The following is a letter sent to Big Island Gazette (BIG). BIG does not edit letters to the editor.
Yesterday was the last day for the Finance Committee Chair Kyle Yamashita to schedule a hearing for HB955 in order to satisfy the 48-hour notice requirement for the First Decking deadline this Friday March 3, 2023. This means that, unless a waiver is requested, traditional birth attendants and many Certified Professional Midwives (CPMs) will become illegal on July 1st of this year.
In anticipation of yesterday’s 48-hour notice deadline, a group of local parents, birth attendants, and midwives gathered in Chair Yamashita’s office to ask for the bill to be put to a vote. Some flew in from Yamashita’s home district on Maui, and others flew in from Hawaii Island. Chair Yamashita refused to acknowledge them, so they decided to camp out in his office overnight, similar to the Furlough Friday sit-ins from 2010. However, around 11pm the Capitol Sheriffs forced them to leave under threat of arrest, so they respectfully left and returned first thing in the morning.
“We are asking Chair Yamashita and Speaker Saiki to re-refer HB955 and remove the finance committee referral,” said Kiana Rowley, an apprenticeship-trained birth attendant from Maui, who will become illegal on July 1, 2023, unless HB955 passes. “This bill has no fiscal impact and should never have been referred to the finance committee in the first place.”
There is plenty of precedent for a re-referral to keep a bill alive, it happened to the original midwifery licensure law, 2019 SB1033, which was originally referred to five committees in the house (HLT/WLH, IAC/CPC, FIN) but got subsequently re-referred to only two committees (HLT, FIN). In the case of HB955, the Finance Committee Chair could re-refer the bill to “waive off” the House Finance Committee anytime until March 8, 2023 which would allow the bill to be put to a Third Reading vote by the First Crossover deadline on March 9, 2023.
Maui County Council recently passed Resolution 23-28 noting the disproportionate lack of access to healthcare services in the extremely rural areas on Molokai, Lanai, and Hana, urging the legislature to pass a bill permanently exempting traditional birth attendants and expanding licensure requirements to allow CPMs who have completed the Portfolio Evaluation Process (PEP) to qualify for licensure. Hawaii County Council’s committee on Governmental Operations and External Affairs passed an almost identical Resolution 57-23, after hearing testimony that many people in rural areas like Puna end up giving birth in their car on the side of the road because they live too far away from the nearest hospital and there aren’t enough licensed midwives to meet the demand in their area.
The national agency that issues the CPM certification (North American Registry of Midwives – NARM) has testified in strong support of HB955, in addition to the National Aboriginal Council of Midwives (NACM), and the Hawaii State Commission on the Status of Women, who noted in their testimony that “In hindsight, Act 32 (2019) was an overcorrection for public safety that should have provided the Portfolio Evaluation Process-exam path to licensure.”
A record-breaking 1,231 organizations & individuals testified in support of HB955 at the first hearing, and only 39 were opposed (but several of those in opposition made comments indicating that they actually support the intent of the bill.)
This has widely become known as “the issue of the year” as the public input vastly trumps other hot-topic bills. In comparison, the “firearms in sensitive places” bill HB984, which had 672 pages of testimony, the “About Time” bill SB34 to deter non-resident housing sales had almost 300 pages of testimony, and a controversial abortion bill, SB1, that had only 194 pages of testimony.
Some opponents claim that traditional birth attendants and PEP-Pathway CPMs had three years to attend the required Midwifery Education Accreditation Council (MEAC) school in order to qualify for licensure, but the preamble of Hawaiʻi’s existing midwifery licensure law, (2019 Act 32, now codified as HRS 457-J), states that the legislature’s intent was not to require all birth attendants to become certified. The preamble states “By the end of the three-year period, the legislature intends to enact statutes that will incorporate all birth practitioners and allow them to practice to the fullest extent under the law.” The 2019 bill also commissioned a task force to study the issue and make recommendations to the legislature, but the legislature has failed to pass their various proposals every year: SB2428 (2020), SB893 (2021), and SB2661 (2022).
Supporters of HB955 say that the requirements for licensure under 2019 Act 32 are prohibitively difficult for local midwives to obtain. This is a violation of the Hawaii Regulatory Licensing Reform Act, HRS Chapter 26H-2(6), which states “Regulation shall not unreasonably restrict entry into professions and vocations by all qualified persons.”
According to records compiled by the Hawaii Home Birth Collective using data from the DCCA and the Department of Health, in the time since 2019 Act 32 has passed, 28 midwives have obtained licensure, but none of them have completed the required MEAC-accredited education without leaving Hawaii for significant periods of time to study on the mainland. More than half (15) of the 28 Licensed Midwives moved to Hawaii with their certification already obtained, and many of those are not currently practicing or taking clients despite holding an active license to practice midwifery in the state. None of the Licensed Midwives are kanaka maoli, and Papa Ola Lokahi has not recognized any Native Hawaiian healers as listed in the exemptions of 2019 Act 32.
Department of Health data also shows that there is no significant difference between hospital and planned home birth outcomes. Home birth risk for neonatal death is 0.1% and hospital birth is also 0.1%.
So why is the Finance committee killing the most popular bill of the year when there aren’t any appropriations or fiscal considerations in the bill? Civil Beat has published several articles about transparency and accountability reform this Session, and the legislature recently tabled HB725 / SB1423 – one of the recommendations of the Commission to Improve Ethical Standards of Conduct – which would have afforded members of the public “the right to expect that standing committees with primary jurisdiction over fiscal matters are not referred bills solely concerning nonfiscal matters,” among other reforms.
A Change.org petition urging the legislature to extend the traditional birth attendant exemption is gaining local, national, and international support with over 8,000 signatures and counting.
“Letting this bill die is a huge blow to women’s rights to make decisions about our own bodies, and is a tragic disservice to our neighbor island communities” said Kii Kahoohanohano. “We already have a crisis in lack of access to medical services on neighbor islands, by removing so many of the highly qualified birth care providers we’ve been depending on for decades means a lot more people will be giving birth unassisted, or in cars as they attempt to drive hours to the nearest hospital.”
Livestream video links:
Initial group: https://www.instagram.com/tv/CpQyIighhYV/?utm_source=ig_web_copy_link
Almost arrested: https://www.instagram.com/tv/CpR7SHAoVcC/?utm_source=ig_web_copy_link
Leaving peacefully: https://www.instagram.com/tv/CpR_OwBKEy8/?utm_source=ig_web_copy_link
Kii Kahoohanohano,
Mālama Nā Pua o Haumea