China’s Advocacy Gap

It’s very hard to advocate for children you can’t see. That’s why Holt’s registration status in China is so critical.

Jian holding a little girl at Holt’s medical foster home in Beijing, Peace House.

Jian stands leaning on a crib in a dimly lit room with high windows, while a half-moon of neatly dressed men and women hang on her every word.

All around her, more cribs, each filled by a small child bundled in heavy winter clothes and tucked beneath layers of comforters and knit blankets. Children coo quietly and stare around wide-eyed at the uncommon commotion in their room.

Jian’s voice is low but firm, and even without understanding Chinese, her tone communicates that she is delivering a serious message.

The three leaders of this orphanage — a home to more than 200 children at any given time — listen intently, wide-eyed, too, nodding along.

“I’m asking them why they haven’t sent this little girl’s file to Beijing,” Jian says, motioning to a toddler with Down syndrome dressed in a thick coat, contently snuggled against a caregiver in worn out lavender-colored scrubs.

Jian Chen lives and works in the U.S. as Holt’s vice president of China programs. But she was born in China, spent half her life in China, and has developed a solid reputation through the years working with the Chinese government and social welfare community to advocate for the rights of orphaned, abandoned and vulnerable children. When Jian speaks, people listen.

The little girl Jian told orphanage staff Holt could find a family for, if only they would prepare her child file and send it to Beijing for adoption processing.

“I tell them that we can find a family for her,” she says of the toddler with Down syndrome, “but they are so surprised to hear that.”

Many of the children in this room are nonverbal, and almost every child has a physical or developmental special need, but they are highly aware of their surroundings. Some children reach their arms up, hoping for someone to touch them or hold them.

This is one of Holt’s partner orphanages — a government-run facility in a smoggy north-central city of a million people in Shanxi Province that feels small by Chinese standards. In addition to the orphanage, several hundred elderly adults live in a nearby building.


In China, Holt partners with more than 20 orphanages throughout the country. Some are large and well funded, like those in provincial capitals. However, most orphanages are smaller, like this one, and receive less government funding, training and staff to help provide care to children.

By partnering with Holt, children at the orphanage receive more direct advocacy to help match them with families in the United States, better funding because Holt donors often help fund critical projects or care needs, and improved access to new training, like the child nutrition program training Holt developed specifically for caregivers of children living in orphanages.

Many orphanages in China care predominately for children with special needs. At an orphanage in Shanxi province that Holt partners with, a caregiver adjusts the blankets around a child with hydrocephalus.

In a country where institutional care remains the most common method of caring for orphaned and abandoned children, it is easy for children — especially those with special needs — to become just one in a sea of faces.

But, when a visitor like Jian stops in, bringing a new perspective — one that insists that all children are equally worthy of love and the chance to grow up in a home of their own — she becomes a voice to children who have no say in where and how they are raised.

Americans embrace the notion that all children are equal. But, in China, kids with special needs aren’t viewed with the same value as healthy children. While adoption is growing more popular in Chinese culture, adopting a child with special needs is still a foreign concept.

Thankfully, this concept has become gradually less foreign through the advocacy of international child development professionals — from both Holt and other organizations.

But recently, Holt’s advocacy efforts have become particularly critical.


In early 2017, the Chinese government issued new regulations requiring that international nonprofit organizations like Holt register with the government to continue providing services to vulnerable children and families — everything from child sponsorship programs to private group home care, medical foster homes and education-based programs.

As a result, far fewer international aid workers and child development professionals are now actively working to improve living conditions for children in China and raise their standards of care.

Holt, however, was fortunate.

Among the first 20 organizations to register and receive a license to continue providing services, Holt can continue to visit children in government-run facilities, advocate for their needs and work to find families in the United States equipped to care for their needs.

Holt was prepared for the changes.

Jian, having heard rumors years ago that China might require such a registration, began working through the process long before it became law. When the registration law finally did pass, Holt’s programs were able to continue operating without a hitch.

But, many organizations haven’t been so fortunate. Some have even been forced to stop operation of their programs.


In Jian’s 20-year tenure with Holt, she has been instrumental to developing Holt’s strong presence and programs across 13 provinces in China.

Jian has spent her entire career fighting for improved child welfare standards, orphanage conditions and support to children living in orphanage care, and helping to introduce foster care and group home care as more nurturing alternatives to institutions.

But as orphanage conditions and models of care have changed drastically over the past 20 years, so too has Jian’s role as a child advocate.

Now, one of her biggest challenges is to advocate for children with special needs —children who many considered less adoptable and less worthy than healthy children.

This is an uphill battle — and one that requires patience, diligent education and, most importantly, access to orphanage directors and staff. You can’t educate people you can’t meet. You can’t ensure children are being properly cared for if you can’t see where they are living. And, it’s very hard to advocate for children you can’t see.

Caregivers with children at an orphanage partner in Shanxi province, China.

That’s why Holt’s registration status in China was and is so critical.

If orphanages — especially smaller institutions like this partner in northern China — don’t send a child’s file to Beijing where adoption is centralized, that child has no chance of joining a family of their own someday.

Often, orphanages don’t send child files for children with special needs that are considered moderate or major because they believe that no one would want to adopt that child anyway, so why bother?

But Jian sees firsthand how many children once considered “unadoptable” are now thriving in families. They are beautiful, normal children — full of potential, loved beyond belief.

Lucy playing on the beach.

They are children like Lucy, now 5, who was born in Nanning, China with Thalassemia — a condition that requires regular blood transfusions to keep her healthy, active and with normal life expectancy.

Jessica Zeeb, Holt’s waiting child coordinator for the China program, met Lucy in her orphanage prior to coming home to her family.

“She was just laying on a cot,” Jessica says. “She barely moved.”

Lucy with her family.

Now, Lucy is an active, adorable and fun little girl. She likes pandas, playing with her brother and running around with her mom. Once per month, she spends a day getting a blood transfusion in her local hospital.

Even 10 years ago, children living in orphanage care in China with treatable conditions like Thalassemia were considered so difficult to place with adoptive families, many caregivers wouldn’t try to find families for these children — nor secure the medical care they needed. Still, today, many medical conditions or special needs that are well-controlled, easily managed and covered by insurance — like HIV, Thalassemia and even Down syndrome — remain stigmatized, misunderstood and expensive to treat.

Many orphanages in China report that between 90 and 95 percent of the kids in care have special needs.

Orphanages are full of kids like Lucy — kids who need extra attention, extra advocacy and extra awareness if they have a chance of being matched with a family.

But, when orphanages hear stories about children with conditions like HIV, Down syndrome or limb difference thriving in families, they are much more willing to help advocate for other children with those same conditions.


Prior to the 2017 law that nonprofit organizations had to be registered in China to enter orphanages or provide hands-on care to children, many U.S. adoption agencies regularly sent staff to meet children in orphanage care, conduct trainings with orphanage staff or check to ensure donations were being spent to improve orphanage conditions and children’s lives.

Now, Holt is the only child welfare and adoption organization registered in China. Another agency, CCAI, is registered to provide family preservation and orphan care programs, but not to do adoption-related work.

A caregiver with a child in orphan care in Shanxi province, China.

This leaves a clear gap in advocacy for kids.

This gap increases the responsibility Holt feels to be actively and consistently working with local and provincial child welfare officials to raise awareness on behalf of kids with special needs.

It’s unclear how long it will be until more agencies are registered, but Jian warns that it could be a long road. She began working towards a full registration status with her teams on the ground in China and in the U.S. more than seven years ago.


In China, there are very few standards about how children should be cared for. For instance, there are not rules regarding how often children in orphanages should see a doctor, how much food they should eat, the type of school support they should receive or how government funding should be spent.

Orphanages in the national capital, Beijing, receive more funding than orphanages in provincial capital cities, while rural orphanages receive even less funding per child in care. However, even if funding to orphanages were exactly the same, the Chinese government does not dictate how money must be spent or how efficiently it must be used.

This is a dangerous imbalance for children, and one that creates inequality in the level of care children receive. Many children are sent to Beijing or larger cities where care is better.

Holt and other aid organizations have been helping China develop their social welfare programs in recent years. Adoption has also provided a way of helping improve the quality of care in orphanages — partially because families give a donation to their child’s orphanages, which helps to cover the cost to care for their child during the adoption process.

As a registered organization in China, Holt is able to visit partner orphanages regularly to ensure children are receiving the highest quality care possible. Or, if a Holt staff member suspects an orphanage is not able to provide appropriate care, they can advocate for a child to be moved to a private care center.

At another orphanage where Holt has partnered with staff for many years, Jian speaks with the director as an old friend. Here, nearly 200 caregivers care for up to 450 children at a time — around 800 kids per year, about 98 percent of whom have moderate to severe medical conditions or special needs.

The facility is bright, clean and spacious, and several large buildings fill a quiet campus with gardens, paved walkways, basketball courts and yards of grass.

In one giant room completely lined with floor mats and flooded by bright sun coming from a wall of windows, more than ten caregivers in sharp, white scrubs sit on the floor, engaged with toddlers just learning to crawl and walk. In another room, about thirty older children, all with special needs, watch a holiday movie together.

Twenty years ago, this was one of the worst orphanages — it was dirty and more than three children shared a single crib. But now, with better funding, oversight and knowledge, it is a quality orphanage.

“Adoption brought a lot of attention here,” the orphanage administrator says. “Then the government invested more, too.”

Today, this orphanage is a bright and beautiful place, with specialized therapies and education for children of all abilities. Bright children’s art lines the walls and mobiles hang over each infant’s crib. They operate an integrated preschool, which also enrolls kids from the community.

The orphanage administrator says that she partners with Holt because she wants as many of the children here to have a loving home of their own. As nice as an orphanage can be, it can never replace the love and attention of a family.

“Last year, we found seven adoptive families in China,” the orphanage administrator says. “That’s not nearly enough, even though it is growing. We know that Holt will look for families for our children with special needs.”

As a registered organization, Holt is thankful that we can continue to advocate for kids directly — and we stand committed to doing all we can, with the resources entrusted to us.

Billie Loewen | Creative Lead

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