Hawaii 2024 Regular Session

Hawaii House Bill HB2649 Compare Versions

Only one version of the bill is available at this time.

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1	1	HOUSE OF REPRESENTATIVES H.B. NO. 2649 THIRTY-SECOND LEGISLATURE, 2024 STATE OF HAWAII A BILL FOR AN ACT relating to access for reproductive care. BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
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3	3	HOUSE OF REPRESENTATIVES H.B. NO. 2649
4	4	THIRTY-SECOND LEGISLATURE, 2024
5	5	STATE OF HAWAII
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7	7	HOUSE OF REPRESENTATIVES
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9	9	H.B. NO.
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13	13	THIRTY-SECOND LEGISLATURE, 2024
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17	17	STATE OF HAWAII
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31	31	A BILL FOR AN ACT
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37	37	relating to access for reproductive care.
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43	43	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
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47	47	SECTION 1. The legislature finds that a person's right to choose where to give birth and who they want as their preferred birth attendant are integral to providing care, safety, bodily autonomy, and comfort during the birthing process. This right is particularly important amongst practitioners of traditional and Indigenous midwifery. The legislature notes that, although most maternal deaths are preventable, maternal deaths have been increasing in the United States since 2000. Although Hawaii has a lower maternal mortality rate compared to other states, Hawaii's mortality rate has over time increased significantly. The United States also has the highest maternal mortality rate among developed countries. In most other countries, midwives outnumber obstetrician‑gynecologists by severalfold. However, in the United States, obstetrician-gynecologists are overrepresented in the maternity care workforce relative to midwives, but there is an overall shortage of maternity care providers, both obstetrician-gynecologists and midwives, relative to the number of births. Furthermore, while the federal Affordable Care Act requires that state medicaid programs cover midwifery care, the supply of providers is often so low that beneficiaries are often unable to access these services. The legislature further finds that protecting the rights of cultural practitioners is enshrined in the Hawaii State Constitution. The United Nations also supports and encourages similar protections. In 2007, the United Nations passed the Declaration on the Rights of Indigenous Peoples, which established a universal framework of minimum standards for the survival, dignity, and wellbeing of Indigenous peoples. The Declaration also elaborates on existing human rights standards and fundamental freedoms as they apply to the specific situation of Indigenous peoples. The legislature also notes that on December 7, 2023, the United Nations International Covenant on Civil and Political Rights' Human Rights Committee distributed its Concluding Observations on the Fifth Periodic Report of the United States of America, wherein it expressed concerns that "in various states, midwifery is severely restricted, banned or even criminalized, limiting the availability of culturally sensitive and respectful maternal health care for those with low incomes, those living in rural areas, people of African descent and members of Indigenous communities". The legislature recognizes that the World Health Organization recommends midwifery as an evidence-based approach to reducing maternal mortality. Several systematic reviews have found that midwifery-led care for women with healthy pregnancies is comparable or preferable to physician-led care in terms of maternal and neonatal outcomes; more efficient use of health system resources; improved patient satisfaction and maternal psychosocial well-being outcomes, including those for postpartum depression. The legislature additionally finds that Act 32, Session Laws of Hawaii 2019 (Act 32), established licensing and regulatory requirements for the practice of midwifery. However, although Act 32 states that "[n]othing 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," there is no statutory provision that would affirmatively protect such practitioners from citation or other criminal repercussions. Additionally, while Act 32 states that midwifery licensing is not intended to "prohibit healing practices by traditional Hawaiian healers ... as recognized by any council of kupuna convened by Papa Ola Lokahi", the legislature recognizes that this is not a means to protect all traditional practitioners of Hawaiian birthing customs in Hawaii. Concerns with Act 32 have also been expressed by the counties. In 2023, resolutions were adopted by three county councils, including the Hawaii county council in resolution no. 57-23; Kauai county council in resolution no. 2023-31; and Maui county council in resolution no. 23-28, urging the legislature to enact a statute permanently exempting birth attendants from state licensure requirements for the practice of midwifery. The legislature further notes that Act 32 stated that the Act will "continue to allow a woman to choose where and with whom she gives birth." However, Act 32 also stated, "[b]y 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 legislature believes that it is now necessary to clarify the intent and scope of Hawaii's midwifery licensure law to facilitate continuity of care and ensure that persons of all cultures and religions in the State have clear, legal access to the birth attendants of their choosing. Accordingly, the purpose of this Act is to clarify the State's midwifery law to ensure that doulas, cultural birth workers, and other pregnancy and birth practitioners are able to offer maternity and newborn care in line with their traditions, ethnic cultures, and religions. SECTION 2. Section 457J-1, Hawaii Revised Statutes, is amended to read as follows: "[[]§457J-1[]] Findings and purpose. The legislature finds that: (1) Midwives, doulas, cultural birth workers, and other pregnancy and birth practitioners offer maternity and newborn care from the antepartum period through the intrapartum period to the postpartum period; (2) The improper practice of midwifery poses a significant risk of harm to the mother or newborn, and may result in death; [and] (3) The regulation of the practice of midwifery is reasonably necessary to protect the health, safety, and welfare of mothers and their newborns[.]; (4) Maternal mortality is significantly higher for Hawaiian, Pacific Islander, and black women than for other ethnicities in the State, with rural women at an elevated risk; (5) Cultural factors and access to care have been found to be significant factors in decreasing maternal mortality rates in the United States; and (6) The regulation of the practice of midwifery shall not preclude or limit care by extended family, cultural supporters, or others with whom a woman chooses to give birth, and shall not deter effective communication between all parties in the event of a hospital transport." SECTION 3. Section 457J-2, Hawaii Revised Statutes, is amended as follows: 1. By adding a new definition to be appropriately inserted and to read: ""Clinical" means involving or relating to the direct medical treatment or testing of patients." 2. By amending the definition of "midwifery" to read: "Midwifery" means the provision of [one or more of the following services: (1) Assessment,] clinical assessment, monitoring, and care during pregnancy, labor, childbirth, postpartum and interconception periods, and for newborns, including ordering and interpreting screenings and diagnostic tests, and carrying out appropriate emergency measures when necessary[; (2) Supervising the conduct of labor and childbirth; and (3) Provision of advice and information regarding the progress of childbirth and care for newborns and infants]." SECTION 4. Section 457J-6, Hawaii Revised Statutes, is amended to read as follows: "[[]§457J-6[]] Exemptions. (a) A person may practice midwifery without a license to practice midwifery if the person is: (1) A certified nurse-midwife holding a valid license under chapter 457; (2) Licensed and performing work within the scope of practice or duties of the person's profession that overlaps with the practice of midwifery; (3) A student midwife who is currently enrolled in a midwifery educational program under the direct supervision of a qualified midwife preceptor; (4) A person rendering aid in an emergency where no fee for the service is contemplated, charged, or received; or (5) A person acting as a birth attendant on or before July 1, 2023, who: (A) Does not use legend drugs or devices, the use of which requires a license under the laws of the State; (B) Does not advertise that the person is a licensed midwife; (C) Discloses to each client verbally and in writing on a form adopted by the department, which shall be received and executed by the person under the birth attendant's care at the time care is first initiated: (i) That the person does not possess a professional license issued by the State to provide health or maternity care to women or infants; (ii) That the person's education and qualifications have not been reviewed by the State; (iii) The person's education and training; (iv) That the person is not authorized to acquire, carry, administer, or direct others to administer legend drugs; (v) Any judgment, award, disciplinary sanction, order, or other determination that adjudges or finds that the person has committed misconduct or is criminally or civilly liable for conduct relating to midwifery by a licensing or regulatory authority, territory, state, or any other jurisdiction; and (vi) A plan for transporting the client to the nearest hospital if a problem arises during the client's care; and (D) Maintains a copy of the form required by subparagraph (C) for at least ten years and makes the form available for inspection upon request by the department. (b) 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. (c) Nothing in this chapter shall prohibit a person from administering care to a person's spouse, domestic partner, parent, sibling, [or] child[.], or other member of a person's immediate or extended family. (d) Nothing in this chapter shall prohibit or restrict healing practices by traditional healers of any ethnic culture or religious faith and their students. (e) Nothing in this chapter shall limit, alter, or otherwise adversely impact any religion or ethnic cultural practices as protected by the Hawaii State Constitution. (f) Nothing in this chapter shall prohibit or interfere with a person right to choose where and with whom that person gives birth." SECTION 5. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored. SECTION 6. This Act shall take effect upon its approval. INTRODUCED BY: _____________________________
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49	49	SECTION 1. The legislature finds that a person's right to choose where to give birth and who they want as their preferred birth attendant are integral to providing care, safety, bodily autonomy, and comfort during the birthing process. This right is particularly important amongst practitioners of traditional and Indigenous midwifery.
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51	51	The legislature notes that, although most maternal deaths are preventable, maternal deaths have been increasing in the United States since 2000. Although Hawaii has a lower maternal mortality rate compared to other states, Hawaii's mortality rate has over time increased significantly. The United States also has the highest maternal mortality rate among developed countries. In most other countries, midwives outnumber obstetrician‑gynecologists by severalfold. However, in the United States, obstetrician-gynecologists are overrepresented in the maternity care workforce relative to midwives, but there is an overall shortage of maternity care providers, both obstetrician-gynecologists and midwives, relative to the number of births. Furthermore, while the federal Affordable Care Act requires that state medicaid programs cover midwifery care, the supply of providers is often so low that beneficiaries are often unable to access these services.
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53	53	The legislature further finds that protecting the rights of cultural practitioners is enshrined in the Hawaii State Constitution. The United Nations also supports and encourages similar protections. In 2007, the United Nations passed the Declaration on the Rights of Indigenous Peoples, which established a universal framework of minimum standards for the survival, dignity, and wellbeing of Indigenous peoples. The Declaration also elaborates on existing human rights standards and fundamental freedoms as they apply to the specific situation of Indigenous peoples.
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55	55	The legislature also notes that on December 7, 2023, the United Nations International Covenant on Civil and Political Rights' Human Rights Committee distributed its Concluding Observations on the Fifth Periodic Report of the United States of America, wherein it expressed concerns that "in various states, midwifery is severely restricted, banned or even criminalized, limiting the availability of culturally sensitive and respectful maternal health care for those with low incomes, those living in rural areas, people of African descent and members of Indigenous communities".
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57	57	The legislature recognizes that the World Health Organization recommends midwifery as an evidence-based approach to reducing maternal mortality. Several systematic reviews have found that midwifery-led care for women with healthy pregnancies is comparable or preferable to physician-led care in terms of maternal and neonatal outcomes; more efficient use of health system resources; improved patient satisfaction and maternal psychosocial well-being outcomes, including those for postpartum depression.
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59	59	The legislature additionally finds that Act 32, Session Laws of Hawaii 2019 (Act 32), established licensing and regulatory requirements for the practice of midwifery. However, although Act 32 states that "[n]othing 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," there is no statutory provision that would affirmatively protect such practitioners from citation or other criminal repercussions. Additionally, while Act 32 states that midwifery licensing is not intended to "prohibit healing practices by traditional Hawaiian healers ... as recognized by any council of kupuna convened by Papa Ola Lokahi", the legislature recognizes that this is not a means to protect all traditional practitioners of Hawaiian birthing customs in Hawaii.
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61	61	Concerns with Act 32 have also been expressed by the counties. In 2023, resolutions were adopted by three county councils, including the Hawaii county council in resolution no. 57-23; Kauai county council in resolution no. 2023-31; and Maui county council in resolution no. 23-28, urging the legislature to enact a statute permanently exempting birth attendants from state licensure requirements for the practice of midwifery.
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63	63	The legislature further notes that Act 32 stated that the Act will "continue to allow a woman to choose where and with whom she gives birth." However, Act 32 also stated, "[b]y 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 legislature believes that it is now necessary to clarify the intent and scope of Hawaii's midwifery licensure law to facilitate continuity of care and ensure that persons of all cultures and religions in the State have clear, legal access to the birth attendants of their choosing.
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65	65	Accordingly, the purpose of this Act is to clarify the State's midwifery law to ensure that doulas, cultural birth workers, and other pregnancy and birth practitioners are able to offer maternity and newborn care in line with their traditions, ethnic cultures, and religions.
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67	67	SECTION 2. Section 457J-1, Hawaii Revised Statutes, is amended to read as follows:
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69	69	"[[]§457J-1[]] Findings and purpose. The legislature finds that:
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71	71	(1) Midwives, doulas, cultural birth workers, and other pregnancy and birth practitioners offer maternity and newborn care from the antepartum period through the intrapartum period to the postpartum period;
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73	73	(2) The improper practice of midwifery poses a significant risk of harm to the mother or newborn, and may result in death; [and]
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75	75	(3) The regulation of the practice of midwifery is reasonably necessary to protect the health, safety, and welfare of mothers and their newborns[.];
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77	77	(4) Maternal mortality is significantly higher for Hawaiian, Pacific Islander, and black women than for other ethnicities in the State, with rural women at an elevated risk;
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79	79	(5) Cultural factors and access to care have been found to be significant factors in decreasing maternal mortality rates in the United States; and
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81	81	(6) The regulation of the practice of midwifery shall not preclude or limit care by extended family, cultural supporters, or others with whom a woman chooses to give birth, and shall not deter effective communication between all parties in the event of a hospital transport."
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83	83	SECTION 3. Section 457J-2, Hawaii Revised Statutes, is amended as follows:
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85	85	1. By adding a new definition to be appropriately inserted and to read:
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87	87	""Clinical" means involving or relating to the direct medical treatment or testing of patients."
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89	89	2. By amending the definition of "midwifery" to read: "Midwifery" means the provision of [one or more of the following services:
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91	91	(1) Assessment,] clinical assessment, monitoring, and care during pregnancy, labor, childbirth, postpartum and interconception periods, and for newborns, including ordering and interpreting screenings and diagnostic tests, and carrying out appropriate emergency measures when necessary[;
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93	93	(2) Supervising the conduct of labor and childbirth; and
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95	95	(3) Provision of advice and information regarding the progress of childbirth and care for newborns and infants]."
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97	97	SECTION 4. Section 457J-6, Hawaii Revised Statutes, is amended to read as follows:
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99	99	"[[]§457J-6[]] Exemptions. (a) A person may practice midwifery without a license to practice midwifery if the person is:
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101	101	(1) A certified nurse-midwife holding a valid license under chapter 457;
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103	103	(2) Licensed and performing work within the scope of practice or duties of the person's profession that overlaps with the practice of midwifery;
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105	105	(3) A student midwife who is currently enrolled in a midwifery educational program under the direct supervision of a qualified midwife preceptor;
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107	107	(4) A person rendering aid in an emergency where no fee for the service is contemplated, charged, or received; or
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109	109	(5) A person acting as a birth attendant on or before July 1, 2023, who:
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111	111	(A) Does not use legend drugs or devices, the use of which requires a license under the laws of the State;
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113	113	(B) Does not advertise that the person is a licensed midwife;
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115	115	(C) Discloses to each client verbally and in writing on a form adopted by the department, which shall be received and executed by the person under the birth attendant's care at the time care is first initiated:
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117	117	(i) That the person does not possess a professional license issued by the State to provide health or maternity care to women or infants;
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119	119	(ii) That the person's education and qualifications have not been reviewed by the State;
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121	121	(iii) The person's education and training;
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123	123	(iv) That the person is not authorized to acquire, carry, administer, or direct others to administer legend drugs;
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125	125	(v) Any judgment, award, disciplinary sanction, order, or other determination that adjudges or finds that the person has committed misconduct or is criminally or civilly liable for conduct relating to midwifery by a licensing or regulatory authority, territory, state, or any other jurisdiction; and
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127	127	(vi) A plan for transporting the client to the nearest hospital if a problem arises during the client's care; and
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129	129	(D) Maintains a copy of the form required by subparagraph (C) for at least ten years and makes the form available for inspection upon request by the department.
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131	131	(b) 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.
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133	133	(c) Nothing in this chapter shall prohibit a person from administering care to a person's spouse, domestic partner, parent, sibling, [or] child[.], or other member of a person's immediate or extended family.
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135	135	(d) Nothing in this chapter shall prohibit or restrict healing practices by traditional healers of any ethnic culture or religious faith and their students.
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137	137	(e) Nothing in this chapter shall limit, alter, or otherwise adversely impact any religion or ethnic cultural practices as protected by the Hawaii State Constitution.
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139	139	(f) Nothing in this chapter shall prohibit or interfere with a person right to choose where and with whom that person gives birth."
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141	141	SECTION 5. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
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143	143	SECTION 6. This Act shall take effect upon its approval.
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147	147	INTRODUCED BY: _____________________________
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149	149	INTRODUCED BY:
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151	151	_____________________________
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157	157	Report Title: Midwives; Practice of Midwifery; Cultural and Traditional Healers; Exemptions Description: Clarifies the State's midwifery law to permit care by extended family, cultural supporters, or others with whom a woman chooses to give birth. Specifies that nothing in the midwifery law shall prohibit or restrict healing practices by traditional healers of any ethnic culture or religious faith or their students; limit, alter, or adversely impact any religion or ethnic cultural practices; or prohibit or interfere with a person's right to choose where and with whom the person gives birth. The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.
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163	163	Report Title:
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165	165	Midwives; Practice of Midwifery; Cultural and Traditional Healers; Exemptions
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169	169	Description:
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171	171	Clarifies the State's midwifery law to permit care by extended family, cultural supporters, or others with whom a woman chooses to give birth. Specifies that nothing in the midwifery law shall prohibit or restrict healing practices by traditional healers of any ethnic culture or religious faith or their students; limit, alter, or adversely impact any religion or ethnic cultural practices; or prohibit or interfere with a person's right to choose where and with whom the person gives birth.
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179	179	The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.