Attorney General Bonta Ensures California Perinatal Care Facilities Comply With Law Requiring Implied Anti-bias Training For Healthcare Providers | State of California – Department of Justice


Implicit anti-bias training is mandated by the California Dignity in Pregnancy and Childbirth Act to help reduce maternal mortality rates among Blacks, Indigenous people and people of color

OAKLAND – California Attorney General Rob Bonta today sent a letter to 191 perinatal care facilities in California to advise and assess whether facilities are complying with state law requiring implicit anti-bias training for all perinatal care providers in covered hospitals, primary care clinics and alternative birth centers. While the overall maternal mortality rate in California has declined 55% since 2006, the maternal mortality rate for women of color remains disproportionate and alarming, and studies show that the implicit bias of health care providers plays a role in the problem. The California Dignity in Pregnancy and Childbirth Act, which came into effect on January 1, 2020, requires continuing education for providers to help them become more sensitive to their own spontaneous biases and improve patient outcomes.

“Implicit bias is present in all aspects of life, but when it comes to health care it can mean 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 you consider that the majority are preventable. Implicit biases are 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 ensure that perinatal facilities in California follow the law and provide implicit anti-bias training to their staff.

The maternal mortality rate in the United States is the highest among developed countries. California’s maternal mortality rate is falling, but the rate has increased nationwide. Even as the state’s maternal mortality rate is declining, women of color, especially black women, continue to die three to four times more than white women.

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

Evidence shows that implicit biases have a significant impact on interactions between patients and their healthcare providers, treatment decisions made by providers, and actual health outcomes. A study published by the California Maternal Quality Care Collaborative found that resident physicians with greater implicit racial bias were less likely to recommend particular chest treatment for a black patient than a white patient with an identical symptom.

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

  • Completion dates for all implicit bias training;
  • Dates of trainings on implicit biases planned for the future;
  • Lists of participants in each training;
  • Copies of all written training materials used;
  • A list of perinatal health workers at the facility who have not yet participated in any training; and
  • A description of efforts to reduce implicit bias among perinatal care providers at the facility.

A copy of the letter is available here.


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