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One crucial aspect when dealing with birth injustices is to ensure more effective client-provider relationships during pregnancy, birth and postpartum. Native women, at any given time during the perinatal period, have the right to open communication with the provider regarding the state of their health and the course of their healthcare. It mandates disclosure of all existing and potential risks,

benefits, and alternatives in healthcare decisions and options. Clarity should be established from the onset to encourage providers to listen to, hear and acknowledge the needs that Native women may have regarding maternal health; never to be ignored, minimized, stigmatized, or stereotyped. It is well established that healthcare providers like many others members of society, have ingrained implicit biases which have been associated with lower quality patient-provider communication, especially with regard to Native women. These prejudicial attitudes and beliefs are activated spontaneously, unconsciously, and shaped by stereotypes taught to them earlier in life, even as early as 3-5 years of age and often resulting in inequitable behaviors toward underserved populations.


The Joint Commission (, 2021) is the nation’s oldest and largest standards setting and accrediting body in health care. The organization released its issue of Quick Safety 23 to discuss the impact of implicit bias on patient safety. What makes implicit bias “frightening” in health and health care is that the result is “unthinking discrimination” of which caregivers are not aware.

Apart from discrimination, there is also the potential for blatant acts of disrespect and abuse that occur in the maternity care of Native women. Although, implicit bias is not just limited to race, it is “Racism, not race” that leads to healthcare inequities and adverse health. The quality of care may be affected through implicit bias or poor cross-cultural communication. Aside from Joint Commission’s

recommendations to examine the processes of hospital organizations, administration, policy and protocols, they also provide guidelines for clinicians.


The following documents are guides to provide direction for clinicians when serving Native women.  The documents also help to enlighten the women as to what they should expect and what they should inquire about when seeking healthcare.

Joint Commission's Quick Safety Issue 23 - Implicit bias in health care

Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care

Handbook on Sensitive Practice for Health Care Practitioners

Addressing the Needs of Native American Women and Girls

Culturally and Linguistically Appropriate Services (CLAS) in Maternal Health Care

Video - Supporting Patients in Pregnancy: ACEs and Maternal Health  

Video’s Slide deck,

American Indians and Alaska Natives must be included in research on adverse childhood experiences

Reproductive Health Access Project

TransLine Health

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