“We’re a Little Biased”: Medicine and the Management of Bias through the Case of Contraception
Abstract
There is a wealth of literature demonstrating the presence of bias throughout the American health care system. Despite acknowledging such presence, however, little is known about how bias functions within medical encounters, particularly how providers grapple with bias in their patient counseling and decision-making. We explore such processes through the case of contraceptive counseling, a highly raced, classed, and gendered context. In-depth interviews with 51 health care providers reveal that providers use four primary strategies to navigate and minimize bias in their care—using scientific rationale, employing “safe” biases, standardizing counseling, and implementing patient-centered care. Paradoxically, using these strategies can exacerbate rather than resolve bias. Understanding these bias management strategies reveals provider-held biases, how they manifest within appointments, and the potential consequences for patients’ health autonomy. Such knowledge informs interventions that promote contraceptive use among women in the United States, addresses bias in health care broadly, and thus ultimately helps combat health disparities.
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Significantly fewer studies focused on interprofessional or multidisciplinary teams (n=6), nurses (n=4), and medical students (n=4).
“It is worth noting that just under two-thirds (n=31)9 18 19 25 28 47 50–74 of research papers on HP SES implicit bias and decision-making focused on doctors/physicians, with significantly less studies focusing on interprofessional or multidisciplinary teams (n=6),75–80 nurses (n=4)29 81–83 and medical students (n=4).27 84–86”
From Health professionals implicit bias of patients with low socioeconomic status (SES) and its effects on clinical decision-making: a scoping review (2024) · cites this paper as [77]
Manzer and Bell, Smith-Oka and Shawahna et al's studies identified the adverse impact of stereotyping on HPs assessment and decision-making.
“Manzer and Bell77, Smith-Oka76 and Shawahna et al’s65 studies identified the adverse impact of stereotyping on HPs assessment and decision-making.”
From Health professionals implicit bias of patients with low socioeconomic status (SES) and its effects on clinical decision-making: a scoping review (2024) · cites this paper as [77]
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- Authors
- Manzer, J. L., & Bell, A. V.
- Affiliations
- University of Delaware (US)
- Corresponding author
- Manzer, Jamie L.
- Venue
- Journal of Health and Social Behavior
- Publisher
- SAGE Publications
- Published
- 2021-04-12
- Volume
- 62
- Issue
- 2
- Pages
- 120-135
- ISSN
- 0022-1465 (ISSN-L)
- 2150-6000
- OpenAlex
- W4205217429
- Cited by
- 58
- References
- 0
- Citations by year
- 2026: 2 · 2025: 11 · 2024: 14 · 2023: 17 · 2022: 10 · 2021: 4
- FWCI
- 9.75
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Health and Social Behavior (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Anonymous Foundation
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Social Sciences › Gender Studies › Diversity and Career in Medicine
- Keywords
- medical bias, contraceptive counseling, healthcare workers, racial bias, socioeconomic status, gender, patient-centered care, health disparities, health autonomy, contraceptive use, clinical decision-making
- MeSH terms
- Contraception, Counseling, Family Planning Services, Female, Health Personnel, Humans, United States, Bias
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