Good intentions are not enough

Even in spaces where the majority of us share a vision of dignity for all, aligning aspirations with outcomes can still be an uphill battle - especially in healthcare and maternal health.

Our dreams of a country that feels like home, where people of all identities can feel a genuine sense of safety and belonging in public and in private, feels far away. This month has jarred so many of us again with fears for our safety and bodily autonomy, and horrific reminders of how many of our fellow citizens are driven by hate. 

But even in spaces where we presume that the majority of people genuinely share a vision of belonging and dignity for all, aligning those aspirations with behavior and outcomes is still too often an uphill battle.

These are the spaces Perception Institute most often works in, where we see how social identities – race, religion, ethnicity, gender, gender expression, sexual orientation, body size and the intersection of those identities – impact us on a daily basis, even among and between people with the best intentions.

One of the areas where we work and see this play out with life or death consequences, is in healthcare - specifically maternal health. 

When it comes to the healthcare you receive, the color of your skin and/or the perception of your identity can make a significant difference in the care you receive. Black and Latino people receive worse care on forty percent of care quality measures, as determined by the U.S. Department of Health and Human Services.

Multiple recent studies also find that these disparities don’t just exist in treatment recommendations or the quality of therapeutic relationships. Pain management and expressions of empathy also impact assessment of pain. One recent study found that 60% of medical residents in training still believed darker skin was thicker and more impervious to pain.

While most providers believe they could never be this biased, and that their intentions are always grounded in fairness, patient outcomes prove otherwise.

We saw this especially as COVID-19 rolled in early 2020, and another pandemic brewed beneath the radar. At least six Black women across the five boroughs of New York succumbed to injuries associated with an adverse labor and delivery, a rate of maternal mortality four times higher than that experienced by white women. In a personal twist of big city small town, this author had community ties to three of the victims.

Perception Interventions

In support of broader goals of reproductive justice and racial equity in maternal health, and toward eliminating preventable maternal mortality in New York City, in 2020 Perception began working with the New York City Department of Health and Mental Hygiene (NYC DOHMH) and Health & Hospitals NYC.

In collaboration with other healthcare providers, we designed interventions to support anti-bias training across the network, and we expanded the trainings to engage not only public-facing positions, but also to address the role of interpersonal bias among and across administrative, clinical and operational staff and personnel. The trainings focus on three key interventions that help healthcare providers and other support staff see where and how implicit bias entered into their interactions:

The late Dr. Toni Morrison often remarked that “racism is a scholarly affair.” It inundates not just our policy and procedure, but our “practice.” 

Perception’s training focus goes beyond right and wrong, and urges participants to unpack the role of history and stereotypes—and in the case of healthcare, the ways in which administrators can support staff to address challenging topics and discomfort. It’s a paradigm shift, and an acknowledgement that the social construct of race leaves a very real biological and social imprint on the lives of our fellow citizens, and ourselves.

There is no silver bullet fix: improving patient outcomes, and saving Black lives in the maternity ward, requires a continuum of training, the repetition of interventions and courageous conversations that hold individuals accountable, without re-traumatizing folk.

Perception in Practice

From Bangkok to Nairobi to Washington, DC, Perception Partner and Senior Advisor Jason Craige Harris has been speaking at global screenings of the new documentary Race to Be Human. The film takes a look at micro-aggressions, allyship, and the role of social media, and shares how we build empathy through courageous conversations at home, work, and school—​​especially among young people.

The Perception Team is Reading …

Girl, Woman, Other by Bernadine Evaristo. We know an empathic perspective-taking is a powerful way to reduce implicit bias, and here’s a book of fiction that does wonders with this. Perception Co-Founder and Co-Director Rachel Godsil can’t recommend it enough.

Nice White Ladies: The Truth About White Supremacy, Our Role in It, and How We Can Dismantle It by Jessie Daniels. 

The Racial Capitalism of Care: a new webinar on inequities in medicine and child welfare, featuring Ruha Benjamin, Bram Wispelwey, Michelle Morse, and Dorothy Roberts.

And for a deep dive focus on individuals, group dynamics, and trauma, Neuroscience and Peacebuilding:  Exploring the Neurobiological Dimensions of Violent Conflict and the Peacebuilding Potential of Neuroscientific Discoveries is a dynamic 3-part series edited by Colette Rausch. 

… What’s on your nightstand or in your open tabs? Send us your recommendations! 

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We do this work because all our research tells us that holding values of equity is not enough. Revealing and diminishing the power of implicit bias in our day-to-day actions is where we see the most powerful possibilities for deep change, and we hope you’ll keep learning with us as we share ongoing research, that of our peers, and most importantly, the actions we can all take to live, work and be truer to our values.

Signed,

Afua and the whole team at Perception