MAJURO, Marshall Islands - With four young children and a fifth on the way, a visibly pregnant Neji Johnny was an easy target for a recruiter for Adoption Choices, an American agency that scours the poverty-scarred streets of this remote Western Pacific atoll on the lookout for mothers willing to give up their babies.
In return for $300 in spending money, Johnny said she agreed to fly to Hawaii. As a resident of a former U.S. trust territory, she could travel without a visa. The adoption agency put her up at the rambling Moanalua Hillside Apartments in Honolulu with about 20 other expectant mothers from the Marshalls. Less than a month later she was taken to Queens Medical Center, where she gave birth to a healthy child Dec. 5.
Four days after that, Johnny signed legal documents written in English - a language she neither reads nor speaks - giving custody of her child to Adoption Choices. The transaction was approved by a judge, who was told in a court filing that she was a resident of Hawaii.
And that was the last she saw of "Baby Girl Johnny."
Adoption Choices charges prospective parents a fee - the going rate is about $25,000, including legal and other costs - for arranging the adoption of Marshall Islands babies such as Johnny's.
American taxpayers typically pay the medical expenses for such births under the Medicaid program.
Pregnant Marshallese "literally get off the plane and get enrolled in Medicaid," said David W. Heywood, vice president of Hawaii Pacific Health, which includes several major health facilities. "They [adoption agencies] seem to have gotten that down pretty well."
Johnny, 28, who said she had no idea that she was permanently relinquishing her infant, went home "angry and upset."
Three weeks earlier, the Marshall Islands had adopted a law drawn from a global treaty that prohibits the soliciting of pregnant women by offering them money, gifts and other benefits and transporting them out of the country to give birth for purposes of adoption. But the law is openly flouted in the small, impoverished country with a sky-high birthrate that increasingly serves as a breeding ground for American agencies fiercely competing with one another to provide babies to parents in the United States.
A lucrative industry
In recent years, the number of Marshallese children adopted as a percentage of the population has become by far the highest in the world, according to a University of Hawaii study, even as the price for each baby has more than doubled. With substantial fees at stake, the rivalry between adoption agencies has become so heated that they accuse each other of raiding birth mothers they have recruited.
Adoption Choices, which does business in Oklahoma, Colorado and Hawaii; Southern Adoptions of Philadelphia, Miss.; and adoption lawyer Linda Lach of Hawaii are at the forefront of a thriving and lucrative industry that has sprung up to profit from this burgeoning commerce in which each infant placed can bring $25,000.
"They are banking on the fact that no one will enforce [the law], said Jini Roby, a lawyer and professor of social work at Brigham Young University who was hired by the Marshallese government to set up a central agency to oversee adoptions. "It's just all this illegal moneymaking that troubles me."
Lawyers such as Lach pocket fees of up to $13,500 for each child. Recruiters, in effect professional baby-finders, search out pregnant women and take a cut of up to $2,500 for delivering them to Hawaii. Referral companies retained by anxious American couples charge as much as $2,500 to find a suitable child. Adoption agencies coordinate the process and rake in the rest.
The agencies staunchly defend their work, saying that the impoverished Marshallese mothers can't support their children and that they are saving youngsters' lives by rescuing them from mean, disease-ridden conditions.
"I think we are on the side of the angels," said Lach, who said she has placed more than 100 babies with families in the United States. Her office in Lihue on the island of Kauai is papered with pictures of adoptive children and their new parents, including Marshallese triplets who are now part of a Colorado family.
"My position is that as long as it is legal [in the United States], I'll do it," she said. "These moms need help."
But the emotional cost is incalculably high to birth mothers like Johnny, who typically do not fully understand what they are agreeing to and say they are deliberately misled by recruiters, known in the business as "facilitators."
"I don't know where she is," Johnny said of her daughter. "I'm really upset because they are not writing or contacting me."
Our babies "are not for sale," said Alik Alik, a member of the Marshall Islands Congress and the director of legal services on the islands who pushed for the new adoptions law. "They are human beings ... our most valuable commodities. It is morally wrong."
Adoptions are relatively common in Marshall Islands society, but traditionally the new parents have been members of the family and the adopted children often returned eventually to their birth parents. Alik himself was adopted by a member of his extended family.
A study conducted by Roby in 2001 found that 64 of the 73 Marshallese birth mothers she surveyed, or 87.6 percent, were told that the children they were giving up for adoption would return to the Marshall Islands when they reached adulthood. If they had known otherwise, the mothers said, they would not have agreed to give up their child.
Southern Adoptions' Web site says "birth parents are counseled about their decision. They give their babies/children up knowing they will have a good home with plenty to eat, shelter, clothing, toys and a college education."
But Roby called the "cultural misunderstanding" under which the birth mothers made their adoption decisions "startling."
Alik said he was particularly moved by the case of a friend, Clarence Clanry, whose daughter was adopted without his knowledge or consent.
"He cried and cried because he couldn't even find out where she was," Alik said.
Marshall Islands infants command a premium over children from countries such as China, Russia, Korea and Guatemala, which also are popular with Americans who want to adopt. This is because Marshallese mothers need no visa to enter the United States under the Compact of Free Association, which governs ties between the two countries; their children are American citizens if born on U.S. soil, reducing red tape; and the children are usually newborns, a quality attractive to adoptive parents who wish to bond immediately.
U.S. officials say there is no easy way to close the loophole that allows the commerce in Marshallese infants to flourish without restricting a key element of the compact - the right of islanders to travel freely to and from the United States.
"There's nothing we can do about it," said Albert V. Short, a Virginia businessman acting on special assignment for the State Department, who recently negotiated a compact extension that provides $1.1 billion in aid over the next 20 years and secures a long-term lease on a missile test range in the islands.
Hawaiian courts, in approving adoptions, do not take into account that the children are born to Marshallese brought to the United States in violation of their nation's law.
"To be honest, 99 percent of the time no one ever raises a question," said Calvin Murashige, a family court judge in Kauai. "The issue of the RMI [Republic of the Marshall Islands] law has never come up."
Tiny village, 27 names
In the village of Laura, in a small house a few feet from where the tide gently laps the tip of Majuro Atoll, the Rev. Eric Fisher and his wife, Barbara, talk about the many pregnant young women who disappear for months at a time, then return without their babies.
They jot down the names - 27 from this tiny village alone in the past five years. Johnny's was among them.
"There has to be something aggressive going on," said Fisher, pastor of the local Baptist church.
His wife said many of the mothers are told that the children will come back when they're older.
"We've tried to tell people it's not going to happen," she said.
Recruiters "come around looking," she said. "We call it soliciting."
The Fishers don't fault the adoptive parents.
"They think they are adopting children who wouldn't otherwise be cared for," he said. "In all honesty, they think they are doing a good thing. But the truth is, none of them had to be adopted out. There are no homeless children in the Marshall Islands."
A trip to Hawaii
In August, nine months after the recruiting of pregnant women was barred in the Marshall Islands, a new group of Marshallese mothers-to-be arrived, telling similar stories, at the apartment complex where Johnny stayed.
"They came to us," said Rosalina Anjerok, 24, of the facilitators who recruited her for Adoption Choices, put her on a Continental Airlines flight to Honolulu, then checked her into an apartment a few doors down from where Johnny was housed in Honolulu's Red Hills district, next to a U.S. military reservation.
Anjerok shared the apartment with another pregnant Marshallese, Marianne Lomae, 22.
"It's a very attractive thing ... to promise them a trip to Hawaii," Roby said.
As an added inducement, Anjerok said, a facilitator allowed a daughter to accompany her to Hawaii for treatment of a hearing problem.
Kimber Lee Liu, a volunteer at Southern Adoptions, said her agency was boarding eight mothers at Moanalua apartments in early August. "It varies," she said, "but we never have more than 12 at a time."
A rival agency, Adoption Choices, was boarding four women at the complex. One young Marshallese was recuperating at the hospital after childbirth.
Usually, birth mothers are matched with adoptive parents before the babies are born. Johnny said she met the new parents at the hospital but never learned their names.
There is a trip to the courthouse for the adoption proceeding.
Johnny, records show, was represented by Honolulu lawyer Raymond F. Zeason, who operates out of the same Ward Avenue office suite as Carl F. Debo, the attorney for Adoption Choices.
Until a baby is born and adoption papers are signed, mothers are fair game for raids by rival recruiters.
Lane L. Lanny, a government official who works as a facilitator for Lach, accused Adoption Choices of raiding birth mothers. "They took some of ours away," he said.
Virginia Frank, the founder of Adoption Choices, did not reply to repeated telephone calls placed to her office in Evergreen, Colo.
Lach has been fending off charges that she took four pregnant women from Southern Adoptions, saying that she stepped in only to save them from mistreatment.
Last month, in a flurry of e-mail posted on RMI-kids - an Internet chat group for those who have adopted or are interested in adopting Marshallese children - Lach wrote that Kathy Lahr, the executive director of Southern Adoptions, had left her a scolding telephone message that said, "You don't break into a person's place and steal their THINGS."
"Unfortunately, that is how SA views the birth moms it works with. Things," Lach wrote.
"I will say only that I was contacted by relatives of some of the women being kept in Honolulu by SA, and asked to help them. They (the women and the relatives) felt they were being treated badly, and asked for our assistance."
Lach, who boards pregnant Marshallese on Kauai and Hawaii until they give birth, said it was no easy feat to fly the women out of Honolulu without proper identification.
"Southern Adoptions took their passports and birth certificates and refused to return them," she wrote. "Kathy Lahr told me she would NOT return them, and that I should 'give the mothers back.'"
Lahr, asked to discuss her operations and Lach's allegations of mistreatment, said: "I don't want the opportunity."
After the women deliver, Adoption Choices tries to enroll some of them in the federally funded Job Corps program, Debo said. A successful job placement spares Adoption Choices the cost of flying the birth mother back to the Marshall Islands.
Island law ignored
A few hundred yards from the Marshall Islands' fledgling central adoption authority, a government official with a direct financial interest in the traffic in babies scoffed when asked whether the new adoption law would have an impact.
"It will affect us, but only if they enforce it," said Lanny, the deputy director of the Marshall Islands Airport Authority, who augments his income by working as Lach's facilitator, shipping pregnant women to Hawaii. "They have a lot of laws they don't enforce."
Lanny said the pregnant women he deals with come from "the poor, the low class" and are given a $100-a-week stipend while in the United States waiting to give birth. Housing is provided free.
He insisted that he never solicits birth mothers, saying, "They call us."
Lanny would not disclose his fee. A rival facilitator, Lina Morris, who arranges for direct adoptions from the Marshalls, said she collected $2,500.
He praised Lach, his associate in Hawaii, as "a very honest person. That's one of the reasons I went to work for her."
Lach, for her part, expressed no concern about the new Marshall Islands law. "It's not aimed at me," she said. "They do not have jurisdiction.
"I realize the government would rather this didn't happen," she added, speculating that the law is "all for show."
Lach, who said she receives $13,500 of the $25,000 fee that adoptive parents pay, contends that her paramount interest is the children. If not for the adoptions she arranges, she said, many of the youngsters she has placed might not be alive.
The infant mortality rate in the Marshall Islands is 38.68 per 1,000 live births, comparable to that in many developing countries. (The rate is 6.69 per 1,000 in the United States.) More than a third of Marshallese children under 5 suffer from vitamin deficiency and malnutrition, according to studies published this year in American health journals.
"I think the people know we do ... the best adoptions in the Marshall Islands," Lanny said. "We make sure [birth mothers] are healthy. We find moms and dads for these poor kids."
When maternity nurses in Hawaii first encountered Marshallese women, they didn't realize they were dealing with foreign nationals because the new mothers were enrolled in Medicaid, said David W. Heywood of Hawaii Pacific Health.
"Only in talking to them does it become clear," he said, adding that the women often are accompanied by a woman from the adoption agency who acts as a translator.
Qualifying Marshallese mothers for Medicaid is an integral part of the adoption agencies' procedures. Marshallese qualify for coverage if a doctor certifies that there is an emergency: A woman about to deliver a baby fits that description.
A recent e-mail sent to a prospective adoptive mother by Aspengrove Referral Service of Clark Fork, Idaho, a referral service specializing in Hawaiian-born Marshallese babies, said she would have to pay $2,640 for "the hospital fee" in Hawaii in addition to $25,500 for the adoption.
"Once the Medicaid application is approved, this fee will be refunded," the e-mail said.
Hospital costs can rise if there are birth complications, and Heywood said that is a common problem with Marshallese mothers. Their babies often require extended stays because they are ill or underweight, a consequence of poor prenatal care.
"Sometimes we have to hold the infant for eight to 10 days to rule out illnesses," Heywood said. Sexually transmitted disease is the most common problem.
The number of pregnant Marshallese enrolling in Medicaid prompted Hawaii state Sen. Rosalyn Baker to sponsor a bill that would force adoption agencies to pay the hospital bills.
"We don't want Hawaii to be the gateway for trafficking in women," said Baker, a Democrat. "One way to stop the practice is to force the adoption agencies to pay the bills. They should at least have to pay for it."
"It's horrible," she said. "The federal government should be doing something."
Nancy Partika, executive director of the Healthy Mothers, Healthy Babies Coalition in Hawaii, which urged Baker to introduce the bill, said she was particularly concerned that the Marshallese were arriving late in their pregnancies, with untreated health conditions.
"This situation appears to exploit, for profit, these women, their infants and families, and the Marshallese people who are losing their future generations," Partika said.
The measure was put on hold and will be reconsidered during the next legislative session.
While Lach said she pays the medical expenses of her Marshallese mothers, Heywood said Medicaid pays for most delivery and postpartum care for the women sent to Hawaii.
Adoption Choices testified against Baker's bill. Carolyn M. Golojuch, a social worker for the agency, told members of Hawaii's Senate Judiciary Committee at a February hearing that the bill was "a misguided missile" aimed at poverty-stricken Pacific Islanders.
She called it "a sign of mean-spirited misunderstanding of the benefits of adoption."
Partika testified that the adoptions of Marshallese in Hawaii appear to be profitable for the adoption agencies, and called the process "shadowy and difficult to monitor."
The bill, she said, "may discourage these agencies from exploiting and depleting one of the Marshalls' few natural resources - its children."
The missing children
In the streets and alleys of Laura, mothers talk about children they never got to know, children gone sometimes within hours of birth.
Rosita Hiram, 32, has six children, including one she gave up in February. Like Johnny, she was recruited, flown to Hawaii and when her daughter was born, she signed her over to adoptive parents.
Hiram, whose sister also gave up a child for adoption, is among the minority of Marshallese birth mothers who continue to have contact with the adoptive family. She receives a $50 gift certificate every month with which to buy groceries in Majuro. Recently she was given a new refrigerator.
She describes the arrangement while sitting on her steps and holding one of the five children who live with her. The family laundry dries on a line running to the house.
Her sister, Roseanna Hiram, tells a different, sadder story. She said she had resisted a recruiter's call to give up her unborn child five years ago but then her husband was approached. He pressed her to relent. She said she tried to run away and was supported by her son Jam, now 11, who said, "Don't give my brother away."
Her husband prevailed, she said.
Describing how adoption agencies go about looking for children, Roseanna said she had been promised pictures and letters from the adoptive parents but never received any. She said she did not know the name of the agency she dealt with.
She thinks her son, now 5, lives in Oregon.
"At the time I was very sad," Roseanna said. "Even to this day I miss him."
In her tin-roofed shack, Johnny keeps the legal papers that show how she signed her baby girl over to Adoption Choices.
One document she signed has an "X" marked next to a line which says that once her daughter reaches "the age of majority, I do wish to have my identity disclosed to said child." Despite the long months with no word of her daughter, Johnny said she is hopeful that the child she gave up will one day seek her out.
"They told me she would come back when she is 18."