What Maternal Health Curricula Omit: Confronting Racial Bias in Professional Training Programs
The statistics have been cited so often they risk losing their urgency: Black women in the United States die from pregnancy-related causes at two to three times the rate of white women. Indigenous women face similarly devastating disparities. These are not marginal variations in outcome data. They are systemic failures—failures that implicate not only healthcare infrastructure and social determinants, but the professionals who deliver care and the training programs that shape them.
If we are serious about preparing the next generation of midwives, nurses, and obstetric providers to serve all patients equitably, we must be equally serious about examining what our curricula are—and are not—teaching about race, bias, and structural inequality.
The Curriculum Gap Is Not Hypothetical
Research on health professions education consistently reveals that explicit instruction on racial health disparities remains inconsistent, underdeveloped, or superficial in many US training programs. When the topic does appear, it is frequently framed around patient demographics rather than provider behavior—emphasizing the characteristics of marginalized populations rather than interrogating the systems and individual biases that produce differential outcomes.
This framing matters enormously. A curriculum that teaches trainees that Black women have higher maternal mortality rates without also teaching why—and, critically, how provider behavior contributes—produces graduates who can recite a statistic but cannot interrupt the harm it represents.
The omission is not always deliberate. Curriculum committees face competing priorities, limited contact hours, and the genuine complexity of integrating social science frameworks into clinically oriented programs. But intention does not neutralize impact. A training program that graduates providers who have never examined their own implicit biases, never practiced navigating a clinical scenario shaped by racial dynamics, and never learned to recognize when a patient's pain is being undertreated because of assumptions about race has failed those providers—and the patients who will depend on them.
What Implicit Bias Training Alone Cannot Do
Many programs have responded to the disparity data by adding implicit bias modules to their curricula. This is a meaningful step, but it is insufficient on its own. Research on implicit bias training in healthcare settings suggests that awareness alone does not reliably translate into behavior change. Without structural reinforcement—through simulation practice, reflective supervision, and accountability frameworks—bias education can function more as an institutional checkbox than a genuine intervention.
Effective training requires more than a single lecture or online module. It requires repeated, scaffolded engagement with the topic across the arc of a program. It requires clinical simulation scenarios that place trainees inside racially complex interactions and ask them to reflect on their responses. It requires faculty who are themselves trained to facilitate these conversations and who model critical self-reflection in their own clinical teaching.
Perhaps most importantly, it requires institutional honesty. Programs that acknowledge racial disparities in the abstract while maintaining clinical training partnerships with facilities that have documented disparate outcomes are sending a contradictory message to their students.
Redesigning for Equity: What Educators Can Do Now
For educators and program directors committed to building more equitable maternal health training, the following curricular modifications represent evidence-informed starting points:
Integrate race and racism as structural—not demographic—concepts. Curricula should distinguish between race as a social construct and racism as a system of power. Trainees need frameworks for understanding how structural racism shapes clinical environments, shapes patient experiences of care, and shapes provider decision-making—even when no individual in the room intends harm.
Develop racially contextualized simulation scenarios. Clinical simulation is among the most powerful tools in health professions education. Programs should develop and standardize scenarios that place trainees in situations where racial dynamics are explicitly at play—a Black patient whose pain reports are questioned, an Indigenous patient whose birth preferences are dismissed, a provider navigating a unit culture that normalizes differential treatment. Debriefs should be facilitated by instructors trained in anti-racism pedagogy, not just clinical skills.
Teach the history. The contemporary disparities in Black maternal mortality cannot be understood in isolation from the history of American obstetrics—a history that includes the experimental origins of gynecological surgery performed on enslaved women, the exclusion of Black women from midwifery licensure, and the ongoing underrepresentation of Black providers in maternal health. This history is not supplementary context. It is foundational to understanding why distrust of medical institutions among Black patients is rational, not irrational—and why that distrust has clinical consequences.
Examine pain assessment and management practices explicitly. Research has documented that Black patients are systematically undertreated for pain across medical specialties, including obstetrics. Training programs should address this directly, examining the false beliefs about biological race differences that contribute to undertreated pain and equipping trainees to recognize when their own assessments may be influenced by these assumptions.
Create space for ongoing reflection. Bias is not a problem that is solved by completing a curriculum module. Programs should build in structured opportunities for reflective practice throughout clinical training—supervision sessions, journaling prompts, peer discussion formats—that allow trainees to return to these questions as their clinical experiences accumulate.
The Institutional Responsibility
Curriculum change does not occur in a vacuum. Educators who want to build more equitable training programs need institutional support: protected time for faculty development, administrative commitment to diversifying clinical faculty and preceptors, and a willingness to evaluate program outcomes not only by licensure pass rates but by equity metrics.
Programs should also be asking harder questions about who is in the room. The racial composition of faculty, clinical preceptors, and student cohorts shapes the learning environment in ways that no curriculum document can fully compensate for. Representation is not a substitute for structural change, but its absence sends its own message.
Training That Reflects the Standard We Claim to Hold
Birth Academy's commitment to evidence-based education extends beyond clinical technique. Evidence is equally clear that racial disparities in maternal health are real, measurable, and substantially influenced by provider behavior and institutional culture. A training program that does not prepare its graduates to reckon with that evidence is not, in any complete sense, evidence-based.
The maternal health professionals being trained today will shape outcomes for patients across the next several decades. The question before educators is whether the programs producing those professionals are honest enough—and rigorous enough—to equip them for the full complexity of the work ahead.
