Centering Equity in Midwifery Legislation

January 19, 2026

A message from NACPM Georgia

As we continue our advocacy for Georgia's HB520 (and successor bills), and licensure for CPMs, it's crucial that we pause to reflect on how midwifery licensure legislation can cause unintentional harm—even when designed with the best intentions. Our work must be guided not only by the goal of professionalizing midwifery care, but by a deep commitment to equity and the protection of traditional midwifery practices.

NACPM Georgia operates in alignment with NACPM's national imperative: traditional midwifery must be supported and protected in all licensure and professionalization endeavors. This means we must approach HB520 and future efforts with both the vision of what licensing can accomplish and the wisdom of what harm it could cause if we're not intentional. We have ensured participation and feedback from Traditional Midwives every step of the way by partnering with Black Midwives Over Georgia for HB520.

When good intentions cause unintentional harm

Maternal and child health advocates should be deeply familiar with the causes of health disparities affecting vulnerable populations before attempting to implement legislation. History offers cautionary tales. In Georgia, when lactation consultants (IBCLCs) sought state licensure as a pathway to Medicaid reimbursement, the legislation inadvertently required all other lactation consultants to work without compensation. The resulting lawsuit struck down the new licensure bill entirely.

This same risk exists with midwifery licensure. When states create licensing frameworks without considering the full spectrum of midwifery practice—including traditional, apprentice-trained, and community-based midwives—they risk criminalizing the very practitioners who have been serving marginalized communities for generations. Exemptions to licensure ensure protection for indigenous and traditional midwives.

The economics of equity

Some states have enacted midwifery licensure with Medicaid reimbursement rates so low that participation becomes financially impossible, particularly for midwives serving rural and underserved communities. This creates what we call "a mirage of support" for Medicaid recipients—the appearance of expanded access without the reality of available providers.

Fair compensation must reflect the comprehensive work midwives do: prenatal care, labor support, postpartum visits, and the countless hours of on-call availability and relationship-building that make midwifery care transformative. When initial reimbursement rates are set too low, it takes years—sometimes decades—to raise them. Some states have created complicated reimbursement schemes that vary based on birth location, method of birth, and number of prenatal visits completed, adding administrative burden that disproportionately affects small practices and solo practitioners. That is why our legislation features language that mandates equal reimbursement rates for Licensed Midwives.

Additionally, payment models should support team-based care that incorporates midwives alongside doulas, community health workers, and other maternal health professionals. This alleviates the unrealistic expectation that any single profession is responsible for solving Georgia's maternal health crisis alone.

Centering BIPOC midwives and communities

While the benefits of midwifery care extend to all birthing people, BIPOC communities specifically benefit from midwifery care, as demonstrated by reduced cesarean rates, fewer preterm births, and improved maternal satisfaction. Expanding Medicaid coverage for midwifery services is one way legislative advocacy can improve health equity for BIPOC birthing families.

But we must apply an equity lens to the midwifery workforce itself. BIPOC birthing people often desire care from providers who are culturally congruent with their own experiences and values. This means that, alongside increasing access to midwifery care, we must intentionally increase access to the midwifery profession for BIPOC individuals.

Centering BIPOC midwives as collaborators in legislative action is non-negotiable. Additionally, successful licensure legislation allows for the  training, education, and certification of BIPOC students to be funded so that aspiring midwives are not financially burdened. Currently, our students do not have access to federal funds for midwifery education. Licensure ensures that Georgia's midwifery workforce reflects the diversity of the communities we serve.

Protecting Traditional Midwifery Practice

As NACPM's national statement makes clear: no midwife should face criminal charges for practicing within their community. This principle must guide our work on HB520 and successor bills.

NACPM recognizes that while the CPM credential has brought visibility and legitimacy to midwifery, the credentialing process has also contributed to the erasure and marginalization of traditional midwifery practices. Indigenous, Black, immigrant, and rural midwives have sustained families and communities long before midwifery was institutionalized—and their wisdom and practices deserve protection, not criminalization.

Georgia's licensing framework must be designed to:

  • Provide a pathway to licensure for CPMs (and other nationally accredited midwifery certifications) while protecting those who practice in traditional or ancestral ways

  • Ensure that non-credentialed midwives can practice openly with systems for transparency and accountability

  • Oppose any requirements for collaborative agreements or physician supervision as conditions of licensure

  • Center autonomous midwifery practice as the international standard

A call to all Georgia midwives

We need to hear from you.

Midwifery licensure will impact every midwife in Georgia—whether you hold the CPM credential, practice traditionally, are apprentice-trained, or serve your community in other ways. The legislation we create together must reflect the real needs, concerns, and wisdom of midwives across all pathways and all communities.

We invite all Georgia midwives to engage in peaceful and meaningful communication about:

  • The specific needs of the communities you serve

  • How licensure might impact your practice and your families

  • What protections and supports you need to continue serving safely

  • Your concerns, questions, and hopes for midwifery's future in Georgia

  • How we can support and empower one another

Your experience matters. Your perspective is essential. Your voice will shape this legislation.

We recognize that midwives hold diverse views about licensure—and that's not only okay, it's necessary. Some may see licensure as long-awaited recognition and protection. Others may worry about barriers it could create or traditions it might undermine. Still others may be uncertain about how it will affect their work. All of these perspectives deserve to be heard with respect and consideration.

NACPM Georgia commits to creating spaces for these conversations that are:

  • Respectful of all midwifery paths and practices

  • Inclusive of voices that have historically been marginalized

  • Honest about both opportunities and risks

  • Solution-focused rather than divisive

  • Grounded in our shared commitment to families and communities

We believe, as NACPM's national statement affirms, that "midwives and policy makers are capable of difficult and nuanced conversations about this complexity while honoring individual choice."

How to engage:

  • Attend NACPM Georgia advocacy calls

  • Share your thoughts and concerns with our legislative committee

  • Reach out directly if you have questions or need support: nacpmga@gmail.com

This legislation belongs to all of us. Let's build it together—with open hearts, honest dialogue, and a shared commitment to protecting the full spectrum of midwifery practice in Georgia.

Tracking progress with data

Equity is ensured when progress is tracked. Data collection is of immeasurable value in understanding whether our legislation is achieving its intended goals or inadvertently creating barriers. Georgia must commit to collecting and analyzing data on:

  • Who is accessing midwifery care under HB520

  • Demographics of licensed midwives

  • Birth outcomes across different populations

  • Barriers to licensure experienced by diverse midwives

  • Geographic distribution of licensed midwives

Our commitment

NACPM Georgia commits to approaching HB520 and successor bills with an unwavering equity lens. We will not support legislation that criminalizes traditional midwifery practice, creates financial barriers to the profession, or fails to center the voices and needs of BIPOC midwives and the communities they serve.

Unless an equity lens is applied, any midwifery licensure legislation risks inadvertently harming the communities that need midwifery care the most. We are committed to ensuring that HB520 expands access, protects traditional practices, supports workforce diversity, and moves us closer to a Georgia where all families can access the midwifery care they want and deserve—without fear, without barriers, and with full autonomy.

This is the work. This is how we honor those who came before us and protect those who are here now.

NACPM Georgia is committed to advancing equitable access to midwifery care while protecting the full spectrum of midwifery practice. For more information about midwifery licensure legislation or to get involved in our advocacy work, contact us at nacpmga@gmail.com.

References:

Alspaugh, A., Suárez-Baquero, D. F. M., Mehra, R., Lanshaw, N., Joseph, J., Combs, M., Spiller, K., McLemore, M. R., & Franck, L. S. (2023). “Patients want to see people that look like them”: Aspiring midwives of color as resistance to racism through concordant care in the United States. SSM - Qualitative Research in Health, 3, 100226. https://doi.org/10.1016/j.ssmqr.2023.100226

Greenwood, B. N., Hardeman, R. R., Huang, L., & Sojourner, A. (2020). Physician–patient racial concordance and disparities in birthing mortality for newborns. Proceedings of the National Academy of Sciences of the United States of America, 117(35), 21194–21200. https://doi.org/10.1073/pnas.1913405117

Katon, J., Enquobahrie, D., Jacobsen, K., Zephyrin, L. (2021) Policies for reducing maternal morbidity and mortality and enhancing equity in maternal health: A review of the evidence. The Commonwealth Fund.https://www.commonwealthfund.org/publications/fund-reports/2021/nov/policies-reducing-maternal-morbidity-mortality-enhancing-equityLinks to an external site.

National Association of Certified Professional Midwives. (2025, July 24). Acknowledgement of Harm and National Call for Decriminalization of Midwifery. Applebaum, J. (2022). Expanding certified professional midwife services during the COVID‐19 pandemic. Birth (Berkeley, Calif.), 10.1111/birt.12643. https://doi.org/10.1111/birt.12643

Ogunwole, S., Karbeah, J., Bozzi, D., Bower, K., Cooper, L., Hardeman, R., Kozhimannil, K. (2021). Health equity considerations in state bills related to doula care (2015-2020). Womens Health Issues. https://pmc.ncbi.nlm.nih.gov/articles/PMC10224765/Links to an external site.

Peters, R. & Robles-Fradet, A.(2025). 2024 Update: Medicaid coverage for doula care requires sustainable and equitable reimbursement to be successful. National Health Law Program. https://healthlaw.org/2024-update-medicaid-coverage-for-doula-care-requires-sustainable-and-equitable-reimbursement-to-be-successful/?fbclid=IwZXh0bgNhZW0CMTEAAR4NUhZRE_jwibqu0CocgMbDU1kkpCySAxFa42OILDqUZARtnO-MIAdC5x8kcw_aem_BuYDT2-xr__sRBn0EzNgDg