Perceived Bias and U.S. Perinatal Health Care Quality: Implications for Practice and Policy

Introduction: U.S. maternal mortality rates are high. Inequities in birth outcomes are pervasive. Patient perception of bias during pregnancy-related care, especially among minoritized communities, is a risk factor for adverse perinatal health outcomes. Addressing this may be vital to lowering maternal mortality and improving care. The aim of this review was to explore the association between patient perception of provider bias and U.S. perinatal health care quality in birthing people. Methods: Following PRISMA-ScR guidelines, we conducted a scoping review of original published studies (2003-2023) addressing perceived bias/discrimination and perinatal care quality metrics. Both qualitative and quantitative studies were evaluated to formulate a broad conceptualization of the research examining perceived bias and perinatal health care quality. Results: Four addressed themes arose from this review that related to the association of perceived bias with: (i) demographic factors such as race/ethnicity and insurance type; (ii) patients' pregnancy-related health care engagement; (iii) a breakdown in communication and trust between patients and providers; and (iv) patients' sense of choice/control in their perinatal health care engagement. Conclusions: Researchers are using first-person accounts of perceived bias to better understand the etiology of inequitable maternal health statistics in the United States. Preliminary outcomes from this body of work indicate a relationship between the perception of bias, provider relationships, health care engagement, and maternal agency. The role of bias perception on maternal mortality may be an important barrier to improved health outcomes, particularly in minoritized populations.