Rethinking Bias to Achieve Maternal Health Equity: Changing Organizations, Not Just Individuals

Abstract

D isparities exist in communication with and treatment of black women compared with white women within the health care setting, and biases play a role. Subsequently, black women receive inferior care, significantly impacting risk of maternal morbidity. Strategies and trainings have been put in place to reduce implicit bias and, though well intentioned, no evidence suggests that (1) disparities between black-white health care treatment have lessened and (2) biases and behaviors of health care professionals have been affected long term. These trainings also focus on individual-level biases rather than socialcontext biases and, therefore, are less effective in a health care setting. As maternal and neonatal outcomes are impacted, it is important to underscore the implicit and explicit biases that occur within health care at large.Having more black physicians would decrease disparities, improve black maternal outcomes, and decrease black infant mortality. Yet, the recruitment and retention of black physicians has not been prioritized. Black people

Diverse Perspectives to Support a Human Rights Approach to Reduce Indiana’s Maternal Mortality Rate

“…We observe that while many researchers examining maternal health are addressing racism and racial bias (e.g. Green et al, 2021;Saluja and Bryant, 2021;Scott, Britton, and McLemore 2019;); we concur with Hall et al (2015:74) that "future studies should also expand the assessment of implicit bias…Bias can exist on multiple social dimensions, and patients with multiple minority identities may be particularly affected. "…”

“…While this is an example of the duty-bearer (a government service) addressing a barrier (racial bias) in a system, further multisectoral planning and budgeting to embed implicit bias training and training that includes but extends beyond race to examine other marginalized identities into health systems are needed. Extending beyond interventions that address interpersonal bias to those that address bias at the organizational and systems levels will also be necessary (Alson et al 2021; Green et al 2021; Taylor 2020).…”

From describing disparities to understanding why disparities exist: Anti‐racist methods to support dental public health research

“…Examples : Revise racialized clinical algorithms; prioritize equity throughout performance improvement and quality improvement processes and measures [48–50]…”

Racial disparities in pregnancy options counseling and referral in the US South

“…Training in patient-centered options counseling and referral can increase providers' confidence and effectiveness in discussing all options, 49 though not necessarily for all providers or in a way that influences their counseling with all patients. While addressing implicit bias through training has limitations, 50…”