Adapted from UCSF Bixby Beyond the Pill CME Course # MMC20087

Bias refers to attitudes or stereotypes that affect our understanding, actions, and decisions. These biases can be unconscious or conscious (Marcelin 2019, Zestcott 2016, Kirwan Institute 2015, Blair 2011). These biases are pervasive and may not necessarily align with our declared beliefs. It is easier to see biases in others than ourselves.

Both unconscious and conscious biases can result in discrimination and health disparities, and can be especially harmful to people from at-risk and marginalized communities when working in reproductive health care. Some important historical examples include the widespread stereotype that “poor people are unable to care for children and so should limit their family size.” This bias has fueled forced sterilization, incentivized LARC use, coverage of LARC placement but not removal, and a lack of insurance coverage of infertility services among poor and/or marginalized patients (Guttmacher 2014). In studies using standardized videos, providers have demonstrated biases about who should use intrauterine contraception based only on patient race/ethnicity and socioeconomic status (Dehlendorf 2010). 

It is important to understand that most societies have systems of oppression in which there are those who benefit. We all have life experience which is a combination of unearned disadvantage and unearned advantage. To see it, one needs to look through a systemic lens, and not only at individuals (McIntosh 1989).

Self-reflection on implicit biases

In order to manage the impact that biases can have on the care we provide, the first step is to become aware of them and their influence on our care. To begin to incorporate self-reflection, you may consider some of the following questions.

  • To what privileged groups (i.e. educated, heterosexual, citizen) and what marginalized groups (i.e. lower-economic status, undocumented) do you belong?
  • Do you find yourself wanting people in specific groups to make certain contraceptive or pregnancy decisions?
Addressing Personal and Systemic Bias

Some best practices that help providers

  • Avoid making assumptions, as they often reflect cultural stereotypes and bias.
  • Listen more than you speak; assume patients are the experts in their own lives.
  • Practice cultural humility – do not impose your values and beliefs on your patients.
  • Cultivate partnerships with local reproductive justice and social advocacy groups.
  • Commit to lifelong self-evaluation and self-critique (Waters 2013).

Additional Resources


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