The Laughable “Security” Justification for Cracking Down on Birth Tourism

2020/01/24 1 Comment

Good analysis by David Bier:

The U.S. Department of State announced a new rule for tourist visa applicants today: prove you’re not going to give birth in America. The rule will not protect national security, will create more fraud and crime, and will cost America people who will contribute productively to this nation.

The tourist visa statute allows noncitizens to visit the United States for “pleasure,” which State has always interpreted to mean “legitimate activities of a recreational character, including tourism, amusement, visits with friends or relatives, rest, medical treatment, and activities of a fraternal, social, or service nature.” — in other words, most anything. But now, “The Department is revising the definition of ‘pleasure’” (p. 2) to exclude giving birth in the United States.

The State Department asserts that the “rule addresses concerns about the attendant risks of this activity to national security.”

The previous regulation failed to address the national security vulnerability that could allow foreign governments or entities to recruit or groom U.S. citizens who were born as the result of birth tourism and raised overseas, without attachment to the United States, in manners that threaten the security of the United States.

The State Department not only doesn’t present any evidence that this is occurring or has ever occurred, but it doesn’t even explain what the threatening “manners” might be that could somehow harm America. It can’t even imagine a hypothetical scenario to give flesh and bones to nightmare. The evidence that it does provide is that “Birth tourism companies advertise their businesses abroad by promoting the citizenship‐​related benefits of giving birth in the United States” (emphasis added). In other words, these are capitalist enterprises led by the market, not governmental efforts led by foreign security agencies.

I have dug through hundreds of national security and terrorism cases over a 30‐​year period to identify the origins of the offenders, and not a single case that I have reviewed followed this fact pattern.

The State Department lists the following reasons for people choosing to give birth in the United States:

obtaining a second citizenship for their child, the perceived low‐​cost medical services available to women in the United States, the lower cost of obtaining U.S. citizenship through birth tourism than through a U.S. investor visa, and the perceived guarantee of a better socioeconomic future for their child.

Not included on this list: developing stealth agents to (somehow) undermine America.

It’s also interesting that the State Department didn’t include the evasion of China’s 1‑child/​2‑child policy. One woman named Liou said in 2015 that she only came to the United States to “skirt China’s one‐​child policy” and will return to China after giving birth. The reason is that the child limit only applies to children born in mainland China. A Shanghai reporter assessed the situation this way in 2011:

American journalists continue to generate stories about birth tourists from China, most often explaining them as seekers of the American dream. They rarely touch on what the Chinese people, and their media, know is a leading cause of the phenomenon: an attempt to evade the Chinese government’s population controls.

This explains why — as I described in 2015—out‐​of‐​county births to mainland Chinese have spiked all around the world, not just in the United States. You would think that the State Department would want to treat people thwarting Chinese totalitarianism as potential allies, rather than threats. Obviously, these women choose to give birth in the United States rather than elsewhere because they believe their children could benefit from having the option to come and live here, but it takes a bizarre sort of nativist paranoia to see this aspiration for the American dream as a threat rather than an opportunity.

The State Department cites a few instances of birth tourism companies defrauding immigrants, hospitals, and property owners, but those actions are already illegal and this rule does nothing to stop fraud. Indeed, by banning this activity, this rule will inevitably push the industry underground and lead to more fraud. Far from protecting women seeking to give birth here, it will place them in much more vulnerable situations.

This rule has no justification other than a desire to keep out foreigners. Indeed, it repeatedly cites the fear that parents of the child could eventually receive green cards when their children reach adulthood. That’s not a fear any reasonable person would treat as a security threat. In fact, the State Department notes that the birth tourists are hoping their children will eventually return to contribute to America. How is this a problem?

The State Department is denying the public the ability to comment on the rule before it becomes finalized — as all other rules must do — because it wants to avoid having to “respond publicly to pointed questions regarding foreign policy decisions.” It must be nice to have the power to harm the lives of tens of thousands of peaceful people, all without the fear of having to answer any questions about it.

Source: https://www.cato.org/blog/laughable-security-justification-cracking-down-birth-tourism

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The Trump Administration’s Travel Ban Against Women of Child-bearing Age

2020/01/24 Leave a comment

One of the initial critiques. Should a future Canadian government decide to implement a comparable measure, many of these points would apply and would need to be considered before implementation.

And it will be interesting to see if the US action diverts birth tourists to Canada, that will take some time to show up in the CIHI data:

Without any new action by Congress, the Trump administration posted a new regulation, effective tomorrow, that bans women of child-bearing age from being issued a visitor visa simply because they could be pregnant. The bottom line: a vast group of women visitors to the U.S. could be barred simply because a consular officer thinks they are pregnant or could become pregnant.  Unless they are able to overcome a new obstacle — proving to a consular officer that, just because they could be pregnant, they do not have the intention to obtain U.S. citizenship for their child by giving birth in the U.S. — millions of women could be denied access to America.

There were approximately 7 million visitor visas issued in 2018, so this rule could apply to millions of women from around the world seeking to visit our country, but not men. The first barrier to entry starts with being a woman. The second: a consular officer’s subjective guess about a women’s reproductive cycle. Third: the fact of a woman’s pregnancy or her ability to become pregnant — which is not, in fact, a bar to visiting the U.S. under the law passed by Congress.

This new rule would apply to a pregnant woman traveling with her family to Disneyland, a pregnant woman coming to the United States for a business meeting, and a pregnant woman who needs specialized medical care to save her baby’s life and her own during birth. Worse yet, the language of the new regulation is so overly-broad, it conceivably could bar any woman in her child-bearing years just because she could possibly become pregnant and have a baby while visiting the U.S. within the ten years that a visitor visa is typically valid for many foreign nationals.

Ur Jaddou, Director of DHS Watch and former USCIS Chief Counsel, said: “Don’t be fooled by the rhetoric of this administration. This new rule is nothing more than a new roadblock for women just because their bodies can become pregnant. This new rule very specifically states that just because a consular officer ‘has reason to believe’ a woman ‘will give birth during her stay in the United States,’ she is automatically presumed to be coming to the United States ‘for the primary purpose of obtaining U.S. citizenship for the child.’ Because the language of the new regulations is so overly-broad, it would not only cause a consular officer to ‘have reason to believe’ an eight-month pregnant woman ‘will give birth during her stay in the United States,’ it could also mean that a consular officer might have ‘reason to believe’ that a woman of any child-bearing age — approximately 30-40 years of her life — ‘will give birth during her stay in the United States.’  That is because a B visa could be granted, and often is granted, for up to 10 years. Even if a woman of child-bearing age is not pregnant on the day of her visa interview, she could conceivably become pregnant, travel to the U.S. while pregnant within the 10 years of her valid B visa, and give birth while in the U.S. during one of those visits. Therefore, a consular officer in any U.S. embassy or consulate could conceivably be banning a woman from the U.S. just because she could one day within the next 10 years be pregnant and give birth during a visit in the U.S. This new regulation is more than absurd and a clear attack on women and their bodies just because they can have babies.”

David Leopold, Counsel to DHS Watch, Chair of Immigration at Ulmer & Berne and former President of the American Immigration Lawyers Association, said:  “The Trump administration has effectively placed a travel ban on women of child-bearing age. Under the false pretext of national security and crime prevention, the administration has concocted a discriminatory rule which empowers overseas visa officers to deny a visitor visa to any woman the officer ‘has reason to believe’ will give birth in the U.S. Translated into plain English that means a consular officer can deny a visa to any woman of child-bearing age. So, with the stroke of a pen Trump has now given low level embassy bureaucrats effective control over women’s bodies. Clearly, any woman seeking to visit the U.S. will be placed in the humiliating position of having to convince a U.S. consular official that she’s not pregnant or going to get pregnant before she travels to the U.S. or while she’s visiting. This indefensible regulation will potentially impact millions of women who seek to travel to the U.S. for business or pleasure. Of course, like many other Trump immigration schemes, the impact of this regulation will be largely on women of color. The rule does not apply to citizens of most Western and industrialized nations who are eligible to travel to the U.S. without a visitor visa.”

The new regulation is deceptively short and simple:  

Any B nonimmigrant visa applicant who a consular officer has reason to believe will give birth during her stay in the United States is presumed to be traveling for the primary purpose of obtaining U.S. citizenship for the child. 

But what it means is much more insidious.  

The regulation gives consular officers vast new power to establish a “reason to believe” that a woman seeking a visitor visa “will give birth during her stay in the United States.” Because there is no limit in the regulation as to what is considered a “reason to believe,” there are so many circumstances that could give rise to that “reason to believe.” Could it be that she appears pregnant during a visa interview? How would a consular officer determine that? Could it even be that any woman of child-bearing age could reasonably become pregnant and give birth in the United States during the 10 years that a typical tourist visa is valid?

As soon as that “reason to believe” is triggered, the presumption is triggered and women are then faced with the roadblock of proving that they do not have the “primary purpose of obtaining U.S. citizenship for the child.” But there is little in this regulation that explains how a woman can overcome this burden.

Moreover, this regulation is squarely aimed at women, banning women unless they overcome the presumption. But what about men who may be coming to support or accompany a woman for the birth of a child? Under the new regulation, there is no additional burden for men, just women, yet both could share the same purpose for the visit that this regulation claims to address.

Understanding the Visa Process

To understand the practical impact of this regulation it is necessary to understand how visa issuance works. After completing an online application the visa applicant is usually briefly interviewed while standing before a row of windows by a consular officer who appears behind a glass partition. During the interview, which is usually no more than a few minutes, the consular officer generally assesses the purpose of the trip to the U.S. and the applicant’s ties to her home country in an effort to determine whether or not she will return home after her temporary trip to the U.S. This regulation now permits the consular officer to legally deny a visa to any woman whom he “has reason to believe” will give birth during her stay in the U.S. because she will be presumed to be traveling to the U.S. to obtain U.S. citizenship for the child. Thus, a business executive, who is pregnant, could be denied a visa for a business meeting in the U.S., even though she has a close economic and family ties in her home country.

Furthermore, depending on the applicant’s country, visitor visas can be issued for up to 10 years. In evaluating visitor visa eligibility under this new regulation, a consular officer is now permitted to estimate whether or not there is reason to believe a woman may at some point during the validity period of a visa — up to 10 years — give birth in the U.S. If so, in addition to existing regulations that apply to both men and women seeking visitor visas, she must overcome the new presumption that she does not have the primary intention of obtaining U.S. citizenship for a child by giving birth in the U.S. to a child she may potentially have at some point in the next 10 years.

Racial Disparity

The State Department regulation specifically states that it “does not change Department of Homeland Security regulations regarding the admissibility of aliens, including Visa Waiver Program travelers.” The Visa Waiver Program allows foreign nationals to travel to the United States without first applying for a visitor visa and only foreign nationals from certain countries may use the VWP program, mainly Western and industrialized nations. Therefore, this new regulation does not apply to women who come from primarily Western and industrialized nations, but does apply to all other nations. The impact, therefore, is likely to fall squarely on women of color seeking to visit the U.S. for business or pleasure, requiring them to overcome the seemingly insurmountable burden of showing they do not intend to give birth in the U.S. for the purpose of obtaining U.S. citizenship for their child.  Women from industrialized countries face no such obstacles if they travel on the Visa Waiver Program.

Source: americasvoice.org/press_releases…

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Birth Tourism, Belts, and Braces

2020/01/23 Leave a comment

Interesting analysis of the visa screening proposal by the Trump administration and some of the implementation issues:

A news story about the likelihood of a crackdown on birth tourism by the current administration got me thinking about birth tourism as a challenge, in and of itself, and how its management is complicated by the number of migration screenings experienced by a pregnant alien woman.

Birth tourism, as my colleagues and I have argued over the years, is a problem because it not only allows instant citizenship for the infant involved, it grants immigration benefits to that child’s parents 21 years later — all without any governmental control, and all beyond the numerical ceilings that control most legal immigration. CIS has estimated that there are about 33,000 such births a year.

The news story reports that the State Department has announced that it is contemplating issuing a new regulation that a tourist visa should not be used in connection with birth tourism, and that Customs and Border Protection (CBP) may being doing the same.

Were both State and CBP to come up with such policies, how would they be enforced? This leads to my comments about the varying number of screenings that a pregnant alien could experience on her way to becoming a birth tourism mother. The more processes, the more likely the pregnancy would be noticed.

The number of barriers that an expecting mother faces would vary, to some extent, by the likelihood of her giving birth in the United States. Women arriving from China, Russia, and Nigeria, often mentioned in this connection, would have a harder time bringing this off than, say, a Canadian, but it’s unlikely that a Canadian would be interested in birthright citizenship for her expected child. (Aliens from the first three countries need visas to enter the United States; Canadians do not.)

In some cases, to use a British metaphor, there would be a single barrier (or belt) to birth citizenship, and in others there could be as many as one belt and two pairs of braces; here are the variations:

  • One belt: The mother in question is from a visa-waiver country, so she would not need a visa, she simply has to get past the immigration officer at the U.S. airport where her plane lands.
  • One belt: The mother is Canadian and needs to be admitted at a port of entry; she might be a passenger in a car, at night, with her body shape hidden in clothing.
  • One belt plus one set of braces: The mother’s nation of origin is such, say Peru, that she needs a visa to come to the United States, so she is screened once at the embassy and again at the airport.
  • One belt plus two sets of braces: That visa-bearing Peruvian woman is in China when she finds out she is pregnant; she chooses to fly to Guam to see her sister, is inspected there, and inspected again in Hawaii on her way to California, another birth tourism hot spot.

The reader will note that the proposed control of birthright citizenship is confined to people with tourist visas. Other longer-term visas are not involved. Some tourist visas are issued for multiple years, and the visa-issuance process regarding birth tourists would not be effective in those cases.

My musing about the number of barriers erected by policymakers is not just a matter of immigration trivia because one of the prime centers of birth tourism is the Commonwealth of the Northern Mariana Islands, just north of Guam. Chinese nationals, while needing a visa to come to the Mainland or Hawaii do not need one to go to CNMI; so there is only the CBP officer at the Saipan airport between them and birth tourism.

Birth Tourism Is Not for Everyone. The baby’s parents have to be financially strong enough to pay the bills, young enough to be parents, and farsighted enough to go through this whole maneuver; though my colleagues may disagree, this is not a bad combination.

Birth tourism, like the movement of immigrant investors in the EB-5 program, attracts well-to-do migrants, as family migration, generally, does not. And both birth tourism and EB-5 are apparently very attractive to well-to-do, but nervous, people from China.

EB-5 is limited to 10,000 visas a year, but there are no limits to birth tourism.

Source: Birth Tourism, Belts, and Braces

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Richmond Hospital set to deliver over 500 possible ‘anchor babies’ in one year

2020/01/23 Leave a comment

From the epicentre of birth tourism, a good profile on Richmond and the associated issues:

Births to non-resident foreigners at Richmond Hospital and Vancouver’s St. Paul’s Hospital have risen significantly in 2019, according to the latest interim data released by the facilities’ respective health authorities.

Both hospitals are on pace to well exceed their prior annual records of non-resident foreigners who, based on available data, are likely to be nearly all Chinese nationals engaged in a birth tourism arrangement – although it is not known explicitly.

Since 2011, in Richmond, non-resident births have risen from a few dozen per year to the point where local residents and hospital staff are voicing concerns about healthcare delivery and immigration fairness.

Over the past five years, just over 2,000 so-called “passport babies” may have been delivered in Richmond from non-resident, non-Canadian parents.

Various services are provided to prospective parents via transnational maternity businesses utilizing local rental homes as so-called “baby houses” in Richmond.

The B.C. Ministry of Health claims it is now inspecting these houses and scrutinizing diversion rates from Richmond’s busy maternity ward.

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 growing industry. To date, no enforcement measures have been announced, unlike in the U.S.

Richmond Hospital is now on pace – for the year ending April 1 – to deliver 549 newborns to non-resident parents.

From April 2019, the start of the hospital’s fiscal year, to late August 2019, Richmond Hospital delivered 221 babies from non-resident patients not enrolled in the provincial healthcare system, according to Vancouver Coastal Health. The annual average over the previous five years is 390 babies from non-residents, or 18.6% of all births.

The interim 2019 numbers show a total of 863 newborns delivered in Richmond, meaning 25.6% of births at the hospital were to non-residents. Last year (2018-19), the percentage of newborns from non-residents was a record 23.1%.

Meanwhile, St.Paul’s Hospital – B.C.’s second most popular hospital for non-residents giving birth – is on pace to deliver 177 babies from foreigners, according to Providence Health Care data from April 2019 to August 2019. That would break a record of 139 new Canadians from foreign parents set the previous year.

Nationality isn’t routinely tracked but a tabulation by Richmond Hospital officials in 2016 showed Chinese nationals accounting for 98% of non-resident births. According to some birth house operators, Richmond is a popular location for Chinese nationals due to the city’s multilingual services and proximity to China as a Western country that allows such automatic citizenship.

Former Liberal MP Joe Peschisolido decried birth tourism as “an abusive and exploitative practice” in a July 2018 petition to Parliament. Peschisolido promised action from Immigration, Refugees and Citizenship Canada; however, its minister has made no announcements on policy reform. The ministry is now studying the matter.

Prior to the Liberal petition, Conservative MP for Richmond Centre Alice Wong asked for stronger action in 2016 via her own petition to end birthright citizenship.

The Conservatives still have ending jus soli in their official policy book (adopted in 2018); however, the party remained silent on the matter during the 2019 federal election. Wong and newly elected Conservative MP for Steveston-Richmond East Kenny Chiu (Peschisolido’s replacement) stated before the election that they oppose birth tourism but support birthright citizenship. Last week, when asked to clarify his position, Chiu said his pre-election response for a debate questionnaire should have been qualified. He said those on tourist visas should not have their babies granted citizenship and the government must tread carefully to ensure people in transition to residency are not labelled as birth tourists. He acknowledges concerns over establishing a bureaucratic process, but he says many Western nations, such as Australia, have made the transition in the past.

Among respondents to a March 2019 Angus Reid poll, 64% believe children born to parents who are here on tourist visas should not be granted Canadian citizenship and 24% said they should.

Ending birthright citizenship outright in the U.S. would be more difficult as it is enshrined in the Constitution. In the 1990s, it had bipartisan support but that has waned. U.S. President Donald Trump has voiced his opposition to the practice but has only chosen stricter enforcement measures to date.

The Trump administration cracked down on baby houses in Southern California as recently as January 2019 when authorities arrested 19 people with crimes such as immigration fraud, money laundering and identity theft. The charges stemmed from evidence baby house operators helped Chinese tourists lie to border agents.

As of last month, the State Department plans to amend its regulation on temporary visitors in the “B non-immigrant visa classification” to provide that a temporary visit “does not include birth tourism.”

This will allow U.S. border agents to deny entrants if a birth tourism arrangement is suspected. In Canada, a border agent has no such powers, particularly if the person entering is honest about the arrangement and can prove sufficient funds during their stay, according to Canada Border Services Agency.

Critics – such as Megan Gaucher, professor in the Department of Law and Legal Studies at Carleton University, and Lindsay Larios, a PhD candidate in the Department of Political Science at Concordia University studying reproductive justice – have recently likened birth tourism media reports as “dangerous discourse” that may be predicated on longstanding racist and sexist immigration legacies that “perpetuate the criminalization and surveillance of racialized pregnant non-resident women.”

They say the non-resident birth data is unclear as it doesn’t discern between a wealthy birth tourist and a vulnerable temporary resident whose motives may not be so explicit.

Indeed, while national numbers on non-resident births are on the rise, it is not known explicitly how many are due to birth tourism, since motives are not known.

Discharge data obtained from the Canadian Institute for Health Information by researcher Andrew Griffiths shows uninsured, self-paying non-residents accounted for 4,099 births in Canada in 2018, whereas they only accounted for 1,354 in 2010. Ontario accounted for 2,917 such births in 2018 whereas B.C. accounted for 712.

Other than Ontario’s large population, the high number of such births there could be because a non-insured, non-resident could be a temporary foreign worker before being enrolled in public healthcare or an international student. But in B.C., international students are included in the Medical Services Plan, unlike in Ontario, meaning non-resident birth stats in B.C. are likely more reflective of explicit instances of birth tourism than in Ontario.

B.C. Minister of Health Adrian Dix says he’s been asked a number of times what he is doing about the increased number of foreigners into maternity wards in Metro Vancouver.

Dix says he’s opposed to the practice but is mindful the numbers remain relatively small – about 2% of all births in the province are to non-residents.

“Primarily, the birth tourism question is an immigration question,” Dix said.

“People get frustrated when I say that.”

He said his role as health minister is to ensure healthcare is delivered properly.

The Ministry of Health told Glacier Media, that it has investigated baby houses in Richmond, only to find no violations.

“Vancouver Coastal Health Authority inspectors have inspected presumed birth houses and found that there was no licensable care being provided, as defined under the Community Care and Assisted Living Act,” said ministry spokesperson Jean-Marc Prevost.

Dix said, “On the birth house question, if they were providing healthcare services there and not just accommodation services … they need to comply with the Community Care and Assisted Living Act – but they’re basically not” providing such services, asserted Dix.

Another concern raised by healthcare workers, such as nurses in the maternity ward, is the non-payment by non-residents.

The health authority says recovery rates are getting better – now at 92% of $5.4 million collected in the 2018-19 fiscal year at Richmond Hospital, for instance.

Richmond-Queensborough MLA Jas Johal has suggested the health authority charge a prohibitive fee for non-resident births; however, according to Prevost, this would be contrary to Section 10 of the Hospital Insurance Act, which “only allows health authorities to recover the costs of providing non-beneficiaries medical services; it provides no mechanism for charging for profit.”

That said, while fees are set on a direct cost-recovery basis, according to a ministry spokesperson in March 2018, such fees do not account for things such as the capital costs to build new hospitals (Richmond needs a new acute care tower) or the countless hours public officials and communities have put in over the decades to build a safe and regulated healthcare system.

As it stands, Vancouver Coastal Health charges $8,200 for a normal vaginal delivery and $13,300 for a C-section surgical delivery to uninsured patients.

Dix said charging above cost recovery, if it were permitted by law, would have unintended consequences, such as overcharging a person awaiting residency status and healthcare coverage or a non-resident Canadian citizen (which is rare since only one or two Canadians pay to give birth in Richmond as non-residents each year, on average).

“What you want to do is charge the cost of the care across the board and ensure that you collect the cost of care,” Dix said. “If you impose special taxes and fees, that has implications for the whole healthcare system.”

The minister also voiced concern about calls by some, such as Vancouver immigration lawyer Richard Kurland, to license and regulate the industry.

“The problem you have if you want to regulate that sector is effectively you’re officialising the role of these places, which we absolutely are not going to do – I am against this, birth tourism, and we’re dealing with it because we have to and we’re an open society and people come here – but if we want to deal with these questions you have to deal with it at the federal level.”

Nurses in Richmond have told Glacier Media, and more recently the CBC’s Fifth Estate, that non-resident patients are receiving better care. One stated to CBC this month that scheduled C-sections for non-residents are never re-scheduled, whereas local residents’ are.

Dix dismissed the allegations as well as concerns over diversions due to an overbooked maternity ward in Richmond.

“On diversion, in general this is not a significant issue” in Richmond, he said. “The biggest diversion issues I’m dealing with are in Fort Nelson or in First Nations communities.”

Vancouver Coastal Health says between April 2018 and September 2019 there were 16 diversions from Richmond Hospital and 15 diversions to it. In 2019, the authority conducted a staffing review that found the Richmond Hospital maternity ward is “staffed appropriately,” said Prevost. “They have had no capacity issues for labour or delivery in recent years.”

The health authority, via freedom of information requests, disclosed that in a six-month period in 2019, hospitals received $514,476 in cash from $3.25 million worth of maternity related charges. The health authority has been asked whether it reports to FINTRAC when receiving sums of cash over $10,000. Glacier Media has not received a response.

Source: https://www.vancourier.com/richmond-hospital-set-to-deliver-over-500-possible-anchor-babies-in-one-year-1.24058984 

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Scoop: Trump to target “birth tourism” in new immigration fight

2020/01/21 Leave a comment

Will be interesting to see if this proposal proceeds and, if so, the inevitable implementation and court challenges:

The Trump administration has a new target on the immigration front — pregnant women visiting from other countries — with plans as early as this week to roll out a new rule cracking down on “birth tourism,” three administration officials told Axios.

Why it matters: Trump has threatened to end birthright citizenshipand railed against immigrant “anchor babies.” The new rule would be one of the first tangible steps to test how much legal authority the administration has to prevent foreigners from taking advantage of the 14th Amendment’s protection of citizenship for anyone born in the U.S.

  • “This change is intended to address the national security and law enforcement risks associated with birth tourism, including criminal activity associated with the birth tourism industry,” a State Department official told Axios.
  • The regulation is also part of the administration’s broader efforts to intensify the vetting process for visas, according to another senior administration official.

The big picture: “Birth tourists” often come to the U.S. from China, Russia and Nigeria, according to the AP.

  • There’s no official count of babies born to foreign visitors in the U.S., while the immigration restrictionist group Center for Immigration Studies — which has close ties to Trump administration immigration officials — puts estimates at around 33,000 every year.

How the new regulation would work: It would alter the requirements for B visas (or visitor visas), giving State Department officials the authority to deny foreigners the short-term business and tourism visas if they believe the process is being used to facilitate automatic citizenship.

  • It’s unclear yet how the rule would be enforced — whether officials would be directed to consider pregnancy or the country of the woman’s citizenship in determining whether to grant a visa.
  • Consular officers who issue passports and visas “are remarkably skilled at sussing out true versus false claims,” the senior official said.
  • “The underlying practical issue is that very few people who give birth in the U.S. got a visa for that specific purpose. Most people already have visas and come in later,” according to Jeffrey Gorsky, former chief legal adviser in the State Department visa office.

This is but one step in the administration’s plans to make it harder for people from other countries to benefit from birthright citizenship.

  • “Rome wasn’t built in a day,” the senior official said. “Just the legal recognition that this is improper and wrong and not allowed is a significant step forward.”
  • The plans to address the use of B visas for birth tourism were included in the latest version of the Unified Agenda of Federal Regulatory and Deregulatory Actions.
  • Immigration experts expect there to be a similar rule for Customs and Border Protection to go along with the State Department’s regulation.

What to watch: Most of Trump’s major immigration moves have been met with lawsuits. If the regulation leaves it to officers’ discretion to ensure that B visas aren’t used for birth tourism, it would be difficult to challenge in court, according to Lynden Melmed, an attorney and former chief counsel at U.S. Citizenship and Immigration Services.

  • “State Department officials have all the discretion in the world to deny people visas,” said Sarah Pierce of the Migration Policy Institute. Foreign nationals who are outside the U.S. and have not yet received visas “don’t have a lot of legal standing.”
  • But specific restrictions that could keep out non-birth tourism visitors — such as pregnant women coming to the U.S. for business, etc. — would be legally questionable, according to Melmed and Gorsky.

Source: Scoop: Trump to target “birth tourism” in new immigration fight

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

2020/01/18 Leave a comment

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                                                                

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Airline Apologizes for Requiring Passenger to Take Pregnancy Test Before Flight

2020/01/17 Leave a comment

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

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Reaction to Fifth Estate segment on birth tourism

2020/01/10 Leave a comment

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

 

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

2020/01/09 Leave a comment

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

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

2020/01/04 15 Comments

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

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