Impact of birth tourism on health caresystems in Calgary, Alberta

This is exactly the kind of detail that is needed for regions and hospitals that have high numbers of non-resident births.

Some highlights of the study from my perspective:

  • 102/227 patients were identified as birth tourist (45 percent)
  • 83% of patients stated they came to Canada with a Visitor Visa
  • Country of origin: Nigeria (25%), Middle East (18%) China (11%), and India (8%) and Mexico (6%), none from Western Europe or Australia
  • 77% stated that their primary reason to deliver their baby in Canada was for the the baby to be eligible for Canadian citizenship, while only 8% stated their reason to deliver in Canada was to access better health care
  • Almost a third of women had a known preexisting medical condition
  • 29 mothers and 17 newborns had unpaid invoices, $290,000 and $404,000 respectively at the time the report was written.

More kind of this detailed analysis by medical professionals and researchers is needed rather than the legal and policy analyses that diminish the issue (disclosure the researchers and I have been in contact over the past few years).

Hospitals where studies would be useful would be for the top ten hospitals with the largest percentage of non-resident births:

Funding should be provided for these kind of empirical studies rather than for more ideological studies such as the one underway by Megan Gaucher, Jamie Lieu and Amanda Cheong (Insight Grant 2021 Birth Tourism and Citizenship):

Background:  Birth  tourism  refers  to  non-resident  women  giving  birth  in  a  country  outside  of  their  own  in  order  to obtain  citizenship  and/or  healthcare  for  their  newborns. We  undertook  a  study  to  determine  the  extent  of  birth  tourism  in  Calgary,  the  characteristics  and  rationale  of  this  population,  and  the  fnancial  impact  on  the  healthcare  system.

Methods:  A  retrospective  analysis  of  102  women  identifed  through  a  Central Triage  system  as  birth  tourists  who delivered  in  Calgary  between  July  2019  and  November  2020  was  performed.  Primary  outcome  measures  were  mode of  delivery,  length  of  hospital  stay,  complications  or  readmissions  within  6  weeks  for  mother  or  baby,  and  NICU  stay for  baby.

Results:  Birth Tourists  were  most  commonly  from  Nigeria  (24.5%).  77%  of  Birth Tourists  stated  that  their  primary  reason  to  deliver  their  baby  in  Canada  was  for  newborn  Canadian  citizenship. The  average  time  from  arrival  in  Calgary  to the  EDD  was  87  days.  Nine  babies  required  stay  in  the  neonatal  intensive  care  unit  (NICU)  and  3  required  admission  to a  non  NICU  hospital  ward  in  frst  6  weeks  of  life,  including  2  sets  of  twins. The  overall  amount  owed  to  Alberta  Health Services  for  hospital  fees  for  this  time  period  is  approximately  $694  000.00.

Conclusion:  Birth Tourists  remain  a  complex  and  poorly  studied  group. The  process  of  Central Triage  did  help  suport  providers  in  standardizing  process  and  documentation  while  ensuring  that  communication  was  consistent. These  fndings  provide  preliminary  data  to  guide  targeted  public  health  and  policy  interventions  for  this  population.

Source: Impact of birth tourism on health care systems in Calgary, Alberta

ICYMI: Insight Grant 2021 Birth Tourism and #Citizenship – Activist or Academic?

Some background of possible interest to this grant.

My initial 2018 analysis (Hospital Stats Show Birth Tourism Rising in Major Cities) provoked rebuttals from Jamie Lieu and Megan Gaucher.

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.

Source: Friday, June 18, 2021 in Department of Law and Legal Studies, News, Research
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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.

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