In Hawai’i, Indigenous Abortion Care Traditions Meet Modern Medicine

Hawai'i has a history of supporting abortion care long before it was colonized, and the tradition of protecting bodily autonomy continues today.

Graphic that reads Greeting from Hawai'i where abortion has been legal since 1970
While modern medicine has since taken over for medical procedures like abortions in Hawaiʻi, many traditional practices to maintain health and well-being continue. Cage Rivera/Rewire News Group illustration

Long before Westerners set foot in Hawai’i, Native Hawaiians used spiritual and herbal medicinal healing practices called lā’au lapa’au to maintain their health and treat illnesses. They especially used traditional medicines to support health practices like birth control and abortion—some of which are still practiced today.

When a person started to menstruate, they stayed at the hale pe’a (menstruation house) set away from the community.

“The further away a temple is from the community, the more mana [divine power] it has, and the same goes for the hale pe’a,” said Makana Kāne Kuahiwinui, a Hawaiian language teacher and waimaka lehua (menstruation) researcher. “They’re so far because it has such great mana coming from women; that time is considered so sacred.”

The elders and other family members cared for the young children of people who stayed at the hale pe’a. As they grew, children were well aware of this time for their mothers, aunties, and grandmothers to go menstruate. Menstrual health matters were not just openly discussed, they were celebrated, and set the tone for other practices related to reproductive health.

Hawai’i was the first state to decriminalize abortions in 1970, three years before Roe v. Wade protected the right to abortions in the Constitution.

While it is unknown how many abortions took place in old Hawai’i, the practice is well documented and not new to the islands.

“Hawaiians knew the health of the community is the health of a woman,” Kāne Kuahiwinui said.

That’s why, for those like the U.S. Sen. Mazie Hirono of Hawai’i, a Japanese immigrant raised in the state, protecting reproductive freedom continues to be at the top of her priorities.

When the draft of the Supreme Court opinion overturning the right to abortion was leaked in May, Hirono delivered a speech on the Senate floor on the need to defend reproductive rights. Hirono said abortion is one of the reasons she became an activist. She also expressed concern for people across the country who do not live in states like Hawai’i that protect their right to an abortion.

In the 14 years that Hirono has represented Hawai’i , she stands at the forefront of fighting for a person’s right to and access to abortions—and not just in the Aloha State.

Hirono’s advocacy for reproductive freedom includes introducing the My Body, My Data Act to protect personal reproductive health; introduced the Affordability Is Access Act to expand over-the-counter access to birth control; hosted a roundtable with patients across the country on how the abortion access shaped their lives; urged the U.S. Department of Health and Human Services to take action to expand access to medication abortion; joined 32 colleagues to introduce the Expanding Access to Family Planning Act to protect access to reproductive health-care services and much more.

And her advocacy for abortion rights follows a long tradition of preserving pregnant people’s bodily autonomy in Hawai’i.

Ceremonies and rituals

In Hawai’i, multigenerational homes are popular and large families are desired. However, spacing out children was also encouraged to ensure the quality of life in raising other young children in the home. Hawaiians used herbal medicine and other practices to space out or stop future pregnancies.

“There were certain plants used for contraceptives for men and for women,” said Adam Keawe Manalo-Camp, an anthropologist and writer for Ka Wai Ola News, a newspaper of the Office of Hawaiian Affairs. “One particular medicine lowered the sperm count for the male to not produce children.”

When a person did not want any more children, they could ho’opā (make stop) using ceremonies and rituals, always with prayer. If needed, lāʻau pā was taken, a medicine that prevents fertilization, much like the emergency contraceptive Plan B. A medical procedure could also permanently or temporarily close the womb.

In some cases, people wore a girdle made of braided cordage from coconut husk, human hair, and animal intestines wrapped around their bodies to let others know she was chaste, as desired by her parents or her lover.

Types of abortion

While Native Hawaiians believed in growing their families and people, several methods and tools were used to administer abortions prior to the introduction of Western medicine. There are two known types of abortions. One is ‘ōmilo, which refers to a medical abortion and hoene were abortions induced by plant medicines taken orally, applied externally, or inserted as a douche to expel the fetus.

“One of the main methods used was ‘awa mixed with some other types of herbs,” said Sean Chun, Native Hawaiian healing practitioner and Kupuna Council chair for Ho’ōla Lāhui Hawai’i.

“The ‘awa used back then was 25 to 40 years old, so a lot stronger. And the idea behind that is, it relaxed the muscles. Women did use specific types of ‘awa, too.”

The root of the ‘awa plant was commonly used as a relaxant in medicine, ceremony, and leisure throughout Polynesia. Other known plants used in abortion procedures include hau, noni, ‘ōhiʻa ‘ai, and young kī.

Herbal medicines were specifically grown, concocted, and administered precisely.

“They had kāhuna [experts and practitioners] that could help with conception, herbal concoctions, lomilomi [massage], everything,” Chun said. “The fetus and mother were taken care of very, very well.”

Kāhuna worked closely with their patients, unlike the typical doctor-patient relationship today. Kāhuna knew if a pregnant person’s life was at risk or predicted when the life of the child was at risk. If an abortion was thought to be necessary and in the best interest of the pregnant person or fetus, kāhuna treated with medicines or procedures.

“It was important to ho’oulu lāhui, to grow the nation,” Chun said. “A lot of prayers and song are about growing the nation. So it was important to protect women.”

Traditional meets modern

When the missionaries first arrived in Hawaiʻi, they documented accounts of abortion and were appalled by the practices they thought to be common. However, Hawaiians made calculated decisions to protect themselves, their family, and their community.

“Our kūpuna [ancestors] practiced abortions and had a very healthy relationship with the ‘āina and medicine. Our kūpuna did what was best for our health,” Kāne Kuahiwinui said.

While modern medicine has since taken over for medical procedures like abortions in Hawaiʻi, many traditional practices to maintain health and well-being continue.

Today, healing practitioners like Chun treat their patients with traditional herbal remedies backed by spiritual guidance, similarly used in old Hawai’i.

Chun said the traditions and practices supporting reproductive health culturally influenced Hawaiʻi to become the leading state in legalizing abortions.

“Anytime you come from a culture that is nature-based, you’re going to have a closer tie to anything, like female health.”

Reasons for abortions

In addition to a kāhuna, pregnant people often saw a pale keiki (midwife). Pale keiki observed signs such as which side of the stomach the fetus sat or symptoms like swelling the pregnant person experienced that determined diagnosis and treatment.

“Sometimes, a pale keiki detected that the fetus had a severe deformity and they felt that the life of the child would be deeply impaired and the more humanitarian practice was to abort it,” Keawe Manalo-Camp said.

The arrival of non-natives also exposed Hawai’i to new disease, such as sexually transmitted diseases.

“More abortions happened in the 19th century because women were getting STDs and the babies were coming out with various problems—especially with syphilis,” Keawe Manalo-Camp said.

There are also accounts of women being kidnapped and raped. And “instead of having them suffer, the woman would be given a medicinal abortive,” Keawe Manalo-Camp said.

Times of scarcity and war in old Hawai’i, as well as life-threatening conditions, also prompted pregnant people and the community to make the decision to abort the fetus.

“If a war broke out and women and children were hiding in the forest, women would commit an abortion to keep the community safe so that she wasn’t heard screaming if she had to go into labor,” Kāne Kuahiwinui said. “This could happen far along into the pregnancy or even after the baby was born. Abortions also took place if it was a matter of saving the woman from dying, too.”

The ali’i (chiefs and chiefesses) practiced abortions for different reasons.

Keawe Manalo-Camp said one of the reasons Hawaiians normalized abortions was because ali’i recieved them. Incest was common among the aliʻi, particularly to protect the child and royal lineage. Because of this, some fetuses were detected to have severe deformations, and they thought it would be better to have an abortion than not to.

Above all else, Hawaiians loved babies and large families. If a pregnant person did not want the child, families in the community would beg for it. Hawaiians would hānai (adopt) an unwanted child and raise it as if they were their own.

The afterlife

Hawaiians were spiritually driven and considered the beginning of life with the first hanu (breath). The fetus was not thought of as a living person yet—in opposition to what conservatives are pushing, that a fetus has “personhood.” While Hawaiians cared for the fetus’ ‘uhane (spiritual life), it was only considered a full life when its body, spirit, soul, and breath all came together in existence.

While Native Hawaiian people had access to and practiced abortions, they still cared for the afterlife of the fetus much like the placenta.

Kāne Kuahiwinui said Native Hawaiians would not bury, but kanu (plant) the placenta of a child in hopes for something to grow. Families practiced similar traditions for a fetus.

Families also planted the afterbirth or fetus in specific places like mountains for hunting families or in the ocean where family guardians dwelled. Hawaiians planted the fetus right under the doorway or around the home so that the family could protect it, care for it, and hope for life in the form of plants to grow.

“Your bones are going to go back into the earth that you love, into that ʻāina [land] that your family is in and people can make sure that no one is desecrating it,” Kāne Kuahiwinui said.