An examination of in-hospital deliveries in Canada outside Quebec: analytical report – Executive summary

Li Xu and Jue Zhang

Research and Evaluation Branch, IRCC

2022

The issue of “birth tourism” has drawn considerable public attention in recent years. There have been frequent media reports on the issue^{Footnote 1} and there were also e-petitions^{Footnote 2} that called on the government to implement measures to reduce or eliminate the practice. However, which births/deliveries in Canada should be attributed to “birth tourism” has not been officially defined. Public discourse concerning “birth tourism” has used the number of in-hospital deliveries for which the services were billed under the “Other country resident self-pay” responsibility for payment (RFP) category in the hospital Discharge Abstract Database (DAD) to proxy the deliveries by short-term visitors and to inform the discussion on the extent of this practice. The number of hospital deliveries under the “Other country resident self-pay” RFP category has shown an increasing trend from around 1,500 in the early 2010s to around 3,600 in 2017. However, the deliveries under this payment category may include a broad range of situations which are worth further examination.

This report uses information from the record linkage between the hospital Discharge Abstract Database (DAD), the Longitudinal Immigration Database (IMDB) and the Derived Record Depository (DRD) to examine hospital deliveries (in the DAD) that occurred in Canada (outside of Quebec) by women’s immigration status (in the IMDB) for fiscal years 2007-08 to 2017-18. The study focuses on deliveries for which services are registered under the RFP 08 category “Other country resident self-pay” in the DAD. Specifically, the advantage of this analysis is to identify and separate, when possible, the deliveries by Canadian citizens by birth, immigrants, temporary residents and short-term visitors.

Our results show that, for the period examined, around 92% - 93% of the total annual hospital deliveries in Canada outside of Quebec (approximately 265,000 of around 285,000 annually) were by Canadian citizens by birth or immigrants, whereas around 1% - 2% (approximately 6,000 annually in recent years) were by temporary residents in Canada: more specifically, around 4,000 births were by temporary foreign workers, more than 1,000 by international students, and around 1,000 by refugee claimants and TR permit holders, annually.^{Footnote 3}

The deliveries billed under the “Other country resident self-pay” RFP category accounted for a small percentage every year of the total deliveries in all RFP categories. In 2010, for example, these type of deliveries consisted of 0.5%; in 2017, they accounted for 1.3%. The analysis confirms that deliveries under the “Other country resident self-pay” RFP category indeed include a broad range of situations. A significant portion (around 30%) of the hospital deliveries registered under this RFP category is linked to the IMDB/DRD and can be attributed to women who were Canadian citizens by birth, immigrants and temporary residents in Canada.

For example, in recent years (2010-2017), among the deliveries billed under the “Other country resident self-pay” RFP category, about 6%-7% were by immigrants or Canadian citizens by birth and over 20% were attributable to temporary residents.^{Footnote 4}

By removing the linked deliveries by Canadian citizens, immigrants and temporary residents (around 30%),  the derived number of “residual” deliveries (around two thirds) under the “Other country resident self-pay” RFP category provides a better estimate of the number of deliveries by short-term visitors than the total number of deliveries under the “Other country resident self-pay” payment category.

The number of estimated deliveries by short-term visitors (i.e., “residual” deliveries) shows an increasing trend in recent years, from around 800 annually in 2010 to around 2,500 in 2017.

Limitations

The study has certain limitations due to the information constraints in the DAD-IMDB/DRD record linkage.

First, the estimated numbers of deliveries by short-term visitors (“residual” deliveries) in this study may also include deliveries under a few other specific situations unrelated to birth tourism:

1. deliveries by spouses of international students or temporary foreign workers, if they came to Canada to accompany their permit holding partners in Canada, but they themselves never had a study or work permit;
2. deliveries by spouses of Canadian citizens or PRs who came to Canada on a visitor visa to give birth to their babies with Canadian fathers;
3. deliveries by Canadians usually living overseas returning to Canada to give birth; and
4. deliveries by diplomats or officials/employees of foreign governments.

The deliveries under these special situations may be relatively small. The “residual” number therefore provides a better estimate of deliveries by short-term visitors compared to the total number of deliveries registered under the RFP 08 category.

Finally, it is important to note that the DAD that is linked to the IMDB and DRD excludes deliveries in Quebec and deliveries out of hospital.