Maternal Health, Reproductive Health, Health Equity
From Assumptions to Outcomes: How Unconscious Bias Shapes Obstetric Care
Francisco Javier Ruiloba Portilla, Adu Appiah-Kubi, Evangelia Deligeoroglou, et al.
June 8, 2026 at 1:15:16 PM
Abstract
Unconscious bias influences clinical judgment and communication across healthcare, but its effects in obstetric practice are particularly consequential due to time-sensitive decision making, high emotional vulnerability, and longstanding maternal health inequities. When bias-driven interactions escalate into coercion, non-consented procedures, or normalized mistreatment, they constitute forms of gender-based violence embedded within routine clinical care. A total of 89 studies met inclusion criteria. Unconscious bias manifested through dismissal of symptoms and credibility discounting; selective information exchange; stereotyping and moral judgment; differential clinical discretion, surveillance, and escalation; and normalized mistreatment and non-consented care. These processes contributed to documented inequities in severe maternal morbidity, intervention rates, and maternal near-miss events, particularly for Black, Indigenous, migrant, low-income, uninsured, adolescent, and disabled patients.
A systematic review with narrative synthesis of 89 studies, this paper maps how unconscious bias shapes obstetric provider–patient communication, shared decision making, and clinical discretion — disproportionately for Black, Indigenous, migrant, low-income, and disabled patients. The authors argue that, at its most severe, bias-driven coercion, non-consented procedures, and normalized mistreatment in obstetrics constitute a form of gender-based violence embedded in routine care.