The Republican-controlled Oklahoma House of Representatives voted this week to encourage medical professionals serving pregnant women to undergo “implicit bias” training.

Supporters said the measure could reduce maternal and infant deaths among minority populations—and reap federal grant money.

“Oklahoma is ranked 47th in maternal and infant mortality. That is not ‘top 10,’” said Rep. Ajay Pittman, D-Oklahoma City. “House Bill 3088 seeks to reduce the high maternal and infant mortality rates in this state and our local communities by educating our birthing centers and health care professionals that come in contact with expecting mothers.”

House Bill 3088, by Pittman, states, “Every hospital that provides inpatient maternity services and every birthing center … may implement an evidence-based implicit bias training program for all health professionals who provide perinatal treatment and care to pregnant women at the hospital or birthing center.”

The floor version of the legislation declared that implicit-bias training programs may include “identifying previous and current unconscious biases and misinformation when providing perinatal treatment and care to pregnant women;” “information on the effects of historical and contemporary exclusion and oppression of minority communities;” “information about communicating more effectively across racial, ethnic, religious, and gender identities;” “information about reproductive justice;” and “how implicit bias may contribute to pregnancy-related deaths and maternal and infant health outcomes.”

However, the bill was amended to remove the explicit references to “gender identity” and “reproductive justice.”

Pittman said the bill has the support of the Oklahoma Department of Health, OU Medicine, the Oklahoma Hospital Association, and Oklahoma City-County Health Department.

“The State Department of Health is trying to apply for a grant for federal funds, and so we need to go ahead and put this in statute so that they can receive those funds,” Pittman said.

Some lawmakers questioned the legislation’s underlying assumptions.

“Are you affirming with this bill and its requirements that implicit bias is causing higher infant mortality among African-American babies?” asked Rep. Jim Olsen, R-Sallisaw.

“I think that it is one of the things,” Pittman said. “It is not the end-all-be-all, but I think it contributes.”

She said other states have similar laws, including Ohio, Maryland, New York, California, Tennessee, Texas, Georgia, Indiana, and Iowa.

Supporters said the bill could improve treatment for pregnant women who are racial minorities.

“There’s a reason why the infant-mortality rate is three to four times higher for black women than that of white women,” said Rep. Reginia Goodwin, a Tulsa Democrat and black lawmaker. “And if I might take the liberty, I do want to stress the race aspect of this.”

She said issues like sickle cell anemia, maternal complications, and similar issues are, in part, race based.

“Black folks and white folks really are different in many ways,” Goodwin said. “Biologically, we’re different.”

Supporters said implicit bias training has generated positive results elsewhere.

“The American College of Obstetricians and Gynecologists have acknowledged that racial bias within the health care system is contributing to the disproportionate number of pregnancy-related deaths among women of color,” said House Minority Leader Emily Virgin, D-Oklahoma City.

Rep. Derrel Fincher, R-Bartlesville, said research has “shown that they’ve improved outcomes by working in implicit bias training even though when they start the implicit bias training, most people deny that they have those implicit biases inside of them.”

Rep. Kelly Albright, D-Oklahoma City, called the bill “a very common-sense piece of legislation.”

“We’re talking about internal bias, implicit bias,” Albright said. “That’s bias I don’t mean to have.”

But opponents said the legislation focuses on what people are accused of thinking, rather than deterring poor medical care.

“Behavior, not thought, should be the target of intervention in the workplace,” said Rep. Tom Gann, R-Inola.

Rep. Denise Crosswhite Hader, R-Piedmont, also worried the legislation was based on a “thought police” approach, and noted implicit bias is difficult to measure because it is “clearly just a mindset.”

While Crosswhite Hader opposed the bias-training legislation, she noted she understands the infant mortality issue better than most.

“I’ve had a child die,” Crosswhite Hader said. “My poor child has been mentioned more this session than I ever have, and he would almost be 30 years old, 29 years old, so I don’t take it lightly. It really, really sucks to have a baby and then they die in your arms, okay?”

Other critics said the proposed training would be both ineffective and offensive to medical professionals.

“The very foundations of this bill are bad,” Olsen said. “Implicit bias makes a wide, sweeping judgement about an entire group of people.”

“I think bigotry ought to be rooted out anywhere we find it,” Gann said. “And I find the bigotry in this implied bias training. It’s the highest form of bigotry, because implied bias training says—strongly suggests—that you’re biased, you’re a racist. That’s what this training is about. This training is insulting. It basically says: ‘You’re a bigot. You just don’t admit it yet.’”

He said he opposes making implicit-bias training a condition of employment for medical professionals, saying it amounts to a “re-education camp.” Gann noted the test to measure implicit bias involves gauging individuals’ reactions to images and words and whether they associate positive or negative traits with the image or phrase, a process he called “silly.”

Gann said “there’s just no convincing scientific evidence” that validates implicit-bias training, and multiple studies have concluded that "implicit-association test scores—in other words, unconscious bias—are very weak predictors of actual behavior.”

“The vast majority of people labeled ‘racist’ by these tests behave the same as the vast majority of people not racist,” Gann said. “This is Orwellian pablum.”

House Bill 3088 passed on a 62-33 vote. Thirty-nine Republicans joined the Democratic caucus in support of the bill, which now proceeds to the Oklahoma Senate.

 

Note: This story has been corrected since initial publication to include material noting the impact of floor amendments to HB 3088.