On a sticky summer’s day in July, a blue-and-white handbag stuffed with cash was shoved into Melanie’s* hands.

It had been given to her by a 36-year-old Chinese woman as she was rushed into surgery for a C-section.

Melanie had been called to the main hospital on the remote island of Saipan to translate for the woman, who had travelled alone from China to give birth in the US territory, automatically giving her baby US citizenship.

“She told me she came for the US passport,” Melanie said. “She said, ‘I don’t have too much money, but I want to give my kids two choices: China or another country. The US passport gives me two countries.’”

Melanie speaks both English and Chinese, a skill that has become increasingly vital on Saipan as translators help pregnant Chinese women to navigate the island’s one hospital and tiny clinics. view of Saipan, with the Imperial Palace Resort Hotel & Casino in the distance, the tallest structure on the island Credit: Peter Blakely for The Telegraph

The network of translators – some of whom are freelancers and some of whom work for birth tourism companies – has become part of the birth tourism economy.

“In China, most cities are very poor, so they don’t want to stay there,” Melanie explained. “If they can’t get to the US, then they come to Saipan.”

Melanie said she would prefer not to reveal the name of the woman or her baby. That is not unusual.

Melanie doesn’t work for a birth tourism company, but the hospital often calls her in to act on new mothers’ behalf.

Many of the women who come to Saipan specifically to give birth to American children are reluctant to discuss what they are doing, wary of drawing attention to a practice that has become increasingly controversial on the tiny Pacific island, and that Donald Trump is at pains to outlaw.

On Aug 6, the US president signed an executive order declaring his intention to end birth tourism.

Travelling to the US explicitly to give birth, thus gaining automatic citizenship for your child, is an exploitative practice, Mr Trump said, adding that “American citizenship embodies a sacred bond between the American people and their nation”.

“Under Secretary Rubio’s leadership, the department of state is taking action around the world to stop this abuse, dismantle birth tourism networks, and hold accountable those who try to scam our system,” a state department spokesman said.

Although it is a 30-hour flight away, Saipan has been a US territory since 1986.

Despite being only 5 miles wide, with a population of just 50,000 and almost no economy to speak of, the island occupies one of the most militarily and geographically significant positions in East Asia.

Some 1,700 miles away from Taiwan, 1,800 miles from China and 1,400 miles from Japan, it is the US front line of Western democracy in East Asia, and an hour’s plane journey from Guam – where the US has established a major military base.

Saipan’s unique geographical position meant that it played a key role in ending the Second World War. In 1944, the US captured the island from Japanese soldiers.A US coast guard manning his machine gun in Saipan whilst wearing a Japanese silk kimono, during the Pacific Campaign of World War Two Credit: US Coast Guard/Getty Images

Its neighbouring island, Tinian, became the site from which Hiroshima was bombed owing to its proximity to Japan.

But what was once considered a useful US outpost in the East has become a potential point of risk thanks to unique visa regulations which, unlike anywhere else in the United States – or indeed the West – allow Chinese tourists to visit the country virtually visa-free.

Now, experts are worried that Saipan is being exploited as an easy route into the US, that birth tourism has enabled the Chinese government to breed spies with American passports, and, perhaps most alarmingly, that the island may be subject to a Chinese soft-power campaign that could leave the US vulnerable to attack.

On the muggy day in July that Melanie rushed to the hospital, the Chinese woman she was translating for told her she had saved up for more than five years to have her baby in Saipan.

The handbag she was given was stuffed with cash and a credit card to pay for the birth.

The woman had come alone and had no one to hold it while she went in for the C-section. She gave birth to a son.

“She didn’t look rich, only regular,” Melanie said. “She said she would pay for everything. She had enough money, and then she could get a birth certificate and the baby’s passport.”

In total, Melanie has translated for four Chinese mothers who gave birth to American babies on Saipan this year alone, but she believes there are more than 10 translators who do the same job on the island.

There are suggestions that the same practices could be happening on the nearby island of Guam too, but stricter visa rules there make it less common.

The run-down island of Saipan was once the heart of garment making, where brands could employ cheap Chinese workers but keep “made in the USA” labels in their clothes.

However, the island has fallen into disrepair, and its economy has all but disappeared following a series of sweatshop scandals in the late 1990s and early 2000s, and the loss of its preferential access to the US market in 2005.Saipan has struggled economically since its garment industry collapsed in the early 2000s Credit: Salwan Georges/The Washington Post

Across the island, paint peels from the walls of squat blocks of flats and shops that stand crumbling against the backdrop of the sparkling blue ocean.

Birth tourism began on Saipan in 2009 after the island’s economy was wiped out.

Chinese tourists were deemed to be a major cash cow for the island’s flailing economy and, under the Obama administration, were allowed into the territory for up to 45 days without a visa.

At its height in 2018, 581 babies were born as a result of “birth tourism”, making up 46 per cent of the total births, according to numbers released by the Commonwealth Health Corporation, the only hospital on the island.

The visa limit was capped at 14 days in 2024 in an effort to reduce birth tourism, but pregnant tourists continue to travel to the island, data show.

In 2024, 58 births were attributed to residents classified as tourists, making up 10 per cent of the total births. Last year, almost 50 women visited Saipan as tourists to give birth, accounting for 8 per cent of the total number of babies born across the island that year.

Mr Trump has faced hurdles in trying to crack down on the practice on the US mainland – in which he claims migrants travel illegally to the States and start families – let alone overseas.