted overseas—and palliative care to severely disabled and terminally ill infants and toddlers. It was independently run and funded by Western evangelical Christians who coexisted harmoniously with the host CWI. Wang argues that the relationship was mutually beneficial, as each side garnered soft power. The international volunteers, including trained nurses, physical and speech therapists, etc., modeled for the Chinese side an individualistic, (neo)liberal ideal of childcare and Christian morality that involved hands-on emotional nurture and stimulating play, which conflicted with the capacity and inclinations of the low-paid, overworked Chinese caregiving staff. The Chinese institutional authorities saved on the exorbitant costs of care while maintaining ultimate authority over the wards and showcased the progressive organization as a symbol of China's modernization. The organization was successful in that it effectively selected “needy” infants who could be “rescued”—through medical procedures and other interventions—and thus turned into desirable children for international adoption, a process explored further in chapter 6. But the selection according to a hierarchy of needs also created stratification among the orphan population in the CWI and did not address the social prejudices against the disabled children or the roots of child abandonment.
Helping Hands of Beijing (the subject of chapter 5) shared similar goals with Tomorrow's Children but was less effective at both servicing orphans and influencing childcare practices. Founded by a Chinese-American woman residing in China, the organization recruited expatriates to donate a couple of hours a week to assist in a Beijing CWI. These were predominantly wealthy, white, Western women whose husbands were assigned to work in Beijing. As “trailing spouses,” they had time to spare and were eager to do something “meaningful” for a few hours a week while their children were at school; charity work with needy children promised authenticity via proximity to local people. Wang uses the term “voluntourism” to emphasize the rather self-centered motivations of typical members and the damaging impact of their misguided attentions, which raised and then dashed children's expectations due to their inconsistency and lack of commitment and even triggered feelings of (re)abandonment among some. Moreover, the local staff were especially unresponsive to Helping Hands’ model of care involving unconditional maternal love; they offered their charges only custodial care, reflecting the official view of disabled people as unproductive hence less worthy of emotional or social investment. Importantly, the relationship between Helping Hands and its host CWI was characterized by mutual distrust, perhaps because at the time of Wang's fieldwork in 2008, Beijing was preparing to host the summer Olympics and thus was especially wary of opening its orphanages to international scrutiny. All these factors limited any positive impact of Helping Hands.
In chapter 6, Wang notes the decreasing availability in China of healthy girls for international adoption due to changing demographics as well as policies allowing for larger families and domestic adoptions. Now the Chinese state promotes “outsourcing intimacy” mainly of “special needs” children: older youth and infants or toddlers with medical and/or physical conditions who, for reasons discussed above, have been abandoned by their families and are difficult to place through domestic adoption. Wang emphasizes the intensive outlay of care and commodified practices involved in turning special needs children into desirable adoptees, and the fortuitous (for these children) rise in the West of evangelical Christianity and its mission of “saving” children through adoption—seen as rescuing them from poverty and redeeming their souls.
Outsourced Children is a thoughtful study that intelligently explains and subtly condemns the gendered and racialized forms of privilege and inequality that are reproduced through neoliberal global capitalism, evangelical Christianity, and China's state policies. Wang's sensitive and empathetic portrayal of well-meaning but misguided volunteer caregivers and institutionalized children will have broad appeal to undergraduate students as well as advanced students and scholars of China, and those interested in the globalization of children's welfare or care work. It should be mandatory reading for policy makers focused on issues of human trafficking and global child welfare, as well as all who are involved in the global adoption industry.
