On June 1st, 2017, a team of CREATE graduates presented a poster at the Rodnick Colloquium on the ‘Race and Reproductive Justice’ workshop held in 2016. This piece has been abbreviated for purposes of publishing in the Beyond Training Blog. For the original version, including citations, click here.
Race and Reproductive Justice:
An argument for focused advocacy and implicit bias training in reproductive health curriculum
As a resident physician, I recall seeing a young Latina mother of 6 children for a second trimester prenatal visit. I checked in with my supervising physician before letting the patient go, and he said, as we were finishing up, “so, is she getting an IUD or a tubal after this delivery? See what you can do to convince her.”
Such well-intentioned, off handed, but woefully biased comments shaped many facets of my medical training. While believing that my attendings, now colleagues, are among the best patient advocates you will find, I also recognize the ways our biases seep into our work, and shape our care. As physicians, we are taught to present patients with multiple categorical identifiers (age, race, gender, etc.), and while attempting to locate a patient in a base of evidence, medical training itself may inadvertently reinforce biases. If we hope to offer truly non- prejudiced and equal care, we can start by identifying, exploring, and unpacking our own biases.
Implicit bias in reproductive health care
The field of reproductive health care suffers with clear and documented health disparities. In fact, in a country with a history of supporting eugenics programs and forced sterilizations, reproductive health care is perhaps one of the areas in which bias has been most troubling. It was just two decades ago when recipients of state welfare benefits were given cash bonuses for getting Norplant, a 5-year contraceptive implant, and one decade ago when inmates in California were coerced into sterilization.
Current research has shown that physicians are more likely to recommend LARC to poor women of color than to white women of the same socioeconomic status, that Latina women were more likely than white women to be counseled about sterilization, and that women of color were less likely to be counseled on or receive fertility treatments.
What can we do about it?
Our own implicit biases, built up and ingrained over lifetimes of exposure to media, family, friends, and professional environments, are clearly not absent in our doctor patient relationships. As a family medicine physician, reproductive health practitioner, advocate and educator, the idea that I might be treating people differently based on the color of their skin is horrifying. But the idea that one can be well meaning, committed to social justice, and rife with implicit bias all at the same time, does give one pause and a window for change.
To combat the learned categorization of our professional training, and the lifetimes of exposure to media and other racially biased systems, we at TEACH recently partnered with family medicine physicians from UCSF and Physicians for Reproductive Health to create a training for residents to explore their own implicit biases and then give them tools to better advocate around these disparities.
We held our training on a Saturday, with the implicit bias session first, followed by an advocacy session in the afternoon. TEACH invited two family medicine doctors to facilitate their anti-oppression workshop on unconscious bias and allyship for health professionals. They customized the workshop to address specific issues in reproductive healthcare.
Participants in this pilot seminar generally reported, on the likert scale surveys, increased comfort with concepts of implicit bias, tools to effectively manage situations where prejudice, power and privilege are involved, physician advocacy, and using patient stories to form advocacy messages.
In reflecting on the most helpful aspects of the training, one resident said they gained a “deeper understanding of all the concepts from implicit bias to advocacy and concrete tools to build on each of these for the future.” Several other residents reflected that the case examples and opportunities for discussion in the implicit bias training were the most helpful part. One resident wrote that it was “the discussion points of my colleagues, and the sharing of the personal perspectives” that was most helpful.
Bias among even well-intentioned healthcare professionals is real, and while not the primary driver of health disparities, it certainly contributes. Exploring our own biases can be the first step to tearing down the systems of oppression that affect us all. This Race and Reproductive Justice training gave residents a greater understanding of implicit bias and tools for advocacy, with a focus on reproductive justice. This seminar is an incremental but important step in residency education to combat the structural racism affecting our patients daily.
We hope to continue offering this workshop as part of the advanced training and leadership curriculum (CREATE) here at TEACH.
– Dr. Baltrushes-Hughes
Diana Wu, MD
Lamericie St. Saint-Hilaire, MD