A Japanese woman was asked to take a pregnancy test before flying to a US island that has become popular for birth tourism

In November, 25-year-old Japanese citizen Midori Nishida was checking into a flight to Saipan, a US island in the Pacific, where she was going to visit her parents. She wasn't pregnant, and said so on a check-in questionnaire, but airline staff made her take a pregnancy test anyways before she was allowed to board.

The Wall Street Journal reports that Nishida was asked to give permission to an authorized medical provider to conduct a "fit-to-fly" assessment, and the form said it was for women who had a body size or shape resembling a pregnant woman.

Nishida told the Wall Street Journal it was "very humiliating and frustrating" to be escorted to a public restroom where she was handed a strip to urinate on. She did not test positive and was able to board the flight.

Hong Kong Express Airways said the test was in response to "concerns raised by authorities in Saipan," where birth tourism resulted in more tourists giving birth there than residents in 2018.  

Some pregnant women are specifically giving birth in Saipan so that their children are eligible for US citizenship. Many of the tourists giving birth in the Commonwealth of the Northern Mariana Islands, where Saipan is the largest island, are from China.

Chinese citizens can visit the Northern Marianas without a visa – the only US soil they can do so on– and 575 Chinese tourists gave birth there in 2018, up from 12 in 2009, the year the China visa-waiver program meant to encourage tourism was introduced. 

While it isn't illegal for pregnant women to travel to the US or give birth in the country or its territories, immigration authorities can send back tourists who lie about their purpose of travel or are intending to have a medical procedure. The financial burden then falls on the airlines, which are required to take back passengers who are denied entry.

Hong Kong Express Airways further specified that the pregnancy test was "to help ensure US immigration laws were not being undermined." However, the airline has suspended the practice and apologized to passengers who were affected.

Authorities of the Northern Marianas have asked airlines to "reinforce pre-screening measures," but have not specifically asked that pregnancy tests be administered.