Hawaii Protects Native Midwives in Legal Settlement

Native Hawaiian midwives no longer face prison time for practicing without a license and according to their traditional practices.

On Oct. 15, the state of Hawaii filed a joint stipulation and settlement with a group of midwives and students, concluding a lawsuit filed last year over a law that made it a crime to provide pregnancy or birth care without a state license. The law, which passed in 2019 but went into full effect in July 2023, also blocked students from learning through apprenticeships or traditional pathways.

The lawsuit prompted the Hawaii Legislature to repeal many of these midwifery restrictions this year with House Bill 1194, which regulates the midwifery profession while removing criminal penalties and protecting Native Hawaiian traditional practices.

Under the new law, those in violation of licensure requirements are now subject to civil offenses punishable by fines—up to $1,000—rather than criminal offenses resulting in jail time. The law clarifies that Native Hawaiian traditional and customary practices are protected under the state constitution and therefore exempted from laws regulating the practice of midwifery.

The settlement adds extra protections, according to attorneys representing the plaintiffs.

“There is still more work to do to shore up protections for midwives in Hawai‘i and to address the vast maternal health crisis in the U.S.,” said Rachana Desai Martin, chief U.S. program officer at the Center for Reproductive Rights, in a press statement. The center, along with the Native Hawaiian Legal Corporation and the law firm Perkins Coie, represented nine plaintiffs, including six midwives and student midwives. “But thanks to the tireless work of our plaintiffs and advocates, traditional Native Hawaiian midwives don’t have to be afraid that they might be thrown into jail for their work.”

According to the settlement, “there are no criminal penalties for practicing midwifery without a license.”

The stipulation also allows students to train locally instead of traveling to the continental U.S.

Hawaiian midwives say repealing these laws should lead to expanded midwifery care in a state with extremely limited pregnancy care options.

As the Honolulu Civil Beat has reported, pregnant Hawaiians in rural communities are advised to relocate to Honolulu in the weeks before giving birth, which can lead to loneliness, family separation and burdensome expenses.

According to a 2024 KFF report, Native Hawaiian or Pacific Islander people are more likely to die during or after pregnancy than any other racial or ethnic group in the U.S. According to KFF, they are also four times more likely than white women to only start receiving prenatal care in the third trimester, or not at all.

Maui-based midwife Ki‘inaniokalani Kaho‘ohanohano told local TV station KHON2 she had stopped practicing after two decades when the restrictions went into effect.

“We finally have a way forward to protect and pass down our sacred practices,” she said. “I can continue to serve my community with the compassionate, culturally informed care they deserve.”

This article was republished from News From the States, part of States Newsroom. Read the original story, reported by Sofia Resnick, here.

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