It’s a question many adoptive families ask when they face prolonged waits for children in need of a permanent home—waits that have grown longer for many in recent years and left some adoption advocates perplexed over how to intervene early for some of the most vulnerable children in the world.

The United Nations estimates some 140 million children worldwide have lost one or both parents. More than 15 million have lost both. Many orphans in developing countries live with extended family, others live in institutions, and a small percentage find permanent homes through international adoption.

Some adoption advocates worry that small percentage will grow even smaller. The intercountry adoption rate in the United States already has fallen by nearly 80 percent: down from a peak of nearly 23,000 foreign adoptions in 2004 to around 5,000 in fiscal year 2017.

The reasons for the decline are complex, but some advocates say government bureaucracy is making it worse. They point to recent changes announced by the U.S. Department of State (DOS) that will raise fees on adoption agencies and adoptive families. Some say the increases will be dramatic.

They also say unclear regulations and a new accrediting agency announced by DOS could make the work of facilitating adoptions even harder, particularly for smaller organizations. Some agencies say they might have to drop the work altogether.

Ron Stoddart, an attorney and adoption advocate, ran a survey for the website SaveAdoptions.org. Out of 60 agencies responding, nearly half said they likely would stop facilitating intercountry adoptions or were uncertain if they could continue under the new accrediting agency.

Officials at DOS say they don’t intend to make adoption dramatically more expensive and that it’s too early for agencies to estimate all the costs they could incur under a new accrediting body.

This much seems clear: Many adoption agencies are bewildered, and the tension has only deepened in recent months. Ryan Hanlon at the National Council for Adoption says better communication is critical: “Relations between the adoption community and the Department of State are at an all-time low.”

The ongoing drama raises basic questions: How did a movement—driven in large part by evangelical concern for orphans—change so dramatically in the last two decades? And what does it mean for widows and orphans in distress?

DISTRESS SPARKED international adoption efforts in the United States.

Some of the first major international adoption movements came after the Korean and Vietnam Wars, as Americans adopted children orphaned by the conflicts.

Other crises—like the global AIDS epidemic—orphaned more children over the following years, and evangelicals were often in the forefront of helping vulnerable populations by creating orphan care ministries and adopting children in need.

By the early 1990s, many countries realized the need to better regulate the burgeoning adoption movement, recognizing the dangers of corruption and fraud.

At the Hague Convention in 1993, dozens of countries established international standards to safeguard children and adoption practices. The United States signed the treaty, and the Department of State became the central authority overseeing international adoptions and the private agencies facilitating them.

Those adoptions peaked in 2004, and then began a steady decline, as a handful of countries changed or closed their adoption programs.

For example, China revised its adoption program as the nation’s one-child policy negatively impacted its population balance.

In 2005, 95 percent of the Chinese children adopted by U.S. families were healthy girls. Today, more than 90 percent are children with special needs. Boys constitute one-third of the adoptees.

The numbers also fell as other countries closed their adoption programs. Guatemala closed its program in January 2008, citing problems with corruption in its own system.

Russia closed adoptions to U.S. families in 2013 as political retaliation. Ethiopia dramatically slowed its adoption flow several years ago, citing the heavy caseloads. In January, the country banned foreign adoption, saying it was concerned that adoptees faced abuse abroad.

As the numbers of adoptions dropped, the number of vulnerable children didn’t plummet. Some agencies (and other groups) developed programs within foreign countries to help birth families keep children if possible and to encourage locals to foster or adopt children.

For example, Bethany Christian Services facilitated adoptions in Ethiopia, but also developed in-country programs to help families. Though Ethiopia closed international adoption in January, Bethany will still be able to continue its local work with orphans and families.

Jedd Medefind of the Christian Alliance for Orphans says that’s part of how the adoption movement matured, as evangelicals recognized the painfully complex nature of some situations involving orphans and the opportunities for helping vulnerable populations who won’t be able to leave their home countries.

But local efforts are challenging, and just as in the United States, many children will still need adoptive homes, and some adoption advocates wonder if the United States has done enough to encourage countries to address problems in their adoption systems, while still trying to keep programs open.

It’s a complex task for a State Department already engaged in massive undertakings all over the world, but former Democratic Sen. Mary Landrieu says she thinks the agency hasn’t showed the capacity or the will to help countries keep their adoption programs viable.

Landrieu was heavily involved in the Hague process and remembers debates over whether to designate Health and Human Services or the State Department as the central authority over adoption. She thinks tapping DOS was “a tragic mistake.”

Landrieu believes DOS has focused on looking for corruption more than building up the overall system and finding ways to keep foreign adoptions viable.

That’s a common criticism of DOS, and the issue of corruption has become a central discussion in debates over international adoption. Ron Stoddart, the founder of the Save Adoptions coalition, believes DOS assumes corruption is systemic, rather than the exception.

He points out that Trish Maskew, now the chief of the Adoption Division at DOS, once testified before Congress: “I entered the world of adoption believing what I had always heard, that most agencies operated ethically and that there were a few bad apples. I no longer believe that is true.”

Maskew said she believes most adoption professionals are well-intentioned, but that some believe the ends justify the means. She has expressed concerns over high-profile cases of adoption abuses, as well as what she called adoption agencies cutting corners.

This raises a vital point. The term “corruption” covers a range of potential faults across a wide spectrum: from worst-case scenarios of orphanages taking children from unsuspecting birth mothers to instances of shoddy paperwork.

Some adoption advocates say extreme corruption is rare, while some critics say advocates downplay concerns over fraud in an effort to try to help children.

Almost all adoption professionals acknowledge some corruption exists, and denying its existence is unhelpful and unrealistic. But advocates like Landrieu say we shouldn’t permanently shut down entire systems because of problems in some segments.

(And it’s not an unregulated system: During the adoption process, the U.S. government and foreign countries conduct investigations to try to establish the legitimacy of each case. Some agencies employ third-party investigators to verify cases as well.)

The Council on Accreditation, the group overseeing agency accreditation until recently, reported that 79 percent of accredited adoption agencies had no substantiated complaints against them over the last decade. (Others have noted that many of the substantiated complaints against other agencies dealt with lax administration procedures.) One agency out of 155 had been debarred.

As the adoption landscape has changed, so have the kinds of children available for international adoption. Many children are older or have special needs. Ahead of a trip to Kyrgyzstan in March, Daniel Nehrbass, president of Nightlight Christian Adoptions, said he expected to see “hundreds of children” in need of adoption.

Nehrbass and his wife adopted a daughter two years ago from the country. He says the little girl has cerebral palsy and a heart defect: “She sat for five years in an orphanage. No one visited her. No one was interested in domestic adoption.” She remained on Nightlight’s photo listing site for four months. When her referral was about to expire, the couple began the process of adopting her.

When it comes to corruption, Nehrbass said there’s no black market for these children. There’s mostly need for families to step up and adopt.

THE ADOPTION CLIMATE grew stormier in 2016, when the State Department proposed a new set of regulations that adoption agencies didn’t expect. Hanlon says the agencies were taken aback that DOS didn’t ask for input.

The State Department withdrew those regulations after President Trump’s election in November and his moratorium on new regulations from executive agencies. But tensions persisted, as the Council on Accreditation (COA) announced it would withdraw as the accrediting agency for international adoption after eight years on the job.

In an interview, COA President Richard Klarberg said DOS began asking his organization to take on a far greater regulatory and policing role, with more in-depth oversight of agencies’ finances and adoption activities abroad.

Though COA does take action against agencies that fail to comply with standards, Klarberg says his group isn’t primarily a policing agency. He believes it’s important to ensure the process isn’t corrupt, but he also says over the last eight years he hasn’t seen evidence that wrongdoing is widespread.

Klarberg thinks the shift to more regulations takes away from agencies’ resources and ability to focus on helping adoptive parents prepare to become families to needy children. He says his four employees working on adoption all agreed COA should withdraw, even if it meant they would lose their jobs.

As COA withdrew, the State Department announced a brand-new accrediting agency would take over, and some adoption agencies say they estimate their costs will triple under the agency’s new fee structure, and some costs could be passed on to adoptive parents.

They also worry about the burdens of more regulation. Lucy Armistead, president of All Blessings International, says that during a conference call with DOS officials indicated agencies would need contracts with anyone facilitating an overseas adoption—an expansion Armistead worries could include everyone from drivers to hotel clerks.

Other agencies seem confused about those details as well, and Armistead says, “There’s so much legal liability on us, we’re wasting our resources. We’re trying our hardest to be compliant … and it kills us.”

Not all agencies are as dismayed. Bethany Christian Services said it was concerned about the new fees, but was satisfied with its relationship with DOS and would work with the new accrediting agency to make sure its adoption processes were in order.

But at least one U.S. senator is asking DOS to clarify the recent confusion. Sen. Roger Wicker, R-Miss., sent a letter to the department, asking officials to address concerns over the new accrediting agency and fees.

In an email, the senator said he had received “an underwhelming response” from Assistant Secretary Mary K. Waters. He said he hoped DOS would address his concerns about “the immense burdens they are placing on adoptive families.”

Gayla Slaughter, Michelet’s adoptive mom, says the burdens of the adoptive process were well worth bringing Michelet home in the end, but she wishes it were easier to help children in clear need. Her mind often goes back to Michelet’s Haitian village and a disabled man she saw crawling down the street, begging for help: “I knew that would have been Michelet’s future,” she remembers. “I said to myself, ‘That cannot be his future.’”