Court Rules Native Hawaiian Midwives Can Resume Providing Care

Native Hawaiian midwives will be able to resume pregnancy and birth care in their communities for now after a state court ruled to temporarily block part of the state’s midwifery restriction law.

The July 23 ruling came in Kahoʻohanohano v. State of Hawaiʻi, brought in February 2024 by the Center for Reproductive Rights, the Native Hawaiian Legal Corporation, and the law firm Perkins Coie to challenge Hawaii’s law. The portion of the law blocked prevents pregnant people from using traditional midwives for their pregnancies and births.

The law, which took effect in July 2023, has been particularly devastating for Native Hawaiian midwifery practitioners as well as people living in rural areas, since midwives are often the only providers who travel to remote areas.

The case was brought on behalf of nine plaintiffs—including midwives, midwifery students, and women who are pregnant or plan to become pregnant and grow their families.

“Today, we are once again able to stand in our own ancestral knowledge and serve our community with skills and traditions passed down through generations,” said Makalani Franco-Francis, a plaintiff in the case. Franco-Francis spent five years apprenticing as a student midwife in Maui before the law took effect and made her training illegal.

“Today’s ruling recognizes that the Midwifery Restriction Law fails to provide the meaningful protections for traditional Native Hawaiian birthing practices that the Hawai‘i Constitution demands,” said Hillary Schneller, Senior Staff Attorney at the Center. “As the court acknowledged, the state does real damage to Indigenous peoples’ health, safety, and culture when—instead of filling the many gaps that already exist in Hawai‘i’s maternal health care system—it takes away trusted midwives.”

Hawai’i Is Facing a Maternal Health Crisis

Pregnant people in Hawai’i face a shortage of care in their communities, inequitable treatment in the care system, and preventable deaths and illnesses during pregnancy, birth, and postpartum. 

Nationally, Native Hawaiian and other Pacific Islander people have the highest pregnancy-related mortality ratio (PMR) among all women of all races, with a rate in 2017-2019 of 62.8 deaths per 100,000 live births—a rate more than four times higher than the rate for non-Hispanic white women.

“Today, we are once again able to stand in our own ancestral knowledge and serve our community with skills and traditions passed down through generations.”

Makalani Franco-Francis, a plaintiff in the case

Read more about the case here:

• Case Background: Kahoʻohanohano v. State of Hawaiʻi
• About the Plaintiffs
• Court Rules in Favor of Native Hawaiian Midwives, 07.24.24 (press release)
• Defending Reproductive Autonomy: Center Sues Hawaiʻi to Protect Midwifery Care, 02.27.24