In response to the alarming maternal mortality rates experienced by Black people (3.5 times higher than non-Hispanic white women), California passed the California Dignity in Pregnancy and Childbirth Act (SB 464) in 2019. The bill required implicit bias training to address disparities in maternal health, yet there were issues.
In 2023, the Multi-Stakeholder Engagement with State Policies to Advance Antiracism in Maternal Health (MEND) study, funded by the California Preterm Birth Initiative, the Agency for Healthcare Research and Quality, and the National Institutes of Health, collected feedback from Black women who had a hospital birth and multidisciplinary perinatal clinicians who worked in the community or safety-net hospitals.
Through a series of focus groups, interviews, and surveys, the study found that both Black women and perinatal clinicians were concerned that the training required in SB 464 was insufficient to resolve disparities in care. Both groups thought that implicit bias instruction should be part of a larger interactive training with real-life stories and a historical perspective on racial bias in health care.
“Black women and birthing people deserve respectful and dignifying maternity care,” says Sarah Garrett, PhD, Principal Investigator of the MEND study and Assistant Professor at the Philip R. Lee Institute for Health Policy Studies at UCSF.
The study highlighted the need for training enforcement, better content, and systemic accountability to create meaningful improvements. Requirements for facilities, and not just individuals, were suggested, as well as additional training for clinicians receiving repeated complaints about biased behavior.
MEND participants noted the importance of addressing intersecting identities — such as race, gender identity, and socioeconomic status — when considering bias in maternal care. They also pointed out the value of including community perspectives in shaping practices and updating training.
An amendment to the California Dignity in Pregnancy and Childbirth Act, AB 2319, was written to correct many of these issues and was signed into law on September 26, 2024.
“AB 2319 addresses key recommendations issued from our research — specifically expanding the scope of trainees and developing enforcement mechanisms,” says Garrett.
Garrett notes that AB 2319 now gives the Attorney General the authority to enforce compliance and publicly report facilities’ compliance data.
“We hope the Attorney General will fully leverage the authority granted by the bill to document, support, and enforce training in the state,” says Garrett.
