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Page 3 <br />I increased safety and well-being. Home birth with a skilled, unlicensed midwife has been found <br />2 to be safe and has not been found to be a contributor to the high maternal mortality rate in <br />3 Hawaii, or any other harm to health and safety. Effective communication during hospital <br />4 transport was also found to be an important factor in safety. Barriers may include, for example, <br />5 fear of legal danger that inhibits communication and information sharing, and might cause <br />6 parents to delay needed transport. Safety is therefore best served by protecting access to all <br />7 types of birthing assistance, and by developing and engaging long-range strategies that <br />8 effectively address proven barriers to safety. <br />9 2. Access to care. Maternal mortality was found by the CDC to be higher amongst <br />10 Native Hawaiians, Pacific Islanders, Black people, Native Americans, and Alaska Natives; and <br />1.1 recent data indicates that Native Hawaiians and other Pacific Islanders now have the highest <br />12 rates of all. Maternal mortality has not been associated with out -of -hospital birthing in any <br />13 way, and is strongly correlated to lack of access to culturally appropriate care and support. <br />14 There is also a severe lack of access to maternal health care overall in Hawai'i. Due to extreme <br />15 physician shortages, particularly in rural neighbor island communities, many neighbor island <br />16 pregnant people are forced to fly to Oahu in order to receive conventional prenatal care, and to <br />17 give birth, often with no family or other support. All three neighbor island counties (Hawaii, <br />18 Kauai, Maui) passed resolutions in 2023 "urging The Hawai'i State Legislature To Enact A <br />19 , Statute Exempting Birth Attendants From State Licensure Requirements." Access is best <br />20 served by keeping all care options legally accessible, while long-term solutions are developed <br />21 that address the complex needs of these communities. <br />22 3. Culture. The need for culturally responsive care has been highlighted in new data <br />23 and other scholarship within the last two years. This is associated with better maternal/infant <br />3 <br />