Chinese birth tourism in Canada and how to stop it
Chinese birth tourists have come to national attention as increasing numbers of pregnant women come to Canada to secure Canadian citizenship for their children.
Just the Basics
The number of pregnant Chinese women coming to Canada to give birth and acquire Canadian citizenship for their children has risen sharply in recent years
While legal, birth tourism has angered many across the political spectrum, with opponents raising ethical, financial, legal and social objections
Workable solutions to the issue exist and the debate is ill served by hyperbolic reactions from all sides in the debate
It is 2016 and Andrew Griffith is about to embarrass Statistics Canada. He has been working on documenting a phenomenon that residents of Richmond, BC have been complaining about for years - birth tourism. By analysing patient payment records, Griffith, a former senior official at Citizenship and Immigration Canada, has revealed that government statistics on birth tourism - the practice of pregnant women travelling to Canada to acquire Canadian citizenship for their newborns - have greatly underestimated the scale of this trend. While Statistics Canada documented 313 children born to non-residents in 2016, Griffith’s research has shown that the number is actually an order of magnitude higher, some 3,200. Conservative estimates suggest that birth tourists account for half this number.
By way of comparison, births by non-residents accounted for 1.2 percent of all births in anglophone Canada in 2016. Richmond is ground zero for this trend: Vancouver Coastal Health Authority has reported a four-fold increase in non-resident births between 2009 and 2014. There are suspicions that crackdowns in other countries have prompted Chinese birth tourists to come to Canada. In 2012, protests in the wealthy Chino Hills suburb of Los Angeles led to the shuttering of a maternity hotel for Chinese women. Of particular interest is that that same year there were protests in Hong Kong after the number of birth tourists from mainland China doubled. That birth tourism is a concern within China undermines narratives that birth tourism is merely a case of China vs. the West (e.g. Canada). As in Canada, the appeal of Hong Kong to mainland Chinese is similar; namely, better medical care and public education.
This revelation comes as the federal government has set up an inquiry to document the nature and scope of birth tourism in Canada. In recent years, Canada has become a popular destination for pregnant Chinese women, who travel to the country to benefit from Canada’s policy of birthright citizenship; a policy which guarantees citizenship to any child born in the country, regardless of the status of their parents. What is important to note is that birth tourism is not an illegal scam, but one that fully abides with the letter (if not the spirit) of Canadian law.
Vancouver’s other real estate boom: Chinese maternity hotels
According to a 2016 audit, over two dozen birthing hotels have been established throughout British Columbia (a three-fold increase since 2009), exclusively marketed to wealthy Chinese expectant mothers. These businesses operate openly, advertise in China (one Richmond hotel alone has seven overseas sales offices) and share photos and stories on social media. All this with no sense that either business owners or clients are acting in an illegal manner - which, in truth, they are not. Nor are these birthing visits to Canada cheap. Pregnant clients usually stay for several months in full service establishments: a three month stay in a two bedroom apartment, excluding meals and prenatal care, can cost some $25,000, according to birth tourist Melody* Bai.
When asked for her reasons for coming to Canada to give birth, Melody explains that “Canada has a good environment, compared to the air pollution in China.” Alongside a healthy atmosphere in which to give birth, Melody and other clients cite the quality of care and the ability to give their children the benefits of Canadian citizenship as key motivations. Unlike the anchor baby phenomenon in the United States, the vast majority of Chinese families coming to Canada to give birth, promptly return to China - they demonstrate little (immediate) interest in settling in Canada. “My child won’t be enjoying any Canadian health benefits as we are living in China,” explains Melody. Clients like Melody argue that they are actually contributing to the local economy as well as subsidizing the Canadian healthcare system as all medical costs are paid out of pocket: Melody says she spent some $60,000 in total during her stay in Canada.
Canada, and British Columbia in particular, has long seen a steady stream of wealthy Chinese migrants and visitors seeking to hedge their bets against an uncertain future back home. “Everything is tied up with the government,” explains Vancouver-based immigration lawyer Will Tao. “Many people have been able to ride the wealth of China, but they realize the foundation isn’t that strong. There is this idea that at any moment, things can turn for them, and what will happen to these things they worked towards? Canada, then, becomes a stable ‘Plan B.’” It should be noted that not all birth tourists are Chinese, with Sonnybrook Hospital in Toronto seeing expectant mothers from Nigeria, Saudi Arabia and the UAE, while in Montreal mainly sees women from Haiti and francophone North Africa.
The issue of birth tourism has become a contentious one, especially in British Columbia where Richmond residents created a petition in 2016 against birthright citizenship sponsored by Richmond Centre Conservative MP Alice Wong. More recently, a March 2018 petition - headed by Steveston-Richmond Liberal MP Joe Peschisolido - calling on the federal government to publicly denounce birth tourism and work to end the practice garnered over 10,000 signatures. In return, Citizenship minister Ahmed Hussen agreed to establish a committee to study the scope and impact of the practice, a move supported by eighty-five percent of BC residents, according to a February 2019 poll.
The same poll revealed that forty-nine percent of BC residents reported that they had followed the issue “very closely”- a number that rises to fifty-five percent in Metro Vancouver. Eighty-two percent believed the practice could be used to unfairly access Canadian social services; and sixty-six percent believed that birth tourism cheapened the value of Canadian citizenship. Furthermore; sixty-three percent feared that birth tourists would displace Canadians at hospitals. To a certain extent this concern appears grounded in reality, as one in five births at Richmond Hospital are by non-residents. From August 12th to November 3rd, 2016, there were - both domestic and non-resident - 552 deliveries at Richmond. During this same period there were eighteen diversions to other maternity wards due to overcapacity. While we cannot know the details surrounding all diversions, it is reasonable to extrapolate that at least some occurred because of the number of non-resident patients at the hospital.
With fifty-three percent of Richmond residents identifying as ethnic Chinese, the city is the most Chinese city outside of Asia. Where some observers might assume a sense of solidarity between the city’s Chinese residents and Chinese birth tourists, polling numbers demonstrate clear resistance to the practice. In terms of demographic breakdown, seventy-five of European-Canadians and seventy-one percent of Canadians of East Asian descent supported modifying the country’s birthright rules. Alongside the concerns mentioned above, some first and second generation immigrants are angered by birth tourists “skipping the que” while others navigate the slow naturalization process.
High profile birth tourism scandal puts issue top of mind for BC
One of the reasons that awareness of birth tourism is so high in British Columbia is the so-called ‘Million Dollar Baby’ scandal from back in 2012. BC residents were outraged following the revelation that non-resident Yan Xia racked up $312,595 in medical expenses due to complications related to her pregnancy, only to leave the country without paying: at an interest rate of two percent per month, the total amount due now exceeds $1,000,000. Yan - who is currently being sued by the BC Supreme Court - is not the only (but definitely the most prominent) bill dodger, despite hefty pre-payment deposits of $8,200 for vaginal and $13,300 for caesarean delivery. For 2014/15 fiscal year Vancouver Coastal Health Authority recorded $693,869 in unpaid non-resident birth bills. While certainly unacceptable, it does well to put these figures in perspective: the BC health ministry’s annual operating expenses total some $18 billion. Consequently, these unpaid bills only represent 0.00004 percent of the province’s total health care costs.
A second concern for Canadian physicians is that should anything go wrong during birth, they could face malpractice lawsuits in a foreign country, something which the Canadian Medical Protection Association cannot support them with. One response to this has been Sonnybrook Hospital’s refusal to provide treatment and ultrasounds to high-risk pregnancies for foreign women without OHIP coverage. “Until twenty-four months ago, it was something I came across every once and awhile,” explains Dr. Murray*, “and now [Sonnybrook] has a policy on it because so many [women from abroad] are showing up.”
While the negative fiscal consequences of birth tourism are negligible, the issue evokes such strong emotions because more than just hospital bills are seen to be on the line. The letter of Canadian law may not be being broken, but many see birth tourism as contravening the spirit of those laws: “birth tourism may be legal, but it is unethical and unscrupulous,” argues Peschisolido.
As things stand, all visa applicants must disclose any physical or mental health conditions that may necessitate social / health services in Canada. There is no injunction preventing pregnant women from travelling to Canada, nor must women declare if they are pregnant on their visa applications, as pregnancy is not considered a medical condition under current regulations. Consequently, women who omit the fact that they are pregnant or are intending to come to Canada to give birth are not breaking Canadian immigration laws.
Nor can the burden of future costs be invoked, for once born, children immediately acquire Canadian citizenship, so even in the case of high-risk pregnancies, “concerns regarding the demands that may be placed on health and social services by the child after birth in Canada may not be used in assessing the medical admissibility of the temporary resident visa applicant.”
What can be done to tackle birth tourism?
In any case, trying to implement any pregnancy screening and declaration policy would be virtually unenforceable. Similarly, any blanket ban on pregnant women travelling to the country who be a massive overreaction. Such a ham-fisted solution would impact women who are pregnant or become pregnant during the process of their legitimate immigration or refugee applications. For instance, women being sponsored enjoy visitor status in Canada, and can easily become pregnant while visiting their sponsoring partners. Ontario immigration lawyer, Gordon Scott Campbell remarks that he has had several clients give birth while waiting for their immigration applications to be completed. “It would seem extremely punitive, even misogynistic, arguably, to say that no woman should be able to become pregnant or be pregnant if [they’re] not a permanent resident or citizen of Canada,” argues Campbell.
So question remains: just what exactly can be done to tackle this issue? Two options present themselves. The first would be to modify Canadian birthright citizenship laws so that only children with at least one parent who is either a permanent resident or citizen are granted automatic citizenship. Plans to alter citizenship laws were explored during the Harper administration, but were eventually dropped following a projected $20-30 million in adjustment costs plus an additional $7 million per year increase in operating costs, according to a 2013 estimate.
Since some forty percent of Canadian do not have a passport, they use their birth certificates to prove their citizenship.Changes to the law would require Canadians to use new forms of ID to access services, increasing costs. The above estimates do not include the higher costs which would be incurred by the provinces who are responsible for more pieces of ID used to access government services than the federal government.
Despite these hurdles, calls to alter the law recently re-emerged during the biennial Conservative Party convention in the summer of 2018, with party members passing a policy resolution to require the aforementioned changes. This announcement sparked a firestorm of outrage, with refugee and human rights activists objecting to claims that a birth tourism crisis exists; warning that changing birthright legislation would open the door to creating stateless children. NDP leader Jagmeet Singh echoed such sentiments, writing that “the NDP unequivocally condemns the division and hate being peddled by Andrew Scheer and the CPC.”
The response from the Trudeau government was equally strong, with Gerald Butts, former principal secretary to PM Justin Trudeau proclaiming that the Conservatives were “committed to give the government the power to strip people born in Canada of Canadian citizenship.” The spokesperson for Ahmed Hussen released similar statements, lamenting that “[it’s a] shame to see the Conservatives going back down the path established by the Harper government, which seeks to strip away the citizenship of people who have only ever known Canada as a home.”
Paradoxically, these statements were made as the government agreed to investigate the birth tourism trend, and was engaged in a court battle to deny citizenship to the children of two Russian spies. In court, the Trudeau government had argued that “only thirty-four countries grant the automatic acquisition of citizenship through birthplace regardless of parent’s nationality or status. This practice is not consistent and uniform enough to ground a rule of international law.” No European country employs unconditional birthright citizenship, and many Canadian allies have instituted legislation limiting birthright citizenship.
Regarding the claim that changes to the law would create stateless children (and thus contravene Canada’s UN treaty commitments), one need only point to New Zealand, which altered its laws in 2006, requiring at least one parent to be a citizen or permanent resident, except in cases where this would create stateless children. Canada could easily adopt such a framework in order to curb birth tourism. Ireland changed its laws in 2005 and the UK and Australia have long operated under a limited birthright framework: all these countries have managed to honour their UN obligations.
The second option that could be pursued either separately or in tandem with changes to birthright rules is working with the Chinese government to curb birth tourism. Whereas Chinese birth tourists are not contravening Canadian law, China does not permit dual citizenship. Currently, Chinese birth tourists acquire Canadian citizenship for their newborns by giving birth in the country, before getting them Chinese passports at a local consulate prior to returning to China. Upon arrival, Chinese authorities are therefore unaware that the child holds a second citizenship. According to Vancouver-based, immigration lawyer Richard Kurland, the practice of Chinese birth tourism could be effectively stamped out if Canadian authorities notified China when Chinese birth tourists where on their way back home.
Chinese birth tourists would then be faced with a very difficult decision; whether the ‘insurance’ of a Canadian passport was worth the immense hassle of raising their children as foreigners in China. These children would require regularly renewed visas, and face potential separation and deportation should the government refuse to renew their documents. These children would also not be eligible to access Chinese social services, including free education and healthcare. Faced with such a high opportunity cost, the appeal of birth tourism to Canada would quickly evaporate.
The Bottom Line
As one of the thirty or so countries (only a handful which are wealthy) with unrestricted birthright citizenship, Canada has seen an increase in the number of pregnant Chinese women coming to the country to give birth. Following backlash in Hong Kong and the United States, this trend has only increased. While perfectly legal, the practice offends many Canadians and is seen as counter to the spirit of Canadian citizenship laws.
Efforts to tackle the issue have been hamstrung by inaccurate statistics as well as calls for heavy-handed responses and the ensuing moral outrage such proposal routinely provoke. Even Andrew Griffith, the man who exposed the disconnect between government statistics and the on the ground reality, has commented that the numbers do not warrant a drastic response. Modifying Canadian birthright laws along the lines of New Zealand would not jeopardize Canada’s UN commitments nor lead to the creation of stateless children: arguments to the contrary are non-starters. Short of legislative changes, cooperation with Beijing to identify birth tourists would compel them to choose between Chinese or Canadian citizenship.
For the first eighty years after 1867, Canadians were considered British citizens, the idea of Canadian citizenship only gained legislative heft in 1947. Since then, unconditional (save for the children of diplomats) birthright citizenship has been at the core of Canadian citizenship. In many ways, Canadian citizenship legislation remains a relic from that time, one that has become increasingly unable to manage the nuances of our globalized world.
*Names altered to ensure anonymity