Clinician Implicit Racial Bias and Contraceptive Counseling in the United States

Objective: Unequal treatment of patients based on race or ethnicity still exists in reproductive health. One possible reason is clinician bias. While explicit bias has been studied in relation to contraception, the influence of a clinician's implicit bias on contraceptive recommendations has not been examined. We sought to assess the degree of implicit racial bias among reproductive health clinicians and to determine whether bias correlates with recommendations for contraception. Methods: Clinicians were approached in-person at multiple hospitals in New York City and one national conference over a 7-month period. The computer-based study included a demographic survey, clinical vignettes about contraception, and a racial Implicit Association Test. The clinical vignettes were randomized 1:1 to describe either all white patients or all Black patients for each provider. We assessed the likelihood that patient race would factor into contraceptive counseling, looking separately at white and Black clinicians. Results: Of 500 clinicians invited to participate, 426 completed the survey and were analyzed. They were mostly non-Hispanic, white female attending physicians working in urban areas. White clinicians showed a pro-white bias (p < 0.001), while Black clinicians did not show racial bias in either direction (p = 0.637). White clinicians with pro-white bias were significantly more likely to recommend sterilization to Black patients than to white patients. Conclusions: Implicit racial bias differed based on clinician race, and contraceptive recommendations differed based on their level of bias. It is important for all reproductive health professionals to understand their own implicit bias and how it may affect their contraceptive counseling.