Lilikala Kameeleihiwa

HONOLULU (WOMENSENEWS)–To some, it’s simply a byproduct of childbirth, a biological waste. To others, it’s even a possible source of biological material for genetic research. But to those of Polynesian and some African and Asian cultures, the placenta is sacred.

In a transformation of an issue that was once a private matter between a woman and her doctor, the placenta became a political issue in Hawaii this spring, and its ramifications could spread to other states.

Following an uproar from Native Hawaiians after the state declared placenta tissue an infectious waste in 2005, the Aloha State has become the first in the nation to expressly give a woman permission to take the placenta home from the hospital following childbirth.

The new Hawaii law was introduced by the bipartisan Honolulu-based Women’s Legislative Caucus and championed by Planned Parenthood of Hawaii, the American Civil Liberties Union, the Healthy Mothers, Healthy Babies Coalition and a myriad of cultural organizations based in Honolulu and the Neighbor Islands.

Four families have taken advantage of the new policy since Gov. Linda Lingle signed it into law April 21. It’s part of a growing sensitivity to the cultural practices of diverse groups even in the midst of greater concerns over diseases such as hepatitis and AIDS that could be spread by biological waste.

The placenta–or "iewe," pronounced eh-AY-vay –has an important symbolism in Hawaiian culture, and some rebuff the modern medical practice of simply throwing it out. Those practicing the religious and cultural ways of their ancestors explain that, in Hawaii, the burial sites of placentas of their forebears have the same significance as where they are buried after they die.

"The iewe of the newborn child is sacred and must be handled in a sacred manner in order to provide for the physical health of the child," Native Hawaiian historian Lilikala Kameeleihiwa told a state legislative committee considering the new law. "Moreover, the careful disposition of the iewe will indicate how the child will grow up and molds the child’s identity."

Research Potential in Placenta

Following President George W. Bush’s July 18 veto of federal funding for embryonic stem cell research, some Native Hawaiians, who make up about 20 percent of the state’s population, are concerned scientists will start harvesting their sacred placentas from hospitals from the approximately 20,000 births in the state each year.

Like stem cells, certain placenta cells have been demonstrated to have the capacity to become cells of other parts of the body and could potentially be used to meet research demands. Indeed, Pittsburgh biotechnology company, Stemnion Inc., has licensed the patent rights to a process for removing stem cell-like material from placentas to treat cirrhosis and diabetes and spur healing, although the company says it uses only donated placentas with permission from the families.

"It is distressing to me and my family that a part of our children is unceremoniously thrown out as waste or used without permission in medical experiments," said Kimo Armitage, a Native Hawaiian rights activist who also testified before legislative committees. "There are no laws governing the acquisition of placenta and placenta-related products. Hospitals across the nation are stealing placentas and selling them for a profit."

Pamela Lichty, a board member of the Honolulu-based ACLU of Hawaii, says the issue goes beyond the cultural aspects and becomes a women’s rights issue as well.

"In our view, it is about the freedom to practice one’s religion and-or cultural traditions and about a woman’s control over her own body," Lichty said.

Secret Ceremony Binds the Child

Native Hawaiians typically "plant" the placenta in the ground following a religious ritual that is kept a closely held secret. Sometimes a tree or bush is planted at the same time. The point, says Kameeleihiwa, a professor of Hawaiian studies at the University of Hawaii as well as a grandmother who has buried placentas of her own descendents, is to bind the child to his or her homeland.

"If planted in the earth, which in our religion is our Grandmother Papahanaumoku, the child will remain tied to the land of Hawaii, will not stray far and will work hard on behalf of the land," she said. "If disposed in a rubbish heap, the child will act like rubbish and be antisocial."

The rituals differ among families–some bury the placenta in the earth, some stick it high in the branches of a tree–and are passed down from mother to daughter. In Thai culture, for example, the placenta is often salted and placed in an earthen jar before being buried under a tree that corresponds to the symbol of the Asian year of the child’s birth. Placenta of children born in the years of the tiger or dog, for example, can be buried under the lotus or jackfruit trees; those born in the year of the snake must have the Siamese sal tree as their "guardian."

In many African cultures, "zan boku" means "the place where the placenta is buried." Some African communities bury the placenta under a tree in a manner similar to some Asian and Native Hawaiian cultures. The Kikuyu of Kenya place it in an uncultivated field and cover it with grains and grasses, while other cultures bury it in the dirt floor of the family’s house.

Culturally Appropriate Standards

Standards for providing culturally and linguistically appropriate medical care have been set by the federal health department and in some cases are required in institutions that receive federal funds. Other standards have been embraced voluntarily by professional health groups, said Kamanaopono Crabbe, a Honolulu behavioral health therapist.

"The ongoing influences of acculturative factors that permeate government, society and health fields that are based on Western paradigms and models of treatment in the past and present continue to alienate not only Native Hawaiians but other ethnic minorities," Crabbe said. "Therefore, it is essential that all levels of government be mindful of their own cultural attitudes when devising laws and policies that impact populations and communities indifferent to mainstream America."

The uproar over the disposal of placentas began in June 2005 when the state Department of Health changed its rules to classify the placenta as infectious waste. When several families were denied access to their placentas, they appealed to Native Hawaiian cultural and legal rights groups. Lawsuits in state and federal courts quickly followed, and lawmakers were pressured to override the Health Department’s new rules by enacting a law.

Other states with high Asian populations may follow suit. California currently has a "don’t ask, don’t tell" policy much as Hawaii did before the new legislation, where a mother-to-be informs the doctor she wants to keep the placenta and it is quietly returned to her so that she may take it with her after childbirth.

"In California, it’s a look-the-other way kind of thing," said Andrew Sprenger, an attorney with the Native Hawaiian Legal Corporation, based in Honolulu, who challenged the Hawaii law on behalf of two families. "Most states have not updated their infectious waste regulation standards in almost 15 years and they are revamping them now to better protect the public as new understandings of public health emerge."

Nancy Cook Lauer is Hawaii capital reporter for Stephens Media Group.