The unequal treatment of patients based on race/ethnicity is an ongoing problem in reproductive health. One possible reason for this is provider bias. While the relationship between explicit bias and providers' contraceptive recommendations has been studied, the relationship between those choices and provider's unconscious or implicit bias has not been examined. Our primary objective was to determine if implicit racial bias exists and if it correlates with providers' recommendations for their patients' contraceptive methods.
Practicing providers (attendings, residents, CNMs, PAs, etc.) who counsel on contraception participated in an IRB-approved computer-based survey at multiple hospitals in New York and at one national conference March 2018 to June 2018. The study included a demographic survey, clinical vignettes about contraception, and the racial Implicit Association Test - a validated tool designed by Project Implicit to assess implicit bias. Participants were randomized to clinical vignettes that described either White patients or Black patients.
Three hundred forty-eight (348) providers participated in the study: 191 attendings, 120 residents, 23 CNMs, 10 PAs, and 4 NPs. Of those, 149 had vignettes with White patients and 199 had vignettes with Black patients. White participants showed a pro-White bias (p<0.001), while Black participants did not show racial bias in either direction (p=.986). White participants showing more pro-White bias were less likely to recommend sterilization for White patients (p=0.14).
Implicit racial bias and contraceptive recommendations differed based on the provider's race. It is important for providers to understand their own implicit bias and how it may affect their contraceptive counseling.