Reaction to Fifth Estate segment on birth tourism

I was given a copy of this letter to CBC complaining of the segment on birth tourism on the Fifth Estate. CanadaLand also had a critical segment but one that was reasonably balanced.

My take is different. The segment focuses on birth tourism, characterized the 5,000 as non-residents and not all birth tourists, and had some good interviews with medical practitioners and politicians.

As to the numbers, I had shared my CIHI numbers with the Fifth Estate and had a number of exchanges regarding what they included and their limitations and do not believe these were mischaracterized as all 5,000 being birth tourists.

In any case, we will have better numbers hopefully late spring/early summer given the work underway by IRCC, CIHI and StatsCan to link immigration status and healthcare data, thus allowing us to isolate those on visitor visas from other temporary residents.

My impression is that some of these critiques reflect an unwillingness to consider that birth tourism is an issue (it certainly is in Richmond) and/or a means to raise other valid healthcare-related issues of asylum seekers and other precarious groups:

Dear Mr Nagler,

I wish to express my concerns about the seriously inaccurate and biased content of the 5th Estate’s documentary “Passport babies: The growing shadow industry of birth tourism”, broadcast on January 5, 2020, and the accompanying web articles.

Since 2003, I have worked as a researcher at the SHERPA Research Centre, affiliated with McGill University, focusing on the impact of public policies on the health and well-being of asylum seekers and precarious status migrants in Canada. Since 2012, one of my main research areas has been access to health care for asylum seekers and other precarious status migrants, and I have co-authored a number of scientific publications on this topic.

The major problem with the “Passport babies” documentary is that it incorrectly and repeatedly suggests that the 5000 ‘non-resident’ births per year in Canada all involve tourists who come to Canada for the sole purpose of conferring Canadian citizenship on the baby.

This phenomenon does exist. However, the documentary fails to explain that the category of ‘non-resident births’ is far broader than tourists. Although precise figures are very difficult to obtain, there is every reason to believe that babies born to tourists represent only a small minority of the 5000 ‘non-resident’ births per year in Canada. If the 5th Estate had done even minimal research on the question, they would have found this out. They clearly failed to conduct a basic, balanced investigation into the topic, and consequently produced a documentary that is very seriously misleading and inaccurate.

The figure of 5000 ‘non-resident’ babies per year is drawn from hospital financial databases. The category involved is actually people who do not have medical insurance and (usually) who do not have permanent status in Canada, rather than being people who do not live in Canada. The content of hospitals’ ‘non-resident’ category varies somewhat from province to province, and even between hospitals, but it typically includes:

  • International students in Canada with a temporary study visa. They generally have private insurance, but this typically does not cover costs related to pregnancy and childbirth, or only a small fraction thereof.
  • Some categories of temporary foreign workers (some temporary work visas allow access to public health care, others do not)
  • Non-status (undocumented) migrants living in Canada. This includes people who are in the process of regularizing their status, e.g., people who have applied for permanent residence based on humanitarian or compassionate reasons.
  • Canadian expatriates, who have lost their entitlement to provincial health coverage because they live outside of the country
  • Tourists who are in Canada for a brief period, with a temporary visitor’s visa

The reason that hospitals place these heterogeneous groups in a single category is because 1) they all have to pay their hospital bills out of their own pockets (no public or private medical insurance) and 2) they are either physically residing outside of Canada (in the case of expatriates and tourists) OR are residing in Canada, but with temporary status. In short, the category is based on billing procedure. Note that asylum seekers (refugee claimants) are in a different category because they are covered by the Interim Federal Health Program (IFHP).

Sadly, there are tens of thousands of people living, working or studying, and paying taxes in Canada who do not have any public health care coverage. And even for those who have private medical insurance, childbirth costs are usually not covered. Most have temporary visas (student or work visas), while others are currently without formal status. In either case, these are not people who have come to Canada for a few months in order to have a ‘passport baby’, but rather people who are here for work or study who happen to get pregnant while they are here. In Québec, for example, hospitals typically charge about 10,000$ to 15,000$ for a birth without complications, and far more if there are complications (e.g., C-section). Unsurprisingly, this population often has difficulty paying these very steep bills.

The situation of tourists who deliberately come to Canada in order to have a ‘passport baby’ is very different. This is the group that is portrayed in the 5th Estate’s documentary. Typically, these are wealthy people who can well afford to pay the hospital and doctor’s bills, as well as the cost of the stay in Canada.

The fees charged to all individuals in the ‘non-resident’ group are unregulated. Typically, hospitals charge at least 3 times as much as they could claim from the public health insurance system. If the ‘non-resident’ is able to pay, this can be very lucrative for the hospitals and doctors. On the other hand, if the person is unable to pay (as is often the case for people living in Canada with a temporary visa or without status), the hospital may be unable to collect on the debt.

It is impossible to know what proportion of the 5000 babies in the hospitals’ ‘non-resident’ category are born to tourists who have come to Canada for the sole reason of having a ‘passport baby’. Logically, however, there is every reason to believe that this is only a minority, simply because the other groups – e.g., international students and non-status migrants living in Canada –   number in the tens of thousands.

To sum up, the 5th Estate documentary contains two major errors:

  • It incorrectly implies that the 5000 ‘non-resident’ babies born in Canada per year are all born to tourists seeking to have a ‘passport baby’. The documentary completely omits any mention of the groups that compose the majority of this category, who are almost all people living in Canada for extended periods in order to study or work.
  • With regard to the implications for the Canadian health system, the documentary confuses two separate issues.
    • Tourists who come to Canada to have ‘passport babies’ typically pay their hospital and medical bills; hospitals and doctors tend to see them as a lucrative source of income. There may be legitimate concerns that some hospitals prefer to prioritize the needs of these high-paying patients over those of people living in Canada.
    • On the other hand, people living in Canada with a temporary visa or without status may have great difficulty paying hospital and doctor’s fees associated with childbirth, especially if there are complications. Understandably, hospitals are concerned that some of these people may be unable to pay. Many experts in the field argue that public health insurance should extend to all people who are actually living in Canada (including those with a temporary visa or without status), at least for certain medical procedures, including childbirth. This is an ongoing debate.

Based on a fundamentally flawed analysis of the situation, the 5th Estate documentary concludes that it might be appropriate to change Canada’s laws in order to deny citizenship to babies born in Canada if the parents are neither citizens nor permanent residents. The documentary implies that this would affect only babies born to the tourists portrayed in the documentary.

In fact, it is very likely that the vast majority of these babies are born to international students, temporary foreign workers or people living in Canada without formal status. Many of the parents (notably international students) will apply for permanent residency in Canada, and eventually become citizens. Depriving their children of citizenship would be an extremely grave decision and a fundamental shift in Canadian values. It is unconscionable for the 5th Estate to present an inaccurate and misleading documentary in support of such a policy change.

I would respectfully urge you to take steps to ensure that appropriate retractions or corrections are issued concerning the 5thEstate’s documentary ‘Passport Babies’.

Janet Cleveland PhD

SHERPA Research Centre

University Institute with regard to Cultural Communities

CIUSSS Centre-Ouest de l’Ile de Montréal and McGill University


About Andrew
Andrew blogs and tweets public policy issues, particularly the relationship between the political and bureaucratic levels, citizenship and multiculturalism. His latest book, Policy Arrogance or Innocent Bias, recounts his experience as a senior public servant in this area.

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