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The Ethics of ‘Birthing Tourism’

U.S. Maternity Hotels Cater to Pregnant Chinese Women

Is it ethical to establish a “maternity hotel” in the United States to accommodate Chinese women who want to give birth to their children in the U.S. solely to reap the benefits for their child of U.S. citizenship? The question is real as “birthing tourism” in the U.S. has become the destination of choice. According to the 14th Amendment to the U.S. constitution (ratified in 1868), anyone born in United States automatically becomes an American citizen and obtains access to public education, university loans, voting, and so on.

Is the practice dishonest because the motivation is to game the immigration system for selfish reasons? Do such practices take away resources that otherwise would go to U.S. citizens? Is it fair to those less well-off and unable to take advantage of the system that those who can afford to fly to the U.S. and pay for the birthing costs reap the benefits of the questionable practice? Should the U.S. ban the practice of birthing tourism and shut down such sites?

The Chinese women who come to the U.S. to give birth to their children pay as much as $20,000 to stay in the hotel facilities during the final months of pregnancy, and then spend an additional month recuperating and awaiting the new baby's U.S. passport. U.S. citizenship will allow some of the children to return to the U.S. to take advantage of free public schools and low-interest student loans. Parents may also be able to piggyback on the child's status and apply for a green card when the child turns 21.

One example of how it works is the case of Liu Li. After consulting quite a few agencies for expectant mothers, Liu chose a reputable one. Airplane tickets, fees for labor, pre- and post-delivery care cost her roughly $20,000. Since most airlines refuse to accept women passengers who are more than 32 weeks pregnant, Liu set off for America when she was six months pregnant and then checked into a Chinese birthing center in California.

After her arrival, Liu Li realized that the area was full of facilities set up for Chinese women like her. On the limited occasions when Liu Li goes to the Punete Hill Mall near her birthing center — the facility limits walks outside its premises to three per week, each time for about three hours — Liu bumps into lots of pregnant Chinese women. Birthing centers such as Liu’s, which are mostly situated in west coastal areas, operate without a business license, and try to be as discreet as possible. In April, a number of illegally converted maternity centers in Los Angeles were discovered and shut down.

Many of the hotels operate in violation of zoning laws, their locations known mainly to neighbors who observe the expectant mothers' frequent comings and goings. Such was the case in Chino Hills, where residents recently protested an alleged maternity hotel operating in a hilltop mansion. City officials have sued the property owner, claiming that the seven-bedroom house was illegally subdivided with 17 bedrooms and 17 bathrooms, with at least 10 mothers and babies living there. San Gabriel officials shut down a similar facility in 2011, and Chino Hills officials hope their lawsuit will result in a similar outcome.

Critics also cite safety concerns surrounding the largely unregulated industry. A local attorney says he is representing a maternity hotel in a case where a baby was dropped and died. The California Department of Public Health also is investigating a case that may involve maternity hotels, said a spokesman who said he could not provide further details.

Federal immigration authorities say no law prevents pregnant women from entering the country. The women typically travel on tourist visas and return home with their newborns, who will have the option of coming to the U.S. for schooling, sometimes while the parents remain in Asia. American citizenship is also considered a hedge against corruption and political instability in the children's home countries. For some, giving birth in the U.S. staves off hefty fines under China's one-child policy.

Maternity hotels have proliferated in the last decade as mainland China's new middle class tries to give its offspring every advantage. But birth tourism is not limited to Chinese and Taiwanese nationals. South Korean and Turkish mothers are also reported to pay thousands of dollars for package deals that include hotel rooms and assistance with the visa process.

Since the publicity surrounding the Chino Hills case, Los Angeles County officials have received at least two dozen complaints, mostly regarding sites in Rowland Heights and Hacienda Heights. The unassuming home at the top of the hill in an upscale Chino Hills neighborhood has been operating as a “maternity mansion” charging women from China high prices to give birth in the U.S., essentially buying American citizenship for their babies, according to neighbors who want the operation shut down.

For me, it is hard to unequivocally label the birthing tourism practice as unethical. No laws are broken and the Chinese women who take advantage of our 14th Amendment pay the costs to travel to the U.S. They are not sneaking into the country illegally as so many others have done especially down by our southern border. We either have to pass a new law to prohibit the practice, if that is what we want to do as a nation, or accept it as a reality in today’s globally interconnected world.

Blog posted by Steven Mintz, aka Ethics Sage, on January 21, 2013