Weight Bias Among Midwives Toward Patients with Higher Body Weights
Bradford, Heather Marie
Nearly 40% of individuals in the U.S. have higher body weights (body mass index (BMI) ≥ 30 kg/m2), a rate that is projected to reach 50% by 2030. Although healthcare provider weight bias toward these individuals has been linked to poor care quality and adverse outcomes in some settings, weight bias among perinatal care providers has been sparsely studied despite many adverse perinatal outcomes attributed to higher weight. The study objectives were to (1) describe implicit and explicit weight bias levels among midwives certified by the American Midwifery Certification Board with comparisons to previously published findings among the U.S. public and other health professionals, and (2) examine the direction and extent of weight bias among midwives across demographic characteristics of age, years since certification, BMI, race, ethnicity, and geographic region. Implicit weight bias was measured using the Implicit Association Test and explicit bias was measured using the Anti-fat Attitudes Questionnaire (AFA), Fat Phobia Scale (FPS), and Preference for Thin People (PTP) measure. A total of 2,257 midwives participated in the study, yielding a response rate of 17.7%. Over 70% of midwives had some level of implicit weight bias (slight bias = 19.3%; moderate bias = 31.2%; strong bias = 19.6%), although to a lesser extent than the U.S. public (p < .01) and other health professionals (p < .01). Implicit bias levels were similar between female midwives and female physicians. Midwives also expressed explicit weight bias, but at lower levels than the U.S. public and other health professionals. Midwives with a lower BMI generally expressed higher levels of implicit (p < .001) and explicit weight bias (p ≤ .01). Younger midwives had lower levels of implicit weight bias (p < .001) while midwives who identified as Black (versus white) had lower explicit weight bias levels on the FPS (p = .004) and PTP (p = .01) measures. This study provides quantitative evidence that weight bias exists among a national sample of midwives. Further research with more diverse samples of perinatal care providers is needed to explore the potential impact of their weight bias on clinical decision-making and perinatal outcomes.