Birth tourism: The pregnant patients most Canadian doctors cannot accept

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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 OB/GYN 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 OB/GYN? 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 I receive a few times a year. Without meeting specific criteria, it is unlikely most hospitals 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 at Sunnybrook Hospital.

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.”

Unfortunately, based on the information you have provided in your question, you do not seem to fit our criteria of having strong ties to Canada and health insurance. For those reasons, we would not be able to accept you as a patient.

Lisa Priest is Sunnybrook’s Manager of Community Engagement & Patient Navigation. Her blog Personal Health Navigator provides advice and answers questions from patients and their families, relying heavily on medical and health experts.  Her blog is reprinted on with the kind permission of Sunnybrook Health Sciences Centre.  Send questions to

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  • Joey Lewis says:

    It is disgusting that those outside Canada can access our health care system in this way. It is another reason why our health care system is failing our citizens that have paid taxes their whole life and are denied proper access to health care re: tests and wait times. Our health care is bursting at the seams .Our govt. should do something !!!!!

    • Tina says:

      The access and wait times is actually due to
      1. Canadians going to the hospital for every small or large symptom since they don’t need to pay
      2. Healthcare professionals not having high incentives to live and work in Canada.

  • Nasir vohraa says:


  • Olubodun azeez says:

    I am a Canadian citizen, male, and I have a woman that I want to marry,still waiting for the divorce of her first marriage, how ever she is pregnant now, and I wish the kid be born in Canada,based on this do I require to pay hospital bills fan r such scenario?

    • Tina says:

      Yes. Unless she can get a temporary visa through work visa or student visa. Look at the Job bank. Any PR applications will require a medical exam and Chest X-ray which most pregnant women would want to avoid.

  • Khayla says:

    Hello, I am currently living in the US as a PR but plan on moving back to Toronto, ON in 2 weeks. I am currently 32 weeks pregnant. I am a Canadian citizen and wish to have the baby in Canada and live there permanently. What are my options in terms of coverage? Will I be eligible to be taken as a patient?I know average out of pocket costs are between 8,000-12,000. Is there any way to help alleviate these costs, like an international insurance plan?

  • Sidrah says:

    Hi, I’m married to a Canadian and have been living in Canada since the past 4 years ( been travelling back and fourth of course but have been living mostly here in Ontario). Since I wasn’t aware of the rules I ended up applying for the permanent residency not so long ago. However I found out that I’m pregnant almost two months ago.. The problem is now I found out I can’t get health insurance since I don’t have my permanent residency yet. What should I do? I’m Norwegian by birth.

    My email address is
    Write to me either here or to my email , I will really appreciate it.

    • Sidrah says:

      I don’t have a private insurance.I don’t get sick , the last time I went to a doctor on Canada was 4 years ago when I had a bladder infection, that’s all. And I paid out of my pocket the doctor fee and the antibiotics the doctor prescribed to me.

      • Nick says:

        We are expecting here in Chicago. I don’t want Canadian citizenship and the benefits that come with it. I am pricing how much it costs to give birth outside of my city, state, and country because the costs vary so much and no one here is answering our questions about cost. I am also looking in Europe, India, and some other countries as a medical tourist. Even with the insurance I am paying for now we will have to pay a large sum of money to the hospital, and that money goes much further elsewhere.

      • Tina says:

        I heard Taiwan is $1000-3000 for vaginal and c section and has great care especially post partum

    • Tina says:

      Apply for insurance coverage regardless of PR status. After your husband passes as a proper sponsor, in some provinces you would qualify before receiving your PR. You may also check with immigration if you can fast track your application since you are pregnant. In the meantime, get prenatal care through a midwife. In Ontario, midwife care does not require insurance but does require Ontario residency. If you do not get insurance coverage in time, the medical and hospital bill will not be as substantial through a midwife. All will work out.

  • Sarah says:

    I am a Canadian citizen (born in Canada) and I have been living and working in Southern Africa for the last year and a half. I am three months pregnant. Although I have a good health plan here for the country I am living, I am very anxious about giving birth abroad and would much prefer to return to my home country.

    I was a resident of BC prior to moving abroad, but my family resides in Ontario.

    Are there different rules for different provinces? Is there a wait period for Canadian citizens wishing to return home to deliver?

    I read on several websites that there is a three month wait period for Canadians living abroad. Due to the nature of my job, it would be very difficult for me to leave a full three months before the baby is due.

    Furthermore, after the baby is born, provided there are no complications, how soon can I return to my current country of residence?

    Can anyone provide any clarification on the rules and regulations?

    • Sam says:

      Hi Sarah,
      I’m in the exact same situation as you. I’m a Canadian but currently non-resident as we are expats outside Canada. I’m due in November and want to give birth back in Canada. Did you find a good international insurance that covers part of the cost? Did you find out what are the rules in BC for finding a doctor and doing the hospital arrangements? I’m just three months now but I’m getting very stressed out about these details already. PLZ share your findings with me :)

  • Maira says:

    Hi there,
    If some one has multiple visit visa and she gives birth in Canada on her own expenses so will her baby get Canadian citizenship for just to born in canada

  • salma says:

    Hi. I dont have a Canadian citizenship but I will visit some friends soon in canada and I was planning to give birth there. I have got an international health insurance wih also cover all maternity fees in canada.So am I applicable to give birth in canada?

    • Nasreen says:

      HI Salman, I hope all went well . I am in the same boat. My parents last year migrated and me and my husband live in dubai. I have to spend my last trimester with my parents and deliver the baby in canda. can you pls guide me, my email is thanks a million !

      • Narges says:

        Hi nasreen
        did you deliver your baby in canada as you wished, if yes how you planned for insurance and how much did it cost for you. My mother and father are immigrants but I am not. I have plan to deliver my baby in toronto. Please let me know about your experinces. Thanks

    • Okey says:

      Hi Salma,

      hope all went well with your baby delivery. I am planning to visit canada and have my baby there. I currently reside outside canada and would like to know how you got your international Health Insurance and how it helped.


    • Sam says:

      Hi, what is the name of international insurance you got? I’m looking for one that covers delivery costs plz help

      • Claire says:

        Hello Sam,

        What International Health Insurance company did you select ? And what plan did you end up buying? And would you recommend it?
        Thank you!

    • Shereen says:

      Where did you get health insurance that covered maternity fees?

  • For babies says:

    I don’t see anything wrong with temporary residents give birth in this country. Maybe we should think about why the law needs to be written in that way in first place. Depriving other people’s legal rights is wrong no matter what the excuse you may have. Besides those foreigners are paying the health care costs on their own account, not misuse taxpayers’ money at all.

    • Other side of the coin says:

      Of course there’s nothing wrong with women who are temporarily in Canada giving birth here BUT what is wrong is the babies automatically getting citizenship. Just because these foreigners are paying the fees out of pocket before birth does not mean the taxpayers’ money is not going to be misused after birth. There are women who intentionally come to Canada, give birth, then go back to their home country while getting child tax benefits. And sadly this happens a lot. I don’t see anyone’s legal rights being deprived by changing the Citizenship Act. We should have Canadian’s interests put first, and that means protecting ourselves from tax fraud/abuse.

      • Zoe Davis says:

        Agree 110% percent. When these Citizenship laws were first introduced no one expected woman to arrive in Canada, ready to give birth, just in order to have a Anchor baby………….. but they do and the Government, has to ensure the laws are changed to ensure the Country, and its legal citizens are not ripped off!.

        Only legal permanent residents and Citizens children, should be entitled to Canadian Citizenship.

  • Beth says:

    My impression was that the querent was, in fact, a Canadian citizen, but temporarily residing outside of Canada and wishing to have her child born in her home country. Canadian citizens will be asked for referrals from family doctors just like anyone else; can you please answer the question as to how a Canadian citizen in this situation would access an OB/GYN here?


Lisa Priest


Lisa Priest is Sunnybrook’s Manager of Community Engagement & Patient Navigation. Her blog Personal Health Navigator provides advice and answers questions from patients and their families, relying heavily on medical and health experts.  Her blog is reprinted on with the kind permission of Sunnybrook Health Sciences Centre.  Send questions to

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