Case: Kahoʻohanohano v. State of Hawaiʻi

This case involves a challenge to midwife licensure restrictions in Hawai’i.

In 2019, Hawai’i enacted the midwifery restriction law (HRS § 457J), which imposed licensure requirements on midwives in the state. Individuals practicing midwifery without a license, or working alongside unlicensed midwives, faced criminal penalties. The law had an exemption that allowed the practice of midwifery without a license through July 2023. 

On February 27, 2024, nine individuals–midwives, midwifery students, and women who were or planned to be pregnant–filed a lawsuit in the Hawai’i state trial court, challenging the licensure restrictions. The individuals sued Hawai’i, the Hawai’i Attorney General, the Department of Commerce and Consumer Affairs, and its Director. The individuals argued that, by defining midwifery broadly, the law required a license for essentially any one providing care, advice, or information during pregnancy, birth, and postpartum. They also alleged that Hawai’i used arbitrary and discriminatory criteria in deciding eligibility.    

Represented by the Native Hawaiian Legal Corporation, the Center for Reproductive Rights, and private counsel, the nine individuals alleged that the midwifery restriction law violated multiple rights guaranteed by the state constitution: the right to reproductive autonomy; to equality of rights; the right to pursue one’s profession free from government interference; and freedom of speech and expression. They also alleged that the law violated the state’s affirmative duty, as laid out in the state constitution, to protect Native Hawaiian traditional and customary practices, and that it was unconstitutionally vague and overbroad.The individuals sought declaratory relief, as well as a preliminary and a permanent injunction. 

Judge Shirley M. Kawamura was assigned to the case. The court held a hearing on the motion for a preliminary injunction on June 10th through 14th. 

On July 23, 2024, Judge Shirley M. Kawamura granted in part and denied in part plaintiffs’ motion for preliminary injunction. The court found that the midwifery restriction law violated state constitutional Native Hawaiian customary rights by effectively removing any viable path for plaintiffs to continue traditional practices. Accordingly, the court enjoined Hawai’i from enforcing the law against individuals practicing, teaching or learning traditional Native Hawaiian healing practices of prenatal, maternal, and child care. However, it denied the other requests for relief, finding that reproductive decisions regarding the use of unlicensed midwife care are not a protected fundamental right under the Hawai’i constitution, and that the state had a legitimate interest in regulating health care practitioners. 

As of September 29, 2025, the case is ongoing and trial is set for January 2026.