The United States and Hong Kong encourage medical tourism. Patients are drawn by the high standard of care, and hospitals find this business to be disproportionately profitable. But both are wary of “birth tourism,” i.e., women entering as visitors with the intent to give birth.
Both the U.S. and Hong Kong grant immigration benefits to foreign children born in their territories. The Fourteenth Amendment to the U.S. Constitution guarantees citizenship to those born in America. And Hong Kong’s Basic Law grants Chinese citizens born there the right of abode. This right includes the right to enter, to remain, and not to be deported or removed. A 2001 court case, Director of Immigration v. Chong Fung Yuen, affirmed that this right extends even to the children of mainland parents who themselves are not residents of Hong Kong.
Another reason mainland mothers-to-be may seek to travel to the U.S. and Hong Kong is that the one-child policy is inapplicable to children born overseas.
The governments’ wariness of birth tourism relates to the potential for unrecoverable medical costs, as well as the perception that the children may be unfairly receiving immigration benefits and access to public education.
The Economist reported that in 2009 a striking 36% of children born in Hong Kong were to mainland tourists. Now, according to The Standard, at least 700 expecting Mainland mothers seeking to give birth in Hong Kong were refused admission by the Immigration Department in the past three months, while over 1600 gave birth in Hong Kong emergency wards without reservations.
To stem the flow of these mothers-to-be, the Immigration Department employs medical staff to check for pregnant women and refuses admission unless hospital reservations have been made and paid for. There is a quota on such reservations.
And Hong Kong’s Chief Executive, Tsang Yam-kuen, has just announced that the Home Affairs Department will conduct a sting operation on illegal inns where pregnant mainland mothers may be seeking shelter.
In the U.S., there have been several newspaper reports of birth tourism, such as this Washington Post article, but I’m unaware of any reliable reports of the actual numbers.
The key requirements to qualify for a visa to travel to the U.S. for medical treatment are that the applicant must have a clear medical diagnosis, a detailed treatment plan at a U.S. medical facility, and the financial resources to pay for the costs estimated by that facility for the treatment. The applicant must also intent to return to a permanent home abroad after a temporary stay in the U.S.
Still, traveling to the U.S. to give birth is both politically and legally controversial. The State Department regulations state that coming to the U.S. for “medical treatment” is a proper purpose. Consistent with that, an official at the U.S. Embassy in Beijing told the Washington Post, “You don’t deny someone because you know they’re going to the U.S. to have children.” But the U.S. Customs and Border Protection, the agency that posts officers at the airports, incongruously states on its website that “[c]oming to the U.S. for the purpose of child birth is not a valid reason for travel.” This creates a risk that even if a visa is granted for birth tourism CBP may still refuse admission.
It appears that both the U.S. and HK will remain wary of birth tourism for the foreseeable future.