Yes, racism exists in the US healthcare system. In fact, there are measurable differences in perceived discrimination AND in the actual medical care received among Black and white women. Perceived discrimination is highest among Black and Latino women. Whether discrimination is perceived or real doesn’t matter- the damage is already done.
Healthcare workers are reluctant to acknowledge their own prejudice and implicit bias, as racism today is so blended into the normal functioning of society that to many, it seems like a solved issue. However, in recent years there has been an increased focus on provider implicit bias, which is the “unconscious attribution of particular qualities to a certain group,” grounded in the stereotypes and ideology that surround a particular group, gender, or race. For Black women who are of higher socioeconomic status, they are still less likely to receive high quality care, revealing the prevalence of implicit bias or outright racism present in providers and across the healthcare system.
Provider implicit bias negatively impacts patient-provider communication, patient’s medical compliance with prenatal appointments, and trust necessary for successful care.
Not only do Black women feel discriminated against, that discrimination translates into differences in quality of care received.
- Black women are: (From the landmark publishing of Unequal Treatment, 2002)
- Less likely to receive routine prenatal care such as antenatal steroids
- Told less information about health risks
- Receive less intensive care
- Less likely to receive correct treatment for cardiovascular issues (why cardiomyopathy is such a concern)
- Less likely to receive routine care, even when comparing women of the same SES and access
- Predominately Black serving hospitals found to perform worse on 12 out of 15 obstetric metrics
- Including: complicated vaginal delivery, complicated cesarean delivery, obstetric trauma, uterine rupture, puerperal infection, and in-hospital mortality. Specifically, Black women had significantly higher rates of puerperal sepsis, urinary tract infection, and complications with vaginal and cesarean delivery
Discrimination in the healthcare system directly hurts the health of Black women. The lower quality of care given to Black mothers exacerbates the effects of racism on the social determinants of health: poorer preconception health due to a lifetime of discrimination. Due to implicit bias, a long history of medical distrust, and/or lack of access, Black women utilize prenatal care less often. When Black women do come into health facilities, they tend to have more severe complications, due to poorer preconception health, and then on top of that, they receive substandard care.
Coupled together, Black women come into health clinics with more advanced disease further along in gestation, and subsequently receive lower quality of care, leading to higher risk of death for Black women than white women.