To Have A Baby In America: A Chinese Dream — An Investigation of Birth Tourism and Chinese Maternity Centers in America

By Liuyu Ivy Chen

In Flushing, maternity centers often blend into neighborhoods with no signs advertising the business.

On Nov. 16, Yufen Wang, 52, walked into a courtroom in Queens County Criminal Court for her second hearing. Wearing a cream-colored jail uniform, she appeared distraught: her head hung low, with long black hair cascading down her shoulder.

Back in September, Yufen had stabbed three newborn infants, two adults and herself during a night shift working at Meibao maternity center. All of the victims survived. In court, Yufen relied on a Chinese translator to understand the accusation against her, as she does not speak English. She is now indicted with 10 charges, including four counts of second-degree attempted murder. Her Chinese lawyer, Jean Wang, pleaded “not guilty” on her behalf and argued for a $10,000 bail for Yufen, which was rejected. When Yufen was escorted out of the courtroom, one of her sons called out to her from the audience: “Mom! Mom!” But Yufen did not turn or answer.

Yufen is currently under suicide watch at Rikers Island. The next court hearing will be held on Jan. 30, 2019. Her story has piqued public interest in the growing maternity center industry and the ongoing debate on birth tourism.

The multifaceted factors around this case can be boiled down to two interplaying forces: a human desire and a commercial contract.

When the stabbing happened, my second sister, who lives in China, was four months pregnant with her second child. Her first daughter, now 8 years old, was born with cerebral palsy, and she was considering the option of having her second baby in America for better medical care. I volunteered to help her find an ideal maternity center.

I called at least a dozen maternity centers in Flushing, most of which answered with voicemail or cut me off after I raised their suspicion. Among the few that responded, the first question was always, “When is she due?” Travel, lodging and medical arrangements are planned around the due day. This question was immediately followed by, “Does she have a visa already? Ask her to show me the medical paperwork! Ask the mother herself to add me to WeChat!” In the end, only one maternity center in Flushing was willing to speak with me in person.

I took the Q28 bus to this two-story multi-family home in a wooded suburban area on the outskirts of Flushing. Upon entering the home, I commented on the quiet neighborhood and the owner was pleased: “Yes, it is a very safe neighborhood with 60 percent whites, 30 percent Asians and 10 percent blacks.”

I followed him to the kitchen in the back of the hallway. There I saw a large former pantry used as a nursery. Five newborn babies were sound asleep in their cradles, breathing gently under soft blankets; another dozen empty cradles were lined up against the walls.

Two middle-age Chinese nannies were looking after these babies. One talkative nanny from Changle, Fujian province, smiled the entire time while cuddling a tiny newborn in her arms: “I love babies.” She had been a newborn caretaker for 10 years, and was now working the 12-hour day shift. Four nannies are employed in this center to work the 12-hour day or night shift.

Boss Jack is a 25-year-old Chinese man with a newborn-care certificate that he earned in America. He left China more than a decade ago and now manages the maternity center on his family property; his mother runs a Japanese restaurant out of state. Jack sleeps in a rental room in the same neighborhood, ready to run over whenever he is needed. The Fujian nanny spoke highly of her boss, citing his expertise in newborn care, his willingness to provide free medical translation services and travel paperwork assistance for overseas Chinese mothers, and his prompt issuance of paychecks.

The mothers usually stay in their bedrooms — two downstairs and three upstairs, each with a private bathroom. The Fujian nanny told me that the center had helped mothers from Mainland China — many from Hangzhou, Zhejiang province, as well as Hong Kong, Taiwan, South Korea and the states of Maryland and Georgia, among others. Some stayed for three months, while others came just to “sit the month” — an important Chinese tradition to keep the mother warm and nourished during the postpartum month.

One mother, suspicious of the Chinese doctors in Mainland China, was impressed with a Chinese doctor at NYU Langone Medical Center, where she gave birth to a baby with an umbilical cord entanglement. The doctor resolved it with deft hands and advanced equipment. The mother left the hospital with a healthy baby in just a week, spreading the good word about the superb medical care in America.

“If you have medical experiences in both countries, you’ll feel the difference,” Jack said. “A Chinese doctor first checks if you have paid the bill — some doctors would leave a patient bleeding to death if the payment is not in place. In America, human lives are valued foremost. If you cannot afford the hospital bill, the doctors will still treat you, and you can make a payment plan later in life.”

I told Jack about my sister’s struggle raising a child with cerebral palsy in China. He said he would recommend a few New York pediatricians for my niece.

Jack told me that he was shocked by the stabbing at Meibao maternity center. He knew the bosses at Meibao and thought their center had a good reputation. This incident, however, has not affected Jack’s business. His rooms are fully booked until next spring. Jack charges each mother $3,500–$5,000 per room per month, including the nanny’s fee — a competitive rate in the market. The mothers must also pay the out-of-pocket hospital fees, which typically range from $11,000 to $17,000.

In Flushing, yuesao (newborn caretakers) are so desirable that they are usually reserved one year in advance. A newborn caretaker can make $4,000 a month plus tips. But Jack did not recommend these nannies.

“Those free-market nannies often have big tempers, bossing everyone around in your home,” Jack told me, “whereas I hire full-time quality nannies and we share a common goal — to make the mothers happy.”

The Fujian nanny added, “Our mother-nanny relationship is very good. Whenever a mother feels blue, she runs downstairs to share her grievances with us, and we try our best to comfort her.”

Jack also hires a part-time housekeeper who tidies up the house once a week, as well as a full-time Shanghai cook who makes five meals a day. The nannies deliver the food to each mother’s room. There is always milk, bread, red-bean soup and other healthy snacks in the kitchen. During holidays, everyone gathers around the kitchen to enjoy a family-style banquet.

Jack’s maternity center is one of dozens in Flushing, and one of hundreds, if not thousands, in America. These centers first took root during the time of an influx of Taiwanese immigrants to southern California in the late 20th century, when it became popular for Taiwanese mothers to “sit the month” in a controlled environment away from home, and for Taiwanese women from overseas to have babies in America. Mainland Chinese mothers have followed the trend in the past decade.

Prior to 2013, Hong Kong, a mountainous island about twice the size and population of Los Angeles, was a popular destination for Mainlanders to evade the one-child policy or seek better medical care. However, the Hong Kong government, concerned about the overused medical resources — and pressured by local citizens’ resentment (some extreme locals called the Mainlanders “locusts”) — banned Mainlanders who had no marital ties to Hong Kong from giving birth in Hong Kong hospitals.

In addition, the booming Chinese economy; the relaxed U.S.-China tourist-visa policy which allows multiple entries over a 10-year period; and the popular 2013 romantic comedy Finding Mr. Right (about a Chinese single mother’s plight and romance in a Chinese maternity center in Seattle) further spurred birth tourism in America. Chinese children with American citizenship can enjoy most privileges back in China, but Chinese citizens in America face daunting obstacles when trying to advance their lives and careers.

When an American-born Chinese baby returns to China, she cannot earn dual citizenship officially, but her parents can still register her hukou (household registration record), send her to local public schools, and enroll her in a Chinese medical insurance plan. A friend of mine who taught in a public elementary school in my hometown of Yongkang, a fourth-tier city in Zhejiang province, told me that there are always one or two American citizens in each classroom. When these American citizens finish high school, they can choose to skip the highly competitive college-entrance examination and go abroad, or enter top Chinese universities such as Tsinghua University with significantly lowered criteria. While the admission rate for Chinese citizens seeking to enroll in Tsinghua University is 0.04 percent-0.1 percent, it is believed that American citizens who speak fluent Chinese are almost guaranteed admission.

To help their children win at the starting line, more and more Chinese mothers cross the ocean. One of the most popular birth tourism destinations for Mainland mothers is Irvine, California. I phoned a maternity center there and the owner, Mr. Zhang, answered cheerfully.

“Irvine is ranked number two among the most livable cities in America. We are located in a rich neighborhood with predominantly new Chinese immigrants. The white people have all moved out!” Mr. Zhang laughed.

His maternity center is operated in two adjacent single-family homes. About seven Chinese mothers live there at any given time. Each mother pays an all-inclusive fee — for food, lodging, transportation and a newborn caretaker — that ranges from $28,000 to $38,000 for three months, plus about $15,000 in out-of-pocket hospital fees. Each newborn caretaker, also from Mainland China, works 24 hours a day for a consecutive month, earning $100 per day plus tips.

When I asked Mr. Zhang if the Flushing stabbing case had had any impact on his business in California, he said, “Not at all! Those low-tier centers in Flushing often hire illegal workers and anything can go wrong. We provide high-end services, and all our nannies and cooks are professionally trained with green cards or work permits.”

Mr. Zhang advised pregnant Chinese women to enter the border honestly by telling the customs officers that they had traveled here to have babies. “Don’t ever lie to the customs officers!” Mr. Zhang warned, assuring me that the honest approach has been tested with proven success. In the past, visa fraud was one of the primary reasons many maternity centers were raided.

According to U.S. Customs and Border Protection, there are no regulations forbidding pregnant foreign nationals from coming to America. As long as they are honest during the visa interview and when going through U.S. Customs, have sufficient medical coverage and plan to return home, they are allowed to enter the country.

Still, tips are widely shared among worried mothers on popular online Chinese forums: Avoid Asian American and female customs officers, who are believed to be more hostile towards Chinese pregnant women; try to enter the border at Hawaii, Las Vegas or other smaller cities.

One of the top reasons conservatives advocate tightened control of birth tourism is the fear that American welfare and healthcare systems will be exploited by those foreign mothers without tax liabilities. I asked Mr. Zhang about the likelihood that a Chinese mother would take advantage of American medical resources for free.

“It might be a marketing strategy for low-tier maternity centers or ‘black [illegal] agents’ to dupe gullible mothers. We provide high-end services and strongly discourage anybody to apply for a ‘white card’ [Medicaid] because the repercussions are severe — you’ll be denied re-entry if they find out that you cheated.”

I thought of another approach for Chinese people to have babies in America and proposed this scenario to Mr. Zhang: If a Chinese mother must spend $40,000 or more to use a maternity center, why doesn’t she enroll in a language or professional studies program (about $6,000 a quarter in southern California), cross the border with an F-1 student visa, rent an inexpensive room, learn a new skill and enjoy health benefits with her school-rate medical insurance plan (about $600 per quarter)?

Mr. Zhang responded that he knew people who had done that, but emphasized that it was not always worth it: “I met a Chinese mother who was looking for a doctor within the network of her school insurance, but the only in-network OB-GYN who would accept her was an old Taiwanese doctor, to her disappointment. She ended up seeking help from us.”

Mr. Zhang also reassured me that his business is legitimate and he pays taxes, though one cannot find his maternity center on English search engines; it can only be found on Chinese-language sites targeting Mainland clients. This is typically the case for most Chinese maternity centers in America as they carefully navigate the strait of legal ambiguity.

Curious about what a Chinese maternity center is like in the American South, I visited such a center near a golf course in an upscale suburban community north of Atlanta, where many well-to-do Chinese immigrants have settled. Atlanta has less than 1 percent Chinese immigrants, and this maternity center was the only one I could find on a local Chinese-language website.

Its ad reads, “Safe! Safe! Safe! There aren’t many maternity centers in Atlanta, thus we are safe and trustworthy. There is a flood of maternity centers in California, each with very a different standard, and you’ll run into great risks there. Plus, they are often raided by the Homeland Security, thus the quality of their services can be severely compromised….”

In the beginning, the manager of the maternity center, Mr. Yu, refused to take a new mother (he receives one client at a time) because his own mother — the sole caretaker, cook, house cleaner and driver in his home-based maternity center — wanted to catch a breath after the previous mother left. But when he found out that I hail from Zhejiang province, he immediately changed his mind and agreed to meet me.

“Zhejiang people are great! We always welcome Zhejiang clients!”

Mr. Yu himself came from the northern Shandong province. He previously hosted a Zhejiang mother who came to America for a secret surrogacy birth (which is illegal in China), and her easy-going spirit left a very good impression on Mr. Yu’s family. They stayed in touch after she left with a healthy baby. She regularly asks Mr. Yu to ship American baby formula to her in China.

When I asked Mr. Yu if his mother is certified to care for newborns, he answered, “My mother does not have a license, but she has over a decade of caretaking experience. She is an excellent nanny, cook and cleaner. There has never been a problem and every mother loved her.”

The fees in Mr. Yu’s maternity center are comparable to those in California. I then asked Mr. Yu if he had registered his business. He paused before providing an honest answer.

“The idea of ‘sitting the month’ is nonexistent in American culture,” he said. He then explained the difficulty inherent in linking his service to the right license category: “If I want to open a business to serve these mothers, should I register it as a healthcare center? Then I would need to hire certified nurses, purchase expensive medical equipment and rent a commercial space — all unnecessary for the Chinese mothers’ recuperation needs. After all, we are just tucking our tails to provide help and make a little money. If you take everything so literally, how can we survive?”

With a profitable market, these maternity centers continue to thrive in different parts of America. According to a 2017 report by Forward Industry Research Center, maternity centers in America generated $4 billion from China in 2016; that number is anticipated to reach $15 billion in 2020.

“We are actually following a commercial contract that provides values both ways. In the process, everyone is equal. We obey the destination government’s law, and the hospital provided standard healthcare services to us,” a Beijing father who participated in birth tourism argued.

Before China’s one-child policy was lifted in 2015, reproductive freedom was the primary reason for birth tourism. Yet the policy’s termination did not stop Mainland mothers from fleeing abroad. Food safety, air pollution, medical crises, the indoctrinating education system, the corrupt legal system, the rigid rural-urban divide, and the Communist Party’s tightened control of basic freedoms are currently among young Chinese parents’ major concerns.

A Mainland expatriate living in England shared a dark view in a 2013 BBC article: “Mainland China has become the world’s second-largest economy. But due to ideological and systematic flaws, this country is haunted. We can’t think, we remain silent, we conform and we are enslaved….You don’t have to worry that we are richer than ever, because what we really desire is your citizen rights!”

Linzi, 29, a wealthy investor from Beijing, has just arrived in Los Angeles by way of Las Vegas to give birth to her baby, due in January 2019. Linzi’s father is a multimillionaire who owns several private businesses and prime Beijing real estate. At her father’s request, Linzi returned to China after she earned her master’s degree in financial engineering from Columbia University in 2013. She worked hard climbing the corporate ladder to maintain the social status her father had established, and wished to improve. Although her lifestyle and earning power are enviable even among the Beijing elite, Linzi is deeply unsettled.

“I feel the atmosphere in China to be quite strange lately. Do you know that our conversation on WeChat is monitored?”

Linzi believes that China’s economic growth in recent years has largely benefited state-owned enterprises through President Xi’s Belt and Road Initiative, whereas the private sector has been grappling with a harsh reality. She is uncertain of what the future holds, and hopes to give her child the option of choosing between China and the United States.

“These three months are really inconvenient for me. I only do it for the sake of my child,” Liinzi explains. She resists the Chinese maternity centers in America: “I have a feeling that once this industry becomes so lucrative, Chinese people in America are highly likely to dupe other Chinese.”

Linzi and her husband, both educated overseas, speak good enough English to make a personalized plan for their stay in Los Angeles: rent a comfortable home, contact top-rated white American doctors and avoid Chinese nannies in America.

“Since American mothers do not use newborn caretakers, I’m afraid there aren’t many qualified nannies to select from,” Linzi says. She hopes to bring a reputable and certified newborn caretaker from Beijing to care for her baby, but is uncertain how to get her an American visa.

Linzi estimates that her three-month birth trip will cost half a million yuan (about $75,000). She says that there are many young Chinese women in her circle who have come or are planning to come to America to give birth. If the husband can make the trip, the couple usually comes up with a personalized plan; if the mother comes alone, she tends to use a maternity center. Today, an estimated 40,000 babies are born to foreign mothers on tourist visas in America every year, 1 percent of the approximately 4 million total newborns in America.

In a parallel universe orbiting the folded reality of Chinese immigrants in America, Yufen Wang is writing a different story that is perhaps illegible to her. After arriving in Flushing with legal documentation in 2010, Yufen and her husband, their two sons and three grandchildren lived together in a red-brick house six blocks from the Main St.-Flushing station. The adults took menial jobs in restaurants and private homes; Yufen worked long hours as a breadwinner while her husband stayed home looking after their grandchildren.

There is a family history of psychological disorders, and Yufen’s mental health began to deteriorate earlier this year. She developed symptoms of forgetfulness, insomnia and suicidal tendency, sleeping little in the four months leading to the stabbing. Yufen’s family members simply suggested that she get more rest, as it remains a foreign concept for Chinese people to seek therapeutic help in times of distress.

Yufen saw a doctor who prescribed sleeping pills. Lawyer Jean Wang argued that the pills’ side effects might have triggered Yufen’s mental breakdown. In the fateful dawn of Sept. 21, Yufen snapped.

Yufen’s story is one of mental health issues gone untreated. Unable to break language, class or mental barriers, she was bearing the brunt of a new immigrant life and the demanding maternity industry. It could have happened to any low-income worker striving to stay afloat in the rocky ocean that is America.

Meanwhile, Chinese maternity centers will continue to grow in America, profiting from the margin where an undying human desire runs headlong into an unrelenting commercial contract.