(328) Unmasking Empathy and Color Evasion: A Mixed-Methods Study of Providers’ Perceptions on Maternal Health Disparities

Bias, racialized care, and institutional structures contribute to unequal experiences and outcomes among Black birthing people. Using a causal attribution framework, we examined obstetric providers’ perceptions and knowledge of maternal health disparity causes.

Study Design:

We conducted a mixed-methods study with obstetric providers (physicians and advanced practice providers) in Georgia from Aug 2023 to Jan 2024. Participants completed a 72-item survey assessing beliefs and perceptions about causes of maternal health disparities, color evasion, and empathy. Respondents were classified by attribution of provider behavior as a cause of disparities (high vs low) and compared using chi-square, Fisher’s exact, t-tests, or Wilcoxon rank-sum tests. A subset of 26 respondents participated in seven focus groups using clinical vignettes to explore beliefs. Thematic and ideal-type analyses identified emerging themes and typologies.

Results:

Among 284 respondents (median age 41; 84.5% female), 82.3% were physicians, with 42% White and 13.9% Black. Compared to respondents with low provider attribution scores (N=168), those with high scores (N=112) included a higher proportion of Black providers (p< .05), reported greater empathy (p< .05), and were more likely to agree that their personal biases affect patient care (p< .05). Color evasion scores were high across groups. Focus groups identified three drivers of disparities: structural/systemic factors (e.g. patient blame culture, workflow issues); organizational constraints (e.g. care discontinuity, burnout); and interpersonal dynamics (e.g. rapport building, "two victims"-providers perceived themselves and patients as system victims). Providers’ perceptions of racism and disparities fit five types: advocacy is healthcare, helpless doctor, knowledge giver, empathy as advocacy, and evasion by communication.

Conclusion:

Findings suggest providers often use color evasion and empathy to disguise personal bias and perpetuate racist stereotypes. The typologies reflect varying approaches providers use to deflect responsibility for overcoming and addressing personal bias.