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Minnie S. McMillian




Connecting Implicit Bias in Pain Perception to the Maternal Mortality Crisis

Minnie S. McMillian, Syracuse University

Globally, maternal mortality is a significant issue, with racial disparities evident in the U.S. In 2020, the maternal mortality rate for Black women was three times higher than that of White women1. The Centers for Disease Control and Prevention (CDC) reported various factors that contribute to these disparities, including structural racism, chronic conditions, implicit bias, and differences in the quality of care2. The combination of implicit racial bias and the quality of care could manifest in whether a physician perceives a mother's pain, especially if she is Black.

Research suggests that White Americans are less likely to perceive the pain of Black people compared to non-Black people. Research on this topic explores how people report the pain level of others after reading fictitious painful scenarios (e.g., slamming their hand in a car door). Further, researchers are particularly interested in examining differences in pain perception when the participant reports the pain level of someone from a different racial or ethnic background than themselves. A meta-analysis confirmed, across forty studies, racial differences in pain perception (see Lin et al., 2020)3. Another study found that White medical residents, medical students, and White adults without medical training endorsed some false biological beliefs about Black people. For example, one belief they read stated that Black people have thicker skin than White people, which is false. As a result of endorsing such false biological beliefs, people without a medical background reported that Black people would feel less pain in painful scenarios. Even more alarming, medical residents and students who endorsed false beliefs also said that a Black patient would feel less pain. Moreover, those same residents and students were less accurate in treatment recommendations for a hypothetical Black patient4. The assumption that Black people are inherently more resilient may also lead to the belief that they can tolerate more pain. For example, some believe that Black people are stronger because they endure more hardships than White people; therefore, they can tolerate more pain (see Trawalter & Hoffman, 2015)5. Therefore, if a non-Black physician believes that all Black people are resilient because of the existing racial disparities they endure, they might also believe their Black patients can tolerate more pain. There are plenty of stories of Black women feeling unsupported or invalidated by their non-Black physicians when disclosing their pain.

It is crucial to recognize that Black people feel pain; the Black women who have or will be birthing children will feel pain. The consequences of overlooking or misattributing pain can be severe, especially for pregnant Black women and Black birthing people. Physician biases may result in inadequate pain treatment or insufficient health recommendations, exacerbating complications during pregnancy. The misperceptions concerning the pain of Black people can be attributed to implicit or explicit racial bias regarding beliefs about biological differences or inherent toughness. Addressing maternal health disparities requires investing in local campaigns, supporting reproductive justice, and advocating for relevant state and national legislation. However, with the recommendations listed above, it is imperative to understand that though they address structural issues, we still must hold individuals within these institutions who perpetuate these disparities accountable.

I want to acknowledge that some people can become pregnant or birth people who do not identify as women. They, too, were considered when writing this piece, but the gender-specific language used is based on the research included.

  1. Hoyert, D. L. (2022). Maternal mortality rates in the United States, 2020.
  2. Centers for Disease Control and Prevention (2023). Health equity: Working together to reduce Black maternal mortality. Retrieved from   
  3. Lin, J., Drain, A., Goharzad, A., & Mende-Siedlecki, P. (2020). What factors fuel racial bias in pain perception and treatment?: A meta-analysis across 40 experimental  studies.
  4. Hoffman, K. M., Trawalter, S., Axt, J. R., & Oliver, M. N. (2016). Racial bias in pain        assessment and treatment recommendations, and false beliefs about biological   differences between blacks and whites. Proceedings of the National Academy of Sciences - PNAS, 113(16), 4296-4301.                 
  5. Trawalter, S., & Hoffman, K. M. (2015). Got pain? Racial bias in perceptions of pain. Social and Personality Psychology Compass, 9(3), 146-157.

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