38 AHMR African Human Mobilty Review - Volume 7 No 3, SEP-DEC 2021 The Conundrum of Birth Tourism and American ‘Jackpot Babies’: Attitudes of Ghanaian Urban Dwellers Ada Adoley Allotey* and Leander Kandilige** * Environmental Protection Agency, Accra, Ghana ** University of Ghana, Ghana Some contemporary international migration literature highlights the practice of the acquisition of privileged citizenship by temporary migrants who give birth in a country other than their home country (birth tourists) and the inherent benefits that accrue to this category of migrants. However, scholars tend to rely solely on the subjective accounts of birth tourists to measure attitudes toward the practice of deliberately migrating to a preferred destination country at an advanced stage of pregnancy to secure citizenship rights for the child. This study employed concurrent triangulation design – a survey and semi-structured in-depth interviews – to collect data from 260 urban dwellers in three metropolises in Ghana – Accra, Cape Coast, and Kumasi – who were yet to give birth in the United States and 15 parents who already had a total of 25 American ‘jackpot babies’, to measure a broader spectrum of attitudes toward this phenomenon. This paper records a nuanced continuum of attitudes to the concept of American ‘jackpot babies’, ranging from favorable, to neutral/indifference, to objection to this phenomenon among Ghanaian urban dwellers. Keywords: birth tourism, attitude, intention, jackpot baby, anchor baby 39 INTRODUCTION Birth tourism to the United States of America (the “United States”, “USA” or “US”) has grown in popularity (Heaton and Dean, 2016). However, little is known about the attitudes toward this travel trend in the home countries of its participants. Birth tourism is travel undertaken by an expectant woman to a foreign country that practices jus soli (right of soil) citizenship to bear a child and return with the child to her country (Lollman, 2015; Ji and Bates, 2017). Feere (2010) and Arthur (2018) observe that there are about 40 countries in the world that practice jus soli citizenship. Canada and the United States are the only developed countries that offer unrestricted citizenship to children born to irregular and temporary immigrants. The only exception is in the instance of children born to diplomats. The US version of jus soli citizenship has been described as more inclusive compared to the other countries and is enshrined in the US Constitution; specifically, the Citizenship Clause of the Fourteenth (14th) Amendment (Schuck, 1998; Ho et al., 2009; Feere, 2010). Birth tourists to the United States come from all over the world, in particular from Latin America, Eastern Asia and Europe, with smaller numbers from Africa (Tetteh, 2010; Guerrero, 2013; Grant, 2015; Altan-Olcay and Balta, 2016; Heaton and Dean, 2016; Nori, 2016; Wang, 2017). Also, Pearl (2011) indicates that statistics on foreign visitors and anecdotal evidence suggest that tens of thousands of women who are on tourist or business visas give birth in the USA every year. A decade ago, Reasoner (2011) estimated that nearly 200,000 children were born annually to short- term visitors to the USA. The Center for Immigration Studies (CIS) in the USA has also reported that out of 300,000 children who are born to foreign citizens in the USA every year, 40,000 are born to birth tourists who are legally in the country (Grant, 2015). Furthermore, Altan-Olcay and Balta (2016) estimated that in 2011 600 Turkish women traveled to the USA during the later stages of their pregnancy to give birth to their children. The number of Chinese women who travel to the USA to give birth has more than doubled over the years, that is, from 4,200 in 2008 to about 10,000 in 2012 (Heaton and Dean, 2016; Arthur, 2018). While the above statistics hardly agree on the exact number of birth tourists who travel to the USA in a year, they confirm that there are large numbers of foreign pregnant women from the different parts of the world who give birth in the USA every year. Wang (2017) has, however, indicated that the global number of birth tourists is small in comparison to immigrant populations at large. Birth tourism to the United States has attracted much empirical attention because of its worldwide popularity, motivations, and implications for the US society. To date, very little attention has been paid to attitudes of the home countries of the birth tourists toward the decision to give birth in the United States. Andriotis (2005) posits that an investigation into the attitudes of residents toward tourism can determine the extent to which the community will support or not support tourism. The objective of this study is to examine the attitudes of the Ghanaian urban population toward their female compatriots who travel to the United States to have The Conundrum of Birth Tourism and American ‘Jackpot Babies’ in Ghana 40 AHMR African Human Mobilty Review - Volume 7 No 3, SEP-DEC 2021 US-born citizens. This paper sheds new light on the intentions to embark on this practice from the perspective of the Ghanaian urban dwellers who are yet to have US-born citizens and Ghanaian parents of US-born citizens, using their attitudes toward Ghanaian birth tourists to the United States as an independent variable. Two reasons accounted for the focus of this paper on the Ghanaian urban population. First, it has been established that most international migrants from Ghana are from the most urbanized regions, especially from the Greater Accra and Ashanti regions (GSS, 2013). Second, middle-class women from urban areas in Ghana travel to the United States to give birth (Tetteh, 2010). MOTIVATIONS BEHIND BIRTH TOURISM TO THE UNITED STATES Scholars and the media both within and outside the United States have reported that birth tourists to the country come from all over the world, in particular from China, Mexico, Nigeria, Russia, South Korea, Taiwan, and Turkey (Feere, 2015; Wang, 2017). Tetteh (2010) observes that several pregnant women from Ghana travel to the United States to have US-born citizens. Several other scholars have also deliberated on these women’s motivations for giving birth on US soil (Tetteh, 2010; Guerrero, 2013; Grant, 2015; Altan-Olcay and Balta, 2016; Heaton and Dean, 2016; Nori, 2016). The first motivation for most of the mothers is the right that their US-born citizens would have from the legal age of 18 onwards as stipulated in the Immigration and National Act (INA) of 1965 to guarantee a path to legal immigration through a sponsorship process for the immediate family members (Feere, 2010; Nori, 2016; Kerwin and Warren, 2019a). This sponsorship process is known as family reunification (Kerwin and Warren, 2019b; Sironi et al., 2019). Others refer to it as ‘chain migration’ (Feere, 2010) but this reference is deemed by some as nativist and offensive. The INA grants this child, at the legal age of 18, a right to sponsor an overseas spouse and his or her unmarried children for permanent residency. Also, at the age of 21, the child can legally sponsor the parents and any siblings (Feere, 2010). For this reason, this US citizen is called, by mostly anti-immigrant scholars, an ‘anchor baby’ (Ward, 2009; Feere, 2010). Interestingly, most of the country’s growth in immigration levels emanates from family-sponsored immigration. Kerwin and Warren (2019a) found that in 2017, 87 percent of all immigrants obtained legal permanent residency through the various categories of family reunification. Contrary to popular belief, Nori (2016) and Kerwin and Warren (2019a) argue that having US-born citizens do not guarantee the fastest path to legal immigration because the sponsorship process for immediate relatives is lengthy. Even though there is no limit on the number of visas issued to immediate relatives, Kerwin and Warren (2019a) assert that these relatives face barriers to securing visas such as the high cost of application and attorney’s fees. An application fee for naturalization and biometric processing is reported to cost $725 (Kerwin and Warren, 2019b). The sponsorship process can only start when the US-born child is 21 years old, has a middle-class income and it also depends on whether the immediate family members are residing 41 in or outside the USA (Stock, 2012; Nori, 2016). Aside from these impediments, as of 1 November 2018 nearly 3.7 million intending applicants were in family-based visa backlogs (Kerwin and Warren, 2019a). The US passport provided shortly after the registration of the child’s birth is the second motivation (Feere, 2010). It is advantageous for a family to have a member being a holder of a US passport as it entitles the holder to enter and reside in the United States, travel whenever and wherever he or she chooses, and enjoy almost unrivaled protection (Castles, 2005; Feere, 2010; Reasoner, 2011; Altan-Olcay and Balta, 2016). Yet, this claim does not entirely represent the reality in contemporary times because Americans require a visa to travel to certain countries like Ghana. Also, being an American in the era of terrorism does not grant unrivaled protection in certain parts of the world. Other motivations include: having access to better maternal care (Tetteh, 2010; Nori, 2016), securing the benefits of dual citizenship for the child – from the parent’s country and the United States (Grant, 2015) and having access to the country’s improved systems of education for their offspring (Nori, 2016). Hence, the expectation of earning these benefits has become a magnet for birth tourists to travel on valid visas to the United States and the emergence of a birth tourism industry (Feere, 2010; Reasoner, 2011; Ji and Bates, 2017; Arthur, 2018). The use of the pejorative term ‘jackpot baby’ to refer to a US-born citizen who was born as a result of birth tourism to the United States, has become widespread (Guerrero, 2013). ATTITUDES TOWARD BIRTH TOURISTS FROM THE PERSPECTIVE OF THE AMERICAN SOCIETY This paper first investigates American citizens’ attitudes toward birth tourists who travel to their country. From the extant literature, the attitudes of American citizens have mostly been expressed as negative appraisals. The most widely discussed negative appraisal is the disapproval that some immigration experts in the United States have against the right that US-born citizens have and use in sponsoring their immediate relatives for American citizenship and receiving other economic benefits (Feere, 2010; Reasoner, 2011). These immigration experts believe that these women are abusing the 14th Amendment of the US Constitution (Ward, 2009; Lederer, 2013). This disapproval has led to the use of potentially derogatory terms such as ‘anchor baby’ and ‘jackpot baby’. However, these terms differ in definitions because of the mothers’ immigration status at the birth of their babies (Ward, 2009; Feere, 2010; Guerrero, 2013). Ward (2009) explains that the term ‘anchor baby’ is used to refer to the speculative possibility that a US-born citizen at the age of 21 will use his or her right to sponsor the extended family members who are non-citizens for permanent residency in the United States. This child becomes an ‘anchor’ for the entire family to reside legally in the country (Feere, 2010). The Federation for American Immigration Reform (FAIR) also defines an ‘anchor baby’ as the offspring of an illegal immigrant The Conundrum of Birth Tourism and American ‘Jackpot Babies’ in Ghana 42 AHMR African Human Mobilty Review - Volume 7 No 3, SEP-DEC 2021 or a non-citizen, who under the current legal interpretation becomes an American citizen at birth but can only sponsor his or her parents for immigrant benefits at the age of 21 (Culliton-González, 2012). Ho (2006) and Ho et al. (2009) dispute FAIR’s assertion that the legal interpretation of the 14th Amendment is recent but affirm that jus soli citizenship has been enshrined in the US Constitution for the past 150 years. Also, the Southern Poverty Law Center reported that FAIR has links with racist groups with a white nationalist agenda (Culliton-González, 2012). On the contrary, Guerrero (2013) uses the urban dictionary to describe a ‘jackpot baby’ as a child planned and conceived abroad and delivered on US soil solely for the parental desires of becoming US citizens indirectly and receiving other economic benefits. For purposes of this paper, the term American ‘jackpot baby’ is used to highlight the contested and anti-immigrant sentiments espoused by a section of academia, while acknowledging the immigration-related benefits expected to be earned by both the US-born citizen and his or her family. More specifically, the paper uses the term American ‘jackpot baby’ to refer to any child who was born in the United States to either Ghanaian parents admitted as short-term visitors or to birth tourists, solely for the child to have access to better opportunities available to American citizens. Opponents of birth tourism, including anti-immigration politicians, immigration reform activists, and some scholars hold the belief that birth tourists use deceptive reasons to apply for a visa, gain entry and give birth to earn American citizenship and a social security number for their offspring (Tetteh, 2010; Grant, 2015). They maintain that these foreign pregnant women are circumventing the legal process of becoming American citizens (Feere, 2010; Reasoner, 2011; Grant, 2015). Furthermore, some Americans regard birth tourism as unethical practice, as they believe that these women have discovered a ‘loophole’ in the Citizenship Clause, and that they are taking advantage to secure US citizenship for their unborn children (Grant, 2015). However, there is evidence that some birth tourists enter the country legally (Reasoner, 2011; Grant, 2015) and then avail themselves of rights enshrined in the US Constitution. Opponents of birth tourism further argue that some immigrants and US-born citizens do not sufficiently embrace the American values and are not fully assimilated into the society to warrant their inclusion as American citizens (Junn, 2011). The former president of the United States, Donald Trump, also added his voice to this negative appraisal. The former president claimed that the abuse of the US’s jus soli citizenship provision by the birth tourists has opened the door to unregulated immigration and instant citizenship (Grant, 2015; Nori, 2016; CNN, 2018). He further alleged, without any credible evidence, that these US-born citizens and their families do not contribute, show love and respect to American society. Consequently, opponents of birth tourism to the United States, including the past president, are advocating for an amendment to or the repeal of the Citizenship Clause to serve as a deterrent to foreign women who want to claim US-born citizenship for their children. This recommendation has ignited debates that, while they are heated, they are by no means novel. As Arthur (2018) observes, these 43 debates have been ongoing for the past 150 years. During the run-up to the mid-term elections on 6 November 2018, former President Trump ignited these debates again when he announced his plans to sign an executive order to end jus soli citizenship (Arthur, 2018). However, such an order had not been signed by the time he left office on 20 January 2021. Other scholars have recommended other measures since the legal route to amend or repeal the Citizenship Clause is fraught with some challenges (Pearl, 2011; Arthur, 2018). While most scholars agree with the need to amend the US Constitution, they admit that this process is exceedingly difficult. As such, one recommendation is to amend the INA that governs most of the visa rules and eligibility (Pearl, 2011). Pearl (2011) explains that this amendment would in the first instance detect, deter and penalize foreign women from purposely traveling to the United States to have American ‘jackpot babies’. Secondly, it aims to prevent the citizen children from sponsoring their families for permanent residency on return to the United States. As a result, on 24 January 2020 the State Department introduced a new travel policy that obliges foreign pregnant women to declare the purpose of their visit to the United States other than for giving birth (BBC, 2020a; Graphic Online, 2020). Conversely, some American citizens have positive attitudes toward birth tourists who travel to their country. To them, American citizens born to foreign parents would become economic and social assets to the United States in adulthood (Stock, 2012). Stock (2009; 2012) observes that this category of citizens has over the years made contributions to the country in the same way as other Americans. They have joined the military, opened prosperous businesses, served in political office, and worked as diplomats. Grant (2015) agrees that American ‘jackpot babies’ who stay behind after their studies can become vital assets to the development of the country. In line with this thinking, some legal scholars, politicians, and immigration experts are against the limitation or elimination of the long-standing American provision of jus soli citizenship because they believe this citizenship principle is the bedrock that the country prides itself on (Schuck, 1998; Stock, 2012). It is also a demonstration of their adherence to the principle of equality for all. On the other hand, there are scholars who have found that this principle is not a reality for all American citizens. There is a denial among some Americans of the citizenship rights in both law and fact for Native Americans, African Americans, and other ethnic or religious minorities in the American society, even if they acquire their citizenship by birth (Schuck, 1998; Aleinikoff, 2001; Castles, 2005). Deducing from the attitudes toward birth tourists to the United States, from the destination country’s perspective, the negative appraisals confirm what Carens (1987) has pointed out, namely that it is common for citizens born in affluent countries like the United States to assume that they are morally entitled to the citizenship of the countries of their birth or countries in which their parents have citizenship. It follows that any potential immigrant from a developing country does not have any right to claim admission into these developed countries beyond an appeal of generosity The Conundrum of Birth Tourism and American ‘Jackpot Babies’ in Ghana 44 AHMR African Human Mobilty Review - Volume 7 No 3, SEP-DEC 2021 (Carens, 1987). Thus, some Americans are demanding strong border control, reforms to the political and legal systems to protect their ‘citizenship privilege’ and to determine how new members can be admitted to their country (Choules, 2006). Choules (2006) describes ‘citizenship privilege’ as the privilege of having citizenship of a safe, stable, and materially affluent country. A distinctive feature of citizenship privilege is that it is acquired through the accident of birth, although it is also possible by naturalization (Aleinikoff, 2001; McIntosh, 2002, cited in Choules, 2006). American citizenship could therefore be regarded as privileged under these circumstances. However, the positive appraisals acknowledge the contribution of US-born children of immigrants (referred to by some as American ‘jackpot babies’) as one of the factors that has led to the United States attaining a superpower status because these immigrants have become economic and social assets to the country (Stock, 2012). THEORY OF PLANNED BEHAVIOR An influential model that used attitude toward behavior as an independent determinant in predicting human social behavior is the theory of planned behavior (Ajzen, 2011; Kor and Mullan, 2011). This theory posits that an individual’s intent to behave in a certain way can be predicted by three independent variables – attitude toward the behavior, subjective norm concerning the behavior, and perceived behavioral control (Kor and Mullan, 2011; Ajzen, 2020). Attitude refers to the person’s overall evaluation of performing a given behavior where the implication is, the more positive the person’s attitude, the more likely he or she will have the intention to perform the behavior (Rise et al., 2010). Also, Nunkoo and Ramkissoon (2010) aver that having a positive attitude toward a behavior is an indication of support while a negative attitude suggests opposition to the said behavior. In this paper, attitudes toward Ghanaian birth tourists who travel to the United States were used to investigate the intention of the country’s urban population to have American ‘jackpot babies’. A frequently cited criticism of this theory is that it is too ‘rational’ and unaffected by emotions (Ajzen, 2011). However, Ajzen (2011) clarifies that behavior can be said to be planned, provided that attitudes toward the behavior follow automatically and consistently from people’s beliefs. It follows that attitudes, intentions, and behaviors are consistent with people’s beliefs even if they are inaccurate, biased, or irrational (Geraerts et al., 2008; Ajzen, 2011). Therefore, affect and emotions can serve as background factors that can influence intention and behavior directly or indirectly (Ajzen, 2011). The investigation of attitude (i.e., personal evaluation) will reveal a different aspect of birth tourism to the United States among the Ghanaian urban population. 45 METHODS Data collection The data pr esented in this paper was extracted from fieldwork conducted by the first author between May 2017 and March 2018, into the intentions and experiences of having American ‘jackpot babies’ among the Ghanaian urban dwellers. The paper uses the term urban dwellers to refer to the Ghanaian urban middle class and adopted the African Development Bank’s (ADB) definition of a middle class. The bank’s representative for Ghana in 2013, Marie-Laure Akin-Olugbade, suggested that everyone who spends the equivalent of $2 to $20 per capita per day has a middle-class status (BBC World Service, 2013; Lentz, 2016). Accordingly, Akin-Olugbade stated that about 46 percent of Ghanaians have a middle-class status. Data was collected from the three most urbanized metropolises located within the most urbanized regions in Ghana – Greater Accra, Ashanti, and Central Regions, using a cross- sectional survey and semi-structured in-depth interviews. The appropriate ethics committee cleared the data collection instruments before use. Accra, Kumasi, and Cape Coast metropolises were thus purposively selected from the sampled regions because of the consistent status of being the most urbanized regions since Ghana’s independence (GSS, 2012; 2013). This method was deemed the most appropriate given that the approach adopted helped to examine the convergence or differences between the attitudes of urban dwellers who were yet to have, and parents who had, American ‘jackpot babies’ toward Ghanaian birth tourists who travel to the United States (Creswell, 2012; Saunders et al., 2012). The researchers developed a survey, using a self-completed questionnaire and took care to sequence the questions so that the responses provided were not biased (McBurney and White, 2010; Saunders et al., 2012). The questionnaire design used a combination of different question types like open-ended, closed-ended, Likert scale, among others. Before the research commenced, the researchers piloted the survey instrument and made minor changes. The researchers opted for a multi- stage sampling procedure, which combined both probability and non-probability techniques to select 400 urban dwellers from a sampling frame of 1,526,433. The sample size was reached with the help of Yamane’s (1967) formula, which considers a 95 percent confidence level and 0.05 level of precision. The questionnaire was administered to urban dwellers with these key variables: aged 18 years and older, literate in English and a Ghanaian language, and have not given birth in the United States. A total of 260 questionnaires were completed, representing a 65 percent response rate. The breakdown of the 260 respondents across the selected study areas was as follows: 115 from the Accra Metropolis, 55 from the Cape Coast Metropolis, and 90 from the Kumasi Metropolis. For the semi-structured in-depth interviews, the researchers recruited parents who are Ghanaian citizens residing in any of the three study areas and who had given birth to American ‘jackpot babies’, through purposive and snowball sampling. The Conundrum of Birth Tourism and American ‘Jackpot Babies’ in Ghana 46 AHMR African Human Mobilty Review - Volume 7 No 3, SEP-DEC 2021 The first author used personal networks to contact the parents, but networks in the Kumasi Metropolis were not able to yield potential interviewees from this city. The initial interviewees were solicited to become de facto research assistants. A de facto assistant is a gatekeeper but also a participant in the study (Biernacki and Waldorf, 1981). Eventually, three de facto assistants recruited six other eligible participants from their social networks to take part in the research. The researchers decided not to recruit any new participants after the 15th interview, as no additional relevant knowledge was obtained (Bailey, 2007; Creswell, 2012; Saunders et al., 2012). Twelve parents in Accra and three parents in Cape Coast were interviewed. The researchers captured the parents’ responses on an audio recorder with their consent and provided assurances of anonymity. Additionally, the researchers took short notes of some key information to allow for further clarification if need be, bearing in mind that the focus of this study is on the parents’ attitudes toward other compatriots who also have American ‘jackpot babies’. The researchers conducted the interviews in English; these lasted between 30 and ninety minutes each. Locations for the interviews were at the parents’ discretion and they chose a variety of locations (i.e., car, homes, and offices). Data analysis The researchers analyzed the data from the survey, using SPSS version 20 and Stata 14.1. The major analyses performed were univariate, bivariate, and logistic regression modeling. The results of the univariate analysis described the socio- demographic characteristics (i.e., age, sex, education, employment, marital status) of the respondents, which are presented first. The results of the logistic regression modeling follow next, which assess the strength of the cause-and-effect relationship between the independent variables, some intermediate variables (not discussed within this paper), and the intentions to have an American ‘jackpot baby’ as the dependent variable (Saunders et al., 2012). The researchers used the urban dwellers’ responses to the question about the attitudes toward Ghanaian birth tourists to the United States to determine the intentions. They also tested all associations at a 95 percent confidence level, using the SPSS and Stata. The researchers then transcribed the audio information from the interviews verbatim into text. Each transcript was then either emailed or hand-delivered to the parents by the first author to read through to ensure their responses were correctly represented and not modified to suit the researcher’s agenda and knowledge (Tong et al., 2007). The research team analyzed the qualitative data obtained using a thematic analysis approach (Braun and Clarke, 2012). This process involved the research team manually developing themes from the transcripts and responses to the open-ended questions on the questionnaires about the attitudes toward Ghanaian birth tourists to the United States, which dictated the discussion (Creswell, 2012). Some of the direct quotes from the survey and transcribed interviews also provided the ‘spice’ for the discussion of the findings within this study (Blumberg et al., 2011). The inclusion of 47 quotations from different parents ensured the transparency and trustworthiness of the findings and interpretations made (Bailey, 2007; Tong et al., 2007). The research team protected the identities of parents by using pseudonyms. The findings are discussed in the succeeding sections. RESULTS AND DISCUSSION Profile of the Ghanaian urban dwellers Over half (51.5%) of the respondents of the survey were females and a little over 7 out of every 10 (72.3%) urban dwellers sampled were between the ages of 20-34 years. Table 1 below illustrates the key socio-demographic characteristics of urban dwellers who were yet to have American ‘jackpot babies’. Out of the overall sample, two-thirds (63.5%) of the respondents were never married whereas about 36.5 percent were ever married. The ever-married category includes currently married (33.1%), informal or consensual union (1.5%), widowed (0.8%), separated (0.7%), and 0.4 per cent were divorced. For the entire sample, 68.8 percent were in salaried or wage employment. Most of the respondents in salaried or wage employment were professionals in academia, administration, banking, health, civil and public service. However, less than a quarter (23.5%) were students, who reflect the social dynamics within the three metropolises, such as being hosts to tertiary institutions (e.g., universities, nursing training schools, among others). Table 1 also shows that most of the respondents (91.1%) had tertiary or higher education, with the majority indicating that they have an undergraduate degree. The target population for this study was urban middle- class Ghanaians who naturally have a higher propensity to have a good education. Additionally, the selected metropolises are popular destinations for Ghanaians who move from rural areas to the cities for better opportunities such as tertiary education and jobs (GSS, 2013; 2014). The parents interviewed were aged from the mid-30s to the late-60s and only three were fathers. Regarding the marital status, there were eight married women, two marital dyads, one divorcee, one husband, and one single woman. The highest education qualification for five of the parents was a doctorate; six had master’s degrees, three had bachelor’s degrees, one had a diploma, and one was a doctoral student. Most of the parents were in salaried or wage employment but two mothers were unemployed. Those who were employed, were in the following professions: academia, banking, civil service, horticulture, marketing, nursing, and teaching. One mother was a lawyer in addition to working in the public service. The sampled parents had a total of 25 American ‘jackpot babies’, whose ages ranged from below 1 year to 32 years. Out of this number, only two were 18 years and above, 13 were males while the rest were females. Thus, each parent had at least one American ‘jackpot baby’, with the maximum being three American ‘jackpot babies’. The Conundrum of Birth Tourism and American ‘Jackpot Babies’ in Ghana 48 AHMR African Human Mobilty Review - Volume 7 No 3, SEP-DEC 2021 Table 1: Socio-demographic characteristics of urban dwellers yet to have American ‘jackpot babies’ Source: Field data, 2018 1 JHS: Junior High School 2 SHS: Senior High School 3 VOC: Vocational 4 Tertiary: Bachelor’s Degree The research study found that both sample sets of Ghanaian urban dwellers have a few similarities. The majority of the respondents were females, of a youthful age, well- educated, and economically active professionals. The diverse formal occupations of the parents were an indication of having the required motility to give birth in the United States (Kaufmann, 2014). Conversely, there was a noticeable difference in the marital status where most of the respondents of the survey were never married compared to the interviewees who were married. This finding confirms what the Ghana Statistical Service (GSS) observed in 2015 – that Ghanaians who partake in international tourism are usually married. Most of the American ‘jackpot babies’ born to the parents were males below the age of 18 years. Variables Frequency Percentage Sex Female 134 51.5 Male 126 48.5 Age (years) <20 22 8.5 20-34 188 72.3 35-49 44 16.9 50+ 6 2.3 Educational attainment JHS 3 1.2 SHS/VOC/TECH 20 7.7 Tertiary/Higher 237 91.1 Marital status Never married 165 63.5 Ever married 95 36.5 Type of employment Salary/wage employee 179 68.8 Self-employed 14 5.4 Student 61 23.5 Other 6 2.3 Total 260 100.0 49 Attitudes toward Ghanaian women who have American ‘jackpot babies’ Attitude is a function of an individual’s belief that performing a given behavior will result in certain outcomes, either positive or negative (Coleman et al., 2011). Ajzen (2020) similarly describes belief as a person’s subjective probability in performing behavior of interest that results in a certain outcome. This study categorized the most frequent recurring responses regarding attitudes into favorable, unfavorable, and neutral (see Table 2). Table 2: Attitudes towards Ghanaian women who have American ‘jackpot babies’ Source: Field data, 2018 Favorable evaluation Two central themes ran through the favorable appraisal: a strategy to secure a better future for children (34.6%); and the acquisition of American citizenship to gain access to its associated benefits (24.2%). Some of the respondents to the survey and most of the interviewees held the belief that giving birth in the United States is a good strategy, driven by parental instinct to guarantee a better future or opportunities for unborn children (Sundari, 2005; Pine, 2014). This could be achieved when the children migrate to the United States in adulthood. This appraisal revealed that parents viewed the travel to the United States to give birth as an exhibition of faith and hope that future migration of the US-born persons to their country of birth will enhance life chances (Pine, 2014). Yet, a father of a US-born child disagreed with this view. He substantiated his objection by comparing the social dynamics within Ghana and the United States. To him, Ghana is far better than the United States: What is a better future? Have you seen the statistics on crime in the United States? Your skin might not help you if they are looking for anybody who is black, and you are at the wrong place at the wrong time. Didn’t you see the Attitude Frequency Percentage Favorable evaluation A strategy to secure a better future for children 90 34.6 American citizenship & its as- sociated benefits 63 24.2 Unfavorable evaluation Disapproval 46 17.7 Lack of patriotism & confi- dence in Ghana 33 12.7 Neutral evaluation Indifference & personal choice 28 10.8 Total 260 100.0 The Conundrum of Birth Tourism and American ‘Jackpot Babies’ in Ghana 50 AHMR African Human Mobilty Review - Volume 7 No 3, SEP-DEC 2021 bombings? So, if you are in here [Ghana] and there is no crisis; why will you have a reason to go over there [the United States]? (Kingsley, 67 years, Accra). The above quote alludes to how an American citizen’s race might endanger his or her life in the United States. Accordingly, some scholars have acknowledged that not every American citizen would be entitled to full and equal rights. This is more so for US-born children of undocumented parents. Castles (2005), for instance, argues that Native Americans, African Americans, other ethnic or religious minorities encounter challenges in successfully claiming rights as American citizens. Although the legal rights and obligations of American citizens are formally equal, there is a denial of rights in law and fact for American citizens from minority groups (Schuck, 1998; Aleinikoff, 2001). Thus, Aleinikoff (2001) asserts that the representation of American citizenship as a magic circle that entitles those within it to full and equal rights is misleading and worrisome. The northern hemisphere summer of 2020 was characterized by heightened racial tension with attendant anti-racism protests in the United States and around the world. These protests, following the killing of George Floyd on 25 May 2020, demanded justice for minority groups (BBC, 2020b). Floyd died as a white police officer knelt on his neck for almost nine minutes. The recent past has seen the frequent shooting incidents of unarmed African Americans and Africans by the police and other citizens and the subsequent acquittal of the perpetrators of these crimes. Resultantly, civil rights movements like the “Black Lives Matter” movement have been holding protests within and outside the United States since its inception in 2013 to demand equality, access to basic human rights, and dignity for the victims and minority groups. These exceptions in claiming equal rights as American citizens confirm the existence of differentiated citizenship within the American society (Castles, 2005). The second theme confirmed the perception that certain rights and benefits are conferred on individuals based on their birthplace (Pessar and Mahler, 2003; Shachar and Hirschl, 2007). Therefore, according to the urban dwellers, Ghanaian birth tourists evaluate what the citizenship status of the two countries offers their offspring. They arrive at the conclusion that American citizenship is more beneficial because of the assurances of certain rights and benefits that Ghanaian citizenship does not guarantee (Castles, 2005; Choules, 2006). Some of the benefits and rights enumerated, included: prestige attached to being an American citizen; a passport that allows the holder to travel without any hindrances; and access to a good education. Most of the female respondents were of the view that giving birth in the United States paves the way for their offspring to have undeniable access to those privileges. Comfort’s response underscores this position: I did that purposely for him to take advantage of the American educational system. America has one of the best educational systems and also boosts confidence in a human being. I realized that here [Ghana] they make us 51 [Ghanaians] very timid. A blend of Ghana’s timidity and America’s confidence was what I wanted for my son (Comfort, 52 years, Accra). The favorable evaluation confirmed the assertion by Coleman et al. (2011) that individuals holding a positive attitude toward a given behavior, believe that executing this behavior (i.e., having an American ‘jackpot baby’) will lead to the desired outcomes for the parents, children, and families. Unfavorable evaluation Conversely, about a third (30.4%) of the urban dwellers were not enthused that their female compatriots were traveling purposely to have so-called American ‘jackpot babies’ because this behavior is associated with undesirable consequences. The two dominant themes identified under the unfavorable appraisal were disapproval (17.7%) and lack of patriotism and confidence in Ghana (12.7%). Some of the negative appraisals were, however, described and expressed in strong language, that included: ‘cheats’; ‘illiterates’; ‘ignorant’; ‘opportunist’; ‘repugnant’; ‘disrespectful’; and an ‘act of betraying our national identity’. Bianchi and Stephenson (2013) maintain that historically, citizenship has been closely associated with national identity. This category of urban dwellers believes that the travels to the United States to have offspring with an American identity convey the message that Ghanaian identity is not valued (Shils, 1995). Smith (1991) and Lewin-Epstein and Levanon (2005) explain that national identity together with nationality help individuals to define who they are and provide them with a sense of purpose through the prism of collective personality and its distinctive culture. One of the female respondents initially agreed with these sentiments but later offered a justification for why birth tourists like her made a decision to give birth in the United States: Yeah, many of us are not proud to be Ghanaians. That is the sad truth. There is no reason to sugar-coat this because many of us [Ghanaians] are trying to get out of the country [Ghana]. But we are afraid for our children. For example, we cannot trust our educational system. So, I think for many of us [parents], we are trying to get the best for our children. In spite of how patriotic we are, the bottom line is that we want what is best for our children (Thelma, 40 years, Cape Coast). Her narrative suggests that a secure citizenship status in a country is a crucial factor in determining an individual’s life chances. Access to privileged citizenship, therefore, perpetuates global inequality (Shachar and Hirschl, 2007; Shachar, 2009; Balta and Altan-Olcay, 2016). Shachar and Hirschl (2007) argue that a child born in a developed country would have far better living conditions than a child born in a developing country. Moreover, citizens born in developed countries are described as having the ‘right’ citizenship because they are more likely to enjoy better life opportunities, social The Conundrum of Birth Tourism and American ‘Jackpot Babies’ in Ghana 52 AHMR African Human Mobilty Review - Volume 7 No 3, SEP-DEC 2021 conditions, and freedoms compared to the citizens who have the ‘wrong’ citizenship from the developing countries who are likely to be poor, suffer starvation and disease, and die younger (Shachar, 2009; Orgad, 2011). Additionally, citizenship in Western liberal democracies has been described as the modern equivalent of feudal privilege – an inherited status that greatly enhances one’s life chances (Carens, 1987; Shachar and Hirschl, 2007). Neutral evaluation The last sentence from Thelma’s quote above supports the viewpoint of about 10.8 percent of the urban dwellers who participated in the survey, who had an indifferent attitude toward Ghanaian birth tourists to the United States. They believed that having an American ‘jackpot baby’ is a personal choice and the right of anyone to decide where to give birth and what is appropriate for their unborn children. Thus, the analyses on attitudes indicate that most of the urban dwellers who participated in this study had a favorable evaluation and an indication of strong intentions to have American ‘jackpot babies’, especially for those who were yet to have one (Ajzen, 2020). Coleman et al. (2011) describe intention as the best predictor of behavior. Moreover, a positive attitude suggests support for birth tourism to the United States (Andriotis, 2005; Nunkoo and Ramkissoon, 2010). Aside from this indication, Ajzen (2020) contends that intentions are dynamic because of access to new information, and people rarely act on their intentions. Furthermore, a favorable attitude at least discloses the motivations of those who are yet to have, and those who have had American ‘jackpot babies’ (Ajzen, 2020). Apart from the favorable and unfavorable evaluation that the theory of planned behavior indicated that people would express toward a given behavior, this research study established that there is also a neutral evaluation. Subsequently, a binary regression model was used to analyze attitudes toward Ghanaian birth tourists to the United States and other factors to determine the intentions of Ghanaian urban dwellers to have an American ‘jackpot baby’ (see Table 3). The model established that 35.4 percent of the intentions to have an American ‘jackpot baby’ are explained by the socio-demographic conditions of the respondents. Thus, 64.6 percent of the intentions to have an American ‘jackpot baby’ are not explained by other factors not considered in the larger study. The only significant predictor variable in the model was the attitudes toward Ghanaian birth tourists to the United States. All the other socio-demographic variables were not significant predictors of intentions to have an American ‘jackpot baby’. Nonetheless, the effect of attitudes toward Ghanaian birth tourists to the United States on intentions to have an American ‘jackpot baby’ was negative. The various attitudes exhibited by the sampled population toward Ghanaian birth tourists to the United States were less likely to influence urban dwellers’ intentions to participate in birth tourism to the United States compared to those who have the attitude that having an American ‘jackpot baby’ is a strategy to secure a better future for children. 53 Table 3: Logistic regession on factors determining the intentions to have an American 'jackpot baby' Variables Socio-demographic characteristics Coef. Std. Err. Odds Ratio P>z Confidence Interval Sex Male (RC) Female -0.300 0.432 0.741 0.487 -1.146 0.546 Age (years) <20 (RC) 20 - 34 0.209 0.980 1.232 0.832 -1.713 2.130 35 - 49 0.087 1.200 1.091 0.942 -2.264 2.439 50+ years -0.380 1.401 0.684 0.786 -3.126 2.366 Education attainment JHS/SHS/VOC/Tech (RC) Tertiary/Higher 0.899 0.795 2.458 0.258 -0.660 2.458 Residence KMA (RC) Cape Coast -0.116 0.813 0.891 0.887 -1.708 1.477 AMA 0.040 0.526 1.041 0.939 -0.990 1.071 Type of employment Salary/wage employee (RC) Self employed -0.292 0.648 0.747 0.652 -1.562 0.978 Student 0.819 0.749 2.267 0.275 -0.650 2.287 Other 0.798 3.122 2.220 0.798 -5.322 6.917 Ethnicity Akan (RC) Ga-Dangme -0.389 0.599 0.678 0.516 -1.562 0.785 Ewe -0.421 0.614 0.656 0.493 -1.625 0.782 Other -0.276 0.819 0.759 0.736 -1.881 1.330 Marital status Never married (RC) Ever married 0.013 0.572 1.013 0.981 -1.108 1.135 Determinants of the intentions to have an American ‘jackpot baby' Awareness of Ghanaian women participation in birth tourism to the United States Yes (RC) No -0.902 0.828 0.406 0.276 -2.524 0.721 Know a Ghanaian birth tourist to the United States Yes (RC) No -0.715 0.425 0.489 0.093 -1.549 0.119 The Conundrum of Birth Tourism and American ‘Jackpot Babies’ in Ghana 54 AHMR African Human Mobilty Review - Volume 7 No 3, SEP-DEC 2021 Source: Field data, 2018. RC: Reference category As seen in Table 3, respondents who had the attitude that having an American ‘jackpot baby’ is proof of the lack of patriotism and confidence in Ghana, are 0.035 times less likely to have the intentions of having an American ‘jackpot baby’ compared with those who think it is a strategy to secure a better future for children. Also, the respondents who disapproved of the idea of having an American ‘jackpot baby’ were 0.018 times less likely to have the intentions to have an American ‘jackpot baby’ compared with those who thought it is a strategy to secure a better future for children. Moreover, respondents who had an indifferent view or belief that having an American ‘jackpot baby’ is an individual choice, were also less likely to have the intentions to have an American ‘jackpot baby’ compared with those who thought it is a strategy to secure a better future for children. This study thus concludes that compared to having the attitude that giving birth in the United States is a strategy to secure a better future for children, urban dwellers at the three metropolises are less likely to have the intentions to have an American ‘jackpot baby’. CONCLUSION The purpose of this paper is to build an understanding of a complex and multifaceted phenomenon – birth tourism to the United States – by investigating the attitudes of Ghana’s urban population toward Ghanaian parents who have US-born babies. This paper has established that there is a favorable attitude toward Ghanaian birth tourists who give birth in the United States, and this represented almost 59 percent of the survey participants. The positive appraisal spelled out the motivations that would induce an urban dweller in Ghana to give birth in the United States and prompt another to follow suit. The binary regression model also revealed that 35 percent of the intentions are explained by the socio-demographic characteristics of urban dwellers. The attitudes toward Ghanaian birth tourists to the United States constitute Attitudes towards Ghanaian birth tourists to the United States A strategy to a better future for children (RC) US citizenship & its benefits -0.328 0.633 0.721* 0.605 -1.568 0.913 Disapproval -4.004 0.710 0.018* 0.001* -5.395 -2.613 Lack of patriotism & confidence -3.340 0.722 0.035* 0.001* -4.756 -1.924 Indifference & personal choice -1.971 0.611 0.139* 0.001* -3.168 -0.774 Amend American jus soli Yes (RC) No 0.180 0.434 1.198 0.678 -0.671 1.031 Constant 1.600 1.149 0.164 -0.652 3.853 Pseudo R2 0.354* 55 the only significant predictor variable in the model but its effect on the intentions to have an American ‘jackpot baby’ is negative. This result disproves some scholars’ assumption that an attitude toward a given behavior is a sufficient predictor of one’s intention to perform a given behavior in relation to birth tourism to the United States, within the Ghanaian context. However, this study recognizes that a missing independent variable in the model could be income. Income could have become a natural predictor in the model since having American ‘jackpot babies’ is a capital- intensive endeavor. Nonetheless, the educational qualifications and the types of employment of respondents to the survey and interviewees, indirectly allude to the income levels. Despite the results from the logistic regression model, this paper has provided a deeper insight into the intentions of having so-called American ‘jackpot babies’ among urban dwellers in a developing country context. That is, the global inequality in the acquisition of citizenship is the primary motivating factor that would drive some Ghanaian urban dwellers to act ‘rationally’ by using international tourism as a means to acquire the ‘right’ citizenship from the United States for their offspring. They see American citizenship as a privileged and opportunity-enhancing tool to obtain for the benefit of their children and families (Choules, 2006; Shachar and Hirschl, 2007). Another strength of this paper is that a neutral evaluation should be taken into consideration in addition to the favorable and unfavorable evaluation that the theory of planned behavior had indicated as criteria in evaluating attitude as an independent determinant of intention to perform a given behavior. Ultimately, a reasonable approach to tackle global inequality perpetuated by hierarchical citizenship leading to the desire to have a so-called American ‘jackpot baby’ is to ensure each country’s citizenship functions as an opportunity-enhancing tool. ACKNOWLEDGMENTS The authors extend special thanks to all the gatekeepers and the participants of the study who formed the basis for this study. The authors also wish to thank Benjamin Kobina Kwansa, Mumuni Abu and Seidu Amenyaglo for their support. DISCLOSURE STATEMENT The authors have no potential conflict of interest to report. FUNDING This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The Conundrum of Birth Tourism and American ‘Jackpot Babies’ in Ghana 56 AHMR African Human Mobilty Review - Volume 7 No 3, SEP-DEC 2021 REFERENCES Ajzen, I. 2011. The theory of planned behaviour: Reactions and reflections. Psychology and Health, 26(9): 1113-1127. 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