DALLAS – Texas has launched one of its toughest measures yet against what state officials describe as “birth tourism,” with Gov. Greg Abbott signing Executive Order GA-57 to authorize a broad investigation into health care providers and organizations suspected of facilitating foreign nationals seeking to give birth in the state for their children to become U.S. citizens.
The order is expected to affect hospitals, doctors and immigrant communities throughout Texas, particularly visitors from Pakistan, India, Bangladesh and other South Asian countries traveling to the United States on visitor visas.
In announcing the order, Abbott declared that “U.S. citizenship is not for sale” and said Texas would no longer tolerate schemes that the state believes exploit the country's immigration system.
The executive order authorizes 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 birth tourism operations within the healthcare sector. State regulators have also been ordered to coordinate with federal authorities when potential violations of federal law are identified, while disciplinary actions could include suspension or revocation of licenses, exclusion from state contracts and other administrative sanctions.
The order follows Abbott's earlier directive this month that directed the Health and Human Services Commission to investigate hospitals that advertise maternity packages to foreign nationals. State officials subsequently referred two Texas hospitals to the Attorney General after promotional material aimed at women in Mexico offered birth packages near the U.S.-Mexico border, with advertised prices of $3,950 for natural births and $5,525 for cesarean sections.
The move comes just weeks after the U.S. Supreme Court concluded its 2025-26 term leaving intact the constitutional principle of birthright citizenship under the Fourteenth Amendment, effectively preventing President Donald Trump from restricting automatic citizenship for children born in the United States.
Austin immigration attorney Kate Lincoln-Goldfinch said the Texas order appeared to be an attempt to regulate activities related to a practice that remains constitutionally protected under federal law. She argued that the state was seeking alternative enforcement mechanisms after the Supreme Court reaffirmed birthright citizenship.
The executive order has drawn particular attention among South Asian communities, where some families have historically viewed childbirth in the United States as a path to securing U.S. citizenship for their children. Members of the Pakistani community in Dallas and Houston said Jang/Geo They knew families who had planned to travel on visitor visas to have children, but were now reconsidering those plans following the governor's announcement.
According to the Migration Policy Institute, fewer than 30,000 of the more than 3.5 million births registered annually in the United States involve women traveling on tourist visas, representing far less than one percent of all births nationwide.
However, legal experts believe the new enforcement measures could result in greater scrutiny of pregnant visitor visa applicants. U.S. consular officials already have the authority, under State Department policy, to deny visitor visas if they conclude that the applicant's primary purpose is to give birth in the United States.
Immigration attorneys in Dallas said Jang/Geo that pregnant applicants should seek legal advice before applying for visitor visas and avoid making inaccurate statements during visa interviews, warning that visa denials or accusations of misrepresentation could affect future travel. They also said that people who previously gave birth in the United States during their visit could face additional questions during future visa renewals.
Lincoln-Goldfinch cautioned, however, that organized birth tourism remains relatively uncommon, noting that women in late stages of pregnancy are often denied boarding on airlines or entry at U.S. ports of entry. He said highly visible pregnancies often draw closer scrutiny from border officials long before delivery occurs.
The order is also expected to create significant compliance challenges for healthcare providers across Texas. Hospitals, obstetricians, and birth clinics may face increased regulatory scrutiny as they attempt to balance legal obligations with the ethical responsibilities of providing health care. Houston immigration attorney Gordon Quan said health professionals may come under increasing pressure to verify patients' immigration circumstances before treatment, although he emphasized that pregnant women remain entitled to necessary medical care regardless of their immigration status.
Several Pakistani and Indian doctors who practice obstetrics and gynecology in Dallas, Fort Worth and Houston said Jang/Geo They were concerned about the practical implications of the new policy. They said denying treatment could expose doctors to medical liability, while treating patients later suspected of participating in birth tourism could also trigger regulatory investigations.
Legal experts say healthcare providers should immediately review marketing materials, strengthen compliance procedures, train staff on the new regulatory environment and maintain detailed patient records to demonstrate compliance if investigations are conducted. Some hospitals previously criticized for advertising maternity services to foreign nationals have already withdrawn those promotional materials, saying they do not support illegal activities.
Civil rights advocates argue that birth tourism accounts for only a small proportion of births in the United States and warn that increased enforcement may deter immigrants from seeking timely medical care. They note that federal law continues to require hospitals to provide emergency medical treatment regardless of a patient's immigration status, while emphasizing that pregnancy alone does not prevent someone from traveling to the United States as a tourist.
