Perpetuating indigenous practices without sacrificing the value added by science has always been a difficult balance to strike. A 2019 law that set out to find that equilibrium and regulate Native Hawaiian midwifery plainly fell short of that aim, so practitioners should not be penalized for that failure of the state.
That’s why it’s right that a state Circuit Court has ruled that practitioners of Native Hawaiian midwifery can resume their services, temporarily, without being at risk of fines and prison time. Further, the court should lift the restriction permanently, while state lawmakers work next session to come up with a better solution.
The court’s July 23 order was a response to a legal complaint from Native Hawaiian midwives who charged that the law, Act 32, unconstitutionally restricts the practitioners because the route it prescribes for them to be exempted does not exist.
The statute more broadly addresses the licensing requirements for all midwives, rules that drew down critics on various fronts. But the part of the law at issue here was codified as Hawaii Revised Statutes 457J-6, which set out exemptions to midwifery restrictions. It includes this paragraph:
“Nothing in this chapter shall prohibit healing practices by traditional Hawaiian healers engaged in traditional healing practices of prenatal, maternal, and child care as recognized by any council of kupuna convened by Papa Ola Lokahi. Nothing in this chapter shall limit, alter, or otherwise adversely impact the practice of traditional Native Hawaiian healing pursuant to the Constitution of the State of Hawaii.”
But, as numerous opponents testified during hearings on what was then Senate Bill 1033, there was no kupuna council with the capacity to do that under Papa Ola Lokahi, a Native Hawaiian nonprofit that promotes Native Hawaiian health but is limited in the health practices it oversees.
One comment came from Laulani Teale, a researcher and coordinator of Ho‘opae Pono Peace Project, a nonprofit in support of health and other aims of the Native Hawaiian community.
“Papa Ola Lokahi does not currently have any mechanism to extend protection to traditional midwives or other birth-related practitioners as such,” Teale said. “While this could potentially be developed in the future, at this time such protection would be entirely speculative. Law cannot be based on speculation …
“The issues surrounding birth and midwifery are very complex, and need comprehensive solutions and real communication,” she added.
That’s absolutely right, and lawmakers simply must go back to the drawing board.
House Bill 955, which sought to establish a more practical pathway to certification by the North American Registry of Midwives, was introduced in 2023 but died in the House Finance Committee. The bill was said to be flawed, but no more so than the original enacted in 2019, which set up a midwifery licensing process that could not be implemented.
In any case, that can be remedied, and legislators could look at various sources for ideas. New Zealand, for example, has a Maori midwifery organization, Nga Maia. It developed an indigenous framework adopted by the country’s College of Midwives and the regulatory Midwifery Council of New Zealand. Some form of collaborative approach like this should be created here.
There is a need for state oversight of midwifery. According to recent Centers for Disease Control and Prevention (CDC) statistics, Native Hawaiian and Pacific Islanders have among the worst maternal mortality rates of any ethnicity in the U.S. That’s intolerable.
But there’s no reason to settle on a solution divorced from Hawaii’s cultural traditions.
