Birth Tourism: The Pregnant Patients Most Doctors Cannot Accept

The Question: I am pregnant and my expected due date is in June. I currently live outside Canada, and would want to go back to Toronto for delivery. I am a cash patient as my current health insurance is from outside of Canada. I tried to book an appointment with one of the OBGYN docs for April (when I’m expected to go back), but I was asked for a referral from a family doctor. As I reside and work outside of Canada, I’m not sure how to provide the same. Would a referral from an international doctor suffice? If not, what are my alternatives to get a successful booking at the hospital with an OBGYN? I do have a couple of preferences for doctors at Sunnybrook. Looking forward for your response and advice.

The Answer: This type of question – a pregnant woman living out of country – wondering if she can give birth in Canada is one we receive a few times a year. Without meeting specific criteria, it is unlikely Sunnybrook could accommodate you.

Generally speaking, obstetricians are not supposed to accept patients from out of country unless they are Canadian citizens living abroad, who wish to come home to have their baby delivered. Women who are non-citizens, are fully insured, who may be residing in Canada for their work and have family in this country are also accepted by obstetricians to give birth here, according to Arthur Zaltz, Chief, Department of Obstetrics and Gynaecology.

According to Sally Bean, ethicist and policy advisor at Sunnybrook, an “out of country obstetrical patient who is not physically present in Canada poses numerous liability and insurance coverage issues.”

As a result, it is difficult for physicians to accept them as patients.

Doctors who agree to accept out-of-country patients would be viewed as having directly or indirectly solicited the patient and may not necessarily be provided coverage if they were sued outside of Canada, she said.

The federal government has been watching this issue closely and is considering changes to citizenship rules in a bid to stamp out so-called birth tourism – cases where a foreign national comes to Canada to deliver their baby, knowing the child will get full citizenship.

Currently, under the Citizenship Act, children born in Canada to parents who are temporarily in the country – visitors, students, temporary workers, asylum claimants – are automatically conferred citizenship, allowing them to access the range of taxpayer-funded benefits that come with it.

Canada and the United States are among the few countries worldwide that confer automatic citizenship by birth on soil; most other countries limit citizenship to those with a parent with permanent status, according to Remi Lariviere, spokesman for Citizenship and Immigration Canada.

“We have been considering bringing forward comprehensive amendments to the Citizenship Act,” Jason Kenney, Minister of Citizenship, Immigration and Multiculturalism, said in a CBC television interview in 2012. “…We don’t have a precise timeline. But we are looking at modernizing the Citizenship Act and this might be considered as one of those amendments.”