We provide an overview of the causes, manifestations, and potential mitigating steps regarding implicit bias in counseling for permanent contraception. The historical context of sterilization abuses and the implications of these on society's notions of fitness for parenthood are reviewed. We present contemporary examples of contraceptive coercion and discuss the impact of implicit bias from health care providers. Finally, we outline steps for ensuring a patient-centered shared decision-making ethical approach to permanent contraceptive counseling.

Introduction The purpose of this study was to explore how doulas of color conceptualize both their work and how their racial and ethnic identities influence their work within the context of racial disparities in birth outcomes in the United States. Methods We conducted semistructured qualitative interviews with doulas of color who had attended at least 3 births as doulas. Participants were recruited from across the United States. The interviews were audio recorded and transcribed verbatim. Qualitative content analysis was used to derive themes from the transcribed interviews. Results Interviews were conducted with 8 doulas of color, ranging in age from 21 to 47 from across the United States. All participants were either current college students or had earned a college degree. Although many of the doulas identified as being of more than one racial or ethnic group, nearly all participants identified closely with being Black or African American first, and their other racial groups second. Four major themes emerged: relationship with the medical system, role of identity in the doulas' work, role of class, and divisions within the natural birth movement. Discussion The majority of doulas who participated in this study stated that their racial identity strongly influenced their work, particularly when working with women of the same race or ethnicity due to their shared identities. Several participants initially became doulas because of a desire to alleviate disparities in birth outcomes for women of color. This suggests a commitment on the part of the study participants to serving their communities and to bridging the gap between women of color and the health care system. Several participants also noted that they feel alienated by both the health care system and the mainstream natural birth community.