Health Advice



To close racial gap in maternal health, some states take aim at 'implicit bias'

Nada Hassanein, on

Published in Health & Fitness

Countless times, Kenda Sutton-El, a Virginia doula, has witnessed her Black pregnant clients being dismissed or ignored by clinicians.

One woman was told by doctors that swelling, pain and warmth in her leg was normal, despite warning the clinicians that she had a history of blood clots. Sutton-El urged her to visit the emergency room. Tests found the pregnant patient did indeed have a blood clot, a situation that can be deadly.

Some clients were told they weren’t doing enough to lose weight. After another client was treated dismissively when she paid for a visit in cash, Sutton-El posed as a patient and got the same response, making her wonder how many other Black women had been treated the same way.

“The biggest thing is that they’re not being listened to,” said Sutton-El, founder of Birth in Color, a nonprofit that offers doula services to expecting Virginians. Doulas support and advocate for pregnant patients. “They’re being dismissed or [clinicians] act as if the pain isn’t there, or act as if the issue is normal, when it’s not.”

As the United States contends with stark racial disparities in maternal health, experts are pushing states to mandate training for medical professionals to combat “implicit bias,” the prejudiced attitudes a person might hold without being aware of it. Lawmakers in more states are heeding that call.

Since 2019, at least five states (California, Delaware, Maryland, Minnesota and New Jersey) have enacted laws mandating implicit bias training for maternal health care providers, according to Stateline research and an analysis by researchers at the University of California, San Francisco. Lawmakers in at least 20 other states have introduced legislation related to implicit bias training for general health care professionals.


Virginia lawmakers recently approved similar legislation, sending it to Republican Gov. Glenn Youngkin. He has not said whether he will sign it.

The training can take different forms. Some courses are offered online, while others can be one-day workshops. Participants typically examine certain scenarios and learn about the history and harms of racial stereotypes.

Sutton-El argues that the training can make a huge difference. She said that one white doctor who completed the training recently told her how it had influenced his treatment of a Black patient. She recalled him telling her: “I had your voice in my head that said, ‘Follow the patient down the rabbit hole, because you’ll find out what’s the real issue.’”

But others say implicit bias training can be insufficient or ineffective. Okunsola Amadou, a doula who founded Jamaa Birth Village, a midwifery clinic and maternal health nonprofit in Ferguson, Missouri, said bias trainings alone can’t change a hospital’s culture.


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