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Ticket, Passport, Pregnancy Test. Flying to This U.S. Island Can Be Complicated.

The Wall Street Journal. logo The Wall Street Journal. 1/12/2020 Jon Emont
a group of clouds in the sky: The view from Mount Tapochau on Saipan in the Northern Mariana Islands. In 2018, more tourists than residents gave birth in the U.S. commonwealth.
© Yuri Smityuk/TASS/ZUMA PRESS The view from Mount Tapochau on Saipan in the Northern Mariana Islands. In 2018, more tourists than residents gave birth in the U.S. commonwealth.

HONG KONG—Japanese citizen Midori Nishida was checking in to a flight in Hong Kong in November to visit her parents on Saipan, a U.S. island in the Pacific, when airline staff made an unusual demand. She had to take a pregnancy test if she wanted to board.

Ms. Nishida, 25 years old, was escorted to a public rest room and handed a strip to urinate on.

The test was part of the response of one airline, Hong Kong Express Airways, to immigration concerns in Saipan. The island has become a destination for women intending to give birth on U.S. territory, making their babies eligible for American citizenship. In 2018, more tourists than residents gave birth in the Commonwealth of the Northern Mariana Islands, in which Saipan is the largest island.

Pregnant foreigners aren’t barred from entering the U.S., or from giving birth in U.S. territory. But immigration authorities can turn away visitors if they are found to be lying about their purpose of travel, or if they come to the U.S. planning to have a medical procedure, such as giving birth, but can’t prove they have the funds to pay for it.

Airlines are required to take back passengers who are denied entry—an incentive to ensure that those who board their flights are likely to be deemed admissible to the U.S.

At the Hong Kong airport, Ms. Nishida had indicated on a check-in questionnaire that she wasn’t pregnant. That didn’t satisfy airline staff, who asked her to give permission to an authorized medical provider to give her a “fit-to-fly” assessment, including a pregnancy test.

The permission form said it was for women who were observed to have a body size or shape resembling a pregnant woman.

“It was very humiliating and frustrating,” Ms. Nishida said. The test was negative and she boarded the flight, she said.

“In response to concerns raised by authorities in Saipan, we took actions on flights to Saipan from February 2019 to help ensure U.S. immigration laws were not being undermined,” HK Express, a budget carrier acquired in July by Cathay Pacific, said in late November in response to questions.

The company said that, under new management, it recognized the concerns its actions had caused. “We would like to apologize unreservedly to anyone who has been affected by this,” it said. “We have immediately suspended the practice while we review it.”

The boom in birth tourism in Saipan comes largely from China. The Northern Marianas are the only U.S. soil that Chinese can visit without first getting a visa—a policy intended to boost tourism from the world’s most-populous country. Japanese citizens such as Ms. Nishida can visit the U.S., including the Northern Mariana Islands, without a visa.

In 2018, 575 Chinese tourists gave birth in the Northern Mariana Islands, up from 12 in 2009, the year the Chinese visa-waiver program was introduced.

Saipan authorities have sought to discourage the practice while keeping the visa-waiver program alive for the hundreds of thousands of Chinese travelers who are critical to the island’s economy. In part because of immigration concerns, the period of visa-free stay for tourists from China was shortened last year to 14 days from 45 days.

Saipan authorities have expressed their misgivings about birth tourism to carriers flying to Saipan, said Kevin Bautista, the press secretary for the Saipan governor’s office. The practice raises health risks for mothers who arrive late in their pregnancies with no records of prenatal care, he said.

It also hurts the island’s reputation as a tourist destination, he said, adding that local officials want people to visit “solely for our beautiful beaches, our unique environment, and our world-renowned island hospitality.”

Authorities recommended to airlines that they implement more effective screening procedures for the health and safety of pregnant women—but didn’t recommend that HK Express require pregnancy tests, Mr. Bautista said. He said the local administration hoped airlines prioritized passengers’ privacy.

The conversations stemmed from concerns brought up by federal and local immigration enforcement agencies, he said.

HK Express is one of at least six commercial airlines that fly regularly from East Asian countries to Saipan, including Beijing Capital Airlines and China Eastern Airlines. Tourists from China also arrive on charter flights.

One carrier, Asiana Airlines of South Korea, said it advises women who are past their eighth month of pregnancy to avoid traveling to the U.S. territory because of the scrutiny they will face at immigration.

Since 2017, after Northern Mariana Islands authorities asked them to “reinforce pre-screening measures,” Asiana’s airport service agents have checked specifically for medical certificates, return tickets and other documents, Asiana said. The company said it doesn’t ask passengers to take pregnancy tests.

Beijing Capital Airlines said it doesn’t recommend pregnant passengers travel to Saipan without a visa, as they are likely to be turned away after landing in Saipan.

Write to Jon Emont at jonathan.emont@wsj.com

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