There is a wealth of literature demonstrating the presence of bias throughout the American health care system. Despite acknowledging such presence, however, little is known about how bias functions within medical encounters, particularly how providers grapple with bias in their patient counseling and decision-making. We explore such processes through the case of contraceptive counseling, a highly raced, classed, and gendered context. In-depth interviews with 51 health care providers reveal that providers use four primary strategies to navigate and minimize bias in their care—using scientific rationale, employing “safe” biases, standardizing counseling, and implementing patient-centered care. Paradoxically, using these strategies can exacerbate rather than resolve bias. Understanding these bias management strategies reveals provider-held biases, how they manifest within appointments, and the potential consequences for patients’ health autonomy. Such knowledge informs interventions that promote contraceptive use among women in the United States, addresses bias in health care broadly, and thus ultimately helps combat health disparities.
Battered mothers often go to great lengths to protect their children from abuse. Most of these efforts play out in private settings such as the home. After their relationships end, women's actions shift to the public sphere for judgment by the courts. Abusers' strategies utilize the courts as another tool with which to call into question and challenge their former partners' parenting. Images of "good mothers" who behave passively are favored by officials who often have incomplete understandings of the dynamics of intimate partner violence and abuse. Existing studies about justice-involved mothers insufficiently portray women's experiences managing both continued abuse from past partners as well as discriminating treatment by the courts. Semistructured interviews with 25 women in the United States who have terminated their abusive relationships reveal strategies of negotiation and resistance used to protect their children both during and after their relationships; the women also recount instances of paternalism and naïveté present in civil and criminal courts. While their male abusers seemed to receive leniency from court officials, despite, in some cases, violating judges' direct orders, the women's efforts were sometimes interpreted as recalcitrance and disobedience when they challenged unfair labels, visitation, and custody decisions. This qualitative study contextualizes women's efforts and actions taken to safeguard their children during and after their relationships to highlight women's experiences the courts overlook and misconstrue as well as what happens when women engage with the courts. Policy suggestions include ways to prevent the continued victimization of battered women by the courts, to challenge the pejorative assessment of mother's protective behaviors, and to illuminate court officials' malfeasance and toleration of fathers' tactics.
In the United States, unintended pregnancy is medicalized, having been labeled a health problem and “treated” with contraception. Scholars find women’s access to contraception is simultaneously facilitated and constrained by health care system actors and its structure. Yet, beyond naming these barriers, less research centers women’s experiences making contraceptive decisions as they encounter such barriers. Through in-depth, semi-structured interviews with 86 diverse, self-identified women, this study explores how the medicalization of unintended pregnancy has influenced women’s contraceptive access and decision-making. We highlight the breadth of such influence across multiple contraceptive types and health care contexts; namely, we find the two most salient forces shaping women’s contraceptive decisions to be their insurance coverage and providers’ contraceptive counseling. Within these two categories, we offer crucial nuance to demonstrate how these oft-cited barriers implicitly and explicitly influence women’s decisions. Paradoxically, it is the health care system, itself, that both offers yet constrains women’s contraceptive decisions.
How do providers rationalize, cope with, and manage bias within their patient interactions and decision-making?Bias, a set of social stereotypes about groups of people, influences how one perceives and interacts with others. In the United States, health care providers hold biases about patients that can positively or negatively affect how they counsel, treat, and diagnose patients. These biases contribute to lower quality care and worse health outcomes for marginalized patients. American medicine acknowledges this problem and has worked to address it through numerous interventions, such as changing medical school curricula and offering provider-level training. Yet bias still remains. Little research looks at how providers subsequently try to rationalize, cope with, and manage bias within their care.
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