By Anna Schecter
This is an update to a previous report from October 28, 2011.
UPDATE: There has been uproar in neighborhoods across Los Angeles county in recent months over a controversial industry called birth tourism. Wealthy foreign women in the late stages of pregnancy fly to the United States and stay at special maternity hotels. The women stay just long enough to give birth and obtain U.S. birth certificates and passports for their newborns.
These maternity hotels are often run out of single family homes in suburbia. Angry neighbors picketed outside a Chino Hills, California, maternity hotel until authorities shut it down for zoning and code violations in December, 2012.
Birth tourism has also ignited outrage on Capitol Hill.
"They are gaming the system…and people should be put in jail,” said Representative Phil Gingrey (R-Ga), one of several members of Congress trying to put an end to birth tourism.
The United States is the only country in the developed world other than Canada that grants jus soli or birthright citizenship. The U.S. law dates back to the 14th Amendment of the Constitution, ratified after the Civil War to ensure that all freed slaves and their children would be American citizens.
NBC News gained access to four birth tourism centers in the New York City borough of Queens. The owners, all women, said they know their industry is controversial, but they hope it will soon be recognized and supported by the U.S. government.
“Yes, our business is a sensitive topic, but we have a lot to offer the American culture and economy,” said Katie, a business owner who asked that her last name not be used.
“These women are the economic elite…and they are fueling the economy here. I take them on shopping trips…one woman bought 15 Coach bags,” said Katie, who said she piles her pregnant clients into her van for the hour and a half drive to Woodbury Commons, an upscale outlet mall in New York where shoppers can indulge in such luxury brands as Prada, Gucci, Dior, and Coach.
Katie runs her business out of two houses, one for pregnant women and one across the street for new mothers and their babies.
“I spoke to a lawyer before opening my business to make sure I would not get into trouble with U.S. authorities,” she said.
As with the other businesses NBC News visited in New York, many of Katie’s pregnant clients are Chinese women who were already in the United States or who travel back and forth between countries. She said the percentage of her clientele who are birth tourists varies from month to month, but she has had close to 150 clients in all since she opened her business in 2008.
She said her clients all want the comforts and familiarity of the traditional Chinese practice of zuo yuezi, a term used for the month of rest and recuperation for the mother following birth. According to Chinese tradition, the mother rests while the babies are cared for by a nurse. Feeding, bathing and sleeping times are meticulously organized in charts. A chef cooks a special diet of Chinese food with lots of meat, seafood, and cooked vegetables for new mothers. They eat five times a day, and do special exercises to slowly build back their core muscles.
“Chinese culture has a lot to offer in terms of pregnancy and new mothers’ health,” said Katie, who added she hopes that her business can spread the healthy traditions to other cultures.
Her business also helps the women navigate the logistics of obtaining American birth certificates, passports, and Social Security numbers for their babies before they fly home to China.
“We help them get information, even drive them to where they need to go to get the papers, so in the fastest possible time, they can get everything settled,” she said.
The cost of the rooms in her house range from $2,000 to $5,000 per month, depending on the size of the room, length of stay, and the woman’s financial resources. The price includes food, laundry, and care for the baby.
The women give birth in hospitals near the birth tourism centers, paying in cash. The hospital fees alone can reach as much as $10,000. Parents usually stay three to four months and spend a total of as much as $30,000 for lodging, airfare, and medical expenses.
Katie said demand has grown so much that she had to rent her second house last year.
“In August alone I had to say no to three prospective clients,” she said.
One wealthy new mother renting a room at Katie’s facility told NBC News that she came to the United States from an eastern Chinese city for the final three months of her pregnancy.
“For my baby, it’s a chance to, a step to two countries’ cultures…Chinese culture and American culture,” said Mrs. Chao, who asked not to be identified by her full name.
While in the United States, Mrs. Chao and her husband bought an iPad, suits and dress clothing, luxury brand perfumes and baby clothes from brands like Polo by Ralph Lauren.
She said that she hopes her newborn daughter, Emily, will return to the United States to attend high school and college. When Emily is 21, she could apply for her parents to become legal residents in America.
Lily, from Beijing, was also staying at Katie’s facility, and asked that her last name not be used. She told NBC News that she was pregnant with her fourth daughter and that she would have to pay a fine if she were to give birth in China. China’s one-child policy discourages women from having more than one baby.
Emmy, staying in the room next to Lily’s, came from Shanghai to give birth. She said she hopes to bring her daughter, her second, to the United States for schooling.
“The mentality is healthier for children in America,” said Emmy. “In China, the children are under too much pressure in school and they have to take too many tests.”
There are no official numbers on how many women are coming to the United States as birth tourists. The most recent statistics from the National Center for Health Statistics show that births of babies on American soil to foreign mothers increased from 5,009 births in 2000 to 7,462 births in 2008. This is a tiny percentage of the more than four million babies born in America each year. There is no tracking system in place to record which countries the mothers are from or why they are in the United States.
Most of the pregnant women come to the United States legally on tourist or business visas and the State Department says it cannot turn away a woman solely because she is pregnant. However, officials do have the right to turn pregnant women away if they can make the case that the woman is coming for the express purpose of taking advantage of American health care.
"When determining if an individual will be allowed to enter the U.S., Customs and Border Protection officers take into consideration the date the child is due for delivery and the length of time the individual intends to stay in the U.S.," a State Department spokesman said.
Southern California has been the hub for birth tourism centers for Asian women over the past decade, usually from South Korea and China.
In March of this year, authorities in the Los Angeles suburb of San Gabriel closed one center after neighbors complained about noise from the babies.
“It was kind of strange seeing the pregnant women walking around,” neighbor Taylor Alderson told NBC News.
City officials closed the center for operating a business in a residential area without a permit. The owner was fined $800.
Still, birth tourism businesses have popped up across the nation over the past five years.
NBC News found dozens of web sites offering packages to expectant parents from around the world, including China, South Korea, Turkey and Eastern Europe. They advertise birth tourism centers in Los Angeles, San Francisco, Chicago, Miami, and New York.
Some of the Web sites blatantly advertise the advantages of free public school in America, a chance to get grants to colleges like Harvard and Yale, and an easier path for the whole family to get green cards once the child turns 21.
Republican lawmakers have taken aim at birth tourism. Representative Gingrey introduced legislation in January that if passed would prevent the practice. He said that both Katie and Mrs. Chao, while not breaking the law, are certainly violating the “spirit” of America’s birthright citizenship law.
“They’re taking advantage of our country and they’re really not giving anything in return,” he said. “They have crunched the numbers and they know that even though they have spent $30,000 in this birth tourism cottage industry that in the long run, they’re going to get a whole lot more out of that than they put into it.”
Gingrey wants the 14th Amendment to be reinterpreted so that citizenship is only given to children born in the United States to at least one American parent or a parent who is a permanent resident.
“They have gamed the system and the misapplication of the 14th Amendment has allowed them to do that,” said Gingrey.
Angela Kelley, the vice president of immigration policy and advocacy for the Center for American Progress, disagrees with Gingrey. She said that a reinterpretation of the Constitution is unrealistic and would undermine the fundamental nature of the United States.
“I don't see this type of legislation having any traction, or being taken seriously,” said Kelley. “I think something as really fundamental and integral to this nation's character: that you're born here, you belong here, that we're not a country club that you apply to-- that would be met with enormous resistance from all sorts of quarters...from left and from the right.”
Kelley said that she does not in any way condone birth tourists.
“It leaves a bad taste in my mouth, the idea of somebody… taking advantage of something that is so unique and important to the character of this country as birthright citizenship,” she said.
However, Kelley argues that banning birth tourism would be impossible to enforce without drastic and unrealistic measures. She said enforcement would hypothetically require costly pregnancy tests for potential female visitors of childbearing age, a complete violation of a woman’s privacy.
“And really, our government resources being used to do that, rather than track down terrorists or other people who actually mean to do us harm? I mean, there's...a cost-benefit ratio here that's crazy, not to mention just frankly, insulting to women,” she said.
Looking at the issue as a whole, according to Kelley, the number of foreign women coming to the United States to give birth is extremely small and there are far bigger immigration problems for Congress to solve.
“Of the top 10 problems facing this country, this isn’t even in the top hundred,” said Kelley.
Editor's Note: Kate Snow's full report airs Friday, March 7 at 10pm/9c on NBC's Rock Center with Brian Williams.