Midori Nishida thought she knew what to expect when flying from Hong Kong to Saipan, an island in the Northern Mariana Islands where she grew up. Then, as she was heading to visit her parents on the island, came the curveball.

Before the flight in November, after filling out a familiar questionnaire that included a question about pregnancy, a representative for Hong Kong Express Airways (also called HK Express) told the 25-year-old that she had been chosen for a random “fit-to-fly” assessment, she says.

She received a medical authorization form and realized the assessment included a pregnancy test ― an apparent effort on the airline’s part to combat birth tourism in the destination, a U.S. commonwealth that doesn’t require a visa for visitors from China and several other countries. Babies born in the Northern Mariana Islands are eligible for U.S. citizenship at birth.

The form indicated there was suspicion about her health, because workers thought she resembled a pregnant woman. Nishida, who was not pregnant, said her reaction was “mostly confusion, because I had never encountered this kind of situation before.”

An employee took her to a bathroom, gave her the test’s strip and told her to go in the stall and use it, she says.

“I wanted to make sure that this was really mandatory, so I asked them, ‘Do I really have to take this test, is this necessary?’ ” said Nishida, a Japanese citizen, in an interview Tuesday. “They said, ‘You can opt out for the test,’ but that means they would deny me boarding the flight. I felt like my hands were tied, so I had no choice.”

She wrote about the experience for the Saipan Tribune that same month. Nishida, who lives in Tokyo, called the ordeal “discriminatory” and “very offensive.”

“I don’t know how they came up with such a policy to address the issue of curbing birth tourism in Saipan,” she said.

Hong Kong Express said in a statement that it had suspended the practice and apologized “for the distress caused.”

“In response to concerns raised by authorities in Saipan, we took actions on flights to Saipan from February 2019 to help ensure U.S. immigration laws were not being undermined,” Hong Kong Express, which was acquired in July by Cathay Pacific, said in a statement. “Under our new management, we recognize the significant concerns this practice has caused.”

In a 2017 report, the Wall Street Journal described Saipan in a headline as “the island where Chinese mothers deliver American babies.” And in 2013, USA Today reported that the United States was telling Chinese travel agencies to stop letting women go to the islands to give birth.

According to the commonwealth’s government data, there have been 3,023 live births by Chinese tourists in the Northern Mariana Islands since 2009. Last year, tourists — the vast majority of them Chinese — gave birth to 582 babies; residents delivered 492.

Pregnant women are allowed to enter the United States, even to give birth, according to U.S. Customs and Border Protection spokesman Jaime Ruiz. But there are stipulations.

“To the extent that an individual is entering with the intent to remain beyond the time period allotted by her visa or to have her childbirth costs paid for by public dollars, this would render an applicant inadmissible,” Ruiz said in an email.

Temporary visitors must not give up their foreign residence, must intend to return and must be able to pay for that trip back as well as all costs in the United States, he said. And anyone “using fraud or deception” to enter the States would be committing a criminal act.

The agency has not asked airlines that fly to the Northern Mariana Islands to take measures like asking for a pregnancy test.

But birth tourism has been “a growing concern” for both law enforcement and medical providers over the last several years. Officials have raised the issue with “local and international tourism partners, stakeholders, and airline partners as a recommendation to protect the health of passengers and our overall tourism industry from potential overstayers,” Kevin Bautista, press secretary for the office of the commonwealth’s governor, said in a statement.

He said local authorities have consulted with the Obama and Trump administrations, the Department of Homeland Security and other federal authorities about the issue. In October, CBP said Chinese visitors to the Northern Marianas without a visa would be limited to a maximum 14-day stay, compared with 45 days before.

“Those discussions were fruitful in achieving greater collaboration to effectively enforce our borders, while making sure our tourism industry remains viable,” Bautista said in the statement. “Birth tourism poses health risks for mothers and their children, and it hurts our reputation as a tourism destination.”

Still, the statement called Nishida’s experience with Hong Kong Express “very unfortunate.”

“We do hope that any airline’s policy, regardless of what it is, prioritizes the privacy and safety of the passenger,” Bautista said.

Nishida says she eventually got an apology from the airline but only after the Wall Street Journal started asking questions for a report published last week.

“They just told me that they were doing this as a response to immigration concerns to the U.S. and that they have decided to discontinue the policy after reviewing it,” she says.

She thinks they could have handled her situation more professionally but says she is relieved no one else will be subjected to the same treatment.

“I think there’s definitely room for improvement, but they did acknowledge that this was a bad policy, and they discontinued that,” she says. “So I’m satisfied to hear that this won’t be a concern for other future passengers.”

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