Advancing Birth Equity Through Quality Improvement Education: The SPEAK UP Champion Course.

Background: Black, non-Hispanic, and Indigenous perinatal patients in the United States experience disproportionately high rates of maternal mortality and morbidity compared with other racial and ethnic groups. While multiple social and institutional factors contribute to these inequities, structural racism, including implicit bias, remains key drivers shaping patient-health care professional interactions and the quality and equity of care. Objective: To evaluate, using a health equity lens, changes in perinatal health professionals' knowledge, attitudes, awareness, and self-reported preparedness and actions to mitigate racism before and after participation in the Institute for Perinatal Quality Improvement's SPEAK UP Champion course on implicit and explicit racial bias. Methods: We analyzed 1,303 pre-course surveys, 772 post-course surveys, and 48 follow-up implementation surveys collected from 28 SPEAK UP Champion courses delivered between 2021 and 2023. Surveys assessed knowledge, attitudes, awareness, and self-reported planned or implemented bias-mitigation strategies. Univariate analyses summarized outcomes, and chi-square tests examined racial differences in self-reported implicit bias. Results: Post-course surveys showed improvements in understanding race as a social construct, increased recognition of racism as a driver of perinatal disparities, and heightened awareness of disrespect toward Black and Indigenous patients. Participants reported greater preparedness to identify biased behaviors and develop equity-focused quality improvement (QI) goals, including self-reported planned or early implementation of bias-mitigation strategies. Implementation survey findings reflected respondent-reported practice changes among a small, self-selected subset of participants. Conclusion: These findings suggest that (1) the SPEAK UP Champion course was associated with increased racial bias awareness and enhanced participants' reported capacity to develop bias-mitigation QI action plans; and (2) integrating equity-focused education on implicit and explicit racial bias with QI methods may represent a promising, systems-level approach to advancing equity across the perinatal continuum that warrants broader implementation and further evaluation using rigorous outcome measures.