Racial implicit biases among obstetric care providers and associated differential care

BACKGROUND: The mechanisms of disparities in maternal and perinatal health between migrant and native women are multiple and remain poorly understood. One hypothesis is the existence of implicit biases among caregivers through which the women's ethno-racial belonging can influence medical decisions and engender healthcare disparities. Their existence and their role in the generation of non-medically justified differential care is being more and more documented in the United States but remains largely unexplored in Europe. OBJECTIVES: The aims of the BiP research program are to test and quantify the existence of implicit biases toward African migrant women among obstetric care providers and to explore the association between implicit biases and differential care. STUDY DESIGN: This study is a national web-based survey to which French obstetricians, midwives, and anesthetists were invited to take part by eight professional societies and networks. The potential existence of implicit biases toward African versus French was quantified through Implicit Association Tests (IAT) for valence and strength. The association between implicit biases and clinical decisions was then assessed using six clinical vignettes. For each, the patient's origin, African/French, was suggested by using typical surnames. RESULTS: The survey was completed by 887 professionals. The IATs showed that caregivers in the three professional categories had strong implicit biases with a preference for French versus African women in terms of valence, while they implicitly tended to attribute more strength to African women. We did not observe any association between Patient's name (French vs. African), caregiver's biases (implicit valence or strength) and the behavioral intention captured through vignettes responses. CONCLUSIONS: This study shows a high level of implicit racial biases among obstetric care providers, but these biases were not associated with differential clinical decisions. KEY MESSAGES: • This study shows a high level of racial implicit bias among healthcare providers. • No association between implicit bias and clinical behavioral intentions were observed.