Insights Into Provider Bias in Family Planning from a Novel Shared Decision Making Based Counseling Initiative in Rural, Indigenous Guatemala

INTRODUCTION

An article by Solo and Festin¹ discusses the importance of addressing provider bias in family planning services. We agree that provider bias in family planning services is a widespread problem that restricts clients' autonomy and empowerment and applaud the authors for directing a spotlight on this important issue.

Our goals in writing this response are 2-fold. First, drawing from our experiences providing family planning services to primarily indigenous Maya women in rural Guatemala, we would like to expand Solo and Festin's discussion on bias against specific groups to include race and ethnicity. In this article, we understand race is defined as a social group based on perceived skin color or other physical qualities and ethnicity is defined as a social group based on common cultural or national traditions.²

Solo and Festin's article highlights sources of client-based bias, including age, parity, and marital status, as well as biases against specific socially marginalized groups, emphasizing youth, women who have HIV, women seeking abortion, those with disabilities, and men seeking permanent contraception. However, race and ethnicity are not singled out as a specific source of bias in their article. In our family planning work, ethnic minority patients report judgment, bias, and coercion in their reproductive health care experiences. We hope to use our professional observations and the current literature on racial and ethnic biases in health care to build on Solo and Festin's article by including race and …