“We’re a Little Biased”: Medicine and the Management of Bias through the Case of Contraception

Abstract

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.

Association of the Delaware Contraceptive Access Now Initiative with Postpartum LARC Use

“…Previous studies have documented biases in the healthcare system towards disproportionately limiting the fertility of disadvantaged patients (Manzer & Bell, 2021 ). Therefore, further research is also needed to ascertain if the increase in LARC use that we observed was produced by interactions centered around patient’s preferences (Dehlendorf et al, 2015 ), and if they were accompanied by unrestricted and timely access to LARC removal (Higgins et al, 2016 ).…”

Criminalization of Care: Drug Testing Pregnant Patients

“…Political and cultural discourses about the deservedness and full citizenship of single black mothers that structure debates about resource allocation and welfare reform often center reproduction and child rearing. These discourses reverberate within prenatal and perinatal care settings where the politics of reproduction meet the material realities of pregnancy and birth care (Bridges 2011; Manzer and Bell 2021). The practice of drug testing allows providers to “do something” with their suspicion by mirroring forms of exclusion and disqualification that exist in the broader social political realm.…”

Do users of long-acting reversible contraceptives receive the same counseling content as other modern method users? A cross-sectional, multi-country analysis of women's experiences with the Method Information Index in six sub-Saharan African countries

“…These findings are in line with studies that have previously examined the MII in the included countries and reflect the range of information given to contraceptive clients across sub-Saharan African countries [ 31 , 34 , 35 , 22 ]. Previous studies have found that clients who did not receive counseling on all components of the MII are more likely to discontinue their method within a year of initiating [ 26 , 36 ]. Discontinuation may be an example of women exercising autonomy over their contraception use, and it may also reflect insufficient counseling on method management prior to adoption.…”