How Implicit Bias Contributes to Racial Disparities in Maternal Morbidity and Mortality in the United States

Abstract

Over the past two decades, maternal mortality rates have declined around the world. In the United States, however, 700 women die each year as a result of pregnancy or delivery complications. This represents a 50% increase in the U.S. maternal mortality rate over the same time period. According to the Centers for Disease Control and Prevention (CDC), the pregnancy-related mortality ratios vary significantly by race, with White women experiencing 13.0 deaths per 100,000 births, compared with 42.8 deaths per 100,000 births for Black women, from 2011 to 2015. Multiple studies suggest that implicit bias-defined as the attitudes or stereotypes that affect our understanding, actions, and decisions in an unconscious manner-is most likely a contributing factor to this alarming racial health disparity. The failure to recognize the pain of African American patients, regardless of whether it is conscious or unconscious, has the potential to affect the way obstetrician/gynecologists counsel patients about treatment options when it comes to chronic conditions, contraception, vaginal birth after cesarean delivery, and the management of fibroids. In this article, we will review implicit bias and the impact it can have on health care and health disparities.

Summary and Conclusion: Framing a New Research Agenda on Maternal Morbidities and Mortality in the United States

“…Environmental stressors are associated with a variety of immediate maternal health impacts, including hypertensive disorders of pregnancy, fibroids, and infertility, as well as long-term maternal health impacts, such as higher risk of breast cancer and metabolic disorders. 30 Saluja and Bryant 31 call attention to the potential role of implicit bias on patient–provider communication and its potential impact on maternal health care and outcomes. Crear-Perry et al 32 call out racism as a structural determinant and root cause of inequities in maternal health outcomes, noting that “many of the social and political structures and policies in the United States were born out of racism, classism, and gender oppression.”…”

“…A major unanswered question and the Holy Grail for a new research agenda on maternal morbidities and mortality in the United States is, ''What can we do about social, structural, and environmental determinants of maternal health?'' The collection of articles in this volume makes a number of recommendations, including assuring traumainformed health care for pregnant women, 29 strengthening implicit bias and cultural humility training for health care providers and trainees, 31 integrating data on social determinants of health into electronic health records and clinical decision support, 33 and capturing environmental exposures across diverse racial and ethnic populations in big data initiatives, such as the National Institutes of Health's All of Us Research Program. 30 Tackling social, structural, and environmental inequities underlying maternal health disparities will require more than developing new services, programs, and trainings; it will require effecting real social, political, and policy change.…”

News media representations of women who kill their newly born children

“…The belief that women ought to know when and if they are pregnant, that they will take to mothering in natural and unproblematic ways and that they would never harm their children continues to negatively impact women (Fernandez Arias et al 2019). Moreover, bias has been known to have a direct impact on maternal health care (Khera et al 2014;Omeish and Kiernan 2020;Saluja and Bryant 2020).…”

Attending to the Adversity of Racism Against Young Black Children

“…For example, white medical students hold beliefs about biological differences between blacks and whites, and those who endorsed false beliefs showed racial bias in the accuracy of their pain treatment recommendations (Hoffman et al, 2016). These biased interactions between black mothers and physicians have been implicated in the racial disparities in maternal and infant mortality and infant preterm and LBW (Saluja & Bryant, 2021).…”