Barrett: Birth Tourism – An Opinion

Yet another sensible commentary by a medical professional:

Personally, one of the things that I find most enjoyable about my position as an academic chair is the collaborative discussion amongst fellow academic chairs in a monthly meeting, facilitated by the Society of Obstetricians and Gynaecologists of Canada (SOGC). Recently, we brought up the topic of birth tourism, which prompted lively discussion, passionate views and the suggestion to write this editorial. Despite different jurisdictions, approaches, and models, there was unanimity on one aspect, and that is to clearly define birth tourism; the “deliberate travel to another country with the purpose of giving birth in that country”. Birth tourism is often motivated to attain citizenship in the long term or to attain medical care that is perceived to be better than in the home country. It is important to delineate that birth tourism is NOT a birth occurring in Canada by a person who happens to be away from their country of citizenship, because of work, study, or as a refugee.

The concept of and the practice of birth tourism is complicated from the patient’s, the healthcare team’s, the facility’s, and the healthcare system’s perspectives. Birth tourism has been recognized as an issue in Canada for some time, but became less prevalent during the COVID-19 pandemic with travel restrictions in place for international travel. Now, as we struggle because our health human resources are in crisis and our systems are struggling in every province and territory, the issue of birth tourism and its impact on our healthcare providers, our patients, our hospitals, and our healthcare systems is a matter of concern once again.

In my personal opinion, Canadian hospitals and physicians should have absolutely zero tolerance for birth tourism, declining to accept these patients into care while concurrently ensuring that patients in Canada for other legitimate reasons, who tend to be underserved, are able to receive unrestricted healthcare without imposing undue financial burden or stress.

In my previous life as a busy clinician, I remember the frustration when the leadership team of a hospital essentially declined to provide services to any patient without provincial insurance coverage, unless they were a refugee, a student, or were in Canada for another work-related reason. Of course, patients presenting as emergencies would be treated without hesitation. In retrospect, despite enjoying the direct re-imbursement that this practice facilitates, I realize now that the leadership team were correct.

They are correct because the facilitation of birth tourism causes everyone to suffer. Mostly, of course, our patient, Canadians, or those here in our country as refugees or here to work or to study.

I do not have to provide any annotated references for the sorry state of affairs in our hospitals in which we currently do not have the resources to provide an acceptable level for those requiring obstetrical and gynaecologic services. Waiting time for uro-gynaecological service is more than 18 months in most of our centres. The thought that even ONE patient seeking birth tourism would potentially take either an obstetrical spot out of our allocated hospital quota, or even worse, a spot on the gynaecologic waiting list, should be enough to unite all in a position that anything that in any way facilitates this practice should be frowned upon.

But that is not the only reason; our hospitals suffer too. A recent publication points to the fact that routinely, hospitals are left with significant shortfalls when a planned low-risk birth goes wrong and babies spend months in the intensive care unit. More specifically, the birth tourist had planned to spend CAD 10 000 for the birth of a baby – not $300 000 caring for the baby when things go wrong.

Finally, the patients may also suffer. There are many reports of people being fleeced by unethical individuals who have charged them large sums of money up-front to facilitate this industry. Finally, although I will not provide specific examples, we the healthcare providers may suffer too. Tempted by large sums of money, even the best of us can be tempted into poor practice.

In my opinion, we must firmly champion the provision of care to patients who are in Canada for work or study or as refugees without demanding excessive payments from them. We must not tempt ourselves to take advantage of the vulnerable or the unlucky. Instead we should unite in a firm stand against birth tourism by refusing to accept the non-urgent planned and deliberate birth tourists in our hospitals, rather than devising elaborate flow diagrams and/or fee schedules that facilitate and may in reality encourage the process.

Our country, our healthcare providers, and our system deserve this.

John F.R. Barrett, Department of Obstetrics and Gynecology, McMaster University

Source: Birth Tourism – An Opinion