HONG KONG & SHENZHEN, China – Anchor babies. Birth tourism. Cross-border births.

It’s a growing global phenomenon driven by Chinese with wherewithal and wealth.  Chinese from a China that – even as it continues to grow and open up to the rest of the world – still faces a restrictive enough present and an uncertain enough future that they choose to give birth outside of China.

Some do it to avoid the one-child policy.  Many do so for the benefits the child will receive as a citizen of the country into which it’s born: free or better education, the freedom to travel, good social services, a safe haven.

The United States is overwhelmingly the most popular destination for wealthy Chinese, a phenomenon covered by NBC News.

But a close second is Hong Kong, the tiny former British colony of 7 million people.

Since its return to Beijing’s oversight  in 1997, and as China has made it easier for its people to travel, tens of thousands of mainlanders regularly head over the border to book up maternity wards at Hong Kong’s good quality and affordable public hospitals.

Of the 88,000 births in Hong Kong in 2010, roughly 45 percent were delivered by mainland Chinese women, according to Hong Kong's government.

The growing number of cross-border births isn’t just straining health care resources and the local population’s goodwill.  It’s also helped to provoke an identity crisis that 15 years after the handover has alienated local residents from their northern neighbors.

A business catering to pregnant mainlanders
For four years, Gordon Li has been running a business from Shenzhen, southern China, arranging travel to Hong Kong for pregnant mainland Chinese women. 

Adrienne Mong/File

Many Hong Kong locals believe their quality of life is being eroded by mainland China---including the air.

(*Gordon Li is not his real name; he did not want to divulge his identity.  Just last week, another agent from mainland China pleaded guilty to breaching Hong Kong immigration laws for helping mainland women give birth in the city.  It was Hong Kong’s first prosecution of its kind and, given the current mood, may not be the last.)

“We work like a travel agency [and] the fee depends on the client –whether they want to stay in a luxury hotel or a small hotel, etc.,” said Li, who charges his clients between a few thousand yuan and 20,000 yuan ($3,200) to navigate the system.  Most of his customers are from the mainland’s wealthiest regions like Guangdong, Zhejiang, Beijing, and Shanghai.

Li estimates that he has helped at least a few hundred mainland women to have babies in Hong Kong.  “Last year was the most,” he said. 

His early clients were trying to get around the mainland’s strict one-child policy, but today most of his new customers travel to Hong Kong because, Li says, there are “a lot of conveniences.”

The public health system in freewheeling capitalist Hong Kong is considered better and safer than it is in its communist neighbor.  Maternal mortality ratio statistics collected by organizations like the World Health Organization support Hong Kong’s reputation for good quality health care for mothers and newborn babies.

Bo Gu

Every day, more than 10,000 students who live in mainland China cross the border to go to school in Hong Kong.

Other benefits for newborns include being automatically eligible for “the right of abode” in Hong Kong, which means becoming permanent residents.  Which in turn means unfettered access to free public education considered superior to that in the mainland; political freedoms; and ease of travel anywhere in the world.

And they are entitled to all of this without giving up their China citizenship.

In fact, more than 10,000 mainland Chinese children who were born in Hong Kong, but live in China, go across the border every day to attend school in the former British colony.

Hong Kong is fed up
Huang Lijuan is a 27-year-old kindergarten teacher from Guangdong Province.  She and her husband, Tsing Ho Nan, a 32-year-old engineer from Hong Kong, met in Shenzhen and moved to Hong Kong after getting married.

“I’m three months pregnant, and the due date is August 5,” Huang told NBC News one afternoon in a community center in Tsuen Wan, Hong Kong.  “But I haven’t been able to book a hospital bed in a maternity ward.  All of the public hospitals are fully booked.”

“There are 80 to 100 [mainland women married to Hong Kong men living here] who are pregnant, but they failed to book any hospitals to deliver their babies,” said Koon Wing Tsang, an organizer with the Mainland-Hong Kong Families Rights Association.  Like Huang, they are all casualties of recent restrictions on non-local women.

Under popular pressure, the Health Authority (HA) in Hong Kong has instituted quotas for non-local residents.  Currently, only 3,400 births by non-local women are permitted at public hospitals this year – down from 10,000 in 2011.  Private hospitals are allowed 31,000 births by non-local women.

“The government and the HA are committed to ensuring that local pregnant women will be given priority in the use of the services over non-Hong Kong residents (non-eligible persons, NEPs),” said a Health Authority spokesman in a written response to NBC News requests for an interview.

But even the new quotas may not be enough.  As Huang found out, all the maternity wards in Hong Kong’s public hospitals – and many private clinics – are fully booked until September. 

Moreover, the quotas don’t prevent mainland women from using the emergency wards as a last resort.  More than 1,600 such births last year were delivered in Hong Kong’s emergency rooms – an unnecessary medical risk since such wards are not equipped or staffed properly for deliveries.

Some Hong Kong government officials have raised the possibility of an outright ban on mainland Chinese women giving birth in the city, but critics have argued enforcement is problematic. 

Others have suggested ending the practice of granting automatic permanent residency status to babies born to non-local parents.  To do so, according to legal experts as well as Hong Kong’s Chief Executive Donald Tsang, would mean having to reinterpret the Basic Law – the territory’s mini-constitution. 

Any such action would require consultations with Beijing, which could prove to be a political minefield for Hong Kong, which prides itself on its Western-style democratic values.

China to ban names that signal 'orphan' status

'Locusts' & 'running dogs'
Adding fuel to the fire is a recent series of tense confrontations between local and mainland residents.

Last month, Hong Kong citizens were outraged over a report that a Dolce & Gabbana boutique had banned local shoppers from taking photographs of its shop, but allowed mainland Chinese tourists and other visitors to snap away.  A Facebook campaign days later galvanized more than a thousand people to protest outside the shop, forcing it to shut early.

Barely a week later, a heated dispute broke out on the Hong Kong subway when a mainland Chinese child was asked to stop eating on the train – a practice banned in the territory.  The argument between locals and mainlanders was captured by a cell phone camera, and the video went viral on the Internet.

Tensions were further inflamed by comments from a Peking University professor, who when shown the video of the subway dispute, called the territory’s residents “running dogs of the British imperialists.”

This month, a group of concerned Hong Kong citizens bought a full-page ad in a popular mainstream Chinese-language Hong Kong daily newspaper that called mainland visitors “locusts.”  The term refers to the large numbers overrunning the territory to consume all its resources.

A “locust” song even made the rounds on the Internet, with spiteful lyrics poking fun at mainland Chinese, and inspiring at least one group of young Hong Kong men to roam around singing the song at visiting mainland Chinese.

An identity crisis
“I think the real reason that Hong Kong people are upset is because they feel helpless politically,” said Wen Yunchao, a mainland blogger and activist now living in the territory.  “The rules they believe in are being broken by all these mainland visitors, and yet they still have to rely on China economically.”

Dr. Elaine Chan at the Center of Civil Society and Governance at Hong Kong University agrees the tension is “a manifestation of something deeper.”

“Hong Kong people do not have a very positive view of mainlanders,” she said.  “Not just because they are buying properties and not just because they are buying all the luxury goods.  But also because of how they carry themselves.”

Both Wen and Chan argue there’s an underlying sensitivity to and awareness of the fact that Hong Kong is bound up with China –culturally, historically, politically, and economically – and yet there remains a gap in fundamental values between the two: in terms of the rule of law or basic civility.  That tension makes some people in the territory uncomfortable.

For now, Beijing has remained silent at least on the cross-border births issue, although authorities in neighboring Guangdong province have promised to find a solution.

But another hot-button topic may soon eclipse that of birth tourism.  The main topic of conversation last week was a government proposal to open up the border to mainland Chinese drivers and their vehicles.  Concern over road safety issues is so great in Hong Kong that an online petition has already gathered 7,000 signatures.

With additional reporting by Bo Gu.