China is a different country today, however, and in an effort to demon­strate how well its abandoned young are now cared for, the Shanghai orphanage’s director, Cai Xuanxuan, has agreed to lead Post Magazine on an exclusive tour of the facilities under her management.

No restrictions are imposed, although the Civil Affairs Bureau considers abandoned children a sensitive issue, so one of its officials tags along, at least for the morning. He leaves after lunch, however, and we are free to go wherever we wish.

The compound’s dozen imposing buildings house about 1,000 minors. Each hopes a family will one day arrive to adopt them, and the constant roar of planes departing from nearby Hongqiao International Airport fans those dreams. The reality, though, is that most will never be taken into the bosom of a loving family.

“Nowadays, fewer than 100 are being adopted every year,” says Cai. And the number is falling.

Total adoptions in mainland China have nearly halved from 34,529 cases in 2010 to 18,820 in 2017. And two years ago, just 2,300 children went to live with families abroad. Parents in Hong Kong, Macau and Taiwan adopted 103.

There are several reasons for the declining number, but the fact that fewer children need new homes is chief among them.

“Chinese people now seldom abandon their children,” says Cai. “Living standards have greatly improved thanks to the country’s economic development, and so has prenatal care. An increase in the tests mothers undergo during the early stages of pregnancy has had a clear effect in producing healthier children. And, therefore, in reducing the number of abandonments.”

Society’s attitude towards disabilities has changed, too.

“Parents now know that children with certain disabilities, like Down syndrome, can lead a normal and happy life. So they don’t perceive them as a burden for the family and try their best to overcome the challenges their development poses,” the director says.

In consequence, the number of abandoned children arriving at the Shanghai orphanage has halved in the past decade, to between 50 and 60 per year.

The picture is similar across the country. According to the 2017 Social Services Development Statistics, the latest data available, published by the Ministry of Civil Affairs, there were 410,000 orphans in China.

That is 101,000 fewer than the figure given just two years earlier, in the China Child Welfare Policy Report. However, an overwhelming majority of new cases and virtually all children over the age of six living in orphanages suffer from some form of illness or disability.

“Ninety-five to 98 per cent of the kids in our care have special needs,” says Cai. “This makes their adoption challenging or outright impossible.”

They appear to be well taken care of, but witnessing the most serious cases is heart wrenching. These children are kept in special accommodation in the main building, in the centre of the compound. Some rooms resemble an intensive-care unit, and only medical personnel are allowed to enter. Hydro­cephaly, cerebral palsy and congenital heart ailments are common conditions afflicting children here.

It is uncomfortably quiet. Most of the children can’t move, so they remain in their metal cots all day long, under the watchful eye of nurses. They seldom cry. Many maintain a blank gaze. Only a few track visitors with their eyes.

A board on the wall lists the children at the orphanage. Alongside each name is a passport-type photo and a card with basic information about the child and the letter they have been assigned.

“After a careful medical assessment, they are classified from A to D, according to their health,” explains a nurse, who asks not to be named. “We use A for healthy kids while D refers to those heavily ill or disabled, among which mortality rates are high. B and C can enter the foster-care programme, but not many Bs are adopted. Chances for Cs and Ds to find a family are close to zero.

Cai admits that the proportion of Ds has increased with time. However, with the end of the one-child policy, in 2016 (all couples can now have two children), girls are no longer abandoned in higher numbers than boys.

“Illnesses are the most prevalent reason for abandon­ment now,” says Cai. “Parents fear not being able to take care of their children.”

Hospitals and railway stations are where most aban­doned children are found. A few years ago, some Chinese cities set up baby hatches, to improve safety for those being abandoned and expedite medical help while protect­ing the privacy of the parents, but most have now closed due to a lack of funding.

“Police will try to find the parents of abandoned child­ren for 90 days,” says Cai. “If they don’t succeed – and it’s extremely rare for parents to come forward – the children are sent to us.

“We have 500 people working here, including volun­teers. Most are trained to handle kids with special needs.”

Under the law, children up to the age of 14 can be adopted, and those above the age of 10 can reject their assigned parents. Because adoptive families need time for emotional bonds to develop, adoptions of children in that age range are uncommon.

Classrooms line a brightly lit corridor on the second floor of the main building; the shouts and giggles of children fill the air. Classes are attended mainly by A- and B-rated children, who are streamed not only according to their age but also their mental ability. Some learn the names of items with the aid of flash cards, others try to master the strokes of intricate characters. There are classrooms dedicated to mathematics and geography, too.

The rehabilitation block is where the C-category child­ren are treated. Most have suffered some form of brain damage. In one room, a patient young man plays with a joyful boy who is trying to insert colourful wooden pieces into the holes of a board with matching shapes. He is easily distracted by our camera.

Two children in an adjacent room are also bewitched by the lens. Their skulls are connected to machines designed to stimulate the brain with electrical impulses, but having their photo taken appears to be much more exciting. Both laugh nervously and try to make a V with their fingers, aiming for the perfect pose.

We make a teenager miss a host of basketball shots; virtual ones. He can hardly move a muscle but he is wearing a sensor-filled glove, used to play computer games. He had racked up an impressive score before we appeared, but he doesn’t seem to mind us ruining the match, and gives a shy smile.

For children with reduced mobility, the orphanage is equipped with a special swimming pool. Unfortunately, the budget is not sufficient to keep the pool open during the coldest months and so it can only be used when there is no need to heat the water.

Chen Huizhen, 19, is in charge of the orphanage’s shop and canteen, where many of the employees enjoy afternoon tea. A B-rated resident who has been in the care home since she was one, Chen has learned how to manage a business and will soon move to an adult care home provided by the state. There she will get help from social workers for one or two more years, until she can lead a life of her own.

“I am ready to become independent next year,” says Chen. “I don’t feel anxious, but I will feel sad to leave this place, because we are a family here.”

Chen is one of the luckier youngsters.

“Unfortunately, many won’t be able to leave the state homes and will be transferred to facilities for the elderly with disabilities, when they turn 60,” says Cai, who worked in the orphanage between 2000 and 2004, and returned in 2014. “Between those times, many things have changed in the way we work with the kids. But the biggest transforma­tion has been society’s attitude towards this issue.”

A good example of this can be found in the main hall of the complex, where a photograph of President Xi Jinping holding one of the children leads a brief historical run of images dating back to 1911, when the institution was estab­lished by Catholic priests and nuns. For decades, orpha­nages were seen as shameful, but things are changing.

“Every city with a population of a million or more is required to have an orphanage. And although conditions in Shanghai are still better than elsewhere, the gap is narrowing,” says Cai.

“The Dying Rooms sparked a global public outcry and a boom in adoptions of Chinese children,” says Francesc Acero, spokesman for the Asociación de Familias Adoptan­tes en China (AFAC), Spain’s largest association of parents adopting in China. “For a couple of years, Spain became the world’s top adopt­ive country in China, surpassing even the United States.”

Since its foundation, soon after the documentary was aired, AFAC has helped 17,000 families to adopt in China.

The Shanghai orphanage bears little resemblance to those depicted in The Dying Rooms, and our visit is no propaganda stunt. Most orphanages in China now provide adequate care, says AFAC. And Ederne Frontela, the 36-year-old elder sister of a Chinese girl adopted in 2010, can testify that even in more remote corners of the country, abandoned children are being cared for properly.

“I found a US NGO [First Hugs] when I was looking for information about my sister, who was adopted from [Dianjiang county] near Chongqing when she was 3½ years old. Then, I chose to do the internship of my Chinese studies master’s degree in an orphanage and the NGO help­ed me to arrange it. I spent three weeks [at an orphanage in Xinxiang, Henan province, in 2015], one of those unsuper­vised, and both infrastructure and staff were great,” says Frontela.

She says she cared for a group of 14 children, most of whom suffered from some kind of ailment. Severe cases were kept in a separate dormitory, as in Shanghai, and “among the rest, we had cases of autism and Asperger’s, and others who were just not what people consider perfect kids”, says Frontela, who recalls seeing a premature baby, an albi­no and a child who had been born without an arm.

“People don’t want them even if they are not sick. And I was shocked to see an adoptive Chinese family return their son just one day after taking him home because he cried too much.”

First Hugs was founded in 2006 by Moya Smith, a Canadian living in Colorado, in the US. Smith had adopted two daughters, in 2002 and 2004, from the same Dianjiang institution in which Frontela’s sister had lived. Orphanages in China can be operated only by the state. Non-govern­mental organisations, however, can work with them to fill gaps in the care they provide.

Besides raising funds to set up a playground in the orphanage, “we began with an eight-hour-a-day prog­ramme offering a better ratio of carers to babies. We paid the nannies’ salaries with money raised through donations from adoptive parents”, Smith recalls.

When the Dianjiang orphanage closed, First Hugs moved to Xinxiang, where it provides 24-hour care and trains staff.

“The past few years we have travelled there with a phy­sio­therapist and have offered training in brain develop­ment, the importance of nurture, and basic physical activi­ties and games to help kids develop on target,” says Smith.

In the 15 years she has been working with abandoned Chinese children, Smith has seen some of the changes noted by Cai. “China’s orphanages are better able to offer a higher ratio of carers to children. The kids overall look healthier,” Smith says.

But healthy kids are increasingly rare. “When we adop­ted, 15-plus years ago, there were many healthy girls in China’s orphanages. But that is not the case today. Orphans in China now are children with special needs,” says Smith.

Although Cai claims international adoptions still make up about half of the total at the Shanghai orphanage – most bound for the US – both AFAC and First Hugs advise parents waiting for a healthy child to give up.

“The waiting time for families in Spain deemed appro­priate to adopt in China is more than 12 years,” says Acero. “And that period keeps increasing, so parents will be of grandparents’ age by the time they are assigned a child.

“Sometimes, desperate parents choose to change their application to the ‘green channel’ [the name Spain gives to the adoption of children with special needs] to shorten the waiting time. But they should be careful,” warns Acero.

“Chinese authorities are opaque with the information they provide and, even though adoptive parents can [in theory] choose the degree of disability or illness they are willing to accept, some may be more severe than anticipated.

“Many times, our doctors’ diagnoses are very different to those made by the Chinese.”

The Briton who introduced foster care to China

Smith is forthright: “I would never advise anyone to adopt any child, anywhere, unless they were willing to manage possible special needs and the emotional needs that come from the loss that is adoption.”

Nevertheless, Noemí Rodríguez, a 40-something from Spain’s Castilla-La Mancha region, is taking her chances and will soon travel to China. In 2006, she adopted a healthy girl from Yunnan province who is now 14. But Rodríguez, now divorced, had to switch to the green channel to get quicker approval for her second adoption. The Hefei Children’s Welfare Institute, in Anhui province, has assigned her a one-year-old boy.

“I believe Chinese orphanages sweeten the children’s stories and underestimate their diseases. I got the boy’s medical records and I’ve consulted Spanish doctors. I’ve also got videos and he seems OK. But I can’t help worrying, because I don’t think I’m ready to take care of someone who needs a lot of special assistance,” confesses Rodríguez, who has paid more than €1,000 (HK$8,800) for the required paperwork and is hesitating before giving the €5,000 donation the Hefei orphanage has suggested she make.

Another Spanish woman, who adopted three Chinese children and asks not to be named, raises concerns about emotional scars. She had no trouble with the daughter she adopted from Anhui in 2005, but complica­tions arose with her two sons, who came via the green channel, one from Guangdong province, in 2010, the other from the Shanghai orphanage, in 2012. Both were born with a cleft lip and adopted when they were five years old, but the woman believes they were victims of some kind of abuse, too.

“The eldest suffers from anxiety,” she says. “He scratches himself until the skin peels off and his nails break. He is often awoken by nightmares and has strong episodes of rage and anger.”

She joined Facebook groups for American adoptive parents and found many instances of children coming from China with similar symptoms.

“One of my sons told me that [care home workers] used to put his head into a pot filled with water every time he peed on himself,” says the woman.

Post Magazine has seen posts by other parents who suspect their children were subjected to physical and sexual abuse, but Acero dismisses their fears: “We can’t rule out some particular cases here and there, because abuse is a worldwide shame, but we’ve never found any proof of it. I’m more inclined to believe that parents mistake the emotional distress usual in adopted children, especially among those older and with certain mental disorders, for abuse.”

At the Shanghai orphanage, Cai’s team keeps track of adopted children, to make sure they adapt to their new homes. “We follow up with families, who send back information about their development, and sometimes we talk to them through the internet,” she says.

Every Lunar New Year, those living nearby return for a gathering. Others come from abroad, and a few arrive looking for answers.

Many of the children adopted after the boom driven by The Dying Rooms are becoming young adults and are starting to wonder about their roots.

“We have had cases of adopted children looking for their parents, and we understand their need to know. We don’t withhold any information, but we truly don’t know who their parents are,” says Cai.

Since 1995, standards appear to have improved mark­edly for the children who find themselves in one of China orphanages. But is there more that could be done?

“The free prenatal checks available in rural areas should be extended to the cities, so the country can further prevent the birth of unhealthy children. The cost of such checks is clearly lower than that of the assistance that dis­abled babies require,” Ma Xu, head of the National Health Com­mis­sion, was quoted as saying in a Xinhua report. “Improving the environment is also key. Atmospheric and water pollution, as well as unsafe food, drive up the number of miscarriages and birth defects in newborn babies.”

Cai believes the number of children under her care will continue to decline. And Smith hopes there will one day be no need for her NGO: “Adoptive parents are not owed anything. It is a privilege to adopt children.

“The best news would be when there is never a need for adoption.”