Kenda Sutton-El, a doula in Virginia, has repeatedly witnessed her pregnant black clients being ignored or ignored by clinicians.
One woman was told that her leg swelling, pain, and warmth were normal, even though she alerted her clinician to a history of blood clots. Ms. Sutton-El encouraged her to visit her emergency room. Tests revealed that the pregnant patient did have a blood clot, a potentially fatal condition.
Some clients were told they weren't working hard enough to lose weight. After another customer received a disparaging treatment when she paid for a visit in cash, Ms. Sutton-El received the same reaction while pretending to be a patient, and how many other black women have faced similar treatment. I thought it was strange.
“The biggest thing is not being heard,” said Sutton Ell, founder of Birth in Color, a nonprofit that provides doula services to pregnant Virginians. . Doulas support and advocate for pregnant patients. “They were fired; [clinicians] Either they act as if the pain doesn't exist, or they act as if the problem is normal when it isn't. ”
As the U.S. faces serious racial disparities in maternal health, experts require training for health professionals to counter implicit bias, or bias that people may hold without realizing it. We are asking each state to do so. Lawmakers in more states are heeding the call.
Starting in 2019, at least five states (California, Delaware, Maryland, Minnesota, and New Jersey) will require implicit bias training for maternal health care providers, according to a Stateline study and analysis by researchers at the University of California, San Francisco. enacted a law. Lawmakers in at least 20 other states have introduced bills related to implicit bias training for lay medical professionals.
The Virginia General Assembly recently approved a similar bill and sent it to Republican Gov. Glenn Youngkin. He did not say whether he would sign the deal.
The biggest thing is that their opinions are not being heard.
– Kenda Sutton-El, Virginia Doula and Founder of Birth in Color
Training can take many forms. Some courses are offered online, while others are his one-day workshops. Participants typically consider specific scenarios and learn about the history and harm of racial stereotypes.
Sutton-El argues that training can make a big difference. A white doctor who recently completed the training told me how his training influenced his treatment of black patients. She recalled him telling her: “She had your voice in her head saying, 'Take the patient down the rabbit hole, you'll find out what the real problem is.'”
But some say implicit bias training may be insufficient or ineffective. Bias training alone won't change a hospital's culture, said Okunsola Amadu, a doula who founded Jama Birth Village, a birth center and maternal-child health nonprofit in Ferguson, Missouri.
“The ultimate problem is that we're only scratching the surface,” Amadou said. “If they're not cooperating, [Black maternal health] If pioneers are rooted in this work and help rebuild, “click-and-go” implicit bias training becomes completely irrelevant. ”
Tiffany Green, an associate professor at the University of Wisconsin-Madison School of Medicine and Public Health, said her team's review of research on antibias training in clinical settings found little evidence that it led to long-term behavioral changes. said.
Racism is a systemic problem, not just an individual one, so institutions must combat bias at an institutional level, Green said. Done wrong, she says, it could provoke the anger of white employees and exacerbate inequality.
Although there is evidence that racial stereotypes among health care providers influence treatment, it is unclear whether or how biased training affects health outcomes for pregnant patients. Yes, she told Stateline.
Rachel Hardeman, director of health equity at the University of Minnesota Center for Antiracism Research and co-author of a study on Black and white physicians, said the training is available online and widely used in states where it is mandatory. We have developed the “Dignity of Childbirth and Pregnancy'' course. California and Minnesota. In the case of Minnesota, her team designed a course that focused on bias against Indigenous women. She said these courses are designed for both clinicians and hospital executives, who “may not be directly involved in patient care on a day-to-day basis, but are involved in leadership decisions. He said that it is aimed at people who are.
evidence of bias
There is ample research to suggest the existence of racial bias in healthcare.
Black women in the United States are about three times more likely to die from maternal health complications than white women, according to the latest data from the Centers for Disease Control and Prevention. Indigenous women are almost twice as likely to die.
Research shows that implicit racial bias contributes to these apparent disparities. Examples of this bias include the erroneous belief that black patients are more pain tolerant and have thicker skin, and that long-standing diagnostic tools (such as pulmonary function tests and kidney function tests) prevent black patients from being properly diagnosed. Examples include:
According to a CDC study released last year, nearly one in three black, Hispanic, and multiracial women said their requests for help during pregnancy and childbirth went unanswered, were yelled at, or were threatened with withholding medical treatment. They report being subjected to other forms of abuse, including being beaten.
Another review, also published last year, analyzed 42 studies since 2014 and found that racial bias and structural racism contribute to maternal health complications among Black women. concludes. A 2020 study also found that Black infants were twice as likely to survive if they were cared for by a Black doctor.
A study by Hardeman et al. found that clinicians were more likely to describe black patients as “disobedient,” “agitated,” and “aggressive.” When such statements are included in a patient's medical record, they can color the perception of other health care providers who view them and affect their interactions with the patient.
Hardeman's course includes patient anecdotes that illustrate bias and strategies for curbing assumptions and practicing more empathy. The course also includes the history of racism in medicine, including the gynecological experiments on black slaves by J. Marion Sims, often called the father of modern gynecology.
Given this history, many Black, Indigenous, and Hispanic patients are wary of the health care system.
“What we're talking about is the fact that our medical education system has been built on a history of racism, and we need to recognize that in order to undo that.” said Hardeman.
“We wanted people to walk away understanding that we all have a role in dismantling these systems. It starts with educating ourselves, and then we It starts with looking at what you're learning and what you've been taught,” and then applying that to the way you interact with a variety of patients and their families. ”
deadlocked law
But passing a law doesn't necessarily mean immediate change.
A year and a half after California's law went into effect in 2020, a California Department of Justice study found that only 17% of providers surveyed had received training for their entire staff. Almost a year after the study began and more support was implemented, training completion rates rose to 81%. A new law introduced this year aims to strengthen the law by imposing fines on medical centers that fail to train their staff, and would extend training requirements to nursing staff.
In many states, implicit bias legislation stalls before it reaches the governor's desk.
In Missouri, a bill introduced in 2022 died in committee. Democratic state Rep. Lakisha Bosley reintroduced it this year. And in Georgia, lawmakers reintroduced a bill this session that would require implicit bias training for health care workers in childbirth settings. Both reintroduced bills remain in committee.
Dr. Letenia “Joy” Baker, an obstetrician-gynecologist in rural Georgia, often sees black patients who have specifically sought her out.
“[They] “I chose you because you were the only black woman in town and I felt more comfortable,” she said. “We have to consider the fact that there is such a lack of diversity in medicine,'' making training for everyone important.
“We really need to unpack the legacy of Southern slavery and how we move past it. So I think legislation on this issue is important. I'll be honest, that legacy is very painful.” Because it's a thing,” she said.
In South Carolina, Democratic Rep. J.A. Moore and other Democratic lawmakers have introduced implicit bias legislation twice since 2020, but neither has passed. Moore said he would re-propose.
“I'm going to fight to the death,” Moore told Stateline, adding that her goals are part of “the challenges facing many women in South Carolina, especially minority women and low-income women.” He said that he should work on it.
Black women in South Carolina were more than four times as likely as white women to die from maternal and child health complications in 2020, according to the state's latest report. The state's Morbidity and Mortality Review Board found that discrimination contributed to more than a third of deaths from 2018 to 2020.
“This is just another way to try to change those numbers,” Moore said. “[It’s] This is an opportunity to make a dramatic change in the health status of many of our very frightening and disproportionately racialized populations. ”
Like the Minnesota Reformer, Stateline is part of States Newsroom, a nonprofit news network supported by a coalition of grants and donors as a 501c(3) public charity. Stateline maintains editorial independence. If you have any questions, please contact Editor Scott S. Greenberger. [email protected]. Follow Stateline on Facebook twitter.
