Canada's "Birth Tourism" Industry

Macleans

"[It's a] sorry state of affairs [that women in Canada face wait times of 18 months or longer for treatment for pelvic pain, uncontrolled bleeding and other women's health issues."

"The thought that even ONE patient seeking birth tourism would potentially take either an obstetrical spot out of our allocated hospital quota, or even worse, a spot on the gynecologic waiting list, should be enough to unite all in a position that anything that in any way facilitates this practice should be frowned upon."

"These are non-Canadians getting access to health care, which we haven't got enough of for our own Canadians."

Dr. Jon Barrett, professor, chief, department of obstetrics and gynecology, McMaster University

"In a system that is tight and stretched, it does become an issue at the hospital level."

"It appears like a short cut, a loophole that people are abusing in order to obtain longer-term benefit for their offspring."

"It sends the wrong message that basically we're not very serious in terms of how we consider citizenship and its meaningfulness and its importance to Canada."

Andrew Griffith, former senior federal bureaucrat, Immigration, Refugees and Citizenship Canada

"The principal motivator is just soli."

"Sometimes it's veiled under, 'I want to get better medical care', but, interestingly, they fly over several countries that can give them the equivalent care to Canada to get here."

"[Denying care is a dangerous and unrealistic] gut reaction [some hospitals have taken]. Let's be very clear: they won't let them through the front door, or they send them on to another hospital."

"You cannot have zero tolerance for patients. You can't do that because that leads to maternal and fetal complications."

Dr. Colin Birch, obstetrician and gynecologist, Calgary

A Calgary study shows the unpaid hospital bills of birth tourists can cost the system hundreds of thousands of dollars. (Ann Rodchua/Shutterstock)

 

Dr. Birch is co-author of a new study on 'birth tourism', considered the first in-depth analysis of birth tourism in Canada where 102 women who gave birth in Calgary were involved as part of the study. Most of the women arrived in Canada on a visitor visa for 87 days on average before their due date. Birth tourists were most frequently from Nigeria, the Middle East, China, India and Mexico. 77 of the total gave their reason for coming to Canada was to give birth to a "Canadian baby".

Denial of care, wrote Dr. Birch in his counter editorial for the Journal of Obstetrics and Gynaecology Canada, is a dangerous and unrealistic "gut reaction". But the question remains, should Canada deny care to pregnant women who visit Canada for the specific purpose of having their babies delivered in the country, given that automatic citizenship is conferred on any baby born in Canada. Canadian hospitals and doctors should have "absolutely zero tolerance" for birth tourism, according to a leadling expert in preterm and multiple births.

Birth tourism has become a practise for years, with pregnant women entering Canada for the sole purpose of giving birth in the country, and its prevalence is rising again, with COVID travel restrictions dropped. Babies can end up spending weeks in intensive care when planned low-risk births become complicated, leaving hospitals with hundreds of thousands in unpaid bills. Almost $700,000 was owed to Alberta Health Services over the 16-month study period.

According to Professor Barrett, the women are at risk of being "fleeced" by unscrupulous brokers and agencies that charge hefty sums upfront for birth tourism packages that include help in arranging tourist visas, flights, "maternity, or "baby hotels" and pre- and postpartum care. "Tempted by large sums of money, even the best of us can be tempted into poor practice", wrote Dr. Barrett. It's been acknowledged for some number of years that 'birth tourism' has become an industry in Canada.

Canada's rule of jus soli -- Latin for "right of soil" citizenship is automatically conferred to any who are born on Canadian soil.And birthright citizenship paves the way to the next step, of when the child becomes 18 they can sponsor their parents. Additionally such citizenship as 'birthright' allows the child access to a Canadian education and health care. At least one parent is required to be a citizen or permanent resident by other developed nations, to confer citizenship at birth.

In pre-COVID years, non-resident births accounted for up to 25 percent of all births at a single hospital in Richmond, British Columbia as well as at a handful of other popular destination hospitals in Ontario and Quebec which approached five to ten percent of all births. Nationally, however, the numbers are more modest with "birth tourism" accounting for roughly one percent of total births. In 2019, for example, nation-wide 4,400 foreign births were recorded.

While doctors cannot deny care to a woman in labour, doctors and  hospitals pre-birth could decline to provide care. "Eventually, if you create this unfriendly environment, if everybody said we are not looking after you and not facilitating this, eventually people will not come", explained Dr. Barrett. Another useful strategy, of course, is to change Canada's jus soli law to match those of other advanced countries.

The number of non-residents giving birth in Alberta more than tripled between 2010 and 2016. (Dragan Grkic/Shutterstock)