State AG Rob Bonta says despite progress, race still impacts healthy pregnancy

State officials cracked down on training for perinatal care providers with the hope to end inequities.

More than 81% of the state’s health facilities have trained pregnancy care providers to recognize and overcome implicit or unconscious racial biases and prejudices that could negatively impact the quality of care for patients of color, according to figures released by state Attorney General Rob Bonta in Los Angeles.

Studies, including one by the California Department of Public Health, found that women of color, and in particular Black women, die of pregnancy-related complications at much higher rates than white women in California, according to Bonta at a news conference in Leimert Park on Friday, Oct. 27.

To help address racial disparities, the California Dignity in Pregnancy and Childbirth Act was passed in 2019. The law requires health facilities to train perinatal care providers in recognizing and overcoming their own racial biases and prejudices that could potentially affect the care they provide to pregnant patients of color, possibly even endangering lives, Bonta said.

In August 2021, the state Department of Justice began an investigation to determine compliance with the law. At that time, fewer than 17% of responding providers had even begun training their employees and not a single employee had been fully trained, according to the attorney general.

By the time the DOJ’s investigation and outreach efforts concluded 10 months later, the training completion rate had risen to more than 81%. The findings are detailed in the Report on Healthcare Facilities and the California Dignity in Pregnancy and Childbirth Act released Friday.

“The disparity in maternal death rates in California reflects the deep and shameful racial inequities in our health care system,” Bonta said in a statement.

“In California, people of color, particularly Black women, continue to die at three to four times the rate of white women. This is unacceptable. … When it comes to health care, bias — even when it’s implicit — can be the difference between life and death for a patient. At DOJ, we will continue to fight for equity in health care and look out for the health and future of all Californians.”

The United States has the highest maternal mortality rate in the developed world — a burden disproportionately borne by communities of color, especially Black women, according to the attorney general. In California, Black women make up 5% of those pregnant but account for 21% of the total pregnancy-related deaths, Bonta said.

According to Bonta’s office, the disparity exists across all income levels, with evidence suggesting one key cause of the disparity is the implicit bias of health care providers. A provider’s level of bias, whether conscious or unconscious, can influence their interactions with patients and their diagnoses and treatment of the patient’s pain, and can undermine patients’ trust and engagement in care, the AG said.