A baby is seen with a Canadian passport in a photo posted by the Baoma Inn. There is no suggestion of wrongdoing, birth tourism is legal in Canada. Photo / Baoma Inn
In the spring of 2012, Yan Xia was admitted to Richmond Hospital in British Columbia, Canada, and had a baby.
But something went seriously wrong, and it would be months before Yan (a non-resident of Canada), and her child (a newly minted Canadian citizen), were discharged.
What they left behind was a massive hospital bill.
With interest, it now stands at almost C$1.2 million ($1.3 million).
Their current whereabouts are unknown, although China would be an excellent guess.
According to Carrie Stefanson, the Vancouver Coastal Health Authority's public affairs leader, the "overwhelming majority" of non-resident mothers who give birth in Richmond Hospital list China as their place of residence.
Yan's case is revealed in a lawsuit by VCH, filed on April 12 in pursuit of the unpaid bill.
VCH refused to provide details of Yan's case, except to confirm that both mother and child had been successfully discharged.
But the phenomenon of "birth tourism", in which pregnant foreigners travel to Canada to give birth in order for automatic citizenship to be conferred upon their children, is on the rise, and Richmond Hospital is at the epicentre of the phenomenon.
One in five of births at Richmond Hospital involve non-resident mothers, in what is now considered a daily occurrence.
Birth tourism has come under fire from both Conservative and Liberal politicians in Canada, with the district's Liberal MP Joe Peschisolido sponsoring a petition that calls for an end to the "abusive and exploitative practice".
Stefanson said VCH took no stance on the issue.
"We recognise that we have to provide care to those who are in need regardless of where they're from," she said.
"So if women come to our hospital and need to deliver a child, we will certainly be there for them and we never deny urgent or emergent care based on anyone's nationality or their ability to pay."
Unpaid bills notwithstanding, birth tourism in Canada is perfectly legal.
Dozens of "baby houses" now cater to the market by offering accommodation to pregnant foreign women who travel to British Columbia specifically to give birth to Canadian citizens, and they appear universally targeted at Chinese visitors.
The Baoma Inn, in a leafy suburb of Richmond, is one such operation.
Towering over neighbouring homes, the inn was built across the road from a park in 2015 and has at least eight bedrooms and 10 bathrooms.
It is conveniently located 4km from Richmond Hospital.
On a recent morning, a pregnant guest could be seen watching children from the nearby RM Grauer Elementary School as they ran laps in the park.
The inn's operators offer Canadian and Chinese passport services for its "precious mothers to be", as well as post-partum help.
The Inn's Instagram page shows pregnant guests on day trips around the region, shopping on Robson Street, watching crabbers in North Vancouver and admiring autumn foliage.
There are also happy photos of new mothers with their babies.
One shows an infant with a Canadian passport.
A video shows a newborn bathed in the ultraviolet light of an incubator.
The operators of the Baoma Inn did not respond to requests for comment; the South China Morning Post makes no suggestion of wrongdoing by the inn or its guests.
A fact sheet provided to the Vancouver Sun under a freedom of information request in 2016 said the BC Ministry of Health's audit branch had identified 26 "baby houses", whose guests were either short-term visitors to Canada, or were permanent residents who had left Canada and allowed their eligibility for BC's medical services plan (MSP) to lapse.
"These individuals stay long enough to obtain a Canadian passport and enrolment in MSP for their child, before returning to their country of origin," the ministry document said.
According to VCH statistics provided to the South China Morning Post, non-resident mothers were involved in 19.9 per cent of all births at Richmond Hospital in 2017-2018, as of September.
That is up from 17.2 per cent, or 384 out of all 2228 births in 2016-2017, and 15.5 per cent in 2015/2016.
A small handful of the non-resident mothers - five in 2016/2017 - were Canadian citizens but non-residents.
From 2009 to 2014, VCH births to non-resident mothers quadrupled, according to the Vancouver Sun.
Stefanson said the vast majority of cases for VCH, which runs nine hospitals in British Columbia, occurred at Richmond Hospital, which has extensive Chinese-language services.
The Vancouver satellite is the world's most-Chinese city outside Asia, ethnically speaking, with 53 per cent of the population identifying as Chinese.
To curb potential difficulties, VCH urges all women intending to use Richmond Hospital's maternity services to register six to eight weeks in advance.
"That may not necessarily reduce the demand on our services, but it certainly helps our staff to be more proactive in planning," she said.
Despite non-resident mothers adding pressure on resources, the hospital had never had to decide whether to grant one priority over a Canadian resident, Stefanson said.
Non-resident mothers are charged on the basis of "full cost recovery", she said.
The prepayment deposit stands at C$8200 for a vaginal delivery and C$13,300 for a caesarean birth.
But as the Yan case demonstrates, fees can run much higher, and the hospital charges a hefty 2 per cent interest per month on unpaid bills.
Infants with non-resident mothers are born Canadian, but their eligibility for free care does not kick in for three months.
"If a baby, for example, required specialised care in the neonatal intensive care unit for a number of days, upwards of a month or two? Those costs would be over C$200,000 or C$300,000," said Stefanson, speaking generally.
In Yan's case, the original amount owing was C$312,595.
Last September, after 59 months, interest had pushed it past the million-dollar mark.
It now stands at C$1,178,130.87.
The case appears to be an outlier, with non-resident mothers' unpaid bills incurred in 2014-2015 coming to C$693,869, according to the health ministry's fact sheet.
"It is unknown what proportion is related to 'baby houses' but it is thought to be small," the ministry said.
It is certainly a tiny amount compared to the BC health ministry's C$18 billion annual operating expenses.
Nevertheless, the backlash against birth tourism has been strong.
The petition to Canada's parliament sponsored by Steveston-Richmond East MP Peschisolido on March 19, and initiated by Richmond resident Kerry Starchuk, says: "The practice of 'birth tourism' is fundamentally debasing the value of Canadian citizenship."
It cites costs related to education, health care and social security, and asserts that "Canadian citizens and permanent residents have been displaced by foreign nationals at local hospitals, thereby requiring [them] to seek medical attention at other facilities".
It calls on the federal government to "expeditiously implement concrete measures to reduce and eliminate this practice", as well as publicly state that birth tourism is unfair, with negative consequences.
Open until July 17, the petition has more than 7800 signatures.
"Birth tourism is wrong," said Peschisolido in a Facebook statement that focused on a different aspect of the issue.
"Women are being exploited by organised efforts to take advantage of the system. These women are the victims of individuals taking advantage of the system and profiting from the situation."
A similar petition was sponsored in 2016 by Alice Siu-Ping Chan Wong, the Conservative member for Richmond Centre.
But the Liberal government dismissed that petition, saying citizenship by birth in Canada had been in place since the first Citizenship Act in 1947.
"While there may be instances of expectant mothers who are foreign nationals who travel to Canada to give birth, requiring that a parent be a citizen or permanent resident in order for their child to acquire citizenship through birth in Canada would represent a significant change to how Canadian citizenship is acquired," said then immigration minister John McCallum, who is now Ambassador to China.
Regardless of the latest petition, "we would never deny care to anyone based on their ability to pay or where they're from," said Stefanson.
"The politics of it are really not for us."
The principle of jus soli - citizenship by birth on soil - is a common feature around the world, but it is far from universal. Here's how various jurisdictions' rules compare.
Canada:
Citizenship by birthplace in Canada, regardless of the status or nationality of parents, has been a feature of the nation's Citizenship Act since it was created 71 years ago. Even children born in Canadian airspace are considered Canadian citizens.
Australia:
Australia does not recognise unfettered jus soli. Children acquire citizenship upon birth in Australia only if at least one parent is an Australian citizen or permanent resident at the time.
New Zealand
By birthplace, you are a New Zealand citizen by birth if you were born in the country before January 1, 2006. If you were born in New Zealand after that date, you are only a citizen if at least one parent is a citizen or permanent resident.
United States:
The US grants citizenship by birth not just to children born in the United States itself, but territories under American jurisdiction, such as Guam and the US Virgin Islands. Many mainland Chinese mothers give birth on Saipan in the Northern Mariana Islands to acquire US birthright citizenship for their children.
China:
Chinese nationality is acquired upon birth only if one parent is a Chinese national, or both parents are stateless but living in China. Further, China considers any child born in a Chinese territory with at least one Chinese national parent to be a Chinese citizen. This situation has led some to discover that they are inadvertent Chinese citizens.
Hong Kong:
The SAR grants right of abode (not citizenship, since Hong Kong is part of China) to the children of Chinese citizens born on Hong Kong soil. The issue has been targeted by community protests, but courts have upheld the current principle.
Japan:
Citizenship of Japan is conferred if either parent is a Japanese national, irrespective of location of birth. It was only in 2008 that a Japanese court ruled that the practice of denying citizenship to children whose foreign mothers were not married to their Japanese father was illegal.
Britain:
In 1981, Britain changed its broad interpretation of jus soli. The new Nationality Act specified that it applied only if at least one parent is a British citizen or permanent resident.
This story originally appeared on the South China Morning Post and is reproduced with permission.
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