Nursing & Healthcare News

Implicit Bias Training Law

Reducing racial disparities in pregnancy and childbirth

A beautiful young African-American woman with braids is kissing her newborn son and looking at him with love on a teal blue background.

Four years ago, California enacted a law requiring hospitals to provide implicit bias training for perinatal care staff. A new report from the California Department of Justice (DOJ) examines how hospitals are complying with that law.

S.B.464 Revisited

As Working Nurse reported back in 2019, the law, known as the Dignity in Pregnancy and Childbirth Act (S.B.464), is intended to address significant racial disparities in maternal mortality and morbidity rates in California, which the Legislature says are often driven by the implicit bias of care providers.

In particular, the Legislature found “a growing body of evidence that Black women are often treated unfairly and unequally in the healthcare system.”

Since 2020, this law has required California hospitals, primary care centers, and alternative birth centers to provide evidence-based implicit bias training for all healthcare providers involved in perinatal care. After the initial training, a refresher course must be completed at least every two years.

Compliance Outcomes

The DOJ report, released in October 2023, surveyed 258 California facilities about their compliance with the law’s training requirement.

Overall, compliance rates were relatively good: 81.4 percent of staff required to complete the initial training had done so by July 2022. However, some hospitals got off to a slow start. About one-third of the facilities that responded to the DOJ inquiry admitted that they didn’t begin training staff until after the hospital had received a letter from the DOJ — and 10 facilities failed to provide any data.

Many facilities misunderstood the scope of the training requirement, which covers all staff who provide care “during pregnancy, labor, delivery, and postpartum and neonatal periods,” not just specialty units like L&D. For example, since most EDs care for some pregnant patients, those providers are supposed to be trained as well. Outpatient clinic staff may also be covered.

Above and Beyond

Encouragingly, the report found that some hospitals have gone above and beyond the letter of the law, such as by extending training to more staff, providing additional seminars and lectures, or launching new internal initiatives or collaborations to better address care disparities.

Although the law doesn’t provide for any specific penalties for noncompliance, the DOJ report suggests that covered facilities would benefit from clearer guidelines, including training deadlines, and from having an appropriate state agency assess the impact on outcomes.

Still, the training requirement is an important first step. In her foreword to the DOJ report, Black Women for Wellness Executive Director Janette Robinson-Flint hopes that the law will help to “lead us to a future where Black maternal and infant health disparities are eradicated, and all families experience safe and nurturing beginnings.”

AARON SEVERSON is the associate editor of Working Nurse.

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