HB955 HD1: License requirements would drive some midwives out of field

The following testimony was presented Feb.15, 2023, by the Grassroot Institute of Hawaii to the House Committee on Consumer Protection and Commerce.

February 15, 2023
2 p.m.
Conference Room 329 and Via Videoconference

To: House Committee on Consumer Protection and Commerce
      Rep. Mark M. Nakashima, Chair
      Rep. Jackson D. Sayama, Vice Chair

From: Grassroot Institute of Hawaii
           Ted Kefalas, Director of Strategic Campaigns


Comments Only

Dear Chair and Committee Members:

The Grassroot Institute of Hawaii would like to offer its comments on HB955 HD1, which would exempt birth attendants practicing before July 1, 2025 from licensure requirements.

This measure correctly recognizes the harm caused by overbroad licensing laws. When states require a laundry list of mandatory training courses and exams for people who simply wish to make a living, they often burden the most vulnerable individuals who cannot afford to spend time or money obtaining a license.

Should this measure fail, Hawaii’s birth attendants will surely be another victim of poorly written regulations. These individuals are trained in traditional birthing practices and should not be subject to the same requirements that licensed midwives are. These requirements can include $2,130 in fees, 730 hours of training, two years of education and passing an exam.[1]

For lower-income birth attendants, these license requirements pose a massive barrier to entry. If the current exemption is not extended, many birth attendants would simply leave the profession instead of applying for a license. The result would be fewer birth attendants available for mothers and higher costs for the services of those who remain.

Anyone worried that unlicensed birth attendants might be untrained and might harm the mother or the baby should note that the bill as written contains limitations on how birth attendants may interact with the families. These limitations are currently law; this bill does not change them.

Regarding licensing in general, I urge members of this committee to consider exempting other occupations from strict licensing laws. A 2022 study by the national Institute for Justice found that Hawaii’s licenses for lower-skilled occupations are some of the most burdensome in the country.[2]

At the same time, there is little evidence that licensing serves a worthwhile purpose.

One study of licensing among medical professionals found that “licensing is associated with restricted labor supply, an increased wage of the licensed occupation, rents, increased output prices, and no measurable effect on output quality.”[3]

We commend the committee for considering this bill and any other measures that would make it easier for individuals to practice their trades without undue interference.

Thank you for the opportunity to submit our comments.


Ted Kefalas
Director of Strategic Campaigns
Grassroot Institute of Hawaii

[1]Hawaii Occupational Licensing,” Institute for Justice, 2022.

[2] Ibid.

[3] Sean Nicholson and Carol Propper, “Chapter Fourteen — Medical Workforce,” in “Handbook of Health Economics, Vol. 2,” Elsevier, B.V., 2012, p. 885.

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