Differences in Hospital Prenatal Care in France: A Qualitative Study within the BIP Research on Racial Implicit Bias in Perinatal Care

o Background Recent statistics indicate that 24% of live births in France are to mothers who were born abroad. Women born in sub-Saharan Africa (SSA) are especially at risk of maternal and neonatal morbidity and mortality. Intermediate explanatory factors probably include access to and quality of care. We therefore wished to explore the hypothesis of less appropriate care for immigrants resulting from racial discrimination in care encouraged by implicit racial biases that healthcare professionals may carry. The BiP multidisciplinary mixed-methods project sought to explore implicit racial biases among prenatal practitioners in one of the first approaches to this issue in France. The qualitative component presented here aimed to assess whether implicit bias might be producing disparities in prenatal care for pregnant women. o Methods A sociological qualitative study was conducted in three public maternity units in the Paris area, France, among 6 obstetrician-gynaecologists, 6 midwives, 6 anaesthesiologists, and 148 pregnant women. The study is based on audio-recorded prenatal consultations and interviews with practitioners. Consultations and interviews were analysed thematically. o Results The countries of birth and social positions of the participating women were globally similar to those of the pregnant women seen in each maternity unit. The analyses showed that the standard of care was globally high and consultations were slightly longer for immigrant women; explanations provided by health-care practitioners were appropriate to their level of understanding. The prenatal follow-up, when standardised, left little room for differential care. Nonetheless, the tone of voice and the type of jokes showed the salience of the social relations of race and class, beyond the strict framework of the care relationship. A few instances of racism in care were identified and analysed, but their consideration by the institution is non-existent. o Conclusions French research is beginning to produce quantified data on racial discrimination in health care, and this qualitative study provides an in-depth understanding of mechanisms leading to less adequate care (which was not observed to be an everyday occurrence). Despite the inclusion bias inherent in this type of approach, this study produced original results about the differential care of immigrant women during hospital prenatal care and underlines the importance of universal access to care in limiting inequalities.