Nursing & Healthcare News

Maternal Mortality and Race

S.B. 464 takes aim at implicit bias

Tackling what she calls a “profound injustice,” State Senator Holly J. Mitchell (D-30) has introduced S.B. 464, the California Dignity in Pregnancy and Childbirth Act, which is intended to address persistent racial and ethnic disparities in pregnancy-associated mortality.

Birth Outcome Disparities

Thirteen years ago, California took steps to address an alarming rise in maternal mortality rates. Although our state’s pregnancy-associated mortality rates have fallen dramatically and are now much better than the national average, maternal mortality and morbidity rates for Black women in California remain disproportionately high.

Although only 5.6 percent of the women who gave birth in California between 2013 and 2015 were Black, Black women accounted for 21 percent of maternal mortality cases during the same period!

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The racial disparities are so great that even healthy, middle-class Black women who don’t smoke and have good prenatal care have statistically worse birthing outcomes than do poor white women.

Implicit Bias and Mandatory Training

S.B. 464 puts a name to one of the likely causes of this disparity: implicit bias, which the bill defines as “bias in judgment or behavior that results from subtle cognitive processes, including implicit prejudice and implicit stereotypes that often operate at a level below conscious awareness and without intentional control.”

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This bill would require hospitals to implement evidence-based training programs designed to identify and dismantle implicit bias in perinatal care, with an emphasis on the ways provider bias and stereotypes can affect outcomes for mothers and infants. Nurses and other clinicians who provide perinatal care would be required to complete such training, with refreshers every two years.

“California has a responsibility to ensure that all its residents can have safe and dignified pregnancy and childbirth,” Mitchell says.

Nurse-Midwife Support

S.B. 464 is being co-sponsored by the California Nurse-Midwives Association. You can learn more about the bill at

Editor’s Note:

S.B.464 subsequently passed both houses of the Legislature and was signed into law on Oct. 7, 2019

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