This blog updates our prior estimate from April 2015 of the scale of birth tourism. Our new estimate it that there were 33,000 births to women on tourist visas in the second half of 2016 and the first half of 2017 who had a child and then left the country. This estimate is almost identical to our April 2015 estimate of 36,000. As in our prior estimate, our new number is based on a combined analysis of birth certificate records and data collected by the U.S. Census Bureau. Both estimates represent a rough approximation, based on limited data, of the possible number of births to women who came to America specifically to have a child and then left once the child was born.
Addresses on Birth Records Unhelpful. At the outset it must be emphasized that the address provided by parents on birth records is almost certainly not very helpful when trying to estimate the scale of birth tourism. In years past, roughly 8,000 women annually who gave birth provided an address outside of the United States. However, the CDC no longer seems to be providing this number. On its face, this might seem like a way to estimate the likely number of women who are engaged in birth tourism. But this is not the case.
The primary purpose of providing an address is to receive the official birth certificate once the birth is registered with the state. Those engaged in birth tourism have a very strong incentive to remain in the United States after the birth of the child until they receive the birth certificate, which allows them to get a passport for their child. Those engaging in birth tourism typically stay with friends, family, or in some other residential setting arranged by those "selling" birth tourism services for immediately before and after they have their babies. There is anecdotal evidence that birth tourist mothers provide the address they stay at before or after giving birth, rather than an address in a home country.1 Providing a U.S. address certainly makes sense because doing so allows the parent to obtain the documents that provide citizenship, which is the whole purpose of the trip, before returning home. Receiving the documents before leaving assures the parents that the birth has been properly registered.2 Another advantage of providing a U.S. address is that doing so avoids using a foreign mail system that may be less reliable.
Method for Estimating Birth Tourism. The American Community Survey (ACS), collected by the Census Bureau, asks women if they had a child in the prior 12 months. The survey is designed to reflect the U.S. population as of July 1 of the year the survey. The 2017 ACS shows 854,896 immigrant women living in the country who had a child in last half of 2016 or the first half of 2017. Birth records collected by the CDC indicate that there were 897,223 births in the United States to mothers born outside of the United States in the second half of 2016 and the first half of 2017.3 Comparing this number to births to foreign mothers in the ACS shows a 51,327 difference.4 The difference between these two numbers implies that about 51,000 foreign-born women gave birth in the United States in the 12 months before July 1, 2017, but were no longer in the country. We adjust this number downward to reflect the fact that the 2017 ACS shows that 35 percent of foreign-born women who gave birth in the prior year were U.S. citizens and could not have been birth tourists. Thus our best estimate is that there were perhaps 33,000 birth tourists in the second half of 2016 and the first half of 2017. This estimate is very similar to our prior estimate of 36,000 for the second half of 2011 and the first half of 2012. The difference between these two estimate should not be interpreted as meaningful, since both estimates contain significant uncertainty.
Important Caveats About These Estimates. First, there is no agency that verifies a mother's place of birth, address, or any other information provided to states by parents on birth certificate records. Second, there is both a margin of error in the ACS and some undercount of foreign-born women in that data. Third, some foreign-born women may have had a child and left the country, but they did so after many years of residence and should not be considered birth tourists. Fourth, a person who comes as a birth tourist but has a miscarriage would not be included in the birth records, which only reflects live births. However, such a person would clearly meet the definition of a birth tourist.
1 In March 2015, CNN reported that one birth tourist used an address in "a high-end Irvine, Calif., apartment complex where one birth tourism company had rented a number of homes" for her newborn's passport application. A USA Today report on the investigation notes that the birth tourists were "promised Social Security numbers and U.S. passports for their babies before flying back home." On p. 76 of the warrant used to raid several birthing centers, the government lists "California birth certificates" as one of the items to be seized. (Affidavit dated March 2, 2015.) Clearly, the government believes that many of the women using such centers have the birth certificates sent to the centers and not to addresses in their home countries. This makes sense because waiting to get a birth certificate and passport before returning to your home country ensures that the birth has been properly registered and citizenship obtained. But this requires use of a U.S. address. I will add that my own personal experience also indicates that those engaged in birth tourism often provide a U.S. address. An immigrant family in my neighborhood in Fairfax County, Va., has complained to me that a relative who stayed with them before having her baby used their address and the family received bills from the hospital long after the women had delivered her baby and returned to her home country.
2 While problems registering a birth are rare, trying to solve an issue if one arises is certainly much easier from within the United States than from a foreign country.
3 Births to mothers in 2016 who themselves were born outside of the United States can be found here and births to foreign mothers in 2017 can be found here. The CDC does not report births to mothers born outside of the United States by month so we assume that the distribution of births to immigrant mothers across months is the same as for the general population. Births by month for 2016 can be found here and births by month for 2017 can be found here. Based on this assumption, there were 466,364 births to foreign-born mothers in the second half of 2016 and 430,859 births in the first part of 2017 to such mothers, for a total of 897,223 over this time period.
4 It should be noted that the Census Bureau defines the foreign-born (immigrants) slightly differently. The CDC figures are based solely on the mother's country of birth while the ACS has a specific citizenship question that records if the mother was born abroad of American parents. We use the CDC definition of the foreign-born in this comparison and code the public-use ACS data accordingly.