Toronto Sun Editorial: Birth tourism growing issue in Canada (surrogacy)

The earlier op-ed in the Globe gets traction in the Sun (How Canada became an international surrogacy destination [another form of birth tourism]:

There were 102 babies born to surrogate moms in British Columbia in 2016 and 2017.

Of those, 45 were babies for parents from other countries.

Parents who travelled here to have their child delivered in Canada, who before they left picked up a Canadian citizenship for their child and who left Canadian taxpayers with the bills for the pregnancy of their surrogate mom as well as costs for the delivery and postnatal care of their newborn.

We know this thanks to reporting by freelance Globe and Mail writer Alison Motluk, who earlier this month wrote about Canada increasingly becoming a destination for international surrogacy.

It’s understandable that foreign parents, especially those who may need to turn to surrogacy to have a child, would find Canada and a bonus Canadian citizenship for their child attractive.

Surrogacy is prohibited in many countries and few countries permit surrogacy for non-residents, let alone pay for costs associated with the surrogate mom’s pregnancy, delivery and postnatal care costs.

Without doubt, some of those parents are likely desperate to have children and may have few options. On compassionate grounds, their desire to seek surrogacy here may be compelling.

However, an open-door policy for birth tourism is also troubling.

Why is citizenship being handed out to the children of birth tourists as a going away prize?

Citizenship is a privilege, something often earned at great cost and difficulty for the many millions of Canadians who immigrated to this country and made it their home.

Why on earth should Canadian taxpayers foot the hospital bills for foreign couples who want to have their babies in this country – $3,000 to $6,000 for uneventful births to potentially more than $90,000 for premature babies with complications?

Is birth tourism something we should be encouraging?

And although B.C. tracks residency data on parents, other provinces don’t.

So we’re not even sure of the scope of birth tourism in this country, let alone its costs.

As Brian Lilley wrote in the Sun on this issue, Real Women of Canada wants Ottawa to close loopholes that permit taxpayer subsidization for foreign surrogacy – something many European countries have already done.

Without such change, there’s little doubt Canada increasingly will become a destination for birth tourism.

Source: EDITORIAL: Birth tourism growing issue in Canada

And the Lilley piece that prompted the editorial:

Call it birth tourism of another kind.

We’ve all heard stories about mothers arriving in Canadian cities just in time to give birth so their child can get Canadian citizenship.

But what about foreign parents having a kid in Canada via surrogacy?

It is happening and it is growing.

In 2016 and 2017 there were 102 babies born to surrogate mothers in British Columbia. A shocking 45 of those babies were born to parents from outside of the country.

Here is the crazy part, you are paying for it and the baby that is quickly whisked off to a foreign land is granted automatic Canadian citizenship.

The numbers, first reported by freelance journalist Alison Motluk in the Globe and Mail, show what experts believe to be a growing issue in Canada.

While surrogacy is tightly regulated in Canada, we are one of a handful of countries that allow foreign parents to find a surrogate within our borders. We also have “free” health care, meaning the “intended parents” of the child born by surrogacy aren’t on the hook for the bill.

Estimates for the cost of an uneventful birth range from $3,000 to $6,000, not including any prenatal or postnatal care. With 45 births in B.C. to foreign parents, that means taxpayers were out $135,000 to $270,000 in health care costs for the birth alone.

If there are complications those costs skyrocket. Estimates say care for a premature baby could top $90,000.

All of that paid for by Canadian taxpayers for a baby that will be shuffled home to a foreign country as soon as all the paperwork is complete.

Those numbers I’ve given you are for B.C. alone. Other provinces either do not keep or will not release stats on the number of surrogate babies for foreign parents.

Whatever the number in other countries, expect this to grow in Canada.

As other countries crackdown on foreign surrogate parents or don’t allow the procedure for non-residents, Canada has no such rules. We also offer complete health-care coverage for the Canadian surrogate and citizenship for the child upon birth.

That means a Canadian passport for life and easier entry, maybe even sponsorship of the parents later in life.

Other countries also make you pay to use their facilities.

One American company offering surrogacy charges a low of US$39,400 in Mexico to a high of US$64,900 for the “Guaranteed Baby” program in Ukraine.

With prices like that, no wonder Canada is becoming a more attractive destination for this kind of birth tourism.

The group Real Women of Canada, which is outright opposed to surrogacy, says the federal government should at least be looking to close this loophole allowing couples from other countries to have their child’s birth subsidized by Canadian taxpayers.

In a submission to Health Canada, which is looking at modernizing rules and regulations around surrogacy, the group calls for non-Canadians to be barred from using Canada as a surrogacy destination, something many European countries already do.

Any discussion of such a ban would be a sticky one for the government, in fact any discussion of the issue is sticky.

Emotions will run high, claims of targeting specific groups will be made.

Here’s an idea though, let’s get better information on this.

It’s understandable that foreign parents may want to give their child the privilege and advantages of a Canadian passport. That’s why we have an immigration system.

But let’s find out from each of the provinces how often this is happening.

Are Canadians paying for the hospital care for babies born to foreign parents?

Are we paying for expensive neonatal care or even IVF treatments so foreign couples can have a child?

Are we handing out citizenship to children that will not live here? And if so, how often is this happening?

This looks like the type of thing  people didn’t think of when the current regulations were devised.

More than a decade in, maybe it’s time we had some honest conversations about what we want to allow, who is going to pay for it and who should actually get a Canadian passport.

Source: LILLEY: Canadians paying bills for birth tourism

How Canada became an international surrogacy destination [another form of birth tourism]

Just as I am working on my article on birth tourism, another example of “reproductive tourism” emerges.

The same issues larger apply in terms of abuse of birthright citizenship.

In addition, given that Canadian surrogate mothers use Canadian healthcare, there is an effective subsidy to foreign parents engaging a Canadian surrogate. Not right (and appears Canada is one of the few countries that allows intended parents living outside the country.

Hard to understand the rationale for continuing this other form of birth tourism:

Here’s an arresting statistic: Almost half of the babies born to Canadian surrogates in the province of British Columbia in 2016 and 2017 were for intended parents who lived outside the country. That’s 45 of the 102 babies born to surrogates there – 44 per cent.

What’s the national tally on such outbound babies? We don’t know. Rather, we aren’t told. The number could presumably be calculated, since individual physicians carry out the procedures and bill for them, and provinces issue birth certificates. But the information is not publicly available. Then again, we should hardly be surprised: In Canada, we don’t even know the total number of babies born to surrogates for any parent, Canadian or otherwise. I and others have been asking around for some time now.

Those B.C. numbers come to us thanks to the hard work of Pamela White, at the Kent Law School in Britain, who had to put in an access to information request with the B.C. government. She tried the province of Ontario, too, but they said they don’t collect data on residency. In the United States, such information is collected by law and published by the Centers for Disease Control and Prevention.

Prof. White, a former Statistics Canada director and data analyst, argues that Canadians deserve that level of transparency, too. She is absolutely right. Without real data, available for scrutiny, how can we make informed public policy decisions? We can’t.

Anecdotal reports and incomplete data suggest that the number of intended parents (IPs) from outside Canada has been growing in recent years. At the annual meeting of the Canadian Fertility & Andrology Society (CFAS) last month, Karen Busby, a professor in the faculty of law at the University of Manitoba, who co-authored a forthcoming paper on the topic with Prof. White, discussed why Canada is becoming an international surrogacy magnet and whether it is desirable.

The backdrop, Prof. Busby says, is that worldwide demand is huge. Many people want to be parents and can’t do so without surrogacy, but they live in countries where surrogacy is either prohibited entirely, or prohibited for them. China, Japan and many European and predominantly Muslim countries have restrictions, she says. People in such places who decide to pursue surrogacy must look beyond their own borders.

Coupled with this growing demand is shrinking supply. In the last few years, India, Nepal, Thailand and Mexico – former international surrogacy hotspots – have closed their doors to non-residents.

So why Canada? For one thing, Prof. Busby says, Canada is one of the few jurisdictions left in the world that both allows surrogacy and allows foreign participation in it. Countries such as Britain, South Africa and Israel, she says, permit surrogacy, but not for foreigners. The only other places that allow foreigners to access surrogacy within their borders, apart from a couple of completely unregulated jurisdictions, are Greece, Ukraine, Russia, Georgia and a few U.S. states.

For a number of reasons, Canada stacks up well against these others. Russia and Ukraine, for instance, only allow married heterosexual couples to participate. Canada, by contrast, does not allow discrimination on the basis of marital status or sexual orientation, Prof. Busby says.

Canada is also fairly efficient about granting legal parental rights. It varies by province, but generally speaking, IPs can be declared legal parents without a lot of hassle in just a few days, and they can be issued a birth certificate within weeks. Also, any child born in Canada has the right to citizenship, so a passport can be issued, and in short order, the families can head home and start their new lives.

Financially, Canada also compares well. Women in Canada enjoy high quality, publicly funded health care throughout the pregnancy, during the delivery and after the birth. This is as true for a woman carrying a baby for someone from France or China as it is for a woman carrying a baby for herself. Our neonatal care is also top-notch – and also publicly funded. Another perk, Prof. Busby says, is that if a Canadian surrogate has a job, then she may also qualify for employment insurance benefits following birth – to a maximum of $6,500.

Here’s another interesting twist. In Canada, it’s illegal – a criminal offence, according to the Assisted Human Reproduction Act – to pay a woman to carry a baby for you, or to pay someone else to arrange for her to do so. Since the law first passed in 2004, this prohibition has caused enormous hand-wringing for Canadian would-be parents looking to form their families with the help of a surrogate. They rightly fear that they could be prosecuted for paying a surrogate, and the penalty is steep: up to 10 years in prison and $500,000 in fines. The prohibition has reportedly driven some Canadian families to leave the country to seek surrogates elsewhere.

Ironically, this prohibition, which was designed to deter commercial surrogacy, may actually be stimulating it – and may favour foreign IPs over domestic ones. Domestic IPs may be reluctant to offer money or will only offer it under the table, but because the law is not applied to acts committed outside the country, Prof. Busby says, foreign IPs can offer money openly, so long as it changes hands somewhere else. It’s conceivable that, given the choice between being paid and not being paid, Canadian surrogates – who are legally allowed to accept the money – may opt to be paid. So foreign IPs may actually be more attractive to Canadian surrogates than domestic IPs. (There’s no data on that, of course, since there’s no data.)

It is true that foreign IPs coming to Canada will still be subject to our other prohibitions, such as paying for local egg or sperm donations or performing sex selection. But, as Prof. Busby points out, most Canadians live near the U.S. border and have easy access to the services offered there. This ability to enjoy the best of both systems only adds to Canada’s appeal.

All of these factors help to explain why Canada has become a go-to place for surrogacy. I’ll add one more that Prof. Busby did not explicitly mention: There are Canadian doctors, lawyers and agencies who actively recruit IPs from around the world. If foreign parents weren’t already aware of Canada’s considerable merits, representatives of the industry are more than happy to point them out. In fact, the newly minted president of the CFAS himself, alongside the CEO of the country’s top surrogacy agency, was recently in London, promoting Canada as a premier surrogacy destination.

And they are right: For all of the above reasons, Canada is a great place to do surrogacy. Loads of people already want to come here and we can only expect that number will grow.

Not everything about this picture is rosy, however. A big question is whether Canadians need to think about recovering medical costs. Pregnancy care, even for an uneventful pregnancy, costs money. So does birth. The average uncomplicated birth in Canada rings in at between $3,000 and $6,000, depending on whether it’s a vaginal or surgical delivery. Complications can increase that figure considerably. Neonatal care can also be pricey. For instance, according to the Canadian Institute of Health Information, care for a baby born at 29 weeks weighing less than kilogram costs an average of $91,946. One baby.

“I am pretty sure that if you asked the average Canadian whether or not the Canadian health-care system should pay for any of the health-care costs incurred in order to produce a child for a non-resident IP, the answer would be no,” Prof. Busby told the CFAS meeting. “In fact, I think it would be an emphatic no.” I suspect she’s right.

As far as Prof. Busby is aware, no province has put in place laws or policies to recover the cost of surrogate pregnancy care from foreign IPs. (A few Ontario hospitals have started charging for infant care, if the infants are for out-of-province parents.) Prof. Busby says governments could consider measures such as asking IPs for money up front or not issuing a birth certificate or passport until the bill is settled.

That’s a lot of work. It would involve co-ordination across departments and even, in some scenarios, levels of government. Another option, she says, would be to follow the lead of other countries and create residency restrictions, stipulating that only people who live in Canada can work with a surrogate here. That option would, in one fell swoop, alleviate the shortage of surrogates available to work with Canadians and eliminate the cost-recovery conundrum.

That would be a tidy solution, and, all things considered, maybe the most workable one. The cost-recovery issue is challenging. Access to surrogates by Canadians is challenging, too. There are other problems. Our country is struggling under a 14-year-old law that still hasn’t rolled out the meat of its regulatory details. We are woefully lacking in transparency about surrogacy – and assisted reproduction in general. Finally, although preliminary findings are reassuring, we have not yet done nearly enough research to establish that Canadian women who act as surrogates are not exploited.

I am not hopeful, given Canada’s track record in this sphere, that we will crack these tough problems any time soon, or ever. But let’s imagine we did – no cost to the Canadian public, adequate numbers of surrogates to work with Canadian families, effective laws for and public scrutiny of the process and confidence that women were treated fairly. Then, it seems to me, Canada would be an excellent place for international surrogacy. Surely the ideal is for surrogates and babies to have quality medical care, for IPs to be free from discrimination, for parentage issues to be resolved quickly.

If we did somehow get our house in order, I’d be the first to ask: If you believe that surrogacy is a legitimate way of achieving parenthood, what would be the argument against welcoming it here?

Source: How Canada became an international surrogacy destination: Alison Motluck

Foreign buyers flocking to Canada to find surrogate mothers after Asian countries crack down

Largely anecdotal rather than hard numbers, but nevertheless another aspect of birth tourism. Ironic that as developing countries crack down, Canada becomes a preferred location:

As doors are closed in some Asian countries, foreigners are flocking to Canada to make use of its surrogate mothers — and the taxpayer-financed health care system that looks after them, consultants and lawyers say.

One agency that helps “intended parents” work with surrogates says it has been “overwhelmed” with a 10-fold increase in business over the last few months.

Owner Sally Rhoads-Heinrich cites the closing recently of international surrogacy arrangements in Thailand, Nepal and — for same-sex couples — India.

Some parents are even having embryos they had stored in such countries shipped to Canada to restart the process here, said another consultant.

“I’m averaging about 600 emails a day,” said Rhoads-Heinrich. “I start usually at about 6:30 in the morning and I’m going until 11:30 at night. I can’t keep on top of it right now so I’ve had to hire more people.”

She used to sign up 20-40 clients a year, but now has more than 200, part of an industry estimated to be worth billions worldwide.

Rhoads-Heinrich worries, though, that people from overseas are essentially taking advantage of the fact Canadian surrogates are covered by medicare, an advantage promoted by at least one of her competitors.

“I don’t like Canada being seen as just a free-for-all for people to come here and use our health-care system,” she said. “We’re being flooded and I’m not seeing Canadian couples being helped. I’m seeing a lot of international couples being helped.”

The demand comes largely from other developed countries with more restrictive laws. Some, like France and Germany, ban surrogacy outright, while others, such as Israel, do not allow it for same-sex couples or single people.

Canadian law permits the practice, but prohibits commercial fees, a system on the verge of being tightened by contentious new rules.

Source: Foreign buyers flocking to Canada to find surrogate mothers after Asian countries crack down

Baby Gammy, whose parents left him with Thai surrogate mom, may still be eligible for Australian citizenship

The complications arising from surrogacy in the case of the Australian couple who didn’t accept their child with Down’s syndrome. Apart from the broader moral issues involved, the citizenship aspects are of interest:

Australian Immigration Minister Scott Morrison told Sydney Radio 2GB on Monday that Pattaramon “is an absolute hero” and “a saint,” adding that the law surrounding the case “is very, very murky.”

“We are taking a close look at what can be done here, but I wouldn’t want to raise any false hopes or expectations,” Morrison said. “We are dealing with something that has happened in another country’s jurisdiction.”

Morrison’s office later said in a statement that “the child may be eligible for Australian citizenship,” without elaborating.

Australian citizens are entitled to free health care in Australia.

In Sri Racha on Sunday, Pattaramon said that she was not angry with the biological parents for leaving Gammy behind, and that she hoped they would take care of the boy’s twin sister they took with them.

“I’ve never felt angry at them or hated them. I’m always willing to forgive them,” Pattaramon told The Associated Press. “I want to see that they love the baby girl as much as my family loves Gammy. I want her to be well taken care of.”Pattaramon was promised 300,000 baht $9,300 by a surrogacy agency in Bangkok, Thailand’s capital, to be a surrogate for the Australian couple, but she has not been fully paid since the children were born last December.

If I recall correctly, for a surrogate baby born abroad to be eligible for Canadian citizenship, the genetic material from one of the parents must be Canadian (see Couple fights federal surrogacy policy to bring their boy back to Canada).

Baby Gammy, whose parents left him with Thai surrogate mom, may still be eligible for Australian citizenship.