Anti-bias training can save Black moms’ lives. New bill would turn up heat on compliance
California Attorney General Rob Bonta is working with leaders of the state’s Legislative Black Caucus to add teeth to a law aimed at curbing the disproportionately high rate of Black maternal mortality.
Health care facilities are failing to ensure their birthing staff get the anti-bias training required under Senate Bill 464, said Bonta, so Assemblymember Lori Wilson will soon introduce a bill that puts enforcement mechanisms in place.
Wilson, a Suisun City Democrat who chairs the California Legislative Black Caucus, said the measure will set deadlines, establish financial penalties and require facilities to post their compliance rates online
The maternal death rate for Black women in California is three to four times higher than for white women, Bonta said.
“Black women make up 5% of pregnant patients but account for 21% of total pregnancy-related deaths,” Bonta said. “It’s a disparity that cuts across income levels. We know a root cause of this problem is implicit bias in healthcare.”
Wilson’s legislation builds upon SB 464, the California Dignity in Pregnancy and Childbirth Act of 2019. In October 2023, Bonta said health care facilities in the state largely failed to ensure that their labor, delivery and other birthing care staff had taken the mandated training.
It was then that Bonta promised his team would add teeth to that law, saying that his wife — Assemblymember Mia Bonta, an Afro-Latina Democrat who represents Oakland — had faced a prolonged illness during her second pregnancy because her providers failed to act on her concerns.
Mia Bonta, who is co-sponsoring the new legislation with Wilson, said she was young, athletic and very excited about adding to her family, and she was struggling with her health in ways she hadn’t done before. Doctors, however, told her she was fine, she said.
“It took six months of multiple doctor’s visits for me to finally say, ‘I know my body. You are wrong. I need help,’” Mia Bonta said, “and for a simple diagnostic blood test to unveil the fact that I had an underlying health condition that had not been discovered but that had been activated by my pregnancy.”
Black women have worse perinatal outcomes
In studies and TED talks, Black women report having their pain minimized or dismissed, allowing conditions such as endometriosis to go undiagnosed and leading to serious complications.
Even Black women who practice healthy behaviors during pregnancy have worse perinatal outcomes than white women who do not, according to a report released earlier this year by the California Department of Public Health and the UCSF Center for Health Equity.
Implicit bias has been shown to negatively affect interactions between patients and providers, provider treatment decisions, adherence to treatments and actual health outcomes, Bonta said, but the training helps to eliminate misconceptions and prejudices.
The proposed bill would introduce new mandates to ensure compliance with SB 464, like expanding the list of health care professionals who need to be trained, setting a firm deadline on when employees must finish the training, and adding more inclusive language.
“By June of 2025, we need to have compliance throughout the state,” Bonta said. Reports on compliance will “need to occur every February thereafter. People are able to comply a little better when they know they have a hard deadline.”
The measure would also give the California Department of Public Health and Department of Justice the power to enforce compliance and set accountability measures. Facilities will be required to publicly post compliance data online.
The proposal would also offer a $10,000 first-time violation penalties for non-compliant facilities. The fee would go up to $25,000 for subsequent violations.
“As Black women, these statistics hit too close to home,” Wilson said. “They acknowledge the sobering reality of being a pregnant woman of color in this country — and even in this state — and highlight the need to correct the course that we are on.”
