Biased Language Common in Birthing People’s Electronic Health Records

Language that conveys stigma is common in clinicians’ notes on laboring and birthing people, findings from Columbia Nursing show. 

The study by Assistant Professor Veronica Barcelona, PhD, and her colleagues appeared in a special issue of the Journal of Obstetric, Gynecologic & Neonatal Nursing, “Women’s Mental Health Across the Life Course.” 

Studies show Black patients’ medical records are more likely to contain biased language than white patients’ records, which could contribute to worse health care, the authors note. While implicit bias and racism are known contributors to worse perinatal outcomes among Black people, they add, to date most research on clinicians’ use of stigmatizing language has been in non-maternity settings. 

To better understand bias in medical records for birthing patients, Barcelona and her colleagues analyzed 1,771 clinical and labor birthing notes from 2017 for two large hospitals, identifying 10 categories of stigmatizing and non-stigmatizing language. 

The most common category of stigmatizing language directed against patients was unjustified descriptions of social and behavioral risks, for example referring to suspected or actual substance use, domestic violence, or teen pregnancy, identified in 22.4% of the notes. Patients were called difficult in 7.2% of notes, while 5.2% of the notes included power or privilege language, for example mentioning a patient’s husband’s job at a prominent financial institution.   

Other stigmatizing categories occurring less frequently included language indicating unilateral, authoritarian decision making (4%), questioning patient credibility (2.9%), and clinician disapproval (1.1%).  

The authors defined two categories of non-stigmatizing language: positive or preferred language, for example using words like “endorses” or “reports” to convey a patient’s point of view, identified in 10.8% of the notes; and language indicating patients exercising autonomy for birth, seen in 0.8%. 

“Implications of this work extend beyond the research context,” Barcelona and her colleagues write. “We aim to improve clinical documentation that reflects each person’s autonomy, is patient-centered, and demonstrates respect to achieve the ultimate goal of developing more inclusive and equitable health care practices for all in the perinatal period.” 

Barcelona’s Columbia Nursing co-authors include postdoctoral associate Jihye Scroggins, PhD; Danielle Scharp, PhD '24; PhD student Sarah Harkins, BS; and Associate Professor Maxim Topaz, PhD. 

The study was funded with a grant from the Columbia University Data Science Institute Seed Funds Program and a grant from the Gordon and Betty Moore Foundation.