‘A lot of these women had no idea what they got into’: inside the world of birth tourism | Documentary

It started a decade ago, when Leslie Tai, who lives outside San Francisco, heard from a woman she’d met in Beijing and who told her that she was staying for a few months in Los Angeles. Tai’s friend was evasive about the purpose of her visit, until the pair finally had a video call and Tai watched her friend oil a round belly on camera. “She said, ‘I have a surprise for you,’ ” Tai recalled. “‘I’m having an American baby.’” Tai, who knew that her friend came from a poor family and was dating a wealthy older artist in China, asked if he had friends in southern California. “And she was like, ‘No, honey, you don’t need friends to do what I’m doing.’”

She was part of the birth tourism industry, which boomed during the Obama years, when scores of pregnant Chinese women of means invested in package deals that cost anywhere from $30,000 to $100,000 and granted buyers the ability to fly across the world and stay for three months at a facility that catered to expectant mothers looking to score American citizenships for their children or skirt the one-child policy that was the law in China until 2015.

Tai, a Chinese American documentary film-maker, wasted no time embedding in the group home where her friend was waiting out the final days of her pregnancy, alongside a handful of other expectant mothers. “I got kind of obsessed with this idea of how on the outside, it’s just nondescript suburban tract housing, with palm trees everywhere, but then behind closed doors there’s this whole world with multiple families living in close quarters and all in this crazy intense situation of waiting to have a baby,” she said.

Securing subjects’ permission was not easy for Tai. “I started asking my aunties and uncles like, do you know anybody who is involved in this industry? They were all like, yeah, actually, my cleaner, or our nanny from when our kids were children ended up working in one of these maternity hotels,” she recalled. Tracking down subjects and winning over their trust took an enormous amount of care and strategy. “Even though what they were doing was not illegal, they had reservations, so it was not like I came in like guns blazing.” Tai’s English fluency proved a valuable resource as she pursued mothers-to-be, nannies, drivers and cooks to grant entry to their private world and anchor the vignettes in her film. “I made myself of service because actually, when they saw me, they were like, Oh my God, you speak English. Can you help me call PG&E?” She had given similar help to her friend, who did not speak English, in the delivery room.

Photograph: PBS

Nearly 10 years in the making, Tai’s entrancing and heartrending film How to Have an American Baby provides viewers insider access to a phenomenon that took place behind closed doors and on Chinese websites where brokers offered pregnant women package deals as if they were cruise holidays. Money-hungry operators offered help obtaining visas and lining up rooms at specialized facilities. There were enormous industrial maternity hotels, as well as private Beverly Hills homes and boutique group homes where up to five women at a time waited out their births and holed up for the 30-day postpartum quarantine that is a Chinese tradition. Then, more often than not, they returned to China.

“By and large, the majority of the women that were coming were simply coming to evade the one-child policy,” Tai said. Some, though, were mistresses, as Chinese law did not allow unmarried mothers to give birth in public hospitals until earlier this year. Sales agents knew how to tap into maternal anxieties, playing up the supposed advantages of American citizenship. “There’s a lot of misinformation that the customers are receiving,” Tai said. “They think that there’s universal healthcare. They think that there’s universal education. It’s sold as a really good investment, but they’ve been lied to.” Babies born in the US have the right to declare their American citizenship at age 18, and apply for green cards for their families when they turn 21. “There was a sentiment of: who knows what the world is going to look like in 18 years? If China goes to hell, what if America goes to hell, whatever, they have two passports.”

Tai’s film is less concerned with policy than offering a textured portrait of the day-to-day, minute-to-minute experience that the mothers went through. The exteriors are mostly shot at night on suburban streets of southern California and the interiors sit with women bathing their babies or microwaving cups of tea while they wait to go into labor. A meditative quality pervades the work, which weaves several vignettes together into a broader portrait of women navigating a terrifying life phase in a strange land. “A lot of these women had no idea what they got into,” Tai said. “It’s almost like they were sold on the pretty pictures of this vacation and then when they come here, they realize: ‘My family’s not here, and I’m having a baby. Oh, my God, I’m sequestered with a bunch of pregnant women. Plus there’s all the drama living in the suburbs. It’s like Real Housewives from hell.”

While many of the visitors enjoyed daily meal deliveries and shopping excursions, they were surrounded by people who saw them as financial marks. The doctors in the film offer all-cash birthing options (vaginal for $3,000 or caesarean for $5,000) with the tenderness of night market vendors hawking ripoff handbags. Tai captured a maternity hotel worker saying about the residents: “If you become too friendly they will use you. The more you give them, the more they complain.”

Expecting mothers on beach - POV How to Have an American Baby
Photograph: PBS

The birth tourism world underwent major upheaval over the course of filming and editing, to the point where Tai said her film was “like a time capsule”. With the rise of Trump and the travel restrictions around Covid, and anti-Chinese and anti-American sentiment flying in both directions, the phenomenon has come to a standstill.

Tai had her own changes as well, namely, the birth of a baby this past January, a few weeks before the world premiere of her film at a festival. “I definitely took a lot of lessons from watching all these births, like making sure I was set up with the right support,” she said.

And now she is in what she called “double postpartum mode”, watching both her baby and film find their footing in the world. While the film has a jaw-dropping concept at its core, the bulk of the footage focuses on the mundanity and emotion that color the days leading up to and following childbirth, as well as the terror and ecstasy of labor itself. (There is a birthing scene more honest and beautifully gruesome than any video they’ll show you at birth class.) Tai’s ambition for her movie is strikingly tender. “I want to fight for the moving image that allows you to really sink into the humanity of the people, regardless, and even in spite of, how controversial the situation is,” she said.

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