NEW YORK—Dark circles formed like warning signs beneath Yu Fen Wang’s eyes as she worked 12-hour graveyard shifts in a Queens, New York, maternity centre that operated on the margins of legality. Her family said she had grown gaunt, could not sleep and told her husband she no longer wanted to live.

Her employers, however, said they needed her to work. And her family needed the money. She earned less than $100 (U.S.) a day, they said, working in a private house that had been converted into a combined nursery and hotel for newborn babies and their mothers.

An open secret in the Flushing community, the centre was part of an underground industry catering to a demanding clientele: local mothers resting after childbirth and Chinese visitors coming to have their babies in the United States, a practice known as “birth tourism.”

On Sept. 21, at 3:40 a.m., these dangers collided to near-fatal effect when, the police say, Wang stabbed three babies sleeping in bassinets on the first floor — all girls — and two adults. She then turned the knife on her own neck and wrists.

The victims all survived. But the horrific act turned a spotlight on a pocket of immigrant New York, where a loose network of businesses tend to mothers and infants in the crucial, fragile month after childbirth but operate without any government oversight. The centre, Mei Xin Care, is one of dozens in the area that vary widely in amenities and quality, leaving workers with few avenues for complaint, and families with little to guide them other than word-of-mouth, internet advertisements and blind trust.

“There are victims at all sides of the spectrum,” said Assemblyman Ron Kim, a Democrat who represents Queens.

Centres like this one — which was alternately known as Mei Bao, or “beautiful baby” in Chinese — provide two services. The first is for newly-arrived immigrant mothers practicing a Chinese tradition some 1,000 years old in which they recuperate for a month after childbirth while other women, often called “aunties,” care for their infants. Authorities said the centres also provide assistance to women from China who wish to give birth in the United States in order to obtain instant citizenship for their children, which is legal under immigration law.

There are some 40 such maternity centres — in private homes and apartments — advertising their services online in the New York and New Jersey area, and nearly 20 in the Flushing neighbourhood.

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At Mei Xin Care, employees were paid off the books, Wang’s family said. One of its nannies, Darong Wang, 63, got the job despite being arrested in May for promoting prostitution at a massage parlour in downtown Flushing. She was slashed in the attack, requiring 20 stitches on her face; a father of one of the children was stabbed in the leg and wrist.

Stuffy and cramped

The crime took place in a three-floor brick apartment house with white metal lattice balconies on the outskirts of Flushing. Its only advertisement existed on the internet, on a Craigslist of sorts for the local Chinese immigrant community.

Mei Xin Care appears to be a combination of the names of two owners: Meiying Gao and Xuexin Lin. Local employment agencies said the owners had been in the business for about a decade but opened their latest location in 2016, when city records show they bought the building for $1.5 million. Reached by phone, the owners declined to comment.

One neighbour said in an interview that she saw a steady stream of clients arriving, sometimes in fancy cars.

Some of them would have been following the custom of a month-long rest after childbirth. The period culminates in a “red egg celebration” to mark the baby’s survival of its fragile first weeks, said Margaret M. Chin, a professor of sociology in the Asian American Studies program at Hunter College.

The centres are an alternative to obtaining visas so family members can fly to the United States, or returning to China, where health care is often less sophisticated. For several thousand dollars, new mothers have access to 24-hour nannies and cooks.

Michael Cheng and his Shanghai-born wife, who live in Flushing, considered using the centre for her recuperation period. They toured the facility twice in the spring and were quoted a fee of $4,800 — in cash.

Cheng said babies were sleeping on the first floor, while their mothers slept in small bedrooms on the second and third floors.

He remembered seeing five to six workers, whom he estimated to be in their 40s and 50s. “They were working 24 hours in shifts,” he said. “I can imagine that it was a very high-stress job.”

Cheng said his wife, who did not want to give her name, spoke with some of the residents on the upper floors, one from China and another who was a New Yorker. “Before we walked out, I was like, ‘Are you sure you like this place?’ to my wife,” Cheng said in an interview. “To me, it felt stuffy in there.”

He was skeptical and asked to see a license. The owners sent a copy of a generic business operation certificate and another for maternity nutrition.

“In hindsight,” he said, “if there was more talk about these places, and people knew if you go to one of these centres that they had to hang their licenses right out in front, some kind of regulations around that, maybe it would help.”

Ultimately, the couple felt uneasy about Mei Xin Care and opted to spend the month at Cheng’s parents’ home on Long Island after their daughter was born. They got their $800 deposit back when another mother quickly filled the spot.

A shortcut to U.S. citizenship

After the stabbings occurred, Flushing was in an uproar. At temples, in food courts and on the streets beneath bright signs in Chinese, residents worried that the incident would stir up anti-immigrant attitudes toward their community.

Others decried the centre’s second purpose, easing the path for birth tourism. “They should not come through loopholes,” said Catherine Chan, 50, a bar owner in Queens who used to work on Wall Street. She came to the United States from China when she was 6, after a long process involving family sponsorship, she said. “There is no shortcut.”

Birth tourism is a well-known phenomenon. In recent years, it has drawn mostly well-off mothers from China, Korea, Russia, Turkey, Egypt and Nigeria to the United States for birthright citizenship, which U.S. President Donald Trump has vowed to eliminate.

It can be legal, as long as pregnant foreigners applying for visas state their intention to give birth when they are in the United States and prove that they can cover the cost. If they conceal their real purpose for travelling they could be subject to visa fraud.

Once U.S. citizens turn 21, they are eligible to sponsor a parent for a green card, giving their parents the option of eventually settling there. Parents do not always use that opportunity, and immigration officials could deny a green card, claiming the parents had willingly defrauded the American government.

Many are more concerned about securing the future of their children who, as American citizens, have the option of schooling in the United States or in competitive private Chinese schools that have lower entry standards for foreign students. They can travel to other countries without having to apply for a visa. It is seen as a status symbol in China.

For Chinese birth tourists, Los Angeles is the marquee destination. Centres compete with each other by advertising stays at plush hotels, shopping extravaganzas in nearby malls, and state-of-the-art hospitals. Fees can range from $50,000 to $80,000.

In 2015, immigration enforcement authorities raided the Los Angeles centres, saying owners had avoided paying taxes.

Still, the raids did not deter business owners who saw an opportunity. As Chinese internet services like Weibo and WeChat expanded, so did advertisements for birth tourism services in New York.

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In the New York metropolitan area, more upscale maternity centres tend to exist in New Jersey and Long Island suburbs. The ones in Flushing appear to be smaller, and less expensive, options, where mothers stay in rooms that often have been subdivided.

Annie Gao, the owner of one upscale birth centre in Center Moriches, on Long Island, expressed disdain for the cramped and somewhat secretive operations of the Flushing centres.

Gao, who opened her centre in Flushing in 2004, said that several years ago she tried to convince other owners to join an association that could self-regulate and keep out cut-rate, potentially unsafe, centres. Gao thought that some centres skimped on food quality and cleaning services, noting that ones she had seen looked “dirty.”

But those owners disagreed, she said.

These centres elude city and state licensing categories and zoning codes. They do not qualify as daycare centres because mothers are on-site; they do not need a medical license because owners offer Chinese nutritional practices.

“There isn’t a real category for these type of activities, and they were able to leverage it and apply for a general business license and pretend that was OK for their clients,” Kim, the assemblyman, said.

Although neighbours of Mei Xin Care filed complaints that it was operating as a hotel, city buildings inspectors were denied access three times, which automatically closes the complaint. Neighbours can file an affidavit to warrant a full inspection, but city records show that did not happen.

The state Office of Child and Family Services, the city’s administration for Children’s Services, the state Department of Health and the city Department of Health all said such centres did not fall under their purview.

The police shut down Mei Xin Care after the stabbing, but less than three weeks later, the centre seemed to have reopened. Women could be seen through the windows, and a pile of diapers sat outside.

She wanted to die

After spending most of her life in poor, southeastern Fujian province in China, Yu Fen Wang, 52, sought a better future. When her husband, Peter, secured an employment visa, he brought his two adult sons and wife to New York in 2010.

There, the Wangs became immersed in a bustling community of Fujianese immigrants. Peter worked in restaurants, as did his two sons. Yu Fen Wang began cleaning homes and taking care of children privately for families. About two years later, she began working at Mei Xin Care’s first location near downtown Flushing.

Her husband suffered leg pain that made it too difficult to work, he said, so the burden of providing for their family fell on Wang. When she came home after tending newborns, she also took care of her three small grandchildren.

Their son Danny said that about six months ago, the family noticed a change in Wang. She kept forgetting her keys and her phone at home. She became unfocused and unable to sleep. She lost a lot of weight.

At a different maternity centre where Wang briefly worked in June so she could do a day shift, one mother saw her napping on couches when the babies were sleeping, telling infants to drink faster when nursing, and complaining about changing diapers.

“She looked tired, and her impatience also suggested she was very tired,” that mother, Jane, 36, said in an interview. She declined to give her last name because she feared repercussions from the owners.

That centre fired Wang after just two days, and she returned to the graveyard shift at Mei Xin Care. By then, her mental state had visibly declined, according to her family.

About two or three months ago, Wang told her husband that her life had no meaning and she wanted to die, her son said. Peter Wang insisted she take two weeks off. They all knew that her older sister back in China had tried unsuccessfully to commit suicide.

Danny Wang said his mother saw a doctor who prescribed her sleeping medication and a tranquilizer.

That is when the owners of Mei Xin called her to come back to work on the 8 p.m. to 8 a.m. shift, her family said. She felt obligated, despite the protestations of her husband and sons.

“Fair or not fair, we can’t do anything about it,” Danny said. “It’s just reality.”

Wang appeared to live in her own darker reality. Her lawyer, Jean Wang, who is not related to her client, said she intended to pursue an insanity defence. “It was left untreated, and finally it just blew,” the lawyer said. Charged with five counts of attempted murder, Wang pleaded not guilty and is under suicide watch at Rikers Island.

In jail, her family and lawyer said, Wang has become even more isolated and distraught. She tried to kill herself by smashing her head against the cell. A spokeswoman for the city’s correctional health services said she could not comment on Wang’s mental state because of privacy laws.

When that first attempt failed, Wang’s lawyer said, she tried to bite her tongue off, a distinctively Chinese form of suicide. She did not succeed.