Why I Left Pakistan to Give Birth in the U.S.

LAHORE, PAKISTAN: When I saw two pink lines slowly emerge on the home pregnancy kit I keep hidden in a cupboard in my bedroom, I sat down on the bathroom floor in shock. Within minutes, I realized the lines weren’t going to disappear no matter how intently I stared at them. Rushing to our bed, I shook my husband awake, placed my mouth close to his ear, and shrieked, “I’m pregnant.” And then, after a pause, “We can’t have the baby here.”

When other excited first parents would have become engrossed in preparing a nursery and shopping for baby clothes, my husband and I began getting our visas sorted out, making travel arrangements, and applying for time off from work. We were headed to America to have a baby.

As Pakistan’s military desperately fights Taliban in the north, and the rest of the country suffers through frequent suicide bombings and security threats, those with money have silently begun purchasing residences abroad. Others have started applying for Canadian or U.K. citizenship. And upper- and middle-class Pakistani mothers, desperate to provide their children with exit options, have started indulging in what’s commonly called birth tourism. Almost every pregnant Pakistani woman I know is scheduling a trip abroad in her sixth month of pregnancy, so that she can stay and deliver the baby in a country that allows your child to become a citizen if he or she is born there. As of 2009, only a handful of countries permit birth-right citizenship. The most prominent are Canada, Mexico, and the United States.

“It’s like an avalanche,” says Dr. Muhammed Tayyab, an obstetrician who takes care of dozens of pregnant women in Lahore every year. “I have never seen so many expecting women planning trips abroad before. The only ones not going are those who can’t afford it or can’t travel for health reasons.” (Most women travel no later than the 24th week of pregnancy, because it decreases your chances of encountering risks, and makes it easier to find a doctor in the States, where doctors are reluctant to take on a patient after six months.)

Fiza Mustanzir, 25, is one of Tayyab’s patients. When she became pregnant after seven months of marriage, she was overjoyed. “I’m very traditional this way. My dreams revolve around a caring husband, a nice home, and beautiful children.” After Fiza broke the news to her mother, she began making plans with her family for the baby shower and setting up the baby’s room. But her husband, Mustanzir Javed, had a surprise in store for her: He informed her about his plan to take her abroad in her sixth month and have the delivery in the United States of America. “I was like what? Why? Why do we have to do that?” she says, remembering her reaction. “I couldn’t imagine going through the process without my mother at my side.” (Her mother did not have a U.S. visa and was unlikely to obtain it in such a short time frame.) Mustanzir, who had studied in the U.S., explains that if they had the delivery in America, their child would be entitled to a U.S. passport. “I wanted my child to have all the advantages of being a U.S. citizen,” he says.

Though Pakistan is a relative newcomer to birth-tourism, women from South Korea, Hong Kong, and Taiwan have been flying into Los Angeles to give birth for many years. A mini-industry has cropped up there: Agencies sign up expectant mothers and assist them in obtaining medical care, navigating the immigration system, and traveling to and from America. One Korean website advertises its services with the slogan "from birth to citizenship."

Current U.S. federal policy is to confer American citizenship automatically on any child born within its borders. The only exceptions are children of foreign diplomats stationed in the United States, who become citizens of their home country regardless of where they are born. The legal status of the parents is deemed irrelevant. Immigration foes in Congress have been lobbying for years to stop this practice; Their efforts have failed so far because the right to citizenship of an American born child is guaranteed by the 14th Amendment to the Constitution, which was added after the Civil War to allow descendants of slaves to become citizens.

These U.S.-born children often serve as “anchor babies,” assisting their parents and minor siblings to obtain American citizenship. Under the 1965 Immigration and Nationality Act, when an American citizen turns 21, he can sponsor his immediate family for green cards and ultimately citizenship. It is estimated that every year more than 300,000 anchor babies are born in the United States.

Though it’s hard to put an exact number on how many women travel to America from Pakistan for the purpose of having a child, U.S. statistics documenting this trend from other countries are staggering. In Stockton, Calif., 70 percent of the 2,300 babies born in San Joaquin General Hospital’s maternity ward in 2003 were anchor babies. In Parkland Memorial Hospital Dallas, the second busiest maternity ward in the United States, 70 percent of the women giving birth in 2008 were illegal aliens.

Yet it’s not necessarily that easy to pull off such a birth. Though Mustanzir and his wife Fiza already had valid tourist visas to the United States, there were still a number of factors to be taken into consideration. For starters, the financial issue. Delivering a baby in America can cost anywhere between $7,000 to $15,000 depending on whether it’s a normal delivery or a Cesarean section. The couple had no American health insurance, and so they would have to bear the cost themselves. Another major issue is getting into the country. U.S. immigration authorities frown on pregnant women who travel to America simply to deliver babies, and Fiza had been warned by friends and family to camouflage her bump. Though it’s not illegal to travel to the United States for the purposes of popping out a baby, immigration officials at the border have been known to deport expecting women under the pretext that they misrepresented their reasons for travel. New York based lawyer Stephen Jeffries told me he had heard of several such deportations. “The immigration officials at the border are within their jurisdiction to send back a woman if they feel she has lied about her reason for traveling to America,” he says.

“I was so scared when I was preparing to travel,” Fiza says, laughing at the memory. “I was planning to board a plane in my seventh month and I got a black outfit stitched which covered my belly well.”

When it was time for me to make the journey, I went to Fiza’s house to show her my travelling outfit. She had recently come back from the States, an American-born daughter in her arms, and against the backdrop of an increasingly insecure Pakistan she felt she had given her child the best gift possible. Only after she nodded at my black poncho with loose sleeves did I breathe a sigh of relief. Even so, before leaving, I had four additional travelling outfits stitched by various designers, all aimed at concealing the growing bump. Hours before my plane was to take off, I was twirling in front of the mirror, figuring out which outfit hid my shape best.

Deciding to cross oceans in the third trimester can lead to condemnation both back home and in America. When I decided to make the journey, my father was one of my most vociferous critics. He made it clear he thought I was being unpatriotic. "But the baby would still be a Pakistani citizen," I insisted. "You're still selling out, and that's a fact," he retorted.

In America, some women I met would show disdain on learning I was hoping to deliver the baby here. "How desperate," said one, while another turned up her nose and remarked: "Our citizenship is not up for grabs, you know." Ignoring their remarks, I set about completing my baby shopping and working my way through what seemed like a never-ending maze of prenatal clinics and hospitals.

Now that the ordeal is over—she has a 7-month-old daughter—Fiza doesn’t have very pleasant memories of her stay in America. “It was exhausting and nerve-wracking to spend three months doing nothing at all and knowing no one,” she says. “I would read the Quran, pray for the baby, watch TV and that’s about it.” Shehla Farooq, 29, says she had to resign from a lucrative job because her employer was unwilling to give her a four-month leave. Her husband had to take a hefty bank loan to pay for the delivery charges, and in the end, they decided he would stay in Pakistan to curtail costs. “It was pretty upsetting to be all alone at such an important time in our married lives,” she says. “But I just kept telling myself I was doing this for the baby.”

I knew by deciding to come here to have my first baby, I had evoked the wrath of many back home who thought I was overreacting to how bad the situation in Pakistan really was. My decision may make me a bad Pakistani. I just hope it makes me a good mother.

Photograph of Pakistani woman and baby by Farooq Naeem/AFP/Getty Images.