Though Rare, Birth Tourism to the United States Sparks Outsized Concern April 29, 2026 Policy Beat By Muzaffar Chishti and Colleen Putzel-K...
A pregnant woman at an airport. (Photo: iStock.com/encrier)
Birth tourism, a phrase describing the rare practice of foreign nationals traveling to the United States for the sole purpose of giving birth so their baby can automatically become a U.S. citizen, has garnered outsized public attention and legal scrutiny in the debate over ending the constitutional guarantee of birthright citizenship.
Though hard to know for certain, the most expansive albeit contested estimate based on review of U.S. Census Bureau data is that up to 26,000 babies born in the United States annually could be attributed to birth tourism—a tiny fraction of the more than 3.5 million U.S. births yearly. Yet the idea has nonetheless taken center stage in the Trump administration’s campaign against the guarantee of birthright citizenship. An executive order, issued by President Donald Trump on his first day back in office, would limit automatic citizenship to children born to at least one U.S.-citizen or lawful permanent resident parent.
In This Article
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Birth tourism accounts for a fraction of U.S. births annually
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The government has taken steps to limit birth tourism over the years
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The Northern Mariana Islands, a U.S. territory in the Pacific, has presented unique questions
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The issue gained new prominence in the Supreme Court argument over ending birthright citizenship
While the administration argues the executive order is necessary to reduce unauthorized immigration to the United States, it made the subsidiary issue of birth tourism central to its legal case during the historic April 1 Supreme Court oral argument over the legality of ending birthright citizenship.
Concerns about birth tourism have flared sporadically over the years, especially in the last decade. In addition to concerns about misusing the guarantee of birthright citizenship, critics cite the immigration fraud, tax fraud, unpaid medical bills, and national security vulnerabilities that flow from the business model of creating package deals, costing tens of thousands of dollars or more, to help pregnant women secure a visa and cover housing, medical arrangements, and transportation.
The Northern Mariana Islands, a U.S. territory in the Pacific, has attracted special scrutiny since it allows visa-free entry to nationals of certain countries. Congressional Republicans have specifically raised concerns about Chinese women using the territory to gain U.S. citizenship for their baby. The issue also received attention after authorities in 2015 raided “maternity hotels” in Southern California used by Chinese women. The prevalence of Russian women giving birth in South Florida has also generated headlines.
The federal government has advanced a number of initiatives to address birth tourism. These include criminal prosecutions of people linked to birth tourism schemes and a 2020 regulation rendering inadmissible women with a tourist visa who are found to be traveling primarily to the United States to give birth. In 2024, the government modified a visa-free program for the Northern Mariana Islands amid concerns about birth tourism abuses. And this April, U.S. Immigration and Customs Enforcement (ICE) launched an initiative to investigate birth tourism networks.
In defending the executive order, the Trump administration has asserted that limiting birthright citizenship to lawfully present and long-term foreign-born residents is the only way to address birth tourism. Critics of the executive order argue these concerns can be effectively addressed by means short of undermining a touchstone constitutional protection with deep roots in U.S. history. Opponents also note that the number of babies who would lack U.S. citizenship at birth would far surpass those born as the result of birth tourism.
The order would lead to an estimated 255,000 babies born in the United States annually without U.S. citizenship to parents who are either unauthorized immigrants or on long-term temporary visas, according to Migration Policy Institute (MPI) calculations. Accounting for other demographic trends, MPI estimates ending birthright citizenship could increase the size of the unauthorized population by up to an additional 2.7 million people by 2045 and 5.4 million by 2075.
This article examines estimates around birth tourism in the United States, policies seeking to limit it, and its role in the administration’s effort to limit birthright citizenship.
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A Small-Scale Problem Presents Large Policy Questions
Birth tourism is not a new phenomenon, yet the push and pull factors are poorly understood. Studies show that the promise of U.S. citizenship and related opportunities for the child, such as access to higher education, are among the motivating factors behind birth tourism. However, other factors, including access to advanced U.S. medical care as well as home-country policies, also play a significant role. For example, many Chinese mothers traveled to give birth in the United States while China’s one-child policy was in effect from 1980 to 2015 (children born outside of China were not covered by the policy).
Birth tourism presents a paradox for policymakers. The act of giving birth on U.S. soil by temporary visa holders is not illegal. However, applying for and securing a visa solely for the purpose of garnering U.S. citizenship for a child is both an act of fraud and grounds for inadmissibility. In addition to issues of visa fraud, birth tourism crosscuts with other concerns, including the prospect that businesses facilitating this travel misrepresent their profits and thereby commit tax evasion, and that these mothers will fail to pay the medical costs incurred during pregnancy and delivery.
There are no official estimates of the number of babies born as a product of birth tourism. However, the U.S. Centers for Disease Control and Prevention (CDC) offers the closest approximation, using data on annual births. In 2024, the CDC reported almost 9,600 babies were born in the United States and U.S. territories to foreign mothers who listed their official address as outside the United States or its territories. While this may be interpreted as a proxy for babies born due to birth tourism, the number includes women who did not necessarily intend to have a baby in the United States, which is necessary under the current definition of birth tourism. Moreover, it excludes births to women who traveled to the United States with the intent to have a baby but who used a U.S. address to avoid scrutiny (this is a part of some business models promoting birth tourism). Even still, these babies were a miniscule fraction of all 3.7 million births in 2024, and the rate has remained steady over time (see Figure 1).
Figure 1. Number of Babies Born in the United States to Foreign Residents and Share of All U.S. Births, 2016-24
Note: Figure shows the number of annual U.S. births to mothers listing their official address as outside the United States or its territories. This includes people who did not come to the United States specifically to have their baby, but not babies born to unauthorized immigrants or to temporary visitors using a U.S. address.
Sources: Data for 2016 are from U.S. Centers for Disease Control and Prevention (CDC), User Guide to the 2016 Natality Public Use File (Atlanta: CDC, N.d.), available online; data from 2017 are from CDC, User Guide to the 2017 Natality Public Use File (Atlanta: CDC, N.d.), available online; data from 2018 are from CDC, User Guide to the 2018 Natality Public Use File (Atlanta: CDC, N.d.), available online; data from 2019 are from CDC, User Guide to the 2019 Natality Public Use File (Atlanta: CDC, N.d.), available online; data from 2020 are from CDC, User Guide to the 2020 Natality Public Use File (Atlanta: CDC, N.d.), available online; data from 2021 are from CDC, User Guide to the 2021 Natality Public Use File (Atlanta: CDC, N.d.), available online; data from 2022 are from CDC, User Guide to the 2022 Natality Public Use File (Atlanta: CDC, N.d.), available online; data from 2023 are from CDC, User Guide to the 2023 Natality Public Use File (Atlanta: CDC, N.d.), available online; data from 2024 are from CDC, User Guide to the 2024 Natality Public Use File (Atlanta: CDC, N.d.), available online.
Even the most expansive estimate that draw on analysis of government data finds birth tourism represents a tiny fraction of all U.S. births. The Center for Immigration Studies, a think tank that advocates for low immigration, suggests the number of babies born as result of birth tourism ranges between 22,000 and 26,000 annually, though this estimate is contested.
Birth Tourism Industry and Global Trends
There has been a proliferation of companies advertising in China, Russia, and beyond their services to facilitate travel, visas, medical care, and other guidance for expectant mothers seeking to give birth in the United States. The fees reportedly range from $20,000 to $100,000.
Companies in Southern California catering to Chinese women and those in Florida working primarily with Russians have made headlines as maternity hotels facilitating end-to-end services. In a March 2026 Senate hearing, witnesses highlighted a range of concerns, specifically noting potential national security issues arising from children born to nationals of U.S. adversaries. The government has referenced news reports citing more than 500 companies operating in China to facilitate birth tourism. As concerns about national security abound, unsubstantiated claims have also circulated that there could be as many as 1.5 million individuals living in China whose U.S. citizenship was derived from birth tourism. National security concerns also came up in the Supreme Court argument; Justice Samuel Alito raised the hypothetical of a child of Iranian descent born in the United States who could be subject to Iranian military obligations.
The challenges and concerns raised by birth tourism are not unique to the United States. More than 30 countries have birthright citizenship (the principle of jus soli), and similar issues have emerged in several of them. For example, Canada has experienced a similar debate about “maternity packages” and “baby houses” marketed to foreign expectant mothers. Prior to a referendum in 2004 ending birthright citizenship, Ireland faced similar concerns as the last country in the European Union to offer citizenship to all upon birth. The United Kingdom, the country from which the United States inherited the tradition of birthright citizenship, abandoned it in 1983 amid a broader rethinking of British nationality after the colonial era.
From “Anchor Babies” to Miami Mamas
Birth tourism, the contemporary phrase, was preceded by the pejorative term “anchor baby,” used since the 1970s to describe the practice by principally Mexican immigrants crossing the border to have a baby who would be a U.S. citizen and could eventually sponsor their extended family to immigrate legally. Without knowing the prevalence of this phenomenon, Congress quietly addressed the issue in the Immigration and Nationality Act Amendments of 1976. The 1976 act for the first time applied an age requirement of 21 to sponsor a relative from the Western Hemisphere for a green card, effectively ending the ability of minor children to act as “legal anchors” for relatives. Though birth tourism was not explicitly mentioned in the law, an internal State Department memo acknowledged the phenomenon, claiming that the provision was necessary because “large numbers of natives of Mexico have qualified to immigrate to the United States as parents of minor United States citizen children.”
Contemporary concerns surrounding a rise in birth tourism—especially visa fraud and tax evasion by business facilitators—gained exposure during the Obama administration. In February 2015, the State Department issued guidance that travel under a B-2 (visitor) visa for medical treatment, including giving birth, was legally permissible. But the guidance reiterated that a certain medical treatment standard must be met: Individuals needed to provide documentation from a physician in the home country to explain the need for U.S. medical care, confirmation of a U.S.-based medical team’s agreement to provide care, and proof that the individual could cover the costs incurred upon birth and that they did not intend to remain in the country. These guidelines were seemingly intended to combat instances of visa fraud; previously, there had been no directives for B-2 applicants traveling specifically to give birth.
Later in 2015, Homeland Security Investigations (HSI), an agency under ICE, for the first time conducted enforcement operations against Southern California maternity hotels. In 2019, the first ever federal charges related to birth tourism were brought against 19 individuals, including company operators and some parents. Part of the long-running case was resolved in late 2024 and early 2025, when the owners of USA Happy Baby were sentenced to 41 months in prison. The Federal Bureau of Investigation (FBI) has also conducted investigations into birth tourism, including in 2017 when authorities arrested an employee of Miami Mama for making false statements on passport applications.
In 2020, the first Trump administration published a regulation, still in effect today, explicitly creating a ground of inadmissibility to travel under a B-2 visa for birth tourism, shifting the burden to pregnant women to prove their intent to travel is not to gain U.S. citizenship for their child. The basis of the rule was reportedly national security concerns and to curb fraud. Proponents described the rule as a step in the right direction but said it did not go far enough; opponents raised concerns about the hurdles for women seeking legitimate medical care and noted that it could lead to birth tourism becoming more covert and increase fraud.
Amid news that some well-heeled individuals were paying to use U.S. surrogates to have children for the purpose of providing the babies U.S. citizenship, Senator Rick Scott (R-FL) last year introduced a bill to end the practice. The ICE operation launched in April focuses on the operations that facilitate birth tourism, visa fraud, and other financial crimes that may be associated with it.
The Unique Case of the Northern Mariana Islands
The issue of birth tourism in the Commonwealth of the Northern Mariana Islands (CNMI), which lies roughly one-third of the way between mainland China and the continental United States, has become a flashpoint among congressional Republicans. They argue the issue raises national security concerns.
Central to the issue are two visa programs specific to the islands: the Guam-CNMI Visa Waiver Program, which allows nationals of some countries to engage in visa-free travel to Guam or the Northern Mariana Islands for 45 days, and the Economic Vitality and Security Travel Authorization Program (EVS-TAP), allowing Chinese nationals to travel to CNMI visa-free for 14 days. The Guam-CNMI visa program began in 2009 when the Department of Homeland Security (DHS) took over immigration and border controls for the Northern Mariana Islands. DHS established protocols and procedures to facilitate immigration to the islands while considering the importance of tourism to the islands’ economy. The EVS-TAP program, originally negotiated during the first Trump term in 2019 and put into effect under the Biden administration in early 2025, was created as a direct response to concerns about birth tourism and was done at the urging of the CNMI government.
Pregnant tourists using these visa-waiver programs do not undergo the same scrutiny as those traveling to the U.S. mainland. Concerns surrounding birth tourism mounted following implementation of the Guam-CNMI program. The year prior to the program’s implementation, there were fewer than ten births to foreign tourists on the island; by 2018 there were reportedly around 600. However, 2018 appears to have been the high-water mark and it seems the changes of 2019 and 2025 worked as intended. Kimberlyn King-Hinds, the CNMI delegate in the U.S. House of Representatives, reported that just 47 babies were born to tourists in 2025.
As on the mainland, birth tourism on the Northern Mariana Islands presents complex policy questions. On the one hand, there are legitimate concerns about covert business operations and visa fraud. For example, in 2018 the U.S. district attorney for Guam and the Northern Mariana Islands sentenced a translator, Sen Sun, for operating an illegal birth tourism business. On the other hand, tourism is an essential business and dampening that revenue stream could be detrimental to the islands’ economy.
Read all MPI analysis related to the Trump administration
Birth Tourism Takes Center Stage at the Supreme Court
Although birth tourism has been addressed through various policies and legal actions, it gained prominence anew in the recent Supreme Court arguments over birthright citizenship, in the case Trump v. Barbara. While the public’s understanding may be that the Trump administration’s motive in limiting birthright citizenship was to reduce unauthorized immigration, its argument at the Supreme Court leaned heavily on birth tourism.
Solicitor General D. John Sauer pointed out that the United States is much more accessible to travelers than it was in 1868, when the 14th Amendment was ratified, and therefore needs a new system for offering citizenship. Emphatic as he was, his comments seemed to have landed on skeptical ears. In what may remain a highly quotable exchange, Chief Justice John Roberts sharply responded, “It’s a new world. It’s the same Constitution.”
A dominant theme in the government’s case concerned five words from the 14th Amendment, which guarantees citizenship to people born or naturalized in the United States and “subject to the jurisdiction thereof.” The administration argued that the phrase referred to having a domicile or a permanent home in the country. “Domicile” is central to the idea of birth tourism because it focuses on one’s intent to stay in the country. By extension, the administration argued that unauthorized immigrants, being unlawfully present, can never have an intent to permanently stay.
The challengers to the executive order, on the other hand, leaned on the English common law tradition from which the 14th Amendment was adopted, asserting that domicile is framed around geography, as has been the predominant interpretation. The only exceptions that still apply to birthright citizenship are those derived from English common law: children of diplomats and of “alien enemies.”
The government argued that domicile is not a mere geographic concept but a political one, referring to allegiance to a country. Thus, a lack of U.S. domicile would apply to children born to unauthorized immigrants and those who, as result of birth tourism, do not owe allegiance to the United States. To the government, the question of allegiance is a critical national security issue, especially when it involves birth to nationals with whom the United States has adversarial relations.
Does Birth Tourism Merit Diluting a Constitutional Protection?
The administration has focused significant attention in its second term on immigration enforcement, including in its public argument to end birthright citizenship. It is therefore intriguing that birth tourism, a heretofore fringe issue in American politics with occasional media splashes, featured so prominently in the legal debate.
When and why that shift happened is unclear. What is evident, however, is that birth tourism is an extremely small phenomenon with no sign of becoming more pronounced. It has raised critical challenges—including visa fraud, tax evasion, business ethics, and access to medical care—that cut across multiple policy lenses including immigration, economics, and national security.
But some of these concerns have already been addressed by executive actions taken by prior administrations, including the 2020 regulation prohibiting use of B-2 visas exclusively for birth tourism, investigations and prosecutions of birth tourism facilitators, and increased screening of pregnant tourists to ensure they can pay for maternity and neonatal care. More recently, advocates seeking to limit the practice have proposed enhancing cooperation with international and national law enforcement agencies to target the businesses facilitating birth tourism. Other policy proposals have included greater scrutiny of pregnant tourists, stricter airline measures restricting how far along in their pregnancy women are able to fly, and increased consequences for those who engage in birth tourism. In addition, calls for increased data collection—to accurately measure the scope and scale of birth tourism—have sounded across the political spectrum.
These measures, if adequately resourced and properly implemented, show that policymakers can respond to the challenge of birth tourism without weakening the Constitution. Birthright citizenship has been regarded as a fundamental American principle of inclusivity and a constitutionally guaranteed protection written 150 years ago to end a troubling legacy of slavery. Undoing this principle to address a small-scale policy issue discounts the many other potential consequences of ending birthright citizenship.
The authors thank Emilie Folsom for her research assistance.
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