“The ultimate problem with that is that it is barely the surface,” Amadou said. “If they’re not working with [Black maternal health] pioneers who are rooted in this work to help them restructure, then the ‘click-and-go’ implicit bias trainings will not hold any weight at all.”

Tiffany Green, an associate professor at the School of Medicine and Public Health at the University of Wisconsin-Madison, said her team’s review of studies on anti-bias training in clinical settings found little evidence that it led to long-term behavioral changes.

Because racism isn’t just an individual problem but a systemic one, Green said, institutions must combat bias at the organizational level. If done incorrectly, it can induce anger in white employees and exacerbate inequities, she said.

While there is evidence that providers’ racial stereotyping affects treatment, it’s not known whether or how bias trainings will impact pregnant patient health outcomes, she told Stateline.

Rachel Hardeman, health equity director at the University of Minnesota Center for Antiracism Research and a co-author of the study on Black and white doctors, developed the widely used “Dignity in Childbirth and Pregnancy” course offered online in states with training mandates, including California and Minnesota. For Minnesota, her team designed a course focused on bias against Indigenous women. She said the courses are designed for both clinicians and hospital management: “People who may not be directly involved in patient care in the day-to-day but are involved in making leadership decisions.”

Evidence of bias

There is ample research suggesting there is racial bias in health care.

Black women in the United States are nearly three times more likely to die of maternal health complications than white women, according to the most recent data from the U.S. Centers for Disease Control and Prevention. Indigenous women are nearly twice as likely to die.

Research has shown implicit racial bias plays a role in those stark disparities. Examples of that bias include false beliefs that Black patients have higher pain tolerance and thicker skin, as well as long-used diagnostic tools — such as lung and kidney function tests — that have prevented proper diagnoses for Black patients.

A CDC study published last year found that nearly 1 in 3 Black, Hispanic and multiracial women reported mistreatment during pregnancy and delivery, such as receiving no response to requests for help, being shouted at, or being threatened with the withholding of treatment.

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