Bay Area Lawmakers Push to Enforce State Anti-Bias Training Requirement for Maternal Health Providers

Two Bay Area lawmakers want to step up enforcement of a 2019 law aimed at reducing the disproportionately high maternal death rate among Black people in California.

The proposed legislation, introduced Monday, would set a firm deadline for maternal care facilities to fully complete a required anti-bias training and impose penalties for those that don’t comply.

State Assemblymembers Lori Wilson and Mia Bonta co-authored the bill, AB 2319, in response to a state Department of Justice investigation that found only a small fraction of California hospitals had completed the required training for their entire staff — and many had not even started the process.

The bill would “create more teeth, more enforcement, more accountability for the important work [of that law],” California Attorney General Rob Bonta, who initiated the investigation, said at a press conference on Monday. “We know a root cause of this problem is implicit bias in health care.”

The proposed legislation would give health care facilities that provide maternal care until June 2025 to complete the anti-bias training. Any facility that is out of compliance would face a $10,000 initial fine and a $25,000 fine for subsequent violations. The bill also specifies that facilities have to train all staff members who interact with patients — including front desk personnel and social workers — not just doctors and nurses and post their compliance rates online.

“By June of 2025, we need to have compliance throughout the state,” Bonta said. “People are able to comply a little better when they know they have a hard deadline.”

The initial 2019 law, known as the California Dignity in Pregnancy and Childbirth Act, requires hospitals and alternative birth centers to complete the anti-bias training with their staff every two years.

In California, pregnant Black people are four to six times as likely to die from pregnancy and birth-related issues than those in all other racial groups, according to the California Health Care Foundation. And the rate of severe health complications during and after pregnancy is twice as high for Black people.

“As Black women, these statistics hit too close to home. They acknowledge the sobering reality of being a pregnant woman of color,” said Wilson, a Democrat from Suisun City and chair of the California Legislative Black Caucus. “It is time for these institutions to come into compliance with the law. This is a small and necessary step towards making California a safer place for Black and brown mothers.”

In a September 2023 national survey of 2,400 mothers conducted by the U.S. Centers for Disease Control and Prevention, about 30% of Black, Hispanic, and multiracial women who received maternity care said they had been mistreated in some manner. Among the most common complaints was a failure by health care providers to respond to their serious requests for help.

Mia Bonta, who is Black and Latina — and the wife of Attorney General Bonta — said she suffered from a prolonged illness during one of her pregnancies because her providers largely ignored or dismissed her repeated requests for help.

“It took six months of multiple doctor’s visits for me to finally say, ‘I know my body. You are wrong. I need help and for a simple diagnostic blood test to unveil the fact that I had an underlying health condition that had not been discovered but that had been activated by my pregnancy,” said Bonta, a Democrat from Oakland.

“We all have these experiences, unfortunately, particularly as Black women and women of color,” she said. “We know what we need. We know that it is entirely possible to reverse the mortality rates and morbidity rates that Black women and women of color face as they’re giving life.”