A dangerous discourse prevails that draws on long-standing racist ideas about who deserves citizenship. Better data and a new focus are needed.

The latest in response to CBC’s Fifth Estate birth tourism episode with the same issue of conflating issues related to wealthy “birth tourists” and the cottage industry that supports them and those pertaining to other temporary residents, which appears to be the main focus of this and related articles. Working on a piece to unpack this and related data issues:

The phrase “birth tourism” has been used by media and political parties to derogatively describe the circumstances in which noncitizen women come to Canada to give birth; the suspicion is that the women do this so that the children can claim citizenship and thus take advantage of their birth country’s education and health care systems, and eventually the children can sponsor their parents to immigrate. At its 2018 convention, the Conservative Party of Canada (CPC) went so far as to pass a nonbinding resolution to refuse automatic birthright citizenship to children born to two nonresident parents, as a solution to the “crisis” of birth tourism. Echoing these sentiments, a recent investigation of birth tourism by the CBC’s Fifth Estate drew three conclusions: Canadian birth tourism is on the rise, it demands a legislative response, and it is a disingenuous pathway to citizenship

All three of The Fifth Estate’s conclusions are flawed, and they have serious implications for those pregnant migrant women who are being labelled birth tourists.

Take the argument that birth tourism is on the rise. Neither the Canada Border Services Agency nor Immigration, Refugees and Citizenship Canada tracks the entry of pregnant nonresidents into the country. Moreover, hospitals are not legally required to inquire about the mother’s nationality, as it is not a prerequisite for a birth certificate. Researchers at the Canadian Institute for Health Information have developed a workaround based on hospital financial data, which include a code for services provided to nonresidents (“other country resident self-pay”). These data show that 3,628 births (1.2 percent of total births) in Canada(not including Quebec) in 2017 were to nonresident mothers. They also show that this number has doubled since 2010 but is geographically focused, primarily in 25 hospitals in Ontario and British Columbia (with comparable numbers in Montreal). But this is only a proxy measure for birth tourism, because it includes international students, migrant workers, those with work visas and foreign government personnel, all of whom could have given birth in Canada, but whose entry into the country was not likely a product of birth tourism.

Nevertheless, the focus on birth tourism has persisted. Parliamentary petitions to refuse birthright citizenship to children born to two nonresident parents were sponsored by Conservative MP Alice Wong in 2012 and in 2018 by Liberal MP Joe Peschisolido. The Fifth Estate segment is the latest in a series of media investigations into the perceived dangers birth tourism presents, not for the pregnant migrant women at the heart of this narrative but for the integrity of Canada’s immigration system and Canadian citizenship at large.

Birth tourism does happen, but the available numbers do not suggest a trend in need of government action — especially action in the form of birthright citizenship refusal. Ministers of both parties reached the conclusion that no measures were necessary: in 2012, it was the Conservative minister of citizenship and immigration, Jason Kenney, and in 2018, the Liberal minister of immigration, refugees and citizenship, Ahmed Hussen. The two MPs’ parliamentary petitions failed to gain any legislative traction; provincial legislatures in Ontario and British Columbia also voted against legislative action. Even the CPC opted not to include any mention of birth tourism in its 2019 electoral platform, despite its convention resolution. The continued focus on birth tourism misrepresents the actual urgency of birth tourism, and ultimately this harms nonresident pregnant women by casting them as illegitimate and glossing over the barriers they face with the Canadian immigration system.

Temporary residents often migrate with their families or stay in Canada for prolonged periods — years — and form intimate personal relationships in their Canadian communities.

Discussion of nonresident births must be contextualized within broader immigration trends and the limitations on access to health care. The number of temporary residents arriving in Canada has steadily increased, and many of these people will pursue permanent residency through programs such as the Canadian Experience Class and contribute substantially to the social and economic well-being of their communities and the country.

For nonresidents temporarily residing in Canada, access to public health insurance depends on their immigration category. For example, international students’ access to health coverage in Quebec is limited by nationality; in Ontario and Manitoba it is not available to holders of study permits. For temporary workers, coverage is restricted based on the type or duration of work permit and can require a three-month wait period. Furthermore, people with temporary-resident visas or who are without formal status do not qualify for any medical coverage whatsoever. People enter and live in Canada with temporary resident visas for all kinds of reasons, including to live with their spouse while waiting for their family sponsorship applications to be processed. Temporary residents often migrate with their families or stay in Canada for prolonged periods — years — and form intimate personal relationships in their Canadian communities. The desire to have a family and children is widely considered a natural aspiration that all people should be free to pursue alongside studying and working. While many nonresidents can access public health insurance, access is not universal — a distinction not addressed in the current data. Our research, which is still ongoing, shows that when nonresident women without insurance arrive at a hospital or clinic seeking perinatal care, they are often assumed to be “birth tourists” and treated as if they are unfairly taking advantage of Canada’s health care and immigration systems.

While technically legal, birth tourism is presented as a way to jump the immigration queue by utilizing a disingenuous pathway to Canadian citizenship, and ultimately taking away resources from more “deserving” and “committed” Canadian citizens. MP Wong spoke in favour of the nonbinding convention resolution, saying that “passport babies” take away resources from Canada’s system and that Canada should “fight for our own babies.” This framing of so-called birth tourists and their children as system cheaters is part of a larger trend of criminalizing migrants using the language of deservedness, desirability and illegality to pit “undeserving” migrants against the generosity of Canadians. To this end, birth tourists and their children are marked as less desirable because they are using what is thought of as an improper — albeit legal — channel to obtain Canadian citizenship.

Claims of deservedness suggest that citizens must have an ongoing commitment and obligation to Canada, and children being born as a result of birth tourism are said to disrupt this because there is no way for them to actively demonstrate a clear connection to their acquired status once they’re adults. This, however, is not the defining feature of birthright citizenship: Canadian-born citizens do not actively commit to their status. Moreover, political scientists Rita Dhamoon and Sunera Thobani, among others, conclude that Canadian-born citizens — specifically white Canadian-born citizens — rarely undergo ongoing evaluations of their commitment to the Canadian state. How, then, do we reconcile this double standard where Canadian children born to nonresident parents are held to different, and arguably unrealistic, expectations around citizenship than those born to resident parents? The unspoken accusation here is that “undesirable” migrants are using a legal channel to claim Canadian citizenship.

The result is that nonresident pregnant women are framed as potential perpetrators of migration or citizenship fraud. While available data do not distinguish between racialized and nonracialized mothers, most media and political analysis focuses on racialized birth mothers. This echoes the historical treatment of nonwhite and non-European immigrants as a security concern. For example, Canada’s heavily racialized temporary foreign worker programs have largely restricted family migration and permanent settlement, and there has been increased scrutiny of our family sponsorship program as officials look for marriage fraud. It is important to also consider how this narrative draws on broader problematic perceptions of racialized (and other marginalized) women as not making “ethical” reproductive decisions: for example, choosing to have children to procure state resources for themselves. Considering that the evidence does not support the broad claim that birth tourism is an imminent threat to the country, we question whether it is an issue in need of a legislative response or simply a dog whistle that calls back long-standing sexist and racist immigration legacies that perpetuate the criminalization and surveillance of racialized pregnant nonresident women.

More research needs to be done on birth tourism. Rather than furthering narratives that demonize and criminalize nonresident mothers as birth tourists, we need to shift the focus to how these women’s experiences are eclipsed as a result of this dangerous discourse. Marking these women as queue jumpers and citizenship fraudsters ignores the real-life obstacles they encounter within the health care system and the Canadian immigration system. In our research, we find that these women face challenges accessing perinatal care, building trusted relationships in health care settings and having their voices heard. They pay high hospital and doctor fees, resulting in situations where they forgo necessary care at their own personal risk. It is this crisis rather than the perceived crisis of birth tourism that is in need of further legislative attention.

Source: Birth tourism and the demonizing of pregnant migrant women                                                                

Airline Apologizes for Requiring Passenger to Take Pregnancy Test Before Flight

Any measures to reduce birth tourism should not be outsourced to an airline rather than government visa or other requirements:

A Hong Kong-based airline has apologized for requiring a passenger to take a pregnancy test before a flight in November to Saipan, a United States territory in the Western Pacific that is a popular destination for so-called birth tourism.

The carrier, Hong Kong Express Airways Limited, said in an emailed statement this week that it had stopped administering pregnancy tests after re-evaluating the contentious practice.

The apology came a little over two months after the passenger, Midori Nishida, blogged about her experience on a Nov. 9 flightfrom Hong Kong International Airport to Saipan, which is in the Northern Mariana Islands.

The commonwealth has become a magnet for expectant Chinese mothers because babies born on the island are eligible for United States citizenship.

“We would like to apologize unreservedly to anyone who has been affected by this,” the airline said in the statement.

Ms. Nishida, 25, a Tokyo resident, was raised on Saipan and was visiting her parents when the episode occurred, she wrote in a blog post on the website of The Saipan Tribune newspaper.

“Despite being a frequent flier to Saipan, none of my previous experience would have prepared me for what happened during my most recent flight: Take a pregnancy test or be denied boarding,” she wrote.

After filling out a mandatory questionnaire from the airline stating that she was not pregnant, Ms. Nishida was selected to undergo a “fit-to-fly” medical assessment and was asked to sign a medical release form, her blog post said.

The form read: “The passenger has been observed to have a body size/shape resembling to a pregnant lady,” according to Ms. Nishida, who said she showed airline employees her return plane ticket, but to no avail.

“I was then led by a female in plainclothes, who claimed to be the medical practitioner, to a public restroom,” she wrote. “I was handed a pregnancy test and when the result came out negative, she failed to record this on the medical form and instructed me to throw the test into the trash. Satisfied that I had no baby in me, the airline staff finally issued me a boarding pass.”

The airline, which Cathay Pacific bought in July, said the pregnancy test requirement arose early last year.

“In response to concerns raised by authorities in Saipan, we took actions on flights to Saipan from February 2019 to help ensure U.S. immigration laws were not being undermined,” the airline said. “Under our new management, we recognize the significant concerns this practice has caused. We have immediately suspended the practice while we review it. We’d like to apologize for the distress caused.”

The United States Department of Homeland Security did not immediately respond to a request for comment on Thursday night.

Ms. Nishida wrote that she was well aware of Saipan’s reputation as a “hot spot” for birth tourism, but that she was appalled by the way the airline had treated her.

“Coming back to Saipan has always been a happy time for me as I look forward to seeing my family and catching up with friends,” she wrote. “But after this incident, I can only think of how I will be suspected, investigated and humiliated before I can return to a place I consider home.”

Source: Airline Apologizes for Requiring Passenger to Take Pregnancy Test Before Flight

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


Combat birth tourism by changing immigration law, B.C. mayor says

From twitter commentary, seems like he is a bit late to the discussion. But nothing is more frustrating to the public when each level of government points to the other rather than working more closely to assess and discuss the options (which of course, include doing nothing given the small provincial and national numbers):

Richmond Mayor Malcolm Brodie is calling on Ottawa to change immigration law to stop pregnant women travelling to Canada and giving birth to babies who are automatically granted citizenship.

The law says anyone born in Canada is automatically a Canadian citizen. According to the latest statistics, nearly 5,000 babies were born to non-residents in 2018-19.

A recent story by The Fifth Estate revealed that non-residents make up nearly a quarter of all births at the Richmond Hospital, which has led to complaints that birth tourists are compromising care for locals and putting strain on staff.

“People are abusing the system and we will pay a price right now with our medical system, but we’ll pay a bigger price in the long term with a number of people coming here who haven’t gone through any qualifications or procedures and they just come to our shores and will live in Canada,” said Brodie on The Early Edition on Tuesday.Brodie suggests changing federal law so that least one parent must be a Canadian citizen in order for a child to also become a citizen.

City ‘helpless’ to stop birth tourism: mayor

According to Brodie, the city has limited power to do anything about the issue because the medical system is the province’s jurisdiction and the federal government is in charge of the immigration system, which he said is the root of the problem.

All the city can do, said Brodie, is enforce short-term rental bylaws at so-called “birth houses,” where many of the women are known to stay, but often the women stay longer than a month and the city can only regulate rentals of 30 days or less.

“We are really helpless to do a lot about it. We can check a business licence if there is a business being run out of a home, but that’s about all,” said the mayor.

No federal action

He said Richmond has seen people abusing the system for years and, despite local members of Parliament raising the issue in Ottawa, there has been no federal response.

‘This is a law and this law can be changed and I don’t have any idea why they haven’t done it,” said Brodie. “The optimist in me says they simply haven’t gotten around to it.”The Early Edition requested an interview with Marco Mendicino, the newly appointed federal minister of immigration, refugees and citizenship, but the minister was unavailable.

Source: Combat birth tourism by changing immigration law, B.C. mayor says

‘All about the money’: How women travelling to Canada to give birth could strain the health-care system

CBC Fifth Estate story on birth tourism, being broadcast January 5. Not much new from provincial (British Columbia) health authorities, British Columbia government or IRCC. Better data should be available later this spring from the joint study between IRCC, Canadian Institutes of Health Information and Statistics Canada:

Women travelling to Canada to give birth to babies who will automatically become Canadian citizens are prompting concerns about the strain they may be putting on the health-care system, The Fifth Estate has found.

At one British Columbia hospital with a high concentration of such deliveries, complaints have arisen that the influx of these non-resident patients — also known as birth tourists — has led to compromised care for local mothers-to-be and struggles for nursing staff.

Some of these patients fail to pay hospital and doctors bills, leaving taxpayers and individual care providers on the hook.

“Most of them, they get the Canadian passport, and then they leave the country,” said Dr. Mudaffer Al-Mudaffer, a B.C. pediatrician and neonatologist who sees babies of non-residents when they need critical care. “It affects the integrity of the fairness of the health system.”

No statistics are available regarding how many people are travelling to Canada specifically to ensure their child is born here and will have a Canadian passport.

But figures from the Canadian Institute for Health Information and several Quebec hospitals indicate there were about 5,000 non-resident births across the country in 2018, an increase of nearly 15 per cent over the previous year.

In the fall of 2019, Cathy Shi arrived in Richmond, B.C., from Shandong, on China’s east coast, to give birth to her third child. She said through a translator that she wanted her unborn child to have more opportunities.

“My concern is about their education, such as going to university. If the kid wants to live in Canada, it would be convenient for them if they’re born here.”

Handful of hospitals

At this point, the practice of birth tourism appears to be concentrated in a handful of hospitals in Quebec, Ontario and British Columbia.

At the Richmond Hospital, south of Vancouver, non-residents make up nearly a quarter of all births, according to records obtained from Vancouver Coastal Health, the health authority which runs the hospital. In many ways, that hospital can be seen as a test case for how this issue could play out elsewhere as numbers continue to climb.

The health authority declined a request for an interview with The Fifth Estate and issued a warning directing its staff not to speak to the media.

Despite that, four current and two retired nurses shared their concerns, requesting that their identities be protected.

Since 2013/14, the number of non-resident births has tripled at the hospital. The patients — many from China — pay privately for their care, often in cash, may not speak English and are unfamiliar with the Canadian health-care system. The nurses who spoke to The Fifth Estate say the influx has led to increased workloads and has compromised care.

“There are times when … the people living here don’t get the service that they need,” one nurse said.

When the unit was very busy, one nurse said services like prenatal tests to check the baby’s health, labour inductions and other tests to check fetal and maternal risk factors would be delayed or cancelled.

“We would often have to decide whose need was greatest and abandon the rest for the next day where we would face the same situation again,” she said.

“Our normal scheduled or add-on C-sections lie here all day and then they take the IV out, we send them home and say come back tomorrow. A private pay never goes home — she gets her C-section that day,” said another nurse.

“She will be fit in somewhere because nobody wants to lose that $5,000. But our normal people are lying there all day, no food or drink, waiting and nobody’s interested in moving them.”

Some hospitals, like Sunnybrook Health Sciences Centre in Toronto, have taken steps to limit the number of non-resident births in order to prioritize residents of their own communities. That hospital says it won’t treat non-residents patients without Ontario Health Insurance Plan coverage.

When asked in an email why the Richmond Hospital doesn’t have a similar policy, Carrie Stefanson, a public affairs representative with Vancouver Coastal Health, said: “VCH cannot speak for other hospitals or health authorities. VCH will never deny urgent and emergent care based on ability to pay or where a patient is from.”

The hospital requests deposits for privately paid births: $10,000 for a vaginal birth and $16,000 for a caesarean. More than $18 million has been invoiced for non-resident births since 2017, according to data released through freedom of information by Vancouver Coastal Health.

Nursing staff say they have not seen this money go into easing their workloads.

“The amount of money that’s coming into Richmond from the private pay, it doesn’t make our staffing better,” said one nurse.

Their union says that is a problem.

“I certainly think adding additional patients into a health-care system that isn’t staffed appropriately, isn’t funded appropriately, is causing strain,” said Christine Sorensen, president of the BC Nurses’ Union.

She said the union has regularly heard complaints from nurses at Richmond Hospital but they have not filed a formal complaint with the hospital.

The health authority declined to answer a question about how it has responded to complaints from nursing staff.

Financial incentives within the medical system

Two doctors at the Richmond Hospital have delivered 1,300 of the 2,206 babies born to non-residents there since 2014, according to documents released through freedom of information.

While the health authority will not disclose their names, insiders and birth tourism company representatives say Dr. Xin-Yong Wang and Dr. Brenda Tan, two Mandarin-speaking family doctors, see the majority of these patients for prenatal care and delivery.

Both appear on multiple websites of companies advertising services such as assistance with immigration, travel and housing to women looking to come to Canada to give birth.

Wang said the companies do not have permission to use his name.

Tan did not respond to interview requests and a list of questions sent to her.

Wang and Tan billed the province $272,198.50 and $428,456.17 respectively in the 2018/2019 fiscal year, according to data publicly available through the province. Those billings do not include earnings from non-resident patients because they pay privately.

There are no limits on what physicians can charge outside the public system in British Columbia, but information from birth tourism company websites suggests that these doctors earn at least $100 per prenatal visit and more than $2,500 for a delivery, several times more than could be billed through the public system for the same services.

In an interview, Wang declined to respond to questions about how much he was earning from birth tourism but said he was not motivated financially to take on these patients.

“It’s like a dessert — occasional patients like this is fine, and it’s pretty financially rewarding … they are a small percentage of our overall income.”

Nurses who spoke to The Fifth Estate said the financial incentives within the health-care system are a problem.

“It is all about the money. If there was no financial income for the hospital or physicians, the private pay would have been out of the door a long time ago,” said one nurse.

Unpaid bills

While these births are bringing in money, bills owed to both health authorities and individual doctors are not always paid.

According to documents released by Vancouver Coastal Health, more than $2 million is outstanding as a result of non-resident births since 2017 at the Richmond Hospital alone. This does not include any debt that has been written off.

Bairths at the Richmond Hospital represent 11 per cent of overall non-resident births outside Quebec, according to 2018 data from the Canadian Institute for Health Information.

No national financial data exists on how much revenue is outstanding as a result of non-resident hospital bills across the country.

But some say the health-care system and Canadian taxpayers are losing out.

Al-Mudaffer said having an uninsured baby in neonatal intensive care can cost $10,000 a day just for the hospital bed, not including doctors’ fees.

Dr. Mudaffer Al-Mudaffer says birth tourism is impacting the Canadian healthcare system. 0:27

He said he’s seen large bills for families with babies requiring multiple nights and even weeks in the NICU.

“You can easily acquire a bill of $100,000 to pay the health authority, and that’s why they can’t pay it, you know? And they leave the country without paying,” said Al-Mudaffer.

He said he has seen hundreds of thousands of dollars in bills go unpaid at the Royal Columbian Hospital where he works, but Fraser Health, which runs that hospital, said it could not confirm this amount.

The Fifth Estate requested provincial numbers on unpaid bills from the British Columbia government but was told these numbers were not tracked provincially.

“Obviously if any bill is unpaid, I’m concerned about that because that’s money that we could and should be spending on something else or saving the health-care system so of course we’re concerned about it,” said B.C. Health Minister Adrian Dix.

Even with little formal research to examine the practical implications of a growing number of non-resident births on the Canadian health-care system, Dix said “we are handling that situation.

“It’s two per cent … of total births in British Columbia, so it’s an issue but there are other issues.”

But it’s not only hospital fees going unpaid. Al-Mudaffer said when he sees birth tourists, he only gets paid three out of 10 times.

He is not alone. Dr. Kathleen Ross, president of Doctors of B.C., has personally been affected by unpaid bills and has called for a national conversation on the issue.

“Our federal government needs to find a way to disincentive people coming to the country to have access to citizenship and to our health-care support,” she said.

Federal research planned

Marco Mendicino, the newly appointed minister of immigration, refugees and citizenship, declined an interview with The Fifth Estate.

But the department wrote that while “statistics indicate that birth tourism is not widespread, the Government of Canada recognizes the need to better understand this practice.”

It said it has started work with the Canadian Institute for Health Information and Statistics Canada to integrate health and immigration data that would allow for a better understanding of the practice of birth tourism by looking at visitor visas and births.

Immigration, Refugees and Citizenship Canada anticipates results from this research will be available in the spring.

Cathy Shi said she hasn’t thought much about criticism of birth tourism and isn’t receiving any government benefits here.

“We may come here often for travelling around, living or even investing. People are not just looking for status by having a baby here. They will have established a connection to Canada and later on some may apply to immigrate.”

Source: ‘All about the money’: How women travelling to Canada to give birth could strain the health-care system

New Estimate: 72,000 USA Births Annually to Tourists, Foreign Students and Other Visitors (CIS)

Bit of an overly simple methodology to use given that it assumes similar behaviours and natality rates between groups. Much more comfortable on the Canadian data despite its limitations, available from CIHI:

Two new analyses by the Center for Immigration Studies estimate that there are 39,000 births a year to foreign students, guest workers and others on long-term temporary visa, plus an additional 33,000 births annually to tourists – 72,000 in total. Those born to these “non-immigrants,” as the government refers to them, are awarded U.S. citizenship because they were born in United States and not because a parent was a U.S. citizen or a Lawful Permanent Resident (green card holders). These births are in addition to the nearly 300,000 births each year to illegal immigrants.

Our analysis does not address the controversial question of whether the U.S. Constitution actually requires “birthright citizenship,” as it is often called, to anyone born in the United States regardless of the parents’ immigration status. Rather, our estimates inform that discussion by estimating the scale of births to non-immigrants, which is one part of the birthright citizenship controversy that is seldom considered.

“Our analysis makes clear that the number of children born to visitors is not trivial; and over time the numbers are substantial,” said Steven Camarota, the report’s lead author and the Center’s Director of Research. “It seems doubtful that the framers of the Fourteenth Amendment could have anticipated that tens of thousands of people each year would automatically be granted citizenship simply because their parents were on a temporary visit to the United States at the time of their birth.”

Births to Long-Term Temporary Visitors

  • The government estimates that in 2016 there were 800,000 women age 18 to 44 in the country on long-term non-immigrant visas, primarily foreign students, guest workers, and exchange visitors.
  • Based on a comparable population of women in Census Bureau data, we estimate there are 49 births per thousand to these women for a total of 39,000 births annually or 390,000 each decade.
  • The birth rate for non-immigrants aged 18-44 is relatively low compared to the 77 births per-thousand for immigrant women generally. However the total number of births to temporary visitors is still large because so many foreign students, guest workers and exchange visitors have been allowed into the country.
  • We estimate that at least 90 percent of the fathers of children born to non-immigrant women were not U.S. citizens, almost all them on temporary visa themselves or illegal immigrants. This means at least 35,000 children were born to a non-immigrant mother and were awarded U.S. citizenship at birth solely because they were born on U.S. soil and not because their parents were citizens or Lawful Permanent Residents (green card holders).

Birth Tourism

  • Many news stories in recent years have focused on “birth tourism,” which describes the phenomenon of pregnant women coming to America shortly before their due dates so their children are born in the United States and are awarded U.S. citizenship.

  • Based on a comparison of birth records and Census Bureau data, we estimate there were 33,000 births to women on tourist visas in the second half of 2016 and the first half of 2017. This translates to perhaps 330,000 such births each decade.

  • While there is significant uncertainty around this number, our new estimate is very similar to our prior estimate for second half of 2011 and first half of 2012.

  • It should be emphasized that the small number of mothers who provide a foreign address on birth documents are probably not birth tourists, as those engaged in birth tourism likely list a U.S. address so they can receive birth certificates and passports before returning to their home countries. These addresses are typically a relative’s or a residence arranged by those “selling” birth tourism services.

Source: 372000 Born to Illegal Aliens and Visitors Every Year, 33000 to ‘Birth Tourists’

Opinion: Canada shouldn’t welcome birth tourists

Two columns the same day in the Globe on birth tourism. Always nice to see some of my analysis provoking more public discussion:

Starting with the stronger piece by health reporter, André Picard:

Birth tourism is the name given to the practice of pregnant women travelling to Canada from other countries – predominantly China – to give birth. They do so because children born on Canadian soil automatically become Canadian citizens.

The children, known as passport babies, can eventually benefit from lower university tuition, visa-free travel to many countries, and even sponsor other family members to become citizens. For wealthy Chinese nationals, it’s a golden ticket out of a country with a repressive regime.

But the practice raises the question: Should Canadians hospitals – unwittingly or not – be selling citizenship?

Until recently, birth tourism was viewed as a marginal issue. Statistics Canada reported that, out of 383,315 births in 2016, only 313 babies were born to mothers who don’t live in Canada. But anecdotal reports suggested the real number of passport babies was much higher.

Andrew Griffith, a fellow at the Canadian Global Affairs Institute, did a deep dive into data from the Canadian Institute for Health Information and foundthere were 3,223 births by non-residents in Canadian hospitals in 2016, excluding Quebec.

That number has since jumped to 4,099 in 2018.

Some of those births could be international students or temporary residents working in Canada, but there is no question the large majority travelled with the express purpose of giving birth in this country.

In B.C., Richmond Hospital alone had 453 births by non-resident mothers last year, 23 per cent of all births. Mackenzie Health in Richmond Hill, Ont., had 229 birth tourists, 13.3 per cent of its births.

Birth tourism is not cheap – roughly $60,000, including hospital fees and a three-month stay in a “birth house,” facilities that have sprung up, mostly around hospitals in suburban Vancouver and Toronto.

There are more than two dozen birth houses in Richmond, B.C. alone. Brokers in China widely advertise the benefits of giving birth in the “maple syrup kingdom,” and collect hefty commissions.

Kathleen Ross, president of Doctors of B.C., recently spoke out about the practice, saying it is straining hospital resources and putting doctors in an impossible position.

While it would be unethical for a doctor to not assist a woman giving birth, some, such as Dr. Ross, have been stiffed by clients who didn’t pay. (An obstetrician is paid between $600 and $1,500 for a birth but they must collect privately if a patient is not covered by medicare.)

Hospitals also had problems collecting from birth tourists. The South China Morning Post reported on the case of the “million-dollar baby,” a patient who had a complicated birth and racked up costs totalling $312,595, then skipped town. Last year, Vancouver Coastal Health Authority sued Yai Xia, alleging she now owes $1.2-million with interest dating back to 2012.

Most hospitals now demand upfront payments, ranging from $8,000 to $15,000. Whether the parents pay or not, the passport babies still have Canadian citizenship. Canada is only one of about three dozen countries in the world which grants birthright citizenship – automatic citizenship to anyone born on Canadian soil. This has been the practice since 1947.

The government of Stephen Harper considered changing the law but determined it would result in too many unintended consequences. Canadians generally use birth certificates to access government services; if citizenship was in question, they would require passports, and 40 per cent of Canadians don’t have a passport.

Birth tourism rankles the public because it feels like cheating. Both Liberal MP Joe Peschisolido and Conservative MP Alice Wong have tabled petitions in the Commons demanding change. It’s not a coincidence that they both represent ridings with large immigrant populations. Newcomers appreciate the difficulty obtaining and the privilege of citizenship.

The answer is not to toss out the jus soli (right of the soil) principle that is part of Canada’s heritage, but to address the specific challenge posed by birth tourism.

The way to do that is to adopt visa restrictions – denying visas to women who are coming to Canada expressly to give birth, and to crack down on both brokers and birth houses. We could also go the way of Australia, which modified its laws so that citizenship was granted only if one of the parents was a citizen or permanent resident, or the child lives at least 10 years in the country.

Neither Canadian identity nor the Canadian health system is threatened by birth tourism. The central issue is fair play: Canada should remain a welcoming country but not one whose citizenship is for sale.

Source: Opinion: Canada shouldn’t welcome birth tourists

Political columnist Konrad Yakabuski:

No one was surprised to learn that Donald Trump was wrong when he declared that the United States is “the only country in the world” that grants birthright citizenship. The U.S. President rarely lets the facts get in the way of an opportunity to score political points on the backs of immigrants.

Unsurprisingly, he was also wrong in suggesting he could revoke U.S. birthright citizenship, which is entrenched in the U.S. Constitution, with the simple stroke of his own pen. But on the eve of midterm elections that will determine control of the U.S. Congress, stoking outrage toward illegal immigrants who give birth on American soil is par for the course for Mr. Trump.

Unfortunately for Canada’s Conservatives, who adopted a resolution at their August convention calling for an end to “birth tourism” in this country, Mr. Trump’s outburst now risks tainting our own debate about birthright citizenship. Even before the U.S. President evoked ending birthright citizenship in his country, opponents seized on the passage of the Tory resolution to score points of their own. New Democratic Leader Jagmeet Singh attacked the “division and hate” peddled by Conservatives. Prime Minister Justin Trudeau’s principal secretary, Gerald Butts, accused the Tories of seeking to “strip people born in Canada” of their Canadian passports.

To be clear, any attempt by the Conservatives to scapegoat certain immigrants for political gain should be condemned. But so should Liberal and NDP attempts to tar the Tories with labels they don’t deserve merely for raising concerns about a phenomenon that undermines the integrity of our immigration laws. Birth tourism, the practice of foreign women coming to Canada to have their babies merely to obtain a Canadian passport for their offspring, is by all accounts a real and growing problem. Is it a big enough problem to warrant an end to birthright citizenship here? Unfortunately, we don’t have good enough data to know. Statistics Canada data on births to non-resident mothers provide an incomplete picture and conflict with evidence reported by hospitals.

In the United States, birthright citizenship emerged as a constitutional principle in the wake of the U.S. Civil War to ensure that freed slaves were entitled to all the rights and privileges of white citizens. It is rooted, hence, in that country’s long struggle against slavery and racial discrimination. Any attempt to deprive those born on American soil of U.S. citizenship would not only require a near-impossible constitutional amendment, it would needlessly reopen old wounds.

In Canada, the issue is not nearly as fraught with symbolism as it is south of the border. Birthright citizenship is a feature of our immigration law, not the Constitution, and can be changed with an act of Parliament. What’s more, federal lawyers recently argued that Canadian citizenship could not be claimed by the Canadian-born children of Russian spies, insisting that even this Liberal government believes the principle of birthright citizenship has its limits.

In most cases, foreigners who travel to Canada to give birth are not desperate, nor are their children at risk of becoming stateless, since they would inherit their parents’ citizenship, anyway. Most appear willing to pay hefty non-resident medical fees to have their babies delivered at Canadian hospitals or stay at for-profit “birth houses” catering to Chinese tourists.

Canada would not be the first country to end birthright citizenship, in part to end the practice of birth tourism. Several developed countries, including Australia, have done so in recent decades. As Canada becomes one of the last “rich” countries outside of the United States to grant automatic citizenship to those born on its soil, we should expect the incidence of birth tourism to increase in the future. That suggests we need to be prepared to have this debate, sooner or later.

The August Conservative resolution called for legislation to eliminate birthright citizenship “unless one of the parents of the child born in Canada is a Canadian citizen or permanent resident of Canada.” Leader Andrew Scheer insisted the policy was aimed strictly at ending “abuse” of our immigration laws, adding: “Conservatives recognize that there are many Canadians who have been born in Canada by parents who have come here to stay and have contributed greatly to our country. I will not end the core policy that facilitates this.”

It would be premature to change our immigration laws before we evaluate alternatives, such as stricter visa requirements, to prevent birth tourism. Ottawa also needs to collect better data to determine the scope of the problem. But we should not let the spectre of Mr. Trump stop us from having a debate about our immigration laws that, if we wait too long, could become inevitable.

Source: Opinion: Canada shouldn’t welcome birth tourists

Birth tourism needs to become an election issue, says president of Doctors of B.C.

Yet another article based upon the latest CIHI data, highlighting some payment issues:

Birth tourism needs to be curtailed by the federal government as the Canadian health care system is “struggling to meet the needs of our own citizens,” says Dr. Kathleen Ross, president of Doctors of B.C.

Births by non-residents seeking to get instant Canadian citizenship for newborns now accounts for about a quarter of all deliveries at Richmond Hospital, according to the latest federal data, but the issue is not getting any attention from political parties even with the federal election in full swing.

In the past six months, Ross has delivered two babies to birth tourists at Royal Columbian Hospital and in both cases, they left the hospital without paying her fees. Ross would not disclose which country the patients came from but said they have ignored multiple invoices sent “after the fact” to the addresses they supplied. The physician fee for vaginal deliveries ranges between $600 and $1,500.

B.C. hospitals ask for deposits when non-residents register, $13,300 for a caesarean section and $8,200 for a vaginal delivery. But those fees are for hospital costs only and physicians who work on a fee for service basis, as do many of those who deliver babies, have great difficulty collecting their separate fees from birth tourists. Occasionally, hospital lawyers have to sue foreign patients in a bid to be paid.

Ross said it is clear that some birth tourists have “no intention” to pay their bills and doctors in many provinces are starting to talk about how to address the problems. She said the federal election campaign is a perfect time to start talking about the fact that if Canadian citizenship weren’t so easy to obtain in such a way, it is doubtful the numbers of birth tourists would be going up the way they are.

“We’re at a crisis, a tipping point, so it’s really important that some higher authority takes this on,” Ross said. “Hospitals and doctors have no option but to provide service. We can’t turn people away if they are sick, injured, or in labour.”

The federal Conservatives flirted with a potential clampdown on birth tourism in the past and the current Liberal government has said it was studying the matter, but no leader has commented during the current campaign about potential changes.

Data for the last fiscal year provided by the Canadian Institute for Health Information (CIHI) shows that eight of the top 10 most popular hospitals for non-resident births are in Ontario, with the other two in B.C. Births to non-resident mothers, a category which also includes international students and other non-permanent residents who are expected to pay for their medical and hospital services, are also growing in frequency in Alberta.

Across Canada, CIHI hospital discharge data shows there were 4,099 births to non-residents in 2018/19 (excluding Quebec), compared to 3,628 the year before. While the number has been increasing every year for the past decade at least, non-resident births still account for only about two per cent of all births in Canada.

However, at Richmond Hospital last year, they accounted for 23.1 per cent of all births and at St. Paul’s Hospital in downtown Vancouver, they accounted for 10.3 per cent of all births.

Andrew Griffith, a fellow at the Environics Institute and the Canadian Global Affairs Institute, said 454 non-resident women delivered babies at Richmond Hospital in 2018/19 and 139 women gave birth at St. Paul’s Hospital. And the number of babies may even be higher than the number of women because some deliveries involve multiple babies.

Griffith noted that across Canada, non-resident births rose 13 per cent in the last fiscal year, a rate that is higher than both immigration and overall population increases. The number of non-resident births in B.C. rose 3.3 per cent overall; at St. Paul’s, they rose by 12.9 per cent from 2017/18 to 2018/19 and at Richmond Hospital, the increase was 5.6 per cent. At one hospital in Ontario, the increase was as much as 49 per cent.

Griffith said it is too early to say whether Ontario and Alberta are going to supplant B.C. as the favoured destinations for birth tourism.

“In general, I prefer to have two years of data before knowing whether this is a shift or simply a one-year anomaly. But it is significant I think that Richmond seems to have stabilized,” he said, adding that it has traditionally accounted for nearly three-quarters of all non-residents births in B.C. Indeed, there are numerous websites marketing services to Chinese women and dozens of birth houses in Richmond, catering to the needs of women coming here to have their babies.

An Angus Reid poll done early this year showed that 64 per cent of Canadians were opposed to granting automatic Canadian citizenship to babies born to birth tourists and an almost equal proportion wanted to see laws changed.

Source: Birth tourism needs to become an election issue, says president of Doctors of B.C.

‘Birth tourism’ could become election issue in B.C. riding considered ‘ground zero’

Not seeing much resonance outside of Richmond and it does not appear that the CPC is wedded to its policy resolution given their immigration critic Michelle Rempel’s comments (Michelle Rempel Garner on Twitter: “3/ I would hope that all …https://twitter.com › michellerempel › status):

On the streets of Richmond, an immigration topic on people’s lips for years has been “birth tourism.”

The practice — where pregnant women travel to a foreign country to give birth, thereby guaranteeing their baby automatic citizenship — has been rising steadily in the city, whose hospital is considered “ground zero.”

Under Canadian immigration law, birthright citizenship is law. But some in the city say people are increasingly taking advantage.

One woman, Kerry Starchuk, has made it her mission to bring an end to birth tourism. She has submitted two online petitions to the federal government since 2016, arguing more needs to be done to clamp down on the practice.

“It is undermining our citizenship,” she said. “Everyone comes through the front door and they work very hard to come here. This is undermining the system.

“People are lying to border guards and not saying why they’re coming here, and coming to stay at places that are unregulated. If we want a healthy community, everyone needs to contribute to being on board.”

Starchuk says several homes in Richmond are being advertised on Chinese websites and Instagram accounts as so-called “baby houses,” where families can rent rooms in advance of their hospital visit.

“We have given the wrong messages by not addressing the issue, so now there are even more operators bringing birth tourism into Richmond,” she said.

Starchuk’s first petition was sponsored by Alice Wong, the longtime Conservative MP for Richmond Centre, and gained more than 8,800 signatures — 5,100 of which came from B.C.

A second petition in 2018 was signed over 10,800 times, again with a majority coming from B.C.

That petition’s sponsor was Liberal MP Joe Peschisolido, whose riding of Steveston-Richmond East sits just east of Richmond Hospital and contains several neighbourhoods where “baby houses” have popped up.

“Birth tourism undermines both the integrity of our immigration system, as well as the integrity of our health care system,” he said. “It’s a business, but it’s an illegitimate business.

“What you have are unscrupulous businesspeople who are making money off our generosity … and that has to stop.”

The petition called on Ottawa to not only declare it doesn’t support birth tourism and study its full extent and effects, but also move towards policies that would dismantle businesses that promote the practice.

Peschisolido says the government in the process of adopting all three of those requests, but admits it’s taking time.

“We have to quantify it and come up with numbers to see what it is, what’s occurring, what kind of problems are involved,” he said. “Then we have to come up with a plan to shut down the industry, and that’s what we’re in the process of doing.”

Numbers increasing

While Statistics Canada data has reported relatively small numbers of births by nonresidents based on birth registrations — just 313 across Canada in 2016 — new studies have shown birth tourism could be much more widespread.

A 2018 Policy Options study that looked at the number of births through hospital discharge data from the Canadian Institute for Health Information (CIHI) found 3,223 cases that same year, more than five times the number from Statistics Canada.

Andrew Griffith, a fellow of the Canadian Global Affairs Institute who was behind the report, says that number has only continued to increase, to 3,628 in 2017 and 4,100 in the last fiscal year, which ended in March.

“That represents a 13 per cent increase year over year, which is quite significant,” he said, while noting the number still represents less than two per cent of all births in Canada.

Griffith acknowledged the data includes all births to nonresidents, including those temporarily living in Canada on student visas, and it’s difficult to tell in each case whether birthright citizenship was a motivating factor.

The CIHI information shows while B.C. may actually lag behind Ontario in the number of births to nonresidents — 689 in 2017, compared to more than 2,000 in Ontario — Richmond Hospital continues to outpace all other hospitals in the country.

In 2017-18, the B.C. hospital saw 469 births to nonresident mothers, accounting for more than 21 per cent of all births there. The next closest figure comes from Scarborough and Rouge Hospital in Ontario, with 163 nonresident births, representing 9.5 per cent of total births at the hospital.

Griffith’s report recommended financial action against nonresidents attempting birth tourism to discourage it, such as hospitals requesting substantial deposits from nonresidents.

Peschisolido says all options are being considered, but pointed to a $52-million government investment meant to help RCMP crack down on “baby houses” as a “good first step.”

Campaign issue

An Ipsos poll conducted in January for Global News found more than half of Canadians surveyed either tend to agree or strongly agree that Canada is too welcoming to immigrants.

In March, an Angus Reid Institute poll suggested 64 per cent of Canadians disagree with the country’s birthright citizenship laws, with 60 per cent calling for stricter laws against birth tourism.

But responses to Starchuk’s two petitions have suggested Ottawa has no plans to get rid of the law, despite admitting birth tourism is a problem that needs addressing.

“While there may be instances of expectant mothers who are foreign nationals who travel to Canada to give birth, requiring that a parent be a citizen or permanent resident in order for their child to acquire citizenship through birth in Canada would represent a significant change to how Canadian citizenship is acquired,” then-immigration minister John McCallum said in response to the 2016 petition, which was ultimately rejected.

Current Minister of Immigration Ahmed Hussen made similar points in response to the 2018 petition, but pledged to study the issue more closely.

Peschisolido, who was first elected to the new Steveston-Richmond East riding in 2015, says he plans to make the issue a key promise in his re-election bid.

“If I’m blessed and fortunate enough to be re-elected … I’m going to be pushing very hard to not only undermine birth tourism, but ultimately stop it and eliminate it,” he said.

Conservative candidate Kenny Chiu and Green candidate Nicole Iaci did not make themselves available for interviews.

At their most recent convention, Conservative Party members vowed to bring an end to birth tourism.

In a statement, NDP candidate Jaeden Dela Torre said the problem is concerning as it related to the health care system, but said any policies that crack down on birth tourism must come with careful considerations.

“We must not use this issue as a way to divide Canadians and fan the flames of racism and xenophobia,” she said.

“We’re reviewing all facts to come up with a fair and compassionate solution that protects health care services for all Canadians.”

Starchuk says she’s been in touch with many of the candidates, but has yet to see the action that Peschisolido has promised.

“I don’t trust anyone right now, because nothing has been resolved,” she said. “It’s a growing issue, but I haven’t seen anyone do anything.”

Source: major issue in the lead up to the Canadian elections

USA: Chinese woman pleads guilty in ‘birth tourism’ case

While the practice is legal, it was the fraud in visa applications that committed her.

Seems like there may be similar opportunities to examine the practices of birth tourism consultants in Richmond and elsewhere:

A Chinese woman has pleaded guilty in the US to federal charges of running a “birth tourism” scheme for Chinese nationals who paid so their children would be born American citizens.

Dongyuan Li admitted her company assisted wealthy Chinese nationals in getting to the US to give birth.

Ms Li would give clients training on how to bypass US immigration control and hide their pregnancies.

She amassed more than $3m (£2.4m) in wire transfers.

Ms Li, who is due to be sentenced in December, could face up to 15 years in jail.

What was the scheme?

Ms Li admitted that between 2013 and 2015, her company You Win USA Vacation Services would charge Chinese nationals – including government officials – between $40,000 and $80,000 for coaching in how to have a baby in the US.

With that came the benefits of American citizenship.

On its website, the company boasted more than 500 customers. It said that being American was the “most attractive nationality” and it would ensure “priority for jobs in US government”.

Ms Li told clients to initially fly from China to Hawaii due to the belief it would be easier to get past US customs. From there they could fly to Los Angeles where they would be housed in apartments.

She also admitted that the clients were coached on how to get through the US consulate interview in China, including by falsely stating that they were going to stay in the US for two weeks.

In reality, they planned to stay for up to three months to give birth.

What are the charges?

Ms Li pleaded guilty to one count of conspiracy to commit immigration fraud and one count of visa fraud.

As part of her plea deal with federal authorities, Ms Li gave up assets including $850,000, her house worth more than $500,000 and several Mercedes Benz cars.

Why was it illegal?

While it is not illegal to visit the US and give birth, making false visa claims is.

Authorities said Ms Li was promoting the benefits of having babies in the US, which would include helping to get family members immigration rights.

US President Donald Trump has talked of revoking birthright citizenship.

Source: https://www.bbc.com/news/world-us-canada-49746063