A growing number of pregnant women from foreign countries are giving birth here just so the babies can win Canadian citizenship, doctors say, raising questions about a long-standing immigration-law tradition.
In Montreal, many of these maternity "tourists" have failed to pay for hospital services, leaving obstetricians without compensation. In B.C., a recent child-abuse case drew attention to a facility that appears to cater to parents visiting from China so they can give birth in Canada and ensure a passport for their newborn.
The phenomenon is not entirely new. A few years ago there were reports of an agency in British Columbia arranging for maternity tours from South Korea, while the daughter of a Syrian general had a baby here in 2005 amid reports that the practice was common among that country's political elite.
But a recent string of cases in Montreal has left some doctors short thousands of dollars in fees, and they are trying to raise attention to the issue. Most have involved relatively affluent parents from francophone countries in the developing world, said Dr. Gaetan Barrette, president of the Quebec Federation of Medical Specialists.
"Obstetricians have seen a recent surge in the numbers," he said. "It's quite amazing to see. Those women will come for one delivery, then come back two times, three times to the same doctor for the same purpose. We're talking about [foreign] families where every child has a Canadian passport."
The mothers tell their physicians the unusual practice is an investment in the future of their children, who could attend school and take advantage of medicare in Canada later in life, Dr. Barrette said.
"What we see is people who have the money to take a trip to this country, vacation a bit, have a baby and go back home."
Anyone born on Canadian soil - except for the children of diplomats - automatically becomes a citizen and is entitled to services such as medicare and subsidized university education. While would-be visitors can be denied visas because of certain health problems, being pregnant is not a ground for refusal, said Nicholas Fortier, a Citizenship and Immigration Canada spokesman.
In fact, pregnant women sometimes tell Canadian officials the purpose of their visit is to have a child here, he said. In those instances, they have to prove they can support themselves while they are in Canada and cover the medical costs they incur, but they are not otherwise discouraged, Mr. Fortier said.
"I'm not aware that this is of great concern at this point," he said of the maternity tourism phenomenon.
Canada is among a number of immigration-based nations that grant citizenship based on ius soli -- latin for right of soil -- a principle that dates from the time when they wanted to encourage the children of new arrivals to stay and help build the country, said Sergio Karas, a Toronto immigration lawyer.
But some countries have added requirements, such as that one of the child's parents has to have legal status in the country, he said. New Zealand tightened its rules in response to maternity tours to that country.
No one suggests that any expectant mother be denied medical care. But some critics question the idea of granting automatic citizenship to the infants, noting that an adult Canadian citizen who has lived his or her entire life in another country could settle here, take advantage of taxpayer-funded services and even sponsor their parents under the family re-unification program.
"They're people who are well off and just want an insurance policy," said Mr. Karas, a Toronto immigration lawyer. "I think there is something fundamentally wrong with the concept ... This is purely selfish. There is nothing in it for us."
Montreal's Jewish General Hospital sees several passport-baby cases a year, mostly from Morocco and other African countries with a French connection, said Dr. Louise Miner, director of obstetrics for the hospital.
Many come with a "wallet full of cash" and pay for their services. In fact the hospital requires payment in advance from mothers who make arrangements with a doctor in advance, she said. But others show up at the hospital for the first time when they are in labour, and leave without paying, Dr. Miner said.
She also has trouble with automatically granting the babies citizenship. "These people are taking advantage of the system."
Obstetricians are supposed to be paid $400 for a normal delivery, but get nothing when an out-of-country mother leaves without paying, Dr. Barrette said. For some obstetricians, it has been "financially quite a burden."
The B.C. case came to light when a newborn was rushed to hospital this month apparently suffering from shaken-baby syndrome. The parents told the Vancouver Province they came to Richmond to give birth to get around China's one-baby policy and secure the child Canadian citizenship. "We wanted our child to have a good future," the father said.
They had been staying at a maternity house that appears to serve parents from China. Anna Marie D'Angelo, a spokeswoman for the Vancouver Health Authority, said the agency does not regulate such facilities and does not have information on their clientele. She suggested, though, that maternity tourism is not a large problem at the Richmond Hospital, at least, as it delivered babies from only three out-of-country mothers last year.
In Toronto, a spokeswoman for Mt. Sinai Hospital in Toronto said her institution has not delivered many passport babies.
Meanwhile, an online forum on magicmaman.com, a France-based parenting Web site, includes posts from three women of undisclosed nationality who indicate they planned to come to Canada have babies as "tourists," with at least one inquiring about the costs of doing so.