Birth tourism a growing concern as health systems struggle

Doctors say it's time to take a closer look at birth tourism, both in Alberta and across the country, and consider whether the federal and provincial governments need to take a tougher stance against it.

A birth tourist is a non-resident who comes to Canada specifically to give birth in this country and they don't qualify for publicly funded health care.

"I think we need to address it. We need to decide how we're going to approach this," said Dr. Colin Birch, a Calgary obstetrician gynecologist.

According to Birch, birth tourism has the biggest impact on cities with international airports — the trend slowed when air travel was shut down early in the pandemic.

"We're seeing a slow creep back up again. Will we make pre-pandemic levels? I firmly believe we will."

Birch, who co-authored a recent Calgary study on birth tourism, noted several key reasons Canada is a destination.

The retrospective analysis, which looked at 102 women between July 2019 and November 2020, found 77 per cent of patients cited birthright citizenship — the system through which Canada grants automatic citizenship to anyone born in the country — as their primary reason.

One-quarter of the birth tourists were from Nigeria. Travellers from the Middle East and China were the second and third most common.

Most patients reported coming to Canada on a visitor visa.

Financial, social impacts

But Alberta's health system, like others across the country,  is under intense strain.

And that has physicians questioning the impacts of this trend.

"In the health-care system the way it is now, we haven't got the space to accommodate these people," he said.

He noted birth tourists can displace local patients — forcing them to deliver at a different hospital with a different health-care provider.

Birth tourists can also be costly.

In Calgary, a system is in place to identify birth tourists and distinguish them from other groups of uninsured patients, through a centralized triage service. A $15,000 deposit is collected for physicians' fees, with any unused portion being returned to patients.

"Really, it's the only place in the country that has attempted to put this into a process," said Birch.

But outside of Calgary, doctors have to try to recoup fees on a case-by-case basis. And Birch's research shows those deposits don't always get paid.

There are also separate hospital costs, and the study reveals unpaid fees to Alberta Health Services for the 16-month period amounted to nearly $700,000.

Preterm twins can cost the system hundreds of thousands of dollars alone, Birch noted.

Alberta government 'concerned'

Data provided by Alberta Health shows the number of non-residents who gave birth in the province more than tripled — from 83 to 287 — between the 2010-11 and 2015-16 fiscal years.

The numbers dipped slightly after that. And the most recent data shows 256 non-residents gave birth in 2020-21, and 245 in 2021-22.

"Alberta's government is concerned about birth tourism and its impact on Albertans and Alberta's health system," said Alberta Health spokesperson Andrew Livingstone in a statement.

"In most cases, birth tourists are patients who have access to quality health-care in their home countries and are not vulnerable individuals, refugees or asylum seekers."

According to Livingstone, emergency or urgent care will always be provided, but individuals without provincial health coverage are expected to pay.

"In some cases … the cost of hospital care for the mother and newborn remains unpaid. We are currently considering a number of options for addressing these circumstances and recovering health-care costs."

The province said it's too early to share details on what options are being considered.

National doctors group to study issue

This week, the Society of Obstetricians and Gynaecologists of Canada (SOGC) decided birth tourism warrants further investigation.

It was a key topic at an SOGC conference in Banff, where Birch gave a presentation on Thursday.

"It became very clear that SOGC wants to be involved. So we are going to take this on," said Dr. Douglas Wilson, SOGC president and professor emeritus at the University of Calgary's Cumming School of Medicine.

Wilson said the group decided to form a committee to look at birth tourism and related issues, and it plans to begin collecting data from the provinces.

"We'll start to get a handle on it. And we'll start to look at some provincial and federal discussions, because this is an issue where the delivery is provincial but immigration is federal, and in most cases, they don't talk to each other," he said.

A key concern, he said, is ensuring safe care, because many of these patients have other health problems, such as diabetes and hypertension.

"If you don't have a chance to watch and look after those women before … and they just show up, then you're going to have a much more complex delivery with potential risk involved."

Meanwhile, Birch said a number of options could be considered, ranging from eliminating birthright citizenship to implementing a universal system — similar to the one in Calgary — that would ensure physician and hospital fees are collected.

"This is not new. But I think we have to decide, is it a big enough issue for us to bother or are we just going to forget it and say, 'this is a part of giving care' and … accommodate as best we can."