Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France; Maternity Unit, Groupe Hospitalier Paris Saint Joseph, FHU Prema, Paris, France.
Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France; Sorbonne University, Maternity Unit, Groupe Hospitalier Pitié-Salpêtrière, DMU Origyne, AP-HP, Paris, France.
J Gynecol Obstet Hum Reprod. 2022 Apr;51(4):102340. doi: 10.1016/j.jogoh.2022.102340. Epub 2022 Feb 16.
The mechanisms of disparities in maternal and perinatal health between migrant and native women are multiple and remain poorly understood. Access to and quality of care are likely to participate in these mechanisms, and one hypothesis is the existence of implicit biases among caregivers through which ethno-racial belonging can influence medical decisions and consequently engender healthcare disparities. Their existence and their role in the generation of non-medically justified differential care have been documented in the United States apart from perinatal care, but remain largely unexplored in Europe. In this article, we present the study protocol and theoretical framework of a study that aims to test and quantify the existence of implicit bias toward African Sub-Saharan migrant women among caregivers working in the perinatal field, and to explore the association between implicit bias and differential care.
This study is based on an online survey to which French obstetricians, midwives, and anesthetists were invited to take part. The potential existence of implicit biases toward African Sub-Saharan migrant will be quantified through a validated tool, the Implicit Association Test. Then we will assess how implicit biases are likely to influence clinical decisions and lead to differential care using clinical vignettes designed by an experts group.
Implicit bias and differential care are concept that are tricky to capture and interpret. This research program opens up in France a field of research on certain forms of health discriminations and sheds new light on the issue of social inequalities in perinatal health.
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移民和本地妇女在母婴健康方面存在差异的机制是多方面的，目前仍知之甚少。获得医疗服务的机会和医疗服务质量可能是这些机制的一部分，有一种假设认为，医护人员中存在隐性偏见，这种偏见可能会影响医疗决策，从而导致医疗保健方面的差异。这种偏见的存在及其在产生没有医学依据的差异化护理方面的作用，除了围产期护理之外，在美国已经有相关记录，但在欧洲，这种作用在很大程度上仍未得到探索。在本文中，我们介绍了一项研究的研究方案和理论框架，该研究旨在测试和量化在围产期领域工作的医护人员对非洲撒哈拉以南移民妇女的隐性偏见的存在，并探讨隐性偏见与差异化护理之间的关联。
这项研究基于一项在线调查，邀请法国的产科医生、助产士和麻醉师参与。通过一项经过验证的工具，即内隐联想测验，来量化对非洲撒哈拉以南移民的隐性偏见的存在。然后，我们将使用专家组设计的临床案例来评估隐性偏见如何影响临床决策并导致差异化护理。
隐性偏见和差异化护理是难以捕捉和解释的概念。本研究计划在法国开辟了一个研究某些形式的健康歧视的领域，并为围产期健康中的社会不平等问题提供了新的视角。
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