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How Chinese Women Get Around the One-Child Policy and Save Money by Giving Birth in the US

Despite a recent crackdown on "birth tourism" centers in California, there are plenty of reasons for pregnant Chinese women to want to give birth on US soil.

Photo by David Leo Veksler

On March 3, Immigration and Customs Enforcement (ICE) launched a series of raids on "birth tourism" centers in Southern California. These companies, which allow Chinese women to give birth in the United States for a fee, were hit with charges including visa fraud, tax evasion, and willful failure to report foreign financial accounts, among others.

Birth tourism is nothing new—and not an exclusively Chinese phenomenon, either—but while it's often said that Chinese women travel to America to give birth chiefly to obtain citizenship and passports for their children, many also seek better and cheaper health care and to avoid fines for having extra children.


According to court documents, the average amount pregnant women pay to birth tourism centers ranges from $16,000 to $50,000, not including medical expenses. While paying tens of thousands of dollars to give birth in America may seem steep, for many Chinese families this decision will actually save them money in the long run.

"You know, if you're going to have a baby in the year of the horse, it's going to cost you a lot to get in with a good doctor," said Katherine, the wife of a mid-ranking Chinese government official, when we spoke about my apprehensions about having a child in China. (Her name, like all others in this article, has been changed to protect her privacy.) "All the best doctors are going to be booked way in advance. You'll need to find a way to get an 'in,' either through a connection, or getting a slot with another department and sneaking your way in. But don't worry. I know some people who can help you pass a hongbao to a good doctor."

The hongbao—red envelopes that are traditionally used to present monetary gifts to newlyweds or small children during the New Year—are one of the ways pregnant women can bribe their way to a competent, trustworthy obstetrician in China's public hospitals during popular birth years. During those times, families try to set their children up for a lifetime of success by giving birth to them on an auspicious date, or at least in an auspicious year.


This belief is so powerful that in the weeks leading up to February 19, 2015, some hospitals saw a ten-fold increase in scheduled C-sections as parents tried to bring their children into the world before the start of the unfavorable year of the sheep. 2014 was the year of the horse (a particularly desirable year) so the hongbao given to doctors were especially fat, containing as much $5,000. Add to that the hospital's fee of $8,000 to $15,000 for a natural birth at an established and highly ranked facility, and spending $15,000 for an American birth—and all of the benefits it entails—starts looking like a bargain.

"Financially speaking, coming to America to give birth is a good deal," said Joanna, a Chinese accountant whose baby was due in the year of the horse. "By the time I found out I was pregnant, all the good hospitals were full. I could spend the money to bribe my way in or give birth at a foreign-operated hospital, but then I'd still have to live in the pollution, work, and slog my way through traffic every day." Plus, Joanna had obtained her tourist visa legitimately on a previous trip to the US, meaning she wasn't at risk of being charged with visa fraud.

"I already had one miscarriage a few years back, so why take the risk?" she said, rubbing her round belly. "The $15,000 is worth it. This way, I get to relax and just focus on growing my baby."

Saving money on medical costs is a minor expense compared to fines for extra births. Lianghui, who lives in Shandong province, paid twice his annual income for his second daughter, and would have paid thrice that for his third child—a long-awaited son—if he didn't have a way out. "Rather than paying the fine, we registered him to my brother who lives in Canada and isn't planning on coming back," he told me.


But not everyone has the ability to exceed birth quotas. In 2012, social media lit up with the case of a woman who was forced to have a late-term abortion by local government officials trying to enforce the one-child policy. Soon, photos were released of the woman laying unconscious on her hospital bed next to her aborted seven-month-old fetus. (Eventually the online outrage led to the responsible officials being fired.)

And for China's wealthiest citizens, giving birth to a child overseas, not registering that child in China, and paying a lifetime of additional fees for China's "out-of-state" education and medical fees will still save them money in the long run—last year, director Zhang Yimou was forced to pay $1.23 million for violating family planning laws

Of course, most families still come to America to give birth as an insurance policy against an uncertain political and economic future. Many, like Daniel, don't have a clear vision of why they want their child to be an American citizen, but go ahead and do it anyway. "Everyone else was doing it, so we figured we would as well," he told me. "If anything, it will ensure that our son has a chance to go to school in America if he can't compete in the academic system here."

Others act with much more urgency, sending both their children and their wealth overseas at a young age. The crackdown on government corruption has fueled massive emigration over the past few years, as thousands of government officials move their money out of China before they are targeted.

Wealthy Chinese businessmen have joined the exodus, including one birth tourism center owner who sold his lucrative franchise, invested enough to be eligible for an EB-5 visa (an investment visa for immigrants who can inject $1 million into the American economy), and moved to Southern California.

"When I first arrived I planned on opening another business, but that's almost impossible for someone who doesn't know the language," he said. "I bought a couple of houses as an investment, but rather than having them sit empty until they appreciate, I thought: Why not start a maternity hotel? Over the past few years I've hosted over 100 women in my neighborhood. It's not a lot of money compared to the big operators, but it pays the bills. Truth be told, it's a boring job, but at least it's something."

When asked whether or not he expected his business to drop in light of the recent raids, he shrugged and said: "This year is the year of the sheep, so there will be a lot less women having babies to begin with. It's hard to say how the raids will affect our business. Honestly, they haven't targeted the women, and the need for the service is still great, so I think women will still keep on coming. Just maybe not this year."

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