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.
The importance of good data and how it could have made a difference in public discussion and debate (not that the real estate industry is likely to change its position given its business interests). Particularly worrisome that a government agency, CMHC, got it so wrong in 2015 with a flawed methodology:
Not so long ago, real estate industry and government officials were doing their best to shut down concerns that skyrocketing housing prices in Vancouver and Toronto were related to non-resident buying.
As it turns out, they were very wrong.
“Basically, if we put every residential property unit that was built in the city of Vancouver from 2006 to 2017 into a single building, every tenth unit [and a bit more] would have been owned by somebody who doesn’t live in the country,” says Andy Yan, urban planner and director of Simon Fraser University’s City Program.
The CMHC condo survey of 2015, a busy year for the real estate market, maintained that foreign ownership of condos was low in metro Vancouver and metro Toronto, at 3.5 and 3.3 per cent respectively.
In 2016, Canada Housing and Mortgage Corporation chief executive Evan Siddall told the Vancouver Board of Trade that blaming foreign buying was creating an “unhealthy tension” between “existing residents and newer arrivals.” Instead, he pointed to local investors, population growth and lack of supply as the big factors in Vancouver’s affordability crisis.
But the CMHC’s latest Housing Market Insight report, released last week, shows the previously released data were off by as much as two to three times the actual rate of non-resident participation in home ownership. Based upon the new study, the numbers are actually 11.2 for metro Vancouver and 7.6 for metro Toronto.
The CMHC’s new Housing Market Insight report, in partnership with Statistics Canada, now reveals the extent of non-resident buying in Vancouver. The CMHC had begun releasing its Condominium Apartment Survey in 2014, after collecting information on non-resident ownership, in response to the affordability crisis. But the CMHC only had access to condo data and its methodology was limited. It partnered with Statistics Canada to form the Canadian Housing Statistics Program (CHSP), to address the major gaps in data on housing. In 2017, as part of the federal budget, StatsCan got extra funding to delve deeper into offshore buying, which is when the data got more interesting – and far more accurate. It meant that instead of interviewing building managers about the number of foreign owners in the buildings – an obviously problematic method – the CMHC had data from Canada Revenue Agency and the provincial land titles office to verify tax residency.
Perhaps the most surprising revelation is the rate of non-resident participation in the buying of newly built condos across the region.
“Of the housing units owned by non-residents, 55 per cent are condos,” says Jordan Nanowski, senior CMHC analyst and co-author of the report.
Where non-resident ownership is concerned, metro Vancouver overshadowed Toronto by a wide margin. And new builds were a particular draw. Non-resident owners played a part in 19.2 per cent of Vancouver condos built between 2016 and 2017. In other words, almost 20 per cent of condos built that year had at least one non-resident on title. In Toronto, meanwhile, the number falls to a mere 9 per cent.
Mr. Yan dug deeper into the CHSP data, and came up with more numbers. Non-residents have participated in the ownership of a shocking 14 per cent of all housing types built in the city of Vancouver in the past decade (as in, at least one person who owns the property is a non-resident). For metro Vancouver, that rate is 11.2 per cent. For the city of Toronto, the rate is 8 per cent; metro Toronto is 5.2 per cent.
In Coquitlam, B.C., 20.8 per cent of new condos had at least one non-resident on title. In Surrey, B.C., the figure is 20.5 per cent of condos in that time period. Burnaby, B.C., is at 25.1 per cent. Richmond, B.C., has the highest percentage of all, at a whopping 25.8 per cent, he says.
“In Richmond, condos built between 2016 to 2017, we’re talking about 26 per cent have non-resident participation. That’s one in four.”
The numbers are big in the broader housing market picture as well, with 7.8 per cent of all single detached houses built in metro Vancouver from 2006 to 2017 owned by at least one non-resident purchaser. For condos, the numbers jumps to 18 per cent of all condos built in that time period.
“This is something that people have denied for so long,” Mr. Yan says. “It measures a form of foreign ownership that many have denied was happening, and in proportions that few could imagined.”
Mr. Nanowski says that non-resident participation tended to increase when density increased and prices increased. Across all age groups, non-residents tended to own more expensive homes. But a number that stood out for him was the higher prices of detached homes owned by non-residents in the city of Vancouver. Detached homes in the city owned by non-residents were, on average, assessed at $1.1-million more than those owned by residents. In Toronto, the difference of a detached house owned by resident and non-resident was only $89,000.
“Big difference,” Mr. Nanowski said. “Yes, non-resident premiums are largest in Vancouver and the prevalences are largest in Vancouver as well.”
Using new methodology, the crown corporation has revealed that many properties have a mix of resident and non-resident ownership. They analyzed this mix in the category of “non-resident participation,” meaning at least one owner on title was a non-resident. Put another way, at least one person on title is a non-tax resident, which means they do not have a principal tax residence in Canada. They earn their income and pay their income taxes elsewhere. This is a key difference from the CMHC’s previous methodology, which was to define “non-resident” ownership as a property that was owned entirely by non-residents, or majority-owned by non-residents.
The definition of a “non-resident” is someone whose principal residence is outside of Canada, irrespective of their nationality.
Also, these rates do not include pre-sale purchases, or what units were not owner-occupied and held as investments. The study authors did not provide data on the source countries of origin for non-resident owners.
“The summary of all this is the globalization of Canadian residential real estate,” Mr. Yan said, “and what are you going to do or not do about it, on a federal, provincial and local policy basis? This is about transparency, taxation and fairness, and how we build housing and for who, in our communities.”
Mr. Nanowski says the previous data they used weren’t flawed, but useful for following trends. The new data is much more comprehensive, he says.
“When we look at this data, we want to compare it to itself only, as a kind of cross section and not compare it to previous data. Because there is a change in methodology,” he says.
Josh Gordon, assistant professor at the School of Public Policy at Simon Fraser University, says that the delay of such important data has likely been a setback. He points out that industry voices used the previously limited CMHC data to bolster their arguments that foreign buying was exaggerated. Prof. Gordon had questioned the CMHC’s reports at the time, and received some flak for it.
“Imagine in 2015 if we had a sense that non-resident buyers were buying 15 per cent or so of new condos. How would that have changed the nature of the debate? Would that not have indicated that there was an issue that needed addressing?,” Prof. Gordon asks.
“Those who wanted to push back against possible restrictions were able to use the ‘authority’ of the CMHC in the debate to good effect, and this delayed possible policy action. More accurate data would have helped build the case for policy restrictions, and that might have mitigated the sharp escalation of prices.”
Mr. Yan found it ironic that the report was released the same week as the City of Vancouver announced its annual homeless count was underway.
“Perversely, this week saw the release of measures on two drastically different ends of Vancouver’s housing situation. With the CMHC release, we see the numbers of homeowners who don’t live in the country, juxtaposed with Vancouver doing its homeless count of those who actually live here, but don’t have the benefit of a home.”
While as I and Rob Vineberg have argued against indefinite voting rights (Canadian expats shouldn’t have unlimited voting rights), it is nevertheless somewhat amusing that the May government made this commitment, tabled legislation, and then failed to implement, perhaps fearing that most non-resident Britons, particularly those resident in the EU, oppose Brexit and thus likely may be less likely to vote Conservative:
Campaign groups accuse Tories of breaking promise made in October to scrap time limit
Up to 3 million Britons living overseas are to be denied a vote in the general election, the Cabinet Office has confirmed.
In a letter sent to the New Europeans campaign group on Friday, the Cabinet Office said that “unfortunately” British citizens who had lived abroad for longer than 15 years would not be entitled to vote on 8 June.
The letter has prompted a furious reaction from Britons living abroad, and in Europe in particular, with campaign groups accusing the Conservatives of breaking yet another promise.
Nathan Lappin of the constitution group in the Cabinet Office told New Europeans that “there is no sufficient time to change the relevant primary and secondary legislation to enfranchise all British expats, scrapping the 15-year time limit, ahead of the dissolution of parliament before the general election”.
“The people most affected by the referendum were not allowed to vote in it, simply because they exercised their right to live in another country,” said Dave Spokes, one of the founders of the support group Expat Citizen Rights in EU. “Now it seems they will miss out again as their government has repeatedly failed to honour repeated promises to repeal this unjust and unfair rule.
“These people spent their lives working in the UK and many still pay taxes there. It is quite disgraceful that any government can so disregard so many of its citizens.”
Jane Golding, a British lawyer living in Berlin and campaigner for the rights of Britons abroad, said the promise has been broken twice as it was in the Conservative manifesto in the 2015 general election and the Queen’s speech that followed.
“So that is twice we have been denied the right to vote and to participate in the democratic process when this had been promised on an issue, leaving the EU, that directly affects our personal and professional status,” she said.
Last October the government promised to scrap the current 15-year time limit as part of a bid to strengthen ties with emigrants following the decision to leave the EU.
The plans followed a court battle spearheaded by the second world war veteran Harry Shindler, who fought in the Battle of Anzio in Italy in 1944. The 95-year-old, who moved to Italy to be near his grandson in 1982, has been unable to vote in the UK since 1997 but cannot vote in Italy either.
As recently as February, the constitution minister Chris Skidmore assured Shindler and others the government was on track, telling them “their stake in our country must be respected”.
In a written answer on the topic to the New Europeans founder Roger Casale, Skidmore promised “this government will not deny them the opportunity to have their say in how the country is governed”. He also revealed that the government estimated “a further 3 million British citizens resident overseas will be enfranchised”.
Samia Badani, director of New Europeans, said the decision not to expedite legislation was devastating for Britons desperate to have a say on their own futures in Europe but it was not too late to get them on the electoral register. “The time for legislation is now. When there is a will, there is a way,” she said.
Badani said: “We are very disappointed – this is another broken promise. We have been campaigning for the removal of the 15-year rule – which is very arbitrary – for years. We were promised that at the next general election all UK citizens could vote, but it now looks like a double-whammy: they couldn’t vote in the referendum and now can’t vote in the next general election.”
Multicultural Meanderings 