Attorney General Bonta Ensures California Perinatal Healthcare Facilities are Compliant with the Law Mandating Anti-Implicit Bias Training for Healthcare Providers

Anti-implicit bias training is mandated by the California Dignity in Pregnancy and Childbirth Act to help decrease the maternal death rate among Black, Indigenous, and people of color 

OAKLAND – California Attorney General Rob Bonta sent a letter today to 191 perinatal healthcare facilities in California to inform and gauge whether the facilities are complying with the state’s law requiring anti-implicit bias training for all perinatal care providers at covered hospitals, primary care clinics, and alternative birth centers. While the overall rate of maternal death in California has decreased by 55% since 2006, the maternal death rate of women of color remains disproportionately and alarmingly high, and studies show that the implicit bias of healthcare providers plays a part in the problem. The California Dignity in Pregnancy and Childbirth Act, which took effect January 1, 2020, mandates continued training for providers in order to help them become more attuned to their own spontaneous biases and lead to improved patient outcomes.

“Implicit bias is present in all aspects of life, but when it comes to healthcare, it can be the difference between life and death,” said Attorney General Bonta. “In California, Black women account for 21% of total pregnancy-related deaths, but only 5% of all pregnancies. The number of deaths is even more concerning when we account for the fact that the majority are preventable. Implicit bias is unconscious, but training has been shown to help providers become aware of their biases and work to intentionally minimize their effects when working with patients. Today, we’re ensuring that perinatal facilities across California are adhering to the law and providing anti-implicit bias training for their staff.”

The maternal mortality rate in the United States is the highest among developed countries. California’s own maternal death rate is on the decline, but the rate has increased in the country as a whole. Even as the maternal death rate in the state declines, women of color, particularly Black women, continue to die at three to four times the rate of white women.

A 2019 article in CalMatters reported on the California Dignity in Pregnancy and Childbirth Act, which at the time was still pending passage by the legislature (Senate Bill 464, Mitchell). The article described the experience of a pregnant Black woman in Los Angeles who, in her second trimester, began experiencing excruciating pain. She went to the emergency room, but was sent home with a urinary tract infection diagnosis. The next day, her doctor and an ultrasound confirmed she was in labor, but rather than admitting her immediately, she was sent away to complete paperwork. When she was finally able to labor and deliver her baby, she was asked not to scream by a nurse. The woman survived, but her daughter, who was born premature, passed away shortly after her birth.

Evidence shows implicit bias significantly impacts interactions between patients and their healthcare providers, the treatment decisions made by providers, and actual health outcomes. A study published by the California Maternal Quality Care Collaborative found that medical residents who exhibit greater implicit racial bias were less likely to recommend a particular chest treatment for a Black patient than a white patient suffering from an identical symptom. 

In today’s letter, the Attorney General requested the following information from perinatal care providers by September 20, 2021: 

• Dates of any implicit bias trainings providers have completed;
• Dates of implicit bias trainings planned for the future;
• Lists of attendees at each training;
• Copies of all written training materials used;
• A list of the perinatal healthcare workers at the facility who have yet to participate in any training; and
• A description of efforts to reduce implicit bias among the facility’s perinatal healthcare providers.

A copy of the letter is available here.