Introduction

A recent study from Columbia University's School of Nursing reveals a troubling trend: language imbued with bias and stigma is prevalent in the electronic health records of birthing patients. This research, published in the January 2025 special issue of the Journal of Obstetric, Gynecologic & Neonatal Nursing (JOGNN), highlights the impact of linguistic discrimination on maternal health outcomes.

Study Overview

The research, led by Dr. Veronica Barcelona, underscores that medical records for Black patients disproportionately feature biased language when compared to their white counterparts. Such negative language not only reflects societal issues like implicit bias and racism but also contributes to poorer health experiences and outcomes for Black birthing individuals.

Methodology

To grasp the extent of this bias within the perinatal context, the research team meticulously analyzed a total of 1,771 clinical and labor birthing notes from two large hospitals recorded in 2017. They identified 10 distinct categories that showcased stigmatizing versus non-stigmatizing language.

Findings

The findings were alarming. The most frequently documented stigmatizing language pertained to unjustified assertions about social or behavioral risks, such as references to suspected substance abuse, domestic violence, or teen pregnancy, which were noted in 22.4% of the records. Additionally, descriptors labeling patients as 'difficult' appeared in 7.2% of the notes, while mentions of social status, like a patient’s spouse working at a prestigious financial firm, fell under the category of power and privilege language in 5.2% of the documentation.

Other categories of damaging language, although less frequent, included authoritarian decision-making (4%), skepticism of patient credibility (2.9%), and overt clinician disapproval (1.1%).

Positive Language