Concerns Growing Over Canada’s Burgeoning Birth Tourism Industry

A newborn baby is cared for at a hospital in a file photo. Lolostock/Shutterstock

“Giving birth in Canada opens up great prospects for your baby,” says the Canada Mama consultancy website. It’s one of many platforms helping expectant mothers travel to Canada to give birth so their babies will become Canadian citizens.

Such platforms outline all the reasons Canada is the preferred destination: Birth tourism is permitted by law, medical expenses are relatively cheap, and Canadian citizenship comes with many social benefits.

While birth tourism has faced occasional scrutiny in Canada over the years, it continues to thrive—often at the expense of taxpayers, and to the detriment of mothers, babies, and an over-burdened health-care system, says Dr. Simrit Brar, an obstetrician-gynecologist at Foothills Medical Centre in Calgary.

Birth tourism can be harmful to the tourists themselves, she said, with some travelling at a late stage in pregnancy to save on accommodation costs. A lack of continuity in care and other elements of the practice can result in risks to mother and child.

Brar is one of the few medical professionals in Canada who has collected detailed birth tourism data and who is running a program aimed at preventing its detrimental impacts. She serves as medical informatics lead for women’s health in the Calgary health zone.

Within Calgary’s health zone, any uninsured patients seeking prenatal care are triaged through the program, which acts as a sort of immigration screening to identify birth tourists.

“Birth tourists that come here have the ability to afford a flight, a place to stay, the living expenses. And their intention is really just to come and have a baby and then return,” Brar told The Epoch Times. They are different from those in more vulnerable populations who may not have provincial health coverage, she said.

Those identified as birth tourists must pay a deposit of $15,000 before receiving service in Calgary. Brar and her team are trying to discourage birth tourism as a practice—and at least make sure the tourists pay their medical bills—while ensuring all patients get needed care.

Taxpayer Pays

A treatment room in the emergency department at a hospital in Calgary in a file photo. The Canadian Press/Jeff McIntosh

A standard birth costs some $10,000 for the delivery plus charges for the hospital stay, though the price balloons rapidly if there are any complications. Birth tourists are billed directly, but Canada’s public health-care system is ill-equipped for these private transactions, Brar said.

“We don’t have a very well-defined fee-collecting process. They know that they’re not consistently going to be charged,“ Brar said. ”And even if they are, there’s no really consistent mode of collection. We’ve recently been noticing people who are now calling our bluff on it, saying, ‘Hey, you’re not going to send a collections agent after me. I don’t have to pay.'" 

Even though birth tourists are supposed to pay a deposit in Calgary, many try to find ways around it, Brar said, or go to other regions without such a robust system in place.

“What they’re trying to do is cut a deal,” she said. They may say they don’t have the money, or they'll try to negotiate for a lower price, Brar said, adding that people swap advice on community forums on how to cut the costs.

Another obstetrician-gynecologist in Western Canada, who spoke on condition of anonymity due to fear of profession repercussions, confirmed that most birth tourists he sees try to haggle or skip out on the bill altogether. “They leave massive bills, sometimes hundreds of thousands,” the doctor said.

The Numbers

Some birth tourists are also genuinely unprepared for the ballooning costs due to a lack of understanding about how the system works.

“My baby DID NOT GET A HEALTH CARD, so I had to pay for every thing that was done for him. Every single thing,” wrote one mother in an online forum helping Nigerians in a thread on giving birth in Canada.

Brar co-authored a 2022 study of birth tourists in Calgary that found almost $700,000 in bills racked up by 102 birth tourists. Nine of the babies in the study ended up in the neonatal intensive care unit.

That was a small sample that gives only a hint at what the costs are nationwide, Brar said. The data isn’t being collected systematically in Canada either, she said. The Epoch Times did not hear back from the Ontario Health Ministry regarding costs incurred for unpaid non-resident births in that province.

Even the number of birth tourists is not well-tracked.

The Canadian Institute for Health Information (CIHI) compiled for The Epoch Times data regarding the number of hospital deliveries under the “Other country resident self-pay” category. This number also captures international students (who typically have private insurance) and others, so there is no data specifically regarding birth tourists.

Hospitals Canada-wide (excluding Quebec) handled 3,849 “other country resident self-pay” deliveries in fiscal year 2023–2024, according to CIHI. Most were in Ontario, which had 2,775 of these births. CIHI could not include the numbers from Quebec by press time, since an additional process is required to get that data.

CIHI provided data as far back as FY 2019–2020. That year, there were 4,400 such deliveries Canada-wide, excluding Quebec. The numbers dipped in subsequent years, presumably due to pandemic travel restrictions, before rising again recently.

An Immigration, Refugees, and Citizenship Canada (IRCC) report published in 2022 looked at that data, including Quebec, up to 2017 and reported “an increasing trend from around 1,500 in the early 2010s to around 3,600 in 2017.”

Planes are seen at the Pearson Airport in Toronto on July 24, 2024. The Canadian Press/Christopher Katsarov

Collecting Payment

Brar said immigration officials should impose consequences for birth tourists not paying their medical bills. Her latest idea is to start sending Canada Border Services Agency (CBSA) a notification when a family hasn’t paid their bill.

She said Alberta’s Health Information Act says a person’s health information may be disclosed without the person’s consent “for the purpose of collecting or processing a fine or debt owing by the individual to the Government of Alberta.”

Brar said she’s going to start including a warning to that effect in an information package given to all birth tourists in Calgary.

CBSA told The Epoch Times, however, that it can’t do anything about unpaid medical bills.

Border agents cannot bar someone from leaving Canada. Police forces can work with CBSA to set up a “lookout” in advance if someone with a criminal warrant may try to leave. But if the police aren’t present, CBSA can only confirm that the departure happened.

“This applies to criminal warrants, not to civil matters,” CBSA spokesperson Jacqueline Roby told The Epoch Times. Civil matters, such as unpaid bills, are entirely beyond CBSA jurisdiction.

Immigration, Refugees and Citizenship Canada is responsible for evaluating if foreign nationals applying for visitor visas can support themselves financially before a visa is issued. However, CBSA agents can also refuse admission at the port of entry if there are any concerns.

On Nairaland.com, a forum focused on helping the Nigerian community, some birth tourists detail their experiences, including encounters with border security. One user reported telling a CBSA agent that he and his wife were arriving as birth tourists. The user said the agent asked which hospital they planned to use, how they planned to pay their medical bills, how much cash they had, and their occupations. The user said the CBSA agent did not ask to see proof of finances.

The user said the agent was satisfied with the couple’s responses and advised them to apply for the baby’s birth certificate and social insurance number before leaving Canada. The Epoch Times wasn’t able to confirm the validity of this encounter.

Strain on Health Care Resources

A newborn baby in the maternity ward at Frimley Park Hospital in Surrey, England, in a file photo. Steve Parsons - Pool/Getty Images

Brar’s concerns are not only related to the costs, however, but also to the strain on Canada’s limited health-care resources.

For example, if a birth tourist’s baby ends up in a neonatal intensive care unit (NICU) bed, that’s one less NICU bed for local babies, she said.

“We are continually deferring deliveries, transferring babies, moving people around, because we don’t have access to that bed,” she said. “Our health-care system is falling apart, and I am one of those providers that strongly believes that there are layers of accountability lacking within our system.”

Dr. Jon Barrett, a professor of obstetrics and gynecology at McMaster University, has expressed similar concerns. He published an opinion piece on birth tourism in the Journal of Obstetrics and Gynaecology Canada last year.

“Waiting time for uro-gynaecological service is more than 18 months in most of our centres. 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 gynaecologic waiting list, should be enough to unite all in a position that anything that in any way facilitates this practice should be frowned upon,” he wrote.

He said refugees or non-residents who happen to be in Canada for work, study, or other reasons should be provided service without undue financial burden. But he suggests a “zero tolerance” policy for the “non-urgent planned and deliberate birth tourists in our hospitals.”

He is head of the of the maternal-fetal medicine program at Sunnybrook Health Sciences Centre in Toronto, which does indeed reject birth tourists.

“Sunnybrook does not accept medical tourists who travel to give birth here. Our primary duty is to provide care to residents of Ontario,” the hospital’s website says.

Canada vs. US

A recent development that could have ramifications for Canada is U.S. President-elect Donald Trump’s plans to end “birth tourism,” and remove “birthright citizenship” for children of those who are in the United States illegally. Although the proposed change would likely go to the Supreme Court and involve constitutional challenges, if it comes to pass it could result in more such births in Canada if the United States no longer allows birth tourism.

Currently, much of North and South America adhere to jus soli, meaning “right of soil,” or automatic citizenship for babies born in the country. Much of the rest of the world follows jus sanguinis, which means “right of blood,” or granting citizenship based on the nationality of the parents.

Immigration consultancy firm Jane Katkova & Associates says Canada is preferred over the United States for being cheaper. “It’s considered 45% cheaper to give birth in Canada compared to childbirth in the US,” its website says.

Brar said she sees American birth tourists because of that price difference.

A Canada Border Services Agency (CBSA) patch is seen on a CBSA officer’s uniform in Tsawwassen, B.C., in a file photo. The Canadian Press/Darryl Dyck

Her study indicated that about a quarter of the birth tourists in Calgary were Nigerian. Other common countries of origin, she said, are India, China, and Middle Eastern countries.

Niladri Mukherjee, a Mississauga, Ont.-based immigration consultant, says in an online video that the number one source country in his experience is China, followed by the United Arab Emirates. India and the Philippines are also common, followed by Nigeria, Ghana, Pakistan, and other places, he said. He estimates a birth tourist’s costs at about $50,000 including medical care, accommodation, and travel.

Immigration lawyer Jean-François Harvey warns that the birth tourism practice can come with legal repercussions despite it being technically permitted in Canada. For instance, a mother may over-stay her visa due to complications in birth.

“Overstaying visas in Canada can lead to severe legal repercussions, including the risk of deportation and future bans on re-entry,” Harvey said in a post on his website earlier this year.

He also noted negative perceptions of birth tourism in Canada. “Some may also see birth tourists as individuals who are ‘gaming’ the immigration system by exploiting loopholes and bending the rules to gain citizenship for their children,” Harvey said.

Brar said she is hoping to see more collaboration between hospitals and immigration officials, and that existing rules stipulating that people on visitor visas fund their own medical care be better enforced. She is also trying to help other hospitals implement Calgary’s triage system.