Bulletin of the World Health Organization
Volume 92, Number 3, March 2014, 153-228
http://www.who.int/bulletin/volumes/92/3/en/

Monitoring polio supplementary immunization activities using an automated short text messaging system in Karachi, Pakistan
AM Kazi, A Murtaza, S Khoja, AK Zaidi & SA Ali
http://www.who.int/bulletin/volumes/92/3/13-122564-ab/en/

Abstract
Problem
Polio remains endemic in many areas of Pakistan, including large urban centres such as Karachi.

Approach
During each of seven supplementary immunization activities against polio in Karachi, mobile phone numbers of the caregivers of a random sample of eligible children were obtained. A computer-based system was developed to send two questions – as short message service (SMS) texts – automatically to each number after the immunization activity: “Did the vaccinator visit your house?” and “Did the enrolled child in your household receive oral polio vaccine?” Persistent non-responders were phoned directly by an investigator.

Local setting
A cluster sampling technique was used to select representative samples of the caregivers of young children in Karachi in general and of such caregivers in three of the six “high-risk” districts of the city where polio cases were detected in 2011.

Relevant changes
In most of the supplementary immunization activities investigated, vaccine coverages estimated using the SMS system were very similar to those estimated by interviewing by phone those caregivers who never responded to the SMS messages. In the high-risk districts investigated, coverages estimated using the SMS system were also similar to those recorded – using lot quality assurance sampling – by the World Health Organization.

Lessons learnt
For the monitoring of coverage in supplementary immunization activities, automated SMS-based systems appear to be an attractive and relatively inexpensive option. Further research is needed to determine if coverage data collected by SMS-based systems provide estimates that are sufficiently accurate. Such systems may be useful in other large-scale immunization campaigns.

Globalization and Health
[Accessed 1 March 2014]
http://www.globalizationandhealth.com/

Research
Diabetes in Algeria and challenges for health policy: a literature review of prevalence, cost, management and outcomes of diabetes and its complications
Lamri L, Gripiotis E and Ferrario A
Globalization and Health 2014, 10:11 (24 February 2014)
Published: 24 February 2014

Abstract (provisional)
Background
Diabetes has become an increasingly prevalent and severe public health issue in Algeria. This article investigates the prevalence, the cost and the management of this disease. Its first objective is to better understand the burden (both from an epidemiological and economic perspective) and management of diabetes. The second objective is to understand the health policy strategy adopted by Algeria in order to respond to the disease.

Methods
We conducted a literature review of prevalence, costs, management and outcomes of diabetes and its complications. This was complemented by data compilations and results of expert consultations.

Results
The epidemiology of diabetes is continually evolving and is becoming more problematic. The national evidence suggests that the prevalence of diabetes in Algeria has increased from 6.8% in 1990 to 12.29% in 2005, but is quite higher among certain groups and areas of the country. This disease affects all population groups, especially 35-70 year olds, who constitute a large segment of the working population. There are very few estimates of the cost of diabetes. These include a 1998 study on the total cost of type 1 diabetes (USD 11.6 million, which, inflated to 2013 value, totals to USD 16.6 million), a study on the cost of complications in 2010 (at 2013 value, ranging from USD 141 for first-year treatment of peripheral vascular disease to USD 30,441 for first-year cost of renal transplantation) and the 2013 IDF estimates of total cost of type 1 and type 2 diabetes (USD 513 million).

Conclusions
As the prevalence of diabetes continues to increase, the financial burden will increasingly weigh heavily on social security resources and the government budget. Future priorities must focus on empowering general practitioners in treating type 2 diabetes, improving screening of diabetes and its complications, tackling the growing obesity epidemic, strengthening health information systems and implementing the national diabetes prevention and control plan.

International Journal of Epidemiology
Volume 43 Issue 1 February 2014
http://ije.oxfordjournals.org/content/current

Frequent relocations between asylum-seeker centres are associated with mental distress in asylum-seeking children: a longitudinal medical record study
Simone Goosen1,2,*, Karien Stronks1 and Anton E Kunst1
Author Affiliations
1Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands and 2Netherlands Association for Community Health Services, Utrecht, The Netherlands
↵*Corresponding author. Netherlands Association for Community Health Services, P.O. Box 85300, 3508 AH Utrecht, The Netherlands. E-mail: sgoosen@ggd.nl
Accepted October 14, 2013.
http://ije.oxfordjournals.org/content/43/1/94.abstract

Abstract
Background
There are concerns about negative effects of relocations between asylum-seeker centres on the mental health of asylum-seeking children. However, empirical evidence comes from cross-sectional studies only. In this longitudinal medical record study, we aimed to assess: (i) whether relocations during the asylum process are associated with the incidence of newly recorded mental distress in asylum-seeking children; and (ii) whether this association is stronger among vulnerable children.

Methods
Data were extracted from the electronic medical records database of the Community Health Services for Asylum Seekers in The Netherlands (study period: 1 January 2000–31 December 2008). Included were 8047 children aged 4 to 17 years. Case attribution was done using International Classification of Primary Care codes for mental, behavioural or psychosocial problems. The association between annual relocation rate and incidence of mental distress was measured using relative risks (RR) estimated with multivariate Cox regression models.

Results
A high annual relocation rate (>1 relocation/year) was associated with increased incidence of mental distress [RR = 2.70; 95% confidence interval (CI) 2.30–3.17]. The relative risk associated with a high annual relocation rate was larger in children who had experienced violence (RR = 3.87; 95% CI 2.79–5.37) and in children whose mothers had been diagnosed with post-traumatic stress disorder or depression (RR = 3.40; 95% CI 2.50–4.63).

Conclusions
The risk of mental distress was greater in asylum-seeking children who had undergone a high annual relocation rate. This risk increase was stronger in vulnerable children. These findings contribute to the appeal for policies that minimize the relocation of asylum seekers.

.
Commentary: Reducing further harm to asylum-seeking children. The global human rights context
Karen Zwi1, and Sarah Mares2
Author Affiliations
1Sydney Children’s Hospital Network, Sydney Children’s Community Health Centre, Randwick, Australia and 2Consultant Infant Child and Family Psychiatrist in Private Practice, Sydney, Australia
Accepted December 5, 2013.
http://ije.oxfordjournals.org/content/43/1/104.extract

Extract
Increasing numbers of adults and children are seeking asylum across the globe. Many Western nations, unlike The Netherlands, have responded to asylum seekers with incarceration and other harsh immigration practices, and there is mounting evidence of the psychological harm associated with detention of already vulnerable children and the adults who care for them.1

Australia (the country of residence of the authors) presents a good example of an increase in the ‘policies of deterrence’,2 with diversion of processing responsibility to poorer neighbouring countries, involuntary relocation between detention centres, reduced rights to family reunification and reintroduction of temporary protection visas, which reduce the length of protection offered and provide no long-term certainty. The shifting of responsibility offshore means involuntary relocations and substandard conditions for detainees (including children and unaccompanied minors), despite well-documented evidence of harm. Political leadership on the issue has led the voting public to view racism and xenophobia as acceptable and in the national interest, exemplified by the recent nomenclature change in Australia of asylum seekers to ‘illegals’, in addition to the long-held policies of mandatory detention (often indefinite) for all asylum seekers arriving by boat, including unaccompanied minors and children.

Journal of Community Health
Volume 39, Issue 2, April 2014
http://link.springer.com/journal/10900/39/1/page/1

Attitudes Affecting the Potential Use of Human Papillomavirus Vaccination: A Survey of Health Promotion Students in Mexico City
Angélica Dolores Ramírez-Rios, William Bonnez
http://link.springer.com/article/10.1007/s10900-013-9770-1

Abstract
Our aim was to explore the knowledge and attitudes of Mexican college students towards human papillomavirus (HPV) vaccination. We conducted a written questionnaire survey of a group of male and female undergraduate students in Health Promotion at the Autonomous University of Mexico City. A total of 163 subjects (40 males and 123 females, median age 24 years) took part. Only 13 % identified the risks factors of cervical cancer and 32 % knew the diseases caused by HPV. Females had a better knowledge than males on matters related to HPV vaccine. Seventy percent (110 of 157) of the respondents completely agreed on the importance of including protection against genital warts in the vaccine. Eighty-eight percent (141/161) of subjects would have accepted receiving the vaccine, but 8 % (13/161) were ambivalent. There was a strong desire in this group of young adults who are not yet included in the current vaccination programs to receive the HPV vaccine, preferably the quadrivalent one. In conclusion, attitudes towards vaccination could be complex and opposed.

Ethnic and Gender Differences in HPV Knowledge, Awareness, and Vaccine Acceptability Among White and Hispanic Men and Women
Rachel A. Reimer, Julie A. Schommer, Amy E. Houlihan, Meg Gerrard
http://link.springer.com/article/10.1007/s10900-013-9773-y

Abstract
The purpose of this study was to examine factors associated with human papillomavirus (HPV) knowledge and awareness, and HPV vaccination among White and Hispanic males and females. Differences in HPV knowledge, sources of information, vaccine awareness, vaccination status, and interest in vaccination were examined. A community sample was recruited from local health care clinics in a medium sized Midwestern city between May 2010 and December 2011. Participants (N = 507) were White (n = 243) and Hispanic, males (n = 202) and females between the ages of 15–30. Results indicate that White and female participants were significantly more likely to have heard of HPV, have higher levels of HPV knowledge, have been diagnosed with HPV, and be aware of the HPV vaccine for women. White and female participants were also more likely to have heard of HPV from their physician and were significantly more interested in receiving the HPV vaccine in the future. There was no effect of ethnicity on interest in the vaccine per a doctor’s recommendation, however. Findings suggest that Whites and females have greater levels of HPV awareness and knowledge and that, while Hispanic participants are less likely than White participants to be told about the HPV vaccine from their provider, they may be equally receptive to such a recommendation.

Journal of Law, Policy and Globalization
Vol 22 (2014)
http://www.iiste.org/Journals/index.php/JLPG/issue/current

Extradition under International Law: Tool for Apprehension of Fugitives
Abegunde Babalola Esq
http://www.iiste.org/Journals/index.php/JLPG/article/view/11045

Abstract
Extradition is intended to bring an end of the era when criminals would have a sunny haven anywhere in the world. This paper examined its rationale, nature, principles and practices and conceptual framework. This paper also examined selected statistics, dynamics and politics of extradition and ends with concluding remarks.The aim of this paper is to emphasis on the importance of extradition as a potent weapon to reduced impunity by ensuring that there is no save haven for dictators, tyrants, cruel rulers and common criminals.This paper is a desk-based research which relies on both primary and secondary  sources of data which were subjected to contentual and contextual analysis.It is the finding of the author herein that extradition can only be effective of states demonstrate genuine will-power and down-play politics in extradition matters. Crime will be reduced if criminals know that they will be fished out.

The Lancet Global Health
Mar 2014   Volume 2  Number 3  e117 – 181
http://www.thelancet.com/journals/langlo/issue/current

Maternal mortality in adolescents compared with women of other ages: evidence from 144 countries
Dr Andrea Nove PhD a, Prof Zoë Matthews PhD b, Sarah Neal PhD b, Alma Virginia Camacho MD c
http://www.thelancet.com/journals/langlo/article/PIIS2214-109X%2813%2970179-7/abstract

Summary
Background
Adolescents are often noted to have an increased risk of death during pregnancy or childbirth compared with older women, but the existing evidence is inconsistent and in many cases contradictory. We aimed to quantify the risk of maternal death in adolescents by estimating maternal mortality ratios for women aged 15—19 years by country, region, and worldwide, and to compare these ratios with those for women in other 5-year age groups.

Methods
We used data from 144 countries and territories (65 with vital registration data and 79 with nationally representative survey data) to calculate the proportion of maternal deaths among deaths of females of reproductive age (PMDF) for each 5-year age group from 15—19 to 45—49 years. We adjusted these estimates to take into account under-reporting of maternal deaths, and deaths during pregnancy from non-maternal causes. We then applied the adjusted PMDFs to the most reliable age-specific estimates of deaths and livebirths to derive age-specific maternal mortality ratios.

Findings
The aggregated data show a J-shaped curve for the age distribution of maternal mortality, with a slightly increased risk of mortality in adolescents compared with women aged 20—24 years (maternal mortality ratio 260 [uncertainty 100—410] vs 190 [120—260] maternal deaths per 100 000 livebirths for all 144 countries combined), and the highest risk in women older than 30 years. Analysis for individual countries showed substantial heterogeneity; some showed a clear J-shaped curve, whereas in others adolescents had a slightly lower maternal mortality ratio than women in their early 20s. No obvious groupings were apparent in terms of economic development, demographic characteristics, or geographical region for countries with these different age patterns.

Interpretation
Our findings suggest that the excess mortality risk to adolescent mothers might be less than previously believed, and in most countries the adolescent maternal mortality ratio is low compared with women older than 30 years. However, these findings should not divert focus away from efforts to reduce adolescent pregnancy, which are central to the promotion of women’s educational, social, and economic development.

Funding
WHO, UN Population Fund.

The Lancet Global Health
Mar 2014   Volume 2  Number 3  e117 – 181
http://www.thelancet.com/journals/langlo/issue/current

Socioeconomic inequality in neonatal mortality in countries of low and middle income: a multicountry analysis
Britt McKinnon MSc a, Sam Harper PhD a, Prof Jay S Kaufman PhD a, Yves Bergevin MD b
http://www.thelancet.com/journals/langlo/article/PIIS2214-109X%2814%2970008-7/abstract

Summary
Background
Neonatal mortality rates (NMRs) in countries of low and middle income have been only slowly decreasing; coverage of essential maternal and newborn health services needs to increase, particularly for disadvantaged populations. Our aim was to produce comparable estimates of changes in socioeconomic inequalities in NMR in the past two decades across these countries.

Methods
We used data from Demographic and Health Surveys (DHS) for countries in which a survey was done in 2008 or later and one about 10 years previously. We measured absolute inequalities with the slope index of inequality and relative inequalities with the relative index of inequality. We used an asset-based wealth index and maternal education as measures of socioeconomic position and summarised inequality estimates for all included countries with random-effects meta-analysis.

Findings
24 low-income and middle-income countries were eligible for inclusion. In most countries, absolute and relative wealth-related and educational inequalities in NMR decreased between survey 1 and survey 2. In five countries (Cameroon, Nigeria, Malawi, Mozambique, and Uganda), the difference in NMR between the top and bottom of the wealth distribution was reduced by more than two neonatal deaths per 1000 livebirths per year. By contrast, wealth-related inequality increased by more than 1·5 neonatal deaths per 1000 livebirths per year in Ethiopia and Cambodia. Patterns of change in absolute and relative educational inequalities in NMR were similar to those of wealth-related NMR inequalities, although the size of educational inequalities tended to be slightly larger.

Interpretation
Socioeconomic inequality in NMR seems to have decreased in the past two decades in most countries of low and middle income. However, a substantial survival advantage remains for babies born into wealthier households with a high educational level, which should be considered in global efforts to further reduce NMR.

Funding
Canadian Institutes of Health Research.

The Lancet Infectious Diseases
Mar 2014  Volume 14  Number 3   p173 – 256
http://www.thelancet.com/journals/laninf/issue/current

Editorial
Pandemic potential of emerging influenza
The Lancet Infectious Diseases
Preview |
In January this year, the first case of highly pathogenic avian influenza H5N1 was detected in the Americas when a Canadian man returning from Beijing fell ill and subsequently died. January also saw a sharp upturn in the number of cases of H7N9 avian influenza in China with 169 cases detected in 1 month, compared with 144 up to the end of last year since it was first identified in March 2013. Another familiar virus, 2009 pandemic influenza A H1N1 has also been hitting the headlines in Egypt, where there have been over 300 cases and around 38 deaths since December, and in Mexico over 400 deaths have been associated with H1N1 this year.

Review
Pandemic influenza A H1N1 vaccines and narcolepsy: vaccine safety surveillance in action
Charlotte I S Barker, Matthew D Snape
Preview |
The 2009 influenza A H1N1 pandemic placed unprecedented demand on public health authorities and the vaccine industry. Efforts were coordinated internationally to maximise the speed of vaccine development, distribution, and delivery, and the European Union’s novel fast-track authorisation procedures mandated increased postmarketing surveillance to monitor vaccine safety. Clinicians in Finland and Sweden later identified an apparent increase in the incidence of narcolepsy associated with a specific adjuvanted pandemic influenza vaccine.

The Pediatric Infectious Disease Journal
March 2014 – Volume 33 – Issue 3  pp: 233-335,e67-e86
http://journals.lww.com/pidj/pages/currenttoc.aspx

A Consensus Statement: Meningococcal Disease Among Infants, Children and Adolescents in Latin America
Rüttimann, Ricardo Walter; Gentile, Angela; Parra, Mercedes Macias; More

Abstract
Invasive meningococcal disease is a serious infection that occurs worldwide. Neisseria meningitidis remains one of the leading causes of bacterial meningitis in all ages. Despite the availability of safe and effective vaccines against invasive meningococcal disease, few countries in Latin America implemented routine immunization programs with these vaccines. The Americas Health Foundation along with Fighting Infectious Disease in Emerging Countries recently sponsored a consensus conference. Six experts in infectious diseases from across the region addressed questions related to this topic and formulated the following recommendations: (1) standardized passive and active surveillance systems should be developed and carriage studies are mandatory; (2) a better understanding of the incidence, case fatality rates and prevalent serogroups in Latin America is needed; (3) countries should make greater use of the polymerase chain reaction assays to improve the sensitivity of diagnosis and surveillance of invasive meningococcal disease; (4) vaccines with broader coverage and more immunogenicity are desirable in young infants; (5) prevention strategies should include immunization of young infants and catch-up children and adolescents and (6) because of the crowded infant immunization schedule, the development of combined meningococcal vaccines and the co-administration with other infant vaccines should be explored.

PLoS One
[Accessed 1 March 2014]
http://www.plosone.org/

Research Article
Monitoring What Governments “Give for” and “Spend on” Vaccine Procurement: Vaccine Procurement Assistance and Vaccine Procurement Baseline
E. A. S. Nelson mail, David E. Bloom, Richard T. Mahoney
Published: February 20, 2014
DOI: 10.1371/journal.pone.0089593
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0089593

Abstract
Background
The Global Vaccine Action Plan will require, inter alia, the mobilization of financial resources from donors and national governments – both rich and poor. Vaccine Procurement Assistance (VPA) and Vaccine Procurement Baseline (VPB) are two metrics that could measure government performance and track resources in this arena. VPA is proposed as a new subcategory of Official Development Assistance (ODA) given for the procurement of vaccines and VPB is a previously suggested measure of the share of Gross Domestic Product (GDP) that governments spend on their own vaccine procurement.

Objective
To determine realistic targets for VPA and VPB.

Methods
Organization for Economic Co-Operation and Development (OECD) and World Bank data for 2009 were analyzed to determine the proportions of bilateral ODA from the 23 Development Assistance Committee (DAC) countries disbursed (as % of GDP in current US$) for infectious disease control. DAC country contributions to the GAVI Alliance for 2009 were assessed as a measure of multilateral donor support for vaccines and immunization programs.

Findings
In 2009, total DAC bilateral ODA was 0.16% of global GDP and 0.25% of DAC GDP. As a percentage of GDP, Norway (0.013%) and United Kingdom (0.0085%) disbursed the greatest proportion of bilateral ODA for infectious disease control, and Norway (0.024%) and Canada (0.008%) made the greatest contributions to the GAVI Alliance. In 2009 0.02% of DAC GDP was US$7.61 billion and 0.02% of the GDP of the poorest 117 countries was US$2.88 billion.

Conclusions
Adopting 0.02% GDP as minimum targets for both VPA and VPB is based on realistic estimates of what both developed and developing countries should spend, and can afford to spend, to jointly ensure procurement of vaccines recommended by national and global bodies. New OECD purpose codes are needed to specifically track ODA disbursed for a) vaccine procurement; and b) immunization programs.

PLoS Neglected Tropical Diseases
January 2014
http://www.plosntds.org/article/browseIssue.action

Editorial
Indonesia: An Emerging Market Economy Beset by Neglected Tropical Diseases (NTDs)
Melody Tan, Rita Kusriastuti, Lorenzo Savioli, Peter J. Hotez mail
Published: February 27, 2014
DOI: 10.1371/journal.pntd.0002449
http://www.plosntds.org/article/info%3Adoi%2F10.1371%2Fjournal.pntd.0002449;jsessionid=5C7F466B45FE35D9D6526E55F6C5F59E

Despite an enormous population and growing economy, the nation of Indonesia has some of the world’s highest concentrations of neglected tropical diseases (NTDs). These NTDs may thwart future national growth and recent gains. Yet, Indonesia and its Ministry of Health, together with the World Health Organization (WHO), have embarked on an ambitious effort to quickly assemble a health and scientific infrastructure suitable for eliminating its NTDs.

Revista Panamericana de Salud Pública/Pan American Journal of Public Health (RPSP/PAJPH
January 2014 Vol. 35, No. 1
http://www.paho.org/journal/index.php?option=com_content&view=article&id=137&Itemid=233&lang=en

Gasto en salud, la desigualdad en el ingreso y el índice de marginación en el sistema de salud de México [Health expenditures, income inequality, and the marginalization index in Mexico’s health system]
Carlos Eduardo Pinzón Florez, Ludovic Reveiz, Elvaro J. Idrovo y Hortensia Reyes Morales

Functioning outcomes for abused immigrant women and their children 4 months after initiating intervention [Resultados en cuanto al desempeño de mujeres inmigrantes maltratadas y sus hijos, 4 meses después de iniciada una intervención]
Sandra K. Cesario, Angeles Nava, Ann Bianchi, Judith McFarlane, and John Maddoux

Structural social determinants and catastrophic illnesses in municipalities in the Colombian department of Valle del Cauca [Determinantes sociales estructurales y enfermedades catastróficas en los municipios del departamento colombiano del Valle del Cauca]
Luis Miguel Tovar Cuevas and Fernando Arteaga Suárez

Fatores associados a cárie dental e doença periodontal em indígenas na América Latina: revisão sistemática [Factors associated with dental caries and periodontal diseases in Latin American indigenous peoples: a systematic review]
Pedro Alves Filho, Ricardo Ventura Santos e Mario Vianna Vettore

From Google Scholar+
Selected content from beyond the journals and sources covered above, aggregated from a range of Google Scholar monitoring algorithms and other monitoring strategies.

Intervention
November 2013 – Volume 11 – Issue 3 pp: 225-367
http://journals.lww.com/interventionjnl/pages/currenttoc.aspx
Do humanitarian crises offer opportunities for change? A critical review of the mental health and psychosocial support post emergency in the Republic of the Congo
Moayedoddin, Babak; Makaya, Christelle Nangho; Canuto, Alessandra
Abstract
Violent explosions rocked the city of Brazzaville (the capital of the Republic of the Congo) on 4 March 2012, officially causing more than 280 deaths and leaving approximately 15,000 people displaced. Two months after this event, despite a large number of people suffering from considerable psychological distress, few people had called for, or had received, appropriate mental health care or any external psychosocial support. A field evaluation, following this emergency, led to a critical review of the limited capacity of the mental health care system in Brazzaville to respond to the population’s needs. This evaluation also allowed a review of the current state of affairs in regard to mental health and psychosocial support by health care actors in Brazzaville. The crisis has, in this way, facilitated an increasing awareness and triggered a process of deeper examination of how to improve mental health care in the Republic of the Congo.

Refugee Survey Quarterly
Volume 32 Issue 4 December 2013
http://rsq.oxfordjournals.org/content/current
Introduction: Continuity and Change in Global Refugee Policy
Alexander Betts* and Gil Loescher**
Abstract
This special issue of the Refugee Survey Quarterly brings together a selection of thepapers from the conference on “Understanding Global Refugee Policy” organized by the Refugee Studies Centre to celebrate its 30th anniversary. One of the many notable themes to emerge from the conference was the extent to which that period has engendered continuity or change in global refugee policy. How has the agenda changed? Has the nature of the challenges facing policy-makers shifted over the last three decades? Has refugee policy become more politicised? Has finding solutions to refugee situations become more difficult? To what extent are main actors different? Is it still a fundamentally state-centric policy field? How have the main forums and institutions within which policy is made changed? The papers in this collection offer a window onto that question of continuity and change. In doing so, they address a range of important emerging themes and cover a wide set of geographical regions.

Human Organization
Volume 73, Number 1 / Spring 2014
http://sfaa.metapress.com/content/hp73713v2376/?sortorder=asc
The Quiet Migration Redux: International Adoption, Race, and Difference
Jessaca B. Leinaweaver1
1Population Studies and Training Center and the Center for Latin American and Caribbean Studies, Brown University
Abstract
Demographers frame international adoption primarily as an unusual kind of migration. This insight offers anthropologists new ways to think about kinship. Drawing on demographic scholarship and anthropological kinship and migration studies, this article develops a new and hybrid approach to international adoption as a complex social process that is both migratory and productive of kinship. Viewing international adoption as a form of migration reveals how the stated “push factors” and actual “pull factors” of international adoption do not align perfectly. Using an anthropological life course perspective, the article then explores how the experiences of these “migrants” and those close to them, over time, are better understood as racialization than solely the product of migration. Looking at adoptees’ lives through a migration lens reveals some of the persistent discomforts that prevent open conversations about racial difference and minority status in an adoptive context, that is, one where children have been caused to migrate, recruited into families. This article draws on data from ethnographic fieldwork with Spanish parents who have adopted Peruvian children to argue that international adoption is a unique form of immigration that produces a minority category within a majority population.