Nigerians call it the Lagos Shuttle, the trend for wealthier women to go overseas to give birth. But Donald Trumps attacks on birthright citizenship cloud the trend.
Image: Pixabay
Aduragbemi Banke-Thomas and Olayinka Lewis
Nigerian women make up a significant proportion of foreign women giving birth in several countries.
A study done in Calgary in Canada found 24.5% of foreign women identified as having travelled abroad to give birth were from Nigeria.
Research in Chicago in the US found the majority (88%) of those seeking obstetric care in a hospital were Nigerian citizens.
In the UK, the phenomenon is labelled by some as the “Lagos Shuttle”, highlighting the high number of Nigerian women said to be so-called “birth tourists”.
It is estimated that over 23% of pregnant Nigerian women would like to travel abroad to give birth.
Why is this? As medical and legal scholars we asked women who had travelled overseas for the birth of their babies to share their experiences.
Existing research has not done enough to capture their voices, which matter in framing service delivery and immigration policies.
We reported findings from this first-of-its-kind study in PLOS Global Public Health.
As there is no registry of foreign pregnant women who gave birth abroad, it is a challenge to find them. For our study, we used social media platforms to recruit 27 Nigerian women who had given birth to at least one child abroad and conducted in-depth interviews with them to understand their motivations and experiences.
Of all recruited, 23 gave birth to at least one child in the US, and four gave birth to at least one child in the UK. One woman each gave birth in Canada, Ireland and Zambia.
All the women in the study had at least a university degree.
We found that reasons for seeking childbirth abroad varied.
Some women were motivated by both perceived and experienced gains of foreign citizenship, which they believed might give their children a good education, a better living environment, and easier access to jobs and loans.
However, it was not all about citizenship. Another motivation was to benefit from “better healthcare”, especially for those who had either had bad experiences during previous births in Nigeria or were concerned because they were carrying what they called a “precious baby”, for example after years of infertility.
Many women in the study also sought childbirth abroad because it is where they had loved ones to support them through pregnancy, childbirth and having a newborn – a motivation not previously reported.
Indeed, the number of Nigerians living in the US has increased over time and as of 2023, over 760,000 Americans identify as being of Nigerian origin. Essentially, more than one in 10 African immigrants in the US are Nigerians.
Some Nigerian women planned to give birth abroad long before they even got pregnant. Others were encouraged to do so by family, friends or colleagues.
Some decided to seek childbirth abroad after their income increased.
Childbirth abroad is mostly a positive experience, but some women reported feeling treated badly because they were “self-paying” patients, “black”, or not native to the country.
While travel for many was mostly uneventful, some experienced life-threatening situations en route to their destination or upon arrival.
They found the cost of care to be exorbitant, but many reported that they were able to pay it off in instalments, or negotiated rebates or discounts from hospitals. A separate study showed that four in five foreign pregnant women who gave birth in a Canadian hospital, including some from Nigeria, had no outstanding bill after discharge.
In our study, those who struggled to pay said they incurred unexpected costs due to complications that resulted in caesarean sections or other surgical procedures.
Support during childbirth abroad was considered crucial and included loved ones from Nigeria who would travel with the pregnant woman to their destination.
With an ongoing exodus of Nigerians out of the country due to push and pull factors, known locally as jàpa, it is more likely that there will be more Nigerian pregnant women who have their support system abroad.
Countries like Nigeria should do more to improve the quality of care obtainable in their health systems.
Clearly motivations vary, and it is not always about birthright citizenship. While most women have mostly positive experiences, some have negative experiences that require attention and safeguards. For example, care guidelines in host countries specifically assuring good quality care for all pregnant women, including women who have crossed the border to seek childbirth.
The return of US president Donald Trump makes the need to install these safeguards particularly urgent. In his first term he ordered the United States Department of State to discontinue the approval of visas for pregnant women.
In his second term he has focused on abolishing birthright citizenship altogether.
Aduragbemi Banke-Thomas is Associate professor, London School of Hygiene & Tropical Medicine. Olayinka Lewis is a senior lecturer, University of Essex