Part 7: The Implicit Bias Industry Has No Outcome Data

Part 7 of Structural Inequity in Prenatal Care

A systematic review of 77 implicit bias training studies found that not one examined patient outcomes. Zero. California passed a law requiring bias training for all perinatal clinicians based on this evidence base. If a pharmaceutical company submitted this data package to the FDA, the drug would not be approved. The training is being mandated anyway. obmd.co

m

In 2022, California passed the Dignity in Pregnancy and Childbirth Act. Among its provisions: hospitals and alternative birthing centers providing perinatal services must provide implicit bias training to all perinatal clinicians. The goal, stated explicitly in the legislation, was to improve clinical outcomes for Black women and birthing people by reducing the influence of implicit bias on clinical care.

This is a law. It has been implemented. Hospitals across California are running training programs. Clinicians are completing modules. Certificates of completion are being filed. The policy machinery of the most populous state in the country has moved.

And the evidence base for the clinical outcome benefit of this intervention is, at the time of this writing, zero. Not thin. Not preliminary. Zero published studies demonstrating that implicit bias training delivered to perinatal clinicians improves patient outcomes for Black women.

I want to be careful to be precise here, because the claim I am making is sometimes misunderstood. I am not arguing that implicit bias does not exist. It does. It has been documented in clinical settings across many specialties. I am not arguing that Black women’s experiences of discriminatory treatment in healthcare settings are imaginary. They are not. They are documented in patient-reported outcome data, in qualitative research, and in the CDC’s own surveys showing that 40 percent of Black birthing people report experiencing discrimination during maternity care.

What I am arguing is that the evidence for implicit bias training as a mechanism for reducing those experiences and improving the clinical outcomes that follow from them is nonexistent by the standards we apply to any other clinical intervention. And in a field that claims to be evidence-based, that distinction matters.

ObGyn Intelligence: Safety analysis, the evidence critique, and the verdict are below -- for subscribers who want the full picture.