The COVID-19 pandemic provided the perfect natural experiment to assess the extent of birth tourism in Canada.
Dramatic declines of 50 per cent compared with the pre-pandemic 2016-20 average occurred in 2020 and 2021 in the number of “non-resident, self-pay” births. That was followed by an overall increase of 53 per cent in 2022 compared with the 2020-21 average, although the 2022 figure is still far below the 2019 peak.
This partial return to growing numbers highlights the need for the government to make good on its 2018 commitment to get a better handle on the extent of birth tourism, and to go so far as to consider an amendment to the Citizenship Act.
Figure 1 captures the steady increase prior to the pandemic and the sharp fall thereafter. Last year’s increase to 3,575 non-resident births from the pandemic average of 2,339 occurred in all provinces.
Table 1 compares non-resident births in 2011-15 and 2016-20 with those in subsequent years. The increase over these five-year periods contrasts with the sharp decline in 2020-21 and the sharp reversal in 2021-22, both of which were particularly notable in British Columbia. Compared to the 2019 high, the number of non-resident births has rebounded to 63 per cent of pre-pandemic levels.
There is no comparable U.S. post-pandemic data because since January 2020, the U.S. no longer issues visas “for birth tourism (travel for the primary purpose of giving birth in the United States to obtain U.S. citizenship for their child).”
Because there is no health-specific code for women travelling to Canada on visitor visas for birth tourism, the broader non-resident self-pay code is used. However, this includes international students, about half of whom are covered by provincial health plans, and other temporary residents.
Overall visitor visas in 2022 largely rebounded to pre-pandemic levels. The number of temporary workers has increased significantly. However, this varies by country.
The percentage of non-resident births fell from 1.6 per cent of total births in 2019 to 0.7 per cent in 2020 and 2021, but it rebounded to 1.0 per cent in 2022. About 50 per cent of non-resident births are estimated to be birth tourists.
Table 2 provides a view of the impact of COVID-19 on non-resident births for the 10 hospitals in Canada with larger percentages of non-resident births. Since the dramatic fall during the pandemic, non-resident births have increased in most hospitals.
British Columbia’s Richmond Hospital was once the epicentre of birth tourism with its supportive “cottage industry” of “birth hotels.” In 2019-20, non-resident mothers made up 24 per cent of its births. But it fell sharply in this category during the pandemic and has rebounded only to four per cent in 2022. It’s now fourth in the Top 10.
The new No. 1 and No. 2 are Toronto’s Humber River Hospital, with 10.5 per cent of all births being non-residents and Montreal’s St. Mary’s with 9.4 per cent. Humber River is also the only hospital that showed an overall increase compared to pre-pandemic period.
There is a need for more hospital-level studies such as the one in Calgary that found about one-quarter of non-resident women who gave birth in the city in 2019-20 were from Nigeria. The study also estimated the cost to Alberta taxpayers.
The development of links between Canadian immigration data (e.g., immigration program and category) and Canadian Institute for Health Information (CIHI) health data on medical services should allow for greater precision about the number of women giving birth while on visitor visas and those under other temporary resident categories.
Overall, the federal government has not followed up on its 2018 commitment to “better understand the extent of this practice as well as its impacts” following the first release of the non-resident self-pay numbers and related media attention. The 2021-22 decline understandably reduced political interest and pressure in addressing the issue.
Given current and planned increases in immigration, it is highly unlikely that the government will act because the number of non-resident births is basically a rounding error compared to overall immigration of 500,000 a year by 2025.
However, as visitor visas largely reverted in 2022 to pre-pandemic levels, it is no surprise that non-resident births, including birth tourism, have increased. The government should resume work to clarify the issue. In particular, it should link immigration and health data to improve understanding of immigration and health issues, including birth tourism. As numbers of non-resident births can be expected to increase further, greater precision regarding the components of non-resident births would inform possible policy and program responses.
A 2019 Angus Reid survey found that 64 per cent of those Canadians surveyed would support a change in the law so that citizenship is not conferred on babies born here to parents on tourist visas.
Policy and operational questions remain about whether birth tourism warrants an amendment to the Citizenship Act, visa restrictions on women intending to give birth in Canada, or other administrative and regulatory measures to curtail the practice.
Visa restrictions would be difficult to administer and regional administrative and regulatory measures might encourage hospital and jurisdiction “shopping.”
So the cleanest approach would be an amendment to the Citizenship Act that would require one parent to be a citizen or permanent resident of Canada. That is the situation in Australia.
Should the Conservatives form a government after the next federal election, they may well decide to revisit the issue of birth tourism given that the Harper government pressed the issue in 2012 only to back off.
A note on methodology
The data is from the CIHI’s discharge abstract database, more specifically “non-resident self-pay” category in the responsible for funding program (RFP), as well as totals for hospital deliveries.
The overall RFP data includes temporary residents on visitor visas, international students, foreign workers and visiting Canadian citizens, and permanent residents. Quebec has a slightly different coding system, but CIHI ensures its data is comparable. Data for Quebec hospitals is not provided through CIHI and thus the larger Montreal area hospitals were approached directly.
Ottawa-area hospitals were not included given the number of diplomatic families likely being a substantial portion of non-resident births. Declines in non-resident births at Trillium-Credit Valley Hospital in Mississauga, Ont., led to that hospital falling off the Top 10 list.
Health coverage for international students varies by province, but most of them are covered by provincial health plans. This is not the case in Manitoba and Ontario, as well as for some students in Quebec if their country of origin does not have a social-security agreement with Quebec. The pre-pandemic baseline is the five-year average 2016-20.
Mackenzie Health’s woman and child program moved from Mackenzie Richmond Hill Hospital to Cortellucci Vaughan Hospital when it opened to the community in June 2021.
Good article based upon the opinion piece by Dr. Barrett shared yesterday:
Should Canada deny care to ”birth tourists,” pregnant women who visit Canada with the sole purpose of delivering their babies here, thereby obtaining automatic Canadian citizenship for their newborns?
It’s a provocative, and, some say, dangerous suggestion. However, a leading expert in preterm and multiple births is arguing that Canadian hospitals and doctors should have “absolutely zero tolerance” for birth tourism, a phenomenon that is rising once again now that COVID travel restrictions have been dropped.
It’s a “sorry state of affairs” that women in Canada face wait times of 18 months or longer for treatment for pelvic pain, uncontrolled bleeding and other women’s health issues, Dr. Jon Barrett, professor and chief of the department of obstetrics and gynaecology at McMaster University wrote in an editorial in the Journal of Obstetrics and Gynaecology Canada.
“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,” Barrett wrote.
“These are non-Canadians getting access to health care, which we haven’t got enough of for our own Canadians,” he said in an interview.
When planned low-risk births go wrong, and babies end up spending weeks in intensive care, hospitals can be left with hundreds of thousands in unpaid bills. One Calgary study found that almost $700,000 was owed to Alberta Health Services over the 16-month study period.
The women themselves are also at risk, Barrett said, of being “fleeced” by unscrupulous brokers and agencies charging hefty sums upfront for birth tourism packages that include help arranging tourist visas, flights, “maternity” or “baby hotels” and pre-and post-partum care.
And, while he declined to provide specific examples, “Tempted by large sums of money, even the best of us can be tempted into poor practice,” Barrett wrote.
The issue has triggered high emotions and debate among Canada’s baby doctors. Under Canada’s rule of jus soli, Latin for “right of soil,” citizenship is automatically conferred to those born on Canadian soil.
Birthright citizenship gives the child access to a Canadian education and health care. They can also sponsor their parents to immigrate when they turn 18.
Other developed nations require at least one parent to be a citizen, or permanent resident.
According to data collected by Andrew Griffith, a former senior federal bureaucrat in Immigration, Refugees and Citizenship Canada, “tourism” births account for about one per cent, give or take a bit, of total births in Canada. Data from the Canadian Institute for Health Information show Canada hosted 4,400 foreign births in 2019.
At a national level, the numbers aren’t huge, however they can become significant at the local level, Griffith said: In pre-COVID years, non-resident births accounted for up to 25 per cent of all births at a single hospital in Richmond, B.C., while the numbers at a handful of other popular destination hospitals in Ontario and Quebec approached five to 10 per cent of all births.
“In a system that is tight and stretched, it does become an issue at the hospital level,” Griffith said.
But birth tourism also undermines the integrity and confidence in Canada’s citizenship process, he said, “It appears like a short cut, a loophole that people are abusing in order to obtain longer-term benefit for their offspring.”
“It sends the wrong message that basically we’re not very serious in terms of how we consider citizenship and its meaningfulness and its importance to Canada,” Griffith said.
Barrett is careful to stress that birth tourism absolutely doesn’t apply to women who happen to be in Canada because of work, or study programs, or as refugees. “We must declare that people who are here for a genuine reason should have seamless access to health care,” he said.
What he opposes are the “non-urgent planned and deliberate birth tourists in our hospitals.”
Doctors can’t deny care to a woman in labour. Emergency care would always be given, he said. “Obviously you’re never going to turn somebody away.”
But doctors and hospitals could decline to provide pregnancy care before birth. “Eventually, if you create this unfriendly environment,” Barrett said, “if everybody said we are not looking after you and not facilitating this, eventually people will not come. They would realize they are not getting what they are seeking, which is optimal care.”
Some women step off the plane 37 weeks pregnant, three weeks from their due date. “That’s why my colleagues say, ‘You can’t do that. People are going to suffer,’” Barrett said. “Yes, unfortunately, people are going to suffer, because they won’t get pregnancy care, and they’ll show up at the hospital without antenatal care.”
While some women do come to Canada seeking superior medical care, “let’s be frank,” said Calgary obstetrician and gynecologist Dr. Colin Birch. “The principal motivator is jus soli.
“Sometimes its veiled under, ‘I want to get better medical care,’ but, interestingly, they fly over several countries that can give them the equivalent care to Canada to get here,” said Birch, countries that don’t offer jus soli.
Birch is co-author of the Calgary study, the first in-depth look at birth tourism in Canada. Their retrospective analysis, a look back over the data, involved 102 women who gave birth in Calgary between July 2019 and November 2020. A deposit of $15,000 was collected from each birth tourist, and held in trust by a central “triage” office to cover the cost of doctors’ fees. A deposit wasn’t collected to cover fees for hospital stays for the mom or baby; women were made aware they would be billed directly.
The average age of the woman was 32. Most came to Canada with a visitor visa, arriving, on average, 87 days before their due date. Birth tourists were most commonly from Nigeria, followed by the Middle East, China, India and Mexico. Overall, 77 per cent stated that the reason for coming to Canada was to give birth to a “Canadian baby.”
Almost a third of the women had a pre-existing medical condition. One woman needed to be admitted to the ICU after delivery for cardiac reasons, another was admitted for a high blood pressure disorder and stroke. Nine babies required a stay in the neonatal intensive care unit, including one set of twins that stayed several months. Some women skip their bills without paying.
“Every conversation about heath care is that we haven’t got money for health care,” Birch said. “Yet you’ve got unpaid bills of three-quarters of a million. It’s not chump change.”
But denying care is a dangerous and unrealistic “gut reaction” that some hospitals have already taken, Birch wrote in his counter editorial for the Journal of Obstetrics and Gynaecology Canada. “Let’s be very clear: They won’t let them through the front door, or they send them on to another hospital.”
“You cannot have zero tolerance for patients,” Birch said. “You can’t do that because that leads to maternal and fetal complications.”
The federal government could tweak the rule of “jus soli,” excluding people who just come to Canada on a temporary visitor visa to give birth, and then leave, he and others said. “You do the Australian approach, that one of the parents has to be a citizen of the country,” said Griffith, a fellow of the Environics Institute and Canadian Global Affairs Institute.
Three years ago, the United States announced it would start denying visitor visas to pregnant foreign nationals if officials believe the sole purpose was to gain American citizenship for their babies.
While some have said birth tourists are being demonized as “queue jumpers and citizenship fraudsters,” Griffith isn’t convinced birth tourism is a politically divisive issue.
“I don’t think there are very many people that really would get upset if the government sort of said, ‘We’re going to crack down on birth tourists, women who come here specifically to give birth to a child and who have no connection to Canada.’”
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
Reference to Richmond only refers to 2022, rather than pre-pandemic years when Richmond General was the epicentre of birth tourism in Canada, with almost one-quarter being birth tourism, supported by a cottage industry of birth tourism hostels:
“Birth tourists being specifically people who are coming in specifically to have a birth then go back to their original country,” said Colin Birch, a Calgary obstetrician gynecologist.
They probably come to give birth for the advantage of birthright citizenship for future gains whether it be for themselves or their family, said Birch. “There are still immense advantages of living in a place like Canada,” he said.
“Is it a big problem? Well if you look at the numbers, absolutely not. It’s small.”
“Is it big enough to be a problem? I actually think it is,” he said.
Reason being Canada is in a healthcare crunch, “every bed is sacred,” said Birch.
As a healthcare system we are suffering from a capacity point of view and the expectation is to do more with less, he said.
“Canada is not really set up because of its socialized healthcare system for private pay patients and the demands that come with private pay patients,” said Birch.
The expectations from paying patients to patients covered by provincial health care are different.
“Not saying their care is different. Care is care,” he said.
Health care is expensive and when it comes to neonatal care it is astronomical if a baby needs to be in the ICU, he said.
The unpaid bills of the hospitals are massive, he said.
Calgary has taken a different approach to hospital bills associated with birth tourism. Birch confirmed the Calgary system requires a $15,000 deposit.
“It’s a very honest and upfront system,” said Birch. “It doesn’t pay the hospital fees no. It’s a deposit which pays basically physician fees.”
From the deposit what doesn’t get spent goes back to the patient, he said.
“We wanted to discourage the practice because it was becoming a bigger burden in Calgary,” said Birch. “The potential problem with that is the patients will then start moving to practitioners who are outside the city limits.”
It isn’t a perfect process but it’s an attempt to implement some sort of order, he said.
Prior to the deposit process birth tourism had impacts on the capacity of the hospital and ability at times to care for Canadian patients, he said.
Canada and the U.S. are the only countries in the G7 to offer birthright citizenship according to canadianimmigrationexperts.ca.
“What we need to debunk is the idea that all people who are not insured are not necessarily birth tourists,” said Birch.
“There’s a large undocumented population in the country,” he said. They are contributing members of society but are not documented, Birch said.
He wanted to make it clear undocumented folks who are uninsured are not birth tourists.
Birth tourism is not just a medical issue but a social issue that should be addressed, he said.
In the fiscal year of 2021 to 2022 Guelph General Hospital had a total of 1,707 deliveries, 11 were people from out of country. This breaks down to 0.6 per cent of deliveries were out of country.
Between April 2022 to February 2023 there were 1,543 deliveries and 18 were people from out of country who gave birth at the GGH. This is 1.2 per cent of the deliveries were out of country.
At the other end of Canada in Vancouver much of the same occurred at Richmond Hospital, in 2022 there were 22 nonresident deliveries. This number accounts for 1.5 per cent of the total deliveries at the hospital.
“All maternity patients coming to Richmond get the care they require to deliver their child safely. Care is always triaged according to the safety of the mother and baby – it is never delayed based on residency,” stated in an email from Vancouver Coastal Health (VCH).
VCH also said it does not support marketing of maternity tourism. Births from nonresidents have not led to disruptions of maternity services, said in the email.
“VCH will never deny urgent and emergent care based on ability to pay or where a patient is from, but we do expect to be compensated as we are accountable to B.C. residents for hospital and health care services. We are committed to collecting compensation from non-residents who use our medical services,” said in the email.
While part of their arguments concerned my interpretation of the data (largely addressed given the sharp drop in visitor visas covered in my Birth Tourism in Canada Dropped Sharply Once the Pandemic Began), the bulk of their arguments were on policy grounds where we disagree.
Ironically, we had submitted a joint-proposal in 2019 for funding research looking at the policy issues, but were unsuccessful. It has now been successfully resurrected with the original researchers but without my “contrarian” presence and thus may well lack balance given the common perspective of the researchers.
Their concern that “proposed measures risk being driven by polarizing narratives about borders and citizenship rather than by evidence” is somewhat ironic as they contest the best evidence that we have regarding the likely numbers of birth tourists.
As a whole, the proposal reinforces critiques of universities and academics not having a diversity of views and perspectives in their work:
Birth tourist is a term used for non-resident mothers (NRMs) who come to Canada with the sole purpose of giving birth so that their child has a claim to Canadian birthright citizenship.
“They are accused of undermining Canada’s jus soli citizenship laws and subsequently labelled ‘queue jumpers’ and ‘system cheaters,’” says Megan Gaucher. “While both completely legal and statistically low, birth tourism continues to be identified by political parties as an issue in need of remedy.”
Gaucher, an associate professor in the Department of Law and Legal Studies, has been awarded a five-year $223,328 SSHRC Insight grant for the project, “Mapping the Discursive and Institutional Landscape of ‘Birth Tourism’ and its Perceived Attack on Canadian Birthright Citizenship.”
“Proposed measures have focused almost exclusively on refusing automatic citizenship to children born on Canadian soil unless one of the parents is a Canadian citizen or permanent resident,” says Gaucher. “Calls for legislative action however, remain reliant on an incomplete picture of the prevalence of and motivations for engaging in birth tourism, the socio-legal structures that facilitate it and the implications current political and public discourse present for NRMs.”
The project will provide the first comprehensive mapping of the state of birth tourism in Canada. Gaucher — along with team members Jamie Chai Yun Liew (University of Ottawa), Y.Y. Chen (University of Ottawa) and Amanda Cheong (University of British Columbia) — will conduct interviews with NRMs and their family members, birth tourism industry insiders, health care practitioners, government officials and local residents.
These interviews will be complemented by an analysis of pre-existing government data, Parliamentary Hansard, birth tourism promotional materials and media coverage from mainstream and ethnic media. “Current conversations about birth tourism tend to rely on data from health facilities,” says Gaucher. “Our project will bring together experts in political science, law, health and sociology to critically interrogate how multiple socio-legal spaces are used to both criminalize and restrict access to NRMs and their future children.”
This study will explore how constructions of foreignness undermine the longstanding assumption that formal legal citizenship is an uncontested condition for membership to the Canadian state and explore how political and public discourse around birth tourism ultimately reproduces settler-colonial imaginaries of “good” familial citizens.
“As debate around birth tourism in Canada and the appropriate policy responses continue to unfold against a backdrop of knowledge gaps, proposed measures risk being driven by polarizing narratives about borders and citizenship rather than by evidence,” she says.
The latest example I have seen of marketing birth tourism services in Canada:
Getting Canadian citizenship for children brings many benefits. From avoiding international tuition fees when a child gets to university age, to easing immigration concerns, Canadian birthright can be advantageous. The opportunity to live and work in the Canadian economy is also something that could be an ideal solution once children reach adulthood and want to make the most of their skills. Accessing one of the world’s most advanced healthcare systems when needed will also provide sound peace of mind.
Despite the benefits of doing so, many people are put off attempting to get Canadian birthright citizenship for their children for fear of acting illegally, or just because of bureaucratic red tape involved. The reality is that with the right help, it is completely legal to do so, and experts can navigate the process on an individual’s behalf.
“Birthright Citizenship Canada are experts in our field, and we do everything we can to make the process as smooth as possible”, a spokesman for the Concord, ON-based childbirth support organization commented. “By commissioning us to work on your family’s project you will know that everything is taken care of. This includes the paperwork, travel arrangements to and from Canada, and all the legal and medical help that will be required along the way”.
“One of the main aspects that discourages people from seeking to obtain birthright citizenship for their children is the processes involved. Obtaining documents such as temporary residence visas can be a daunting prospect for people not familiar with Canadian procedures. Our team are skilled in such matters, and can allow you to concentrate on enjoying your new arrival.”
The Canadian Citizenship Act made it legal to get citizenship for a baby born in Canada to foreign parents. In fact in simple terms, the act states that citizenship is available to all children born within the country. Even still, the perception of complexity and bureaucracy discourages many people.
“To ease peoples’ concerns about complexity and legalities, we combine everything into ‘birth packages’. These bundle in everything from transport and accommodation arrangements to healthcare and paperwork. Our experts handle multiple files on a daily basis. As a result, they know how to get things done, and where the potential bottlenecks are. Not only that, but they take the time to communicate with the customer at every step of the way.”
Birthright Citizenship Canada’s role involves being the go-between to navigate different stakeholders from the start of the process. Only when the family leaves the country again with a Canadian citizenship passport does the project conclude.
“Our job is all about removing pain points and hassle”, the spokesman continued. “We even do our best to save our customers some money where we possibly can. For example, we advise people to have pre-natal testing carried out prior to traveling to Canada. Doing this in their country of origin is almost always cheaper, and this way it is already organized before touching down in Canada. We also have different packages available depending on peoples’ budgets and requirements.”
About Birthright Citizenship Canada
Birthright Citizenship Canada are experts in childbirth support. The Toronto-based consultants specialize in obtaining citizenship for non-residents’ children born on Canadian territory. By offering packaged services covering legal, medical and administrative requirements, Birthright Citizenship Canada aim to take the stress and hassle out of the process. This allows people to focus on the birth of their child.
Media Contact Company Name: Birthright Citizenship Canada Contact Person: Media Relations Email:Send Email Phone: +1-647-646-5437 Address:7250 Keele Street, Unit 425 City: Toronto State: Ontario L4K 1Z8 Country: Canada Website:https://birthrightcanada.com/
More British Columbia media coverage of birth tourism, following a recent poll and my release of the CIHI data:
One in four births taking place at Richmond Hospital involve an international mother, according to new statistics.
So-called “birth tourism” is a controversial phenomenon in which expectant mothers from other countries come to Canada for the purpose of accessing a Canadian passport for their newborn babies and skipping the standard immigration processes.
“It’s perceived as an abuse of birthright citizenship,” said Andrew Griffith, a former director of Immigration Refugees and Citizenship Canada who is currently a fellow at the Environics Institute.
“Birthright citizenship was really designed for people who moved to Canada, who immigrated to Canada, gave birth to their children, so their children would automatically have Canadian citizenship,” Griffith said. “It was never designed for a world where you could stay in a birth hotel or a hostel, give birth and fly back to your country of origin.”
Over the last couple of years, Griffith has been collecting numbers from the Canadian Institute for Health Information, which compiles data from hospitals across the country, excluding Quebec.
A chart Griffith created shows a 10-year trend of births by non-residents and reveals an upward curve of the practice.
Griffith notes that the term “non-resident,” in this data can also refer to international students and foreign workers. He estimates birth tourists account for roughly half of the non-resident births.
The new numbers show the 2019-2020 fiscal year and don’t include the majority of the months during the COVID-19 pandemic.
They reveal that births by non-residents made up 24 per cent of the deliveries at Richmond Hospital, a slight uptick from the year before.
The numbers jumped by more than a third for St. Paul’s and and Mount Saint Joseph hospitals in Vancouver, where non-residents made up 14 per cent of the total births.
“What I find interesting is that I haven’t seen really any similar outcry in any other community – even in those centres where there seems to be fairly high numbers of non-resident births – and I’m just not quite sure why that is, because it seems like the focus always is on Richmond,” he said.
Politicians from all three levels of government in Richmond have been pushing Ottawa to do more to stop the practice.
“We just feel that that is not fair, it really degrades the citizenship that we all enjoy,” said Richmond Mayor Malcolm Brodie.
He said the municipal government has been advocating that birth tourism be addressed, but those requests seem to have fallen on deaf ears.
“We can insist that those practices that are operating a business to house the birth tourists have a business licence. There’s not all that much more that we can do, other than keep highlighting the problem,” Brodie said.
Jas Johal, the BC Liberal MLA for Richmond-Queensborough, said the province can step in by increasing fees for international mothers to discourage the practice, but the responsibility lies with the federal government.
“One out of four children born at our hospital are foreign nationals – that’s not a hospital anymore, it’s a passport mill,” he said. “If you’re coming here to have a child on a tourist visa, well, guess what? That application for citizenship is null and void. A simple change like that would probably reduce, and probably eliminate, birth tourism in Canada.”
The two Conservative members of parliament for the area, Kenny Chiu and Alice Wong, have also voiced their objection to the practice.
Chiu’s office has been encouraging people to write letters to the immigration minister and offering to help deliver them.
A recent survey also found a majority of people would like the federal government set up a committee to address birth tourism.
CTV News Vancouver reached out to Immigration Refugees and Citizenship Canada regarding birth tourism, but did not receive a response before deadline. This story will be updated if a response is received.
And the poll from Researchco that prompted the coverage (IMO, questions are tendentious and leading, and the methodology is not that rigorous:
Many B.C. residents are tuned into the practice of birth tourism in Canada and most want the federal government to launch an investigation into it, a new poll suggests.
According to a survey conducted by Research Co., 49 per cent of B.C. residents have been following media coverage of birth tourism – a practice of travelling to a specific country for the purpose of giving birth and securing citizenship for the child.
Canada is one of fewer than three dozen countries that follow the practice of citizenship based on birthplace and some – including Australia and Britain – have modified or ended automatic birthright citizenship in recent years
“Residents of British Columbia are more likely to be paying attention to this issue, partly because of the situation that has unfolded in the city of Richmond,” said Mario Canseco, president of Research Co., in a news release.
“Almost half of British Columbians (49 per cent) are following stories about ‘birth tourism,’ compared to just 34 per cent of Albertans.”
But most B.C. residents polled don’t have favourable views of the practice.
According to the survey, 77 per cent of British Columbians say they feel birth tourism can be unfairly used to gain access to Canada’s education, health care and social programs. Meanwhile, 64 per cent worry that birth tourism could displace Canadians from hospitals.
Additionally, 67 per cent of those polled feel birth tourism “can degrade the value of Canadian citizenship,” while 71 per cent agree with the statement that the practice of granting birthright citizenship may have made sense at one point, “but now people have taken advantage of existing rules.”
With that, 82 per cent of B.C. residents said they agree with the federal government establishing a committee to investigate the extent of birth tourism in the country. Just eight per cent disagreed with the idea, while 12 per cent said they weren’t sure.
According to the nation-wide poll, however, support for a new approach to birthright citizenship in Canada is highest in Manitoba and Saskatchewan at 66 per cent. Alberta follows at 60 per cent, with B.C. standing at 56 per cent hoping for new regulations.
Results are based on an online study conducted from Aug. 28 to Aug. 30, 2020, among 1,000 adults in Canada. The margin of error—which measures sample variability—is plus or minus 3.1 percentage points, 19 times out of 20.
More coverage of the latest non-resident birth numbers, including MA graduate Yousif Samarrai’s proposal to use SIN as a gatekeeper for those on visitor visas (in contrast to students and temporary residents who are issued SIN).
Those without a SIN would not be issued a birth certificate by the provincial vital statistics agencies (hospitals would still issue attestations of birth).
Like all proposals, there would be a number of complications, operational, jurisdictional and legal, but if doable, it would be a targeted approach that would reduce collateral impact.
Three hundred more non-resident women gave birth at a handful of Canadian hospitals in 2019 compared with the year prior, with the largest increases occurring at two Toronto-area hospitals and one within Vancouver.
The statistics from the Canadian Institute for Health Information show that Richmond, B.C., still registers the highest number of these births in the country, with 502, or one out of every four babies born last year involving women who are not Canadian residents.
The national tally of births from non-resident mothers represents only 1.6 per cent of all births across Canada last year, save Quebec, but locals in and around Richmond have denounced the practice of “birth tourism” – where women travel to Canada to deliver a baby who will then gain Canadian citizenship.
While municipal, provincial and federal politicians want the practice banned, Andrew Griffith said the data he obtained from the Crown corporation captures those women, as well as students studying in Canada and women who live here but who have not completed the citizenship process.
Mr. Griffith, an Ottawa-based fellow at the Canadian Global Affairs Institute and a former high-level federal bureaucrat, said because of the lack of precise data, the long-term impact of any birth tourists remains unclear.
It is legal for non-residents to give birth in Canada, which then grants the baby citizenship, but Mr. Griffith said changing birthright citizenship probably isn’t worth the effort at this time given the numbers.
“And if you assume that roughly half of those numbers are pure birth tourists, you’re still talking about less than 1 per cent of the total number of live births in Canada, and you’re still talking about less than 1 per cent of the total number of immigrants to Canada,” Mr. Griffith said.
“Are you going to penalize the 99 per cent to address a problem that affects the 1 per cent?”
The data show that after Richmond Hospital, North York’s Humber River Hospital had the next-highest number of these births last year at 329, followed by Mackenzie Health’s facility in Richmond Hill, Ont., with 287. Vancouver’s St. Paul’s Hospital recorded 203 during the 2019 fiscal year, more than double the number recorded five years earlier.
Spokespeople for these various hospitals told The Globe and Mail on Monday they never deny or delay care to anyone based on their residency status, but they do seek compensation for this care from patients without medical coverage, with these fees covering the treatment.
Richmond Mayor Malcolm Brodie said steps need to be taken to prohibit birth tourism, which he said is creating pressure on resources of the city’s lone hospital.
“It is fundamentally not right that people would adopt a strategy to come here and have their babies and then go back without contributing in any meaningful way to the local economy or paying taxes here or any other form of support,” he said in an interview.
In February, Richmond City Council wrote letters to Prime Minister Justin Trudeau and other federal and provincial politicians requesting a change to immigration laws to end “this strategic opportunity taken by people who have no official connection to Canada.”
A year ago, Joe Peschisolido, Liberal MP for Steveston-Richmond East, called on his government to end the practice of birth tourism, telling The Globe that he had spoken with then-minister of immigration, refugees and citizenship minister Ahmed Hussen about the issue.
On Monday, the federal Immigration Minister’s head spokesperson said Ottawa is focused on cracking down on immigration fraud and while “birth tourism is not widespread” the department is researching the extent of the practice to see how many of these non-resident mothers are tourists.
Yousif Samarrai, who recently wrote his master’s thesis in public policy on the issue at Simon Fraser University, said “birth tourism” has become so controversial in B.C. because unlicensed hotel companies in Richmond have been caught marketing packages to expectant Chinese mothers.
He said a simple fix to this issue would be to require a new parent to submit their own social insurance number in order to get a birth certificate – and the resulting citizenship – for their child. Every class of visitor to Canada receives a SIN except tourists, he said.
“The whole idea of changing these laws is you don’t want to impact anybody that’s coming here through legitimate means,” Mr. Samarrai said. “However, if we change the administrative way that people attain a birth certificate, that’s a little more practical.”
The number of women coming to Canada to give birth, which automatically bestows citizenship on the baby, is expanding much faster in British Columbia than the rest of the country.
Richmond Hospital is the centre of the trend, often called “birth tourism.” New data released this week shows one out of four births in the past year at the hospital in the Vancouver suburb, which features many illicit “birth hotels” advertising their services in Asia, were to foreign nationals.
A Veteran Richmond councillor, Chak Au, says virtually everyone in his municipality, in which more than half of the population is ethnic Chinese, would be disturbed to learn that 502 non-resident births took place in the past year at Richmond Hospital, 48 more than in the previous year.
Richmond residents, Au said on Thursday, want politicians to stop birth tourism, in part because they realize it burns up resources that could be directed to other health departments.
St. Paul’s Hospital and Mount St. Joseph’s Hospital, both in Vancouver, are also fast turning into hubs for birth citizenship, with the two hospitals experiencing a 38 per cent rise in births by non-resident women, one in seven of the total.Virtually no country outside North and South America provides citizenship to babies solely because they’re born on their soil.The newly released figures show there were 4,400 births in Canada in the past year to non-resident mothers, an overall hike of seven per cent. Ontario doctors still preside over the most non-resident births, 3,109, with one hospital in Toronto, Humber River, having a sudden jump of more than 119 per cent.But Ontario’s volume of privately funded procedures has not risen nearly as fast as in B.C., which had a total of 868 non-resident births. That’s a six-fold increase from 2010.
Source: Canadian Institute for Health Information/Andrew Griffith
The new data, compiled by Andrew Griffith, a former senior director of the federal Immigration Department, comes from the Canadian Institute for Health Information, which captures billing information directly from hospitals up until the end of March. It doesn’t include births in Quebec.
Birth tourism has recently been strongly condemned by Richmond Mayor Malcolm Brodie, Liberal MLA Jas Johal (Richmond-Queensborough), former Liberal MP Joe Peschisolido (Richmond East), the head of Doctors of B.C. and others.
Prime Minister Justin Trudeau’s government, which controls immigration policy, has been silent on the matter. Former Conservative party Leader Andrew Scheer said in 2018 he would end birth tourism. NDP leader Jagmeet Singh has accused those who raise the issue of being guilty of “division and hate.”
In February, Richmond council sent letters to Immigration Minister Marco Mendicino, to leading B.C. politicians and to Vancouver Coastal Health. Council called for “permanent changes to immigration laws which would end automatic Canadian citizenship being bestowed on babies born in Canada to non-resident parents who are not citizens of Canada.”Last week, Mendicino’s department finally responded, saying the minister is aware “of the increase in births by non-residents in Canada” and promised to “monitor” it.“All levels of government are trying to pass the buck” on birth tourism, said Au. He acknowledged Richmond was itself failing to combat the dozens of shadowy birth hotels and agents in the city, which help women give birth in Canada for fees in the tens of thousands of dollars.Ads aimed at women in China who want to have babies in Canada tout luxurious accommodation, birthright citizenship in the “world’s most livable country,” 12 years of free public education, university fees just 10 per cent of those paid by foreign students, free health care and eventual family reunification for the parents of the baby who obtains the passport.Au said Richmond officials could be cracking down on underground birth-tourism operations because they don’t have proper business licences. But council and staff, he said, haven’t yet come up with an effective way to do so.
Au is also suspicious that hospital administrators and the few doctors who perform full-fee deliveries for foreign mothers are not countering the problem for financial reasons. “We don’t want our hospitals dependent on this income.”
Source: Canadian Institute for Health Information/Andrew Griffith
In a piece on his website, Multicultural Meanderings, Griffith says figures provided by the Canadian Institute for Health Information show all “non-resident births” in Canada, which includes women who give birth while here as foreign students or temporary workers. Griffith estimates about 50 per cent of the total are full-blown “birth tourists.”
After Griffith wrote a 2018 piece on the subject for Policy Options, three female academics responded by saying those who want to end birthright citizenship are “demonizing pregnant migrant women,“ “encouraging violence against stateless people” and “fuelling discrimination.”
Nevertheless, the academics supported Griffith’s call for better data. He lamented this week, however, that the federal departments that previously promised to link health care and immigration data to monitor non-resident births have “stalled.”
David Chen, the former Pro Vancouver mayoral candidate, has publicly expressed concern about birth tourism. He said Thursday that granting citizenship to anyone born on Canadian soil “poses problems on several fronts.”
As a child of immigrants, Chen, who is now a vice-chair of Vancouver’s NPA party, said it “shortchanges those who went through proper channels only to see people with much more disposable cash jump the line and have an easier route to Canadian citizenship.”
Australia, Britain, New Zealand, France, Germany and South Africa have all, in relatively recent times, altered their citizenship laws to discourage birth tourism. More than 150 nations do not permit it.
While recognizing the issue is complicated, Au, a nine-year member of council, said he believes he understands the views of most Richmond residents, where the fast-changing population is now 53 per cent ethnic Chinese, 24 per cent white, seven per cent South Asian and seven per cent Filipino.“Ethnic Chinese feel the same as everyone else in Richmond,” he said. “They’re concerned.”
It was another record year for birth tourism in B.C., according to new data released by health officials.
The province saw a 21.9% spike in non-resident births between April 1, 2019 and March 31, 2020, as 868 non-residents of Canada – the vast majority of whom are understood to be Chinese nationals on tourist visas – paid to give birth in local hospitals in order to garner automatic citizenship for their newborns. The prior year, 712 non-residents gave birth in B.C.
“Vancouver area hospitals continue to have the largest percentages of non-resident births, with an active cottage industry supporting women coming to give birth from China,” said researcher Andrew Griffiths, who first reported the new annual data from the Canadian Institute for Health Information.
The epicentre of the budding industry is Richmond, where an annual record of 502 births to non-residents took place, up from 458 in the year to March 2019 and 474 in the year to March 2018.
Those 502 newborns represent 24% of the 2,094 total newborns at Richmond General Hospital. That is the highest total and share of non-resident births at a hospital across Canada. Meanwhile, Vancouver’s St.Paul’s Hospital is second in the nation, with 14.1% of all births being to non-residents. There, 203 babies were born to non-residents.
Non-resident births also peaked across Canada, with CIHI reporting 4,400 newborns to non-residents in 2019/2020, up 7.3% from the previous year’s total of 4,099, excluding Quebec.
B.C. figures do not include international students, who are enrolled in the public healthcare system. As such, Griffiths said B.C.’s figures are a more accurate indication of birth tourism (those non-residents who fly to Canada for the explicit purpose of obtaining citizenship for their newborns).
Griffiths, a former director general of the Citizenship and Multiculturalism Branch, Department of Citizenship and Immigration, said he estimates about half of the non-resident births outside of B.C. to be tied to parents on tourist visas. However there is no reportable data along those lines, as a federal review of the issue, first announced in November 2018, appears stalled.
“Hopefully, the work to link healthcare and immigration data will resume shortly, not only to provide more accurate numbers with respect to birth tourism but to improve our understanding of healthcare and immigrants more generally,” said Griffiths.
Non-resident births by hospital, 2018-2019 and 2019-2020. Figure by Andrew Griffiths
Glacier Media requested information on non-resident births tied to patients on tourist visas but Vancouver Coastal Health Authority said such data does not exist and the task to obtain it from paperwork would be too onerous – although such data is what the federal government stated it would acquire in its review.
Canada is one of two Western countries, along with the United States, to offer birthright citizenship – a concept also known as jus soli – meaning babies born to two foreign nationals on tourist visas are granted automatic citizenship.
It remains unclear exactly what the federal government is doing to enact policies to curb the practice. To date, no enforcement measures have been announced, unlike in the U.S., which has convicted “baby house” operators of money laundering and fraud in 2019.
The U.S. State Department further cracked down on birth tourism in January, with a new rule that “travel to the United States with the primary purpose of obtaining U.S. citizenship for a child by giving birth in the United States is an impermissible basis” for a tourist visa.
The lack of action to address birth tourism, which is widely perceived by the public as an abuse of Canada’s immigration system, has frustrated Richmond community activist Kerry Starchuk, who has documented dozens of “baby houses” in the Vancouver suburb offering accommodation and doula services for Chinese nationals, who typically arrive three to four months prior to giving birth on a six-month or extended tourist visa.
“It’s a joke. It’s so blatant you can see it. They’re advertising this in China,” said Starchuk.
In a written response to Starchuk, dated July 8, 2020, Immigration, Refugees and Citizenship Canada (IRCC) said it was “aware of the increase in births by non-residents in Canada.”
IRCC said, “While statistics indicate that birth tourism is not widespread, IRCC is researching the extent of this practice, including how many of the non-residents are short term visitors.”
Birth tourism is technically legal in Canada, in so much that nothing bars a pregnant woman from entering Canada to give birth, so long as they are honest with border agents.
“Providing false information or documents when dealing with IRCC is considered misrepresentation and has immigration consequences. However, non-residents giving birth in Canada is not considered fraud under the Citizenship Act,” stated IRCC.
“Additionally, under the Immigration and Refugee Protection Act, a persons are not inadmissible nor can they be denied a visa solely on the grounds that they are pregnant or that they may give birth in Canada,” wrote IRCC.
Starchuk said the federal Liberal government has dragged its feet on the matter.
“I’m not interested in writing any more letters. I want action,” she said.
Non-resident births in Canada by year. Figure by Andrew Griffiths
Richmond Conservative Members of Parliament Kenny Chiu and Alice Wong have proposed a hybrid jus soli policy that would bar those on tourist visas from obtaining citizenship for their newborns. Newborns of non-resident international students, for instance, would continue to obtain citizenship under their proposal.
Griffiths said birth tourism businesses in Richmond are at a stand still with COVID-19 flight restrictions and visitor visas from China down 72.2% between January and March, and down 99.79% by June.
A poll from Research Co. in February, 2019 showed almost three in four (73%) believe it is time to end automatic citizenship for people born in Canada (adopting rules used by most Western countries). An Angus Reid poll in March, 2019 showed 60% of Canadians want the law changed.
Immigration Minister Marco E.L. Mendicino declined to be interviewed on this matter.
The 2019-20 numbers, obtained from the Canadian Institute for Health Information (CIHI) for all provinces save Quebec, show an overall increase of about 7 percent compared to the previous year, with British Columbia showing an increase of more than 20 percent.
Quebec does not authorize CIHI to release their comparable data, unfortunately.
As non-resident numbers are a broader measure than those on visitor visas coming to give birth (e.g., students, temporary workers), my estimate is that about 50 percent are likely birth tourists.
It appears that the efforts underway by IRCC, CIHI and Statistics Canada to link healthcare and immigration data, that would allow identification of those on visitor visas from other non-residents, has stalled given shifting priorities due to COVID-19.
So these numbers remain the best we have.
Vancouver area hospitals (Richmond General: 24 percent, St. Pauls and Mount St. Joseph: 14.1 percent) continue to have the largest percentages of non-resident births, with an active cottage industry supporting women coming to give birth from China. While awareness of COVID-19 in China was greater and earlier than elsewhere, with a corresponding decrease in visitor visas issued and air travel, this did not impact non-resident births, likely given that plans were set.
2020 numbers, of course, are expected to reveal a sharp decline reflecting travel restrictions, particularly with respect to birth tourists on visitor visas.
Hopefully, the work to link healthcare and immigration data will resume shortly, not only to provide more accurate numbers with respect to birth tourism but to improve our understanding of healthcare and immigrants more generally.
Multicultural Meanderings 