Summary

Summary

Native Hawaiian midwife Kiʻinaniokalani Kahoʻohanohano had been practicing midwifery for over 20 years when a devastating new law took effect.

Known as the Midwifery Restriction Law, the state legislation prevented people from using traditional midwives for their pregnancies and births.

But in Hawaiʻi, traditional midwives like Kiʻinaniokalani Kahoʻohanohano are vital—especially for Native Hawaiians and families of color, who are most impacted by the state’s ongoing maternal health crisis. Not only can traditional midwives offer culturally informed, respectful care, they’re often the only providers who can travel to help pregnant people in rural areas.

Represented by the Center for Reproductive Rights, Kahoʻohanohano and eight other plaintiffs filed this case asking a Hawaiʻi state court to block the midwifery restriction law and let traditional midwives continue providing care.

In July 2024, the state court temporarily blocked the law—allowing midwives like Kahoʻohanohano to keep practicing while the case continues.

Background

Background

For decades, Native Hawaiian healing practices were suppressed and restricted by the state.

In 1998, that finally changed: Hawaiʻi repealed its restrictive midwife licensing requirement, allowing midwives to practice openly.

Over the next 25 years, cultural practitioners revitalized Native Hawaiian practices around pregnancy and birth, and a new generation of midwives—many apprentice-trained—started to emerge.

But in 2019, Hawaiʻi lawmakers enacted a new midwifery restriction law, HRS §457J, that forces Hawaiian midwives to meet specific licensing requirements under a broad new definition of midwifery. The law included an exemption that let midwives practice without a license, but it expired in July 2023.

The law is harmful to midwives and their patients because:

• It defines midwifery in overly broad terms—essentially requiring a specific license for anyone who provides advice, information, or care during pregnancy, birth, or postpartum.
• It uses arbitrary, discriminatory criteria to determine who’s eligible for a license, including by requiring midwives to complete certain accredited programs. Some midwives were cut off from state licensure just because they completed their training paths after 2020.
• It threatens legal penalties against anyone who practices “midwifery” without a license—including midwives who have practiced for years. Even licensed midwives, who used to be able to work alongside traditional midwives and other birth workers, now risk criminal penalties for “aiding and abetting” unlicensed midwifery. 

Hawai’i is already facing a maternal health crisis. Many pregnant people don’t have access to care in their communities, while others are treated unfairly by the health care system—causing preventable deaths and illnesses during pregnancy, birth, and postpartum. 

Nationally, Native Hawaiian and other Pacific Islander people have the highest pregnancy related mortality ratio among all women of all races, with 62.8 deaths per 100,000 live births—compared to a rate of 39.9 for non-Hispanic Black women and 14.1 for non-Hispanic white women.

According to the World Health Organization, increasing midwifery interventions could avert 41% of maternal deaths, as well as 39% of neonatal deaths and 26% of stillbirths.

About the case

About the case

The Center and its partners filed this case February 27, 2024, in the Circuit Court of the First Circuit, Honolulu, Oʻahu.

Brought on behalf of nine plaintiffs—including midwives, midwifery students, pregnant women, and women planning to grow their families—the lawsuit asks the court to:

• Stop the threat of criminal and other penalties against traditional and apprenticeship-trained midwives, plus others who fall within the law’s broad reach, by issuing a preliminary injunction.
• Eliminate the law’s 2020 cutoff for students pursuing their certified professional midwife (CPM) credential through apprenticeship training.

The Center argues that the midwifery restriction law violates the Hawaiʻi Constitution because it:

• Violates the right to reproductive autonomy, which the state constitution guarantees through its protections for rights to privacy, life, liberty, and equality.
• Violates the state’s duty to protect Native Hawaiian traditional practices.
• Is unconstitutionally broad, causing a chilling effect that stops pregnant people, midwives, and others from exercising their constitutional rights.

On July 23, 2024, a state court ruled to temporarily block part of the state’s midwifery restriction law, allowing Native Hawaiian midwives to resume pregnancy and birth care in their communities while the case continues.

This lawsuit is part of the Center’s strategy to defend reproductive autonomy rights—fundamental rights that people don’t lose just because they’re pregnant.

Reproductive autonomy means having the right to make informed choices about where, how, and with whom to get care during pregnancy, birth, and postpartum.

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