By Laura Smith-Spark
The row over pop star Madonna's intended adoption of 13-month-old David Banda from Malawi shows no sign of dying down.
Madonna's intended adoption of a boy from Malawi has made waves
Acres of column space have been devoted to discussion of the legality and the ethics of her decision to bring the boy to her London mansion.
Among critics' concerns was that the singer appeared to be following a recent trend among celebrities to look abroad for children, with Angelina Jolie adopting in Ethiopia last year.
But while the spotlight has fallen on orphans in Africa, in reality the continent is not often the first stop for Western adopters.
Even though more than 12 million children in sub-Saharan Africa have lost one or both parents to Aids, according to UN figures, relatively few children are adopted by families in the West.
In the US - where inter-country adoptions have tripled in 15 years to reach some 22,700 in 2005 - most children currently come from China, Russia, Guatemala and South Korea.
ORIGIN OF ORPHANS GIVEN US VISAS IN 2005
China - 7,906
Russia - 4,639
Guatemala - 3,783
South Korea - 1,630
Ukraine - 821
Source: US Department of State
The only African nation to feature in the top 10 countries of origin for adoptees to the US last year was Ethiopia, with 441 orphans given US visas, according to US state department figures.
In part this is because it is customary for African children to be taken in by the extended family.
However, the pressures of poverty and HIV infection increasingly mean orphans end up in over-stretched institutions - or struggle alone to look after younger brothers and sisters.
Recent political history and countries' individual adoption policies also play a role in directing prospective adoptive parents to one part of the world over another.
ORIGIN OF ORPHANS GIVEN US VISAS IN 1991
Romania - 2,594
Korea - 1,818
Peru - 705
Colombia - 521
India - 445
Source: US Department of State
Thousands of children were adopted from Romania in the 1990s in response to TV footage of desperate conditions in orphanages - but, since a moratorium on international adoptions was imposed in 2001, the number has fallen sharply.
China, having recently opened its doors to the West and with thousands of girls available for adoption, has now become the first port of call for many would-be adoptive parents.
Many Americans have adopted children from Korea, perhaps in response to their nation's involvement in the Korean War.
The US state department website notes that some parents have recently inquired about adopting from Iraq and Afghanistan - but points out that full adoption is not possible under local and Islamic law.
So what challenges face those parents who bring home a child from abroad to join their family?
Dr Larry Gray, co-founder of the International Adoption Clinic at the University of Chicago Comer Children's Hospital, stresses that it is not something to be undertaken lightly.
"Families often choose international adoption because they believe it's a speedier process - domestic adoption in the US can take a long time," he says.
However, international adoption "is not as quick as people think", he says, and the children involved can have greater medical and developmental problems than those adopted in the US.
Some are HIV positive or have tuberculosis or other infectious diseases. Many are affected by abuse or the trauma of being separated from their birth parents.
To complicate matters, there is no "one-size-fits-all" family, Dr Gray adds.
Prospective parents can be in their 20s, 30s or 40s - some infertile but many already with their own children - and the challenge is to maximise the adopted child's "fit" with its new home.
A chief concern among critics of international adoption is the lack of regulation governing the process - and the danger that children's needs are not put first.
Several dozen nations are signatories to the Hague Convention on Inter-Country Adoption, which seeks to protect children by requiring the same scrutiny of international as of domestic adoptions.
But the UN children's agency, Unicef, warns that lack of legal oversight in some countries "has spurred the growth of an industry around adoption, where profit, rather than the best interests of children, take centre stage".
It advises against allowing children to be adopted from countries affected by natural disasters, such as the Indian Ocean tsunami, because homes can often be found within their community.
There is a growing awareness worldwide of the potential harm that can be done in uprooting a child from its own culture and taking it to an alien land.
David Holmes, chief executive of the British Association for Adoption and Fostering, points out that inter-country adopters face "huge challenges".
Thousands of children were adopted from Romanian orphanages
"They will need to consider how best to reinforce the child's ethnic and cultural heritage and their sense of identity," he says. "Every adoption has challenges but this is the additional dimension."
Jonathan Pearce, of the charity Adoption UK, agrees that parents who adopt from abroad may need even more support than domestic cases.
Given that a failed adoption could mean the child ends up in the care system of its new country, the pressure for families to succeed is high.
So is it right or wrong to adopt a child from another country?
Mr Pearce says: "Not all [placements] are successful but those that are, are certainly better than the child being in an institution."
However, many charities agree that the key to helping children in poor countries is to provide the healthcare and support that keep families together in the first place.