Health care providers play a unique, and intimate, role in the health and future of San Diego’s Black Legacy. Even with good intentions, providers may unknowingly contribute to health inequities. Implicit bias, when individuals act on the basis of prejudice and stereotypes without intending to do so, occurs among health care providers just as much as the wider population. 1 However, implicit bias in health care settings, and larger issues of structural racism, lead to poor birth outcomes such as preterm and low birthweight babies, and even maternal and infant death.
The American College of Obstetricians and Gynecologists
acknowledges that racial bias within the
health care system is contributing to the disproportionate number of
pregnancy-related deaths among women of color. Providers spend less
time
with Black patients, ignore their
symptoms, dismiss their complaints, and
undertreat their pain.
Studies have noted that implicit bias influences patient-provider
interaction and indicates that biases are likely to influence
diagnosis and treatment decisions. This contributes to a higher
allostatic load and adversely affects the health of the mother and
fetus.
In a community meeting of Black mothers in San Diego in 2018, women
noted implicit biases and racism during provider-patient interactions,
feeling disrespected and judged by clinic and medical providers, with
80% of women feeling their provider did not care about them.
In San Diego County, Black infants are over 5 times more likely to
die, about 50% more likely to be born premature, and twice as likely
to be born with low birthweight than White infants.
California’s Black women are over 3 times more likely to die
from pregnancy-related causes than White women.
During 2017-2021, preterm African-American infants were more than
twice (2.6 times) as likely to die as preterm White infants (44.1 vs.
16.9 deaths per 1,000 live births, respectively).
Inequities in maternal and infant health outcomes frequently persist
irrespective of income or education. An infant of an African-American
woman with a college degree is more likely to die than one of a White
woman who graduated high school. Much research has shown that
structural racism drives the inequities.
Nationally, averaging 2018-2022, infants of African-American mothers
with a college degree were more likely to die than those of white
mothers who graduated high school (7.3 vs. 6.4 deaths per 1,000 live
births). Source: Centers for Disease Control and Prevention, National
Center for Health Statistics, National Vital Statistics System, Period
Linked Birth/Infant Deaths on CDC WONDER Online Database.
The best way to understand the role of implicit bias in health care is to examine our own biases. It is well documented that providers treat Black patients differently often with a lesser quality of care. Implicit bias training for providers shifts the burden of change from the individual to the systems level.
Senate Bill 464, also known as the California Dignity in Pregnancy and Childbirth Act, requires implicit bias training for all health care professionals working in perinatal services. The trainings should include:
The following are some resources to learn more about implicit biases in health care.
In addition, health care providers can play a role in being actively anti-racist and raising awareness of this issue by joining the Perinatal Equity Initiative’s Community Advisory Board or attending a meeting, and sharing information with your colleagues. You can also share and post the Black Legacy Now campaign resources in your office, clinic or colleagues.
“Doctors, like all other people, are subject to prejudice and discrimination. While bias can be a problem in any profession, in medicine, the stakes are much higher.”
Damon Tweedy, M.D, Black Man in a White Coat: A Doctor's Reflections on Race and Medicine