Implicit biases are social stereotypes about certain groups of people that individuals form outside their conscious awareness. Implicit bias happens outside of our control. It occurs automatically and is triggered by our brain making a quick judgment. These implicit attitudes, actions or judgments are controlled by automatic evaluations without our own awareness. These instinctive decisions/preferences about other people play a significant part in the way we engage people and the decisions we make about them.

Implicit bias results in subtle but highly impactful behaviors, messages, and other signals that send positive or negative messages. They reveal our unconscious thoughts and send messages of disapproval, dislike, or distaste and are revealed slights that cause others to feel devalued, slighted, discouraged and excluded. On the positive side, Micro-Affirmations support signals that cause others to feel valued, included, and encouraged.

Some general examples of implicit bias include:

• Constantly being interrupted while you are talking.
• Being left out of a discussion/project.
• Trying to speak with someone who is reading or sending e-mails during conversation.
• Talking with someone who keeps looking at his/her watch.
• Not being introduced in a meeting and then being ignored.
• Avoidance of eye contact.

Since the passage of the Trafficking Victims Protection Act in 2000, work has been done to identify some of the assumptions, notions, and preconceptions about human trafficking, and to address them. For example, people used to say about a teen-ager in prostitution that “She’s a bad girl,” or “She likes that life,” or “She’s just a prostitute.” This resulted in years of girls being identified as juvenile delinquents or criminals when they were actually being exploited by pimps and traffickers. Now we have laws that identify children in prostitution as victims, not criminals.

Survivors tell us stories about the way implicit bias in healthcare and service providers negatively affected their treatment. Here are some examples:

• “When I was being taken from the waiting room to a clinic room, two nurses looked at me, whispered to each other and laughed at me. Even though I really needed help, I left the clinic without being treated.”
• “The doctor was so abrupt doing the pap smear that it hurt me. I could tell it was a judgment about me and the situation (trafficked into prostitution) I was in.”
• “The pregnancy test came back positive but instead of congratulating me, the staff made an assumption that I would not want the baby or be capable of taking care of the baby.”
• “The doctor and nurses treated me with such disdain. I’d been in before and I think they thought I was just a local prostitute. When I complained about nausea, pain in my abdomen, bloating, and a feeling of fluid and fullness in my uterus, they told me it was all in my mind. A year later, I found out I had cancer and had to have my uterus removed.”
• “I was trafficked from Central America into a factory in the U.S. that made boxes. They made us work 17 hours a day assembling boxes and they didn’t pay us. During the time I was there, I was raped by one of the bosses and got pregnant. When I went to the clinic, I didn’t have ID and I think they assumed I was smuggled in illegally and turned me away.

Scientists estimate that 80 - 90% of our mind works unconsciously New research says that bias, preconceptions, and interpretations are unavoidable and that people do not have insight into their own bias. One model for addressing implicit bias is the RAM Model (Recognize, Address, and Manage).¹

Recognize:

• Become more aware through training, self-examination and admission.
• Seek opportunities to learn more about people/cultures that are unfamiliar.
• Actively engage others and support diversity and inclusion events.

Address:

• Assess training needs on implicit bias. Many excellent courses are available.
• Learn more about the social stigma associated with sex and labor trafficking.
• If you see implicit bias in your staff or colleagues, provide feedback about the behavior not the person.

Manage:

• Seek out positive images/stories of victims of trafficking.
• Create a Specialized Training on Human Trafficking for all staff to take.
• Learn how to take the unconscious and make it more conscious.
• Create and ensure enhanced opportunities for staff engagement and learning. One survivor of human trafficking suggested holding “Lunch and Learns” or other events in which survivors can tell their stories and talk about their experiences with seeking services in family planning and other local clinics.

¹U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA) and HHS Human Resources. https://thinkculturalhealth.hhs.gov/maternal-health-care/assets/pdfs/Combating_implicit_bias_and_stereotypes.pdf