Governor Greg Abbott orders a wide-ranging investigation into healthcare providers linked to birth tourism, saying American citizenship is “not for sale.”
Texas has introduced one of its strongest measures yet against what state officials describe as “birth tourism”, with Governor Greg Abbott signing Executive Order GA-57. The order authorises a broad investigation into healthcare providers, hospitals and organisations suspected of helping foreign nationals travel to Texas to give birth so their children automatically receive US citizenship under the country’s birthright citizenship laws.
The move is expected to have implications for hospitals, physicians and immigrant communities across the state, including visitors from Pakistan, India, Bangladesh and other South Asian countries who travel to the United States on visitor visas.
Governor Abbott announces crackdown
While announcing the executive order, Governor Abbott said “American citizenship is not for sale,” adding that Texas would no longer tolerate schemes that, in the state’s view, exploit the US immigration system.
The order directs six state agencies—including the Texas Department of State Health Services, the Health and Human Services Commission, the Texas Medical Board, and the Texas Board of Nursing—to investigate suspected birth tourism operations within the healthcare sector.
State regulators have also been instructed to coordinate with federal authorities if potential violations of federal law are identified. Healthcare providers found violating regulations could face licence suspension or revocation, exclusion from state contracts and other administrative penalties.
Action follows investigations into maternity packages
The executive order follows another directive issued earlier this month by Abbott, asking the Texas Health and Human Services Commission to investigate hospitals advertising maternity packages specifically aimed at foreign nationals.
Following those inquiries, Texas authorities referred two hospitals to the state’s Attorney General after promotional material targeted women from Mexico by offering childbirth packages near the US-Mexico border. According to state officials, the advertised prices were approximately $3,950 for natural delivery and $5,525 for Caesarean section.
Birthright citizenship remains protected
The Texas action comes shortly after the US Supreme Court concluded its 2025–26 term by leaving intact the constitutional principle of birthright citizenship under the Fourteenth Amendment.
The ruling effectively prevented President Donald Trump’s efforts to restrict automatic US citizenship for children born on American soil.
Immigration attorney Kate Lincoln-Goldfinch said the Texas order appears to regulate activities surrounding birth tourism rather than challenging birthright citizenship itself, which remains protected under federal law.
Impact on South Asian communities
The new policy has attracted particular attention among South Asian communities, where some families have historically viewed childbirth in the United States as a way for their children to obtain American citizenship.
Members of Pakistani communities in Dallas and Houston told Jang/Geo that some families who had planned to travel on visitor visas for childbirth are now reconsidering those plans following Abbott’s announcement.
According to the Migration Policy Institute, fewer than 30,000 of the more than 3.5 million births recorded annually in the United States involve women travelling on tourist visas, representing well under 1% of all births nationwide.
Greater scrutiny for visitor visa applicants
Legal experts believe the new enforcement measures could lead to increased scrutiny of pregnant applicants seeking US visitor visas.
Under existing US State Department policy, consular officers already have the authority to refuse visitor visas if they determine that an applicant’s primary purpose is to give birth in the United States.
Immigration lawyers also warn that applicants should provide accurate information during visa interviews, as visa refusals or findings of misrepresentation could affect future travel. Individuals who previously gave birth in the US while visiting may also face additional questioning during future visa renewals.
Healthcare providers face compliance challenges
The executive order is expected to create new compliance challenges for hospitals, maternity clinics and obstetricians throughout Texas.
Healthcare providers may face greater regulatory oversight while balancing their legal obligations with their ethical duty to provide medical treatment. Immigration attorney Gordon Quan noted that although hospitals may face additional scrutiny, pregnant women remain entitled to necessary emergency medical care regardless of their immigration status.
Several Pakistani and Indian obstetricians and gynaecologists practising in Dallas, Fort Worth and Houston also expressed concern about the practical impact of the policy. They said physicians could face legal risks whether they deny treatment or later become subject to regulatory investigations.
Legal experts advise healthcare providers to review their marketing materials, strengthen compliance procedures, train staff on the new regulatory requirements and maintain detailed patient records. Some hospitals that had previously advertised maternity services to foreign nationals have already withdrawn those promotions, stating that they do not support any unlawful activity.
Civil rights advocates, meanwhile, argue that birth tourism accounts for only a tiny share of births in the United States. They warn that stricter enforcement could discourage immigrants from seeking timely medical care, while emphasising that federal law continues to require hospitals to provide emergency treatment regardless of a patient’s immigration status.
