As a result of litigation and legislative advocacy, Native Hawaiian practitioners can now train and engage in traditional birthing practices without fear of criminal penalties  

Today, the state of Hawai‘i agreed to end a case brought by the Center for Reproductive Rights, Native Hawaiian Legal Corporation (NHLC), and the law firm Perkins Coie. The case challenged a law that restricted midwifery in the state, preventing pregnant people in Hawai‘i from using skilled midwives and traditional birthing practitioners for their pregnancies and births, as they have for generations, and threatening Native Hawaiian traditional birthing practices with criminal liability. The lawsuit shed light on these problematic restrictions when it was filed in 2024, prompting Hawai‘i lawmakers to repeal many of the midwifery restrictions at issue in the case. Now, Native Hawaiian traditional birthing practitioners can continue providing culturally-informed care to their communities without threat of prison time, and more people can train to become midwives through a range of pathways.  

 

“Pregnant people should be able to give birth with whichever skilled provider they choose —whether that be at home with a midwife or in a hospital with a doctor. Repealing these laws is a significant step towards making that a reality in Hawai‘i. Midwives have a long history of being criminalized and pushed out of the healthcare system, even though pregnant people face a real lack of maternal healthcare providers. ” said Rachana Desai Martin, Chief U.S. Program Officer  at the Center for Reproductive Rights. “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. 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.”  

 

The midwifery restriction law, which first went into full effect in July 2023, penalized essentially anyone providing advice, information, or care, during pregnancy, birth, and postpartum who does not have a specific state license. This forced many traditional midwives and traditional Hawaiian birthing practitioners to stop practicing for fear of criminal penalties. The law also took away students’ ability to train through traditional and apprenticeship-based pathways, which have served pregnant people in Hawai‘i since it was an independent nation.  

 

The Center, NHLC, and Perkins Coie on behalf of nine plaintiffs including six midwives and student midwives, challenged the law and successfully blocked part of it. In response to the lawsuit, the Hawai‘i state legislature passed a bill in 2025 repealing many of these restrictions.  

 

Both the bill and a joint stipulation filed today by the State of Hawai‘i and the plaintiffs ensures that traditional Native Hawaiian traditional birthing practitioners will not face criminal penalties for practicing without a midwifery license. Additionally, students can train locally and through traditional pathways without having to travel thousands of miles to the U.S. mainland for western programs. While these are vital steps towards expanding access to midwifery in the state and protects Native Hawaiian traditional birthing practices, financial penalties remain for midwives who practice without a license.  

 

“We finally have a way forward to protect and pass down our sacred practices. I can continue to serve my community with the compassionate, culturally informed care they deserve,” said Ki‘inaniokalani Kaho‘ohanohano, who served her community in Maui as a practitioner for twenty years before the Restriction Law went into effect. “The fight is not over. I have travelled throughout the state and have seen firsthand the maternal health crisis we are in. We will continue to reclaim our traditions so that our families are protected for generations to come.” 

 

“Going through apprenticeship training to become a midwife was life changing. And now I can build a community of midwives by training more students in culturally-affirming, community-based midwifery practices,” said Ezinne Dawson, a midwife in O‘ahu. “My students and I are dedicated to helping our communities be safe, healthy, and thrive and we will continue to advocate for our health and families.”   

 

 “Native Hawaiian traditional and customary practices are safeguarded by the Hawaiʻi state constitution,” said Kirsha Durante, Litigation Director at Native Hawaiian Legal Corporation. “The litigation and legislative outcomes achieved affirm the protection of cultural birthing practices and ensures that Native Hawaiian birthing practitioners can continue serving their communities—free from the threat of criminalization.”  

 

Pregnant people in Hawai‘i face a shortage of maternal health care providers in their communities, inequitable treatment in the health care system, and preventable deaths and illnesses during pregnancy, birth, and postpartum. Today, Native Hawaiian and Other Pacific Islander people are 4.5 times more likely to die from pregnancy-related causes than white people, and have the highest rates of mortality overall. 

 

In Hawai‘i, pregnant people in rural areas have to drive hours—or travel to another island—to reach the nearest hospital. Having access to midwives in these communities makes it possible for pregnant people to get care closer to home. Many pregnant people prefer to use a midwife and traditional birthing practitioners and give birth at home, as doctors in the U.S. hospital system routinely pressure their patients into unnecessary medical interventions such as cesarian surgery and override patients’ wishes about what position they give birth in, who can accompany them, and even whether they can drink water during labor. 

 

In the face of poor health outcomes and discrimination in health care, it is critical that pregnant people have access to the trusted provider of their choosing and that their cultural values and traditions are respected.  

 

The lawsuit was filed by the Center for Reproductive Rights, Native Hawaiian Legal Corporation, and Perkins Coie on behalf of plaintiffs Ki‘inaniokalani Kaho‘ohanohano, Kiana Rowley, A. Ezinne Dawson, Makalani Franco-Francis, Kawehi Ku‘ailani, Moriah Salado, Morea Mendoza, Alex Amey, and Pi‘ilani Schneider-Furuya.  

 

Counsel from Native Hawaiian Legal Corporation included Kirsha Durante, Terina Faʻagau, and Devin Kamealoha Forrest. Counsel from Perkins Coie LLP included Javier Garcia, Cecily T. Barclay, Aaron Ver, and Kaela Shiigi. Counsel from the Center for Reproductive Rights included Hillary Schneller, Pilar Herrero, Astrid Marisela Ackerman, and Zhuya Beatrix Lu.