Listen to me: The communicative exchange and unconscious bias in a maternity setting.

本博士旨在使用对话分析（CA）来应对孕产妇健康结果中种族健康不平等的紧迫现实问题。在英国，孕期和产后期间的种族健康不平等现象十分明显。MBRRACE-UK在2021年11月的报告中指出，2017-2019年期间，黑人和白人妇女的孕产妇死亡率差异超过四倍。英国皇家助产士学院承认存在系统性的种族主义和无意识的偏见，并发起了一项“种族问题”战略。助产士发现无意识的偏见会对实践产生负面影响（Chitongo等人，2021年），研究表明，在病房中，普遍存在的文化神话，例如，黑人女性不太容易受到疼痛的影响（Saluja & Bryant， 2021年），更具攻击性（Ashley， 2014年）。尽管沟通对母婴关系至关重要（Heys等人，2021年，Nicholls和Webb 2006年），并支持母婴的安全结局（Dickson 1997年），尽管黑人妇女报告说她们没有被倾听（Jomeen和Redshaw 2012年，MBRRACE-UK， 2021年），但在这一领域的实证研究很少。本博士将研究黑人母亲和白人助产士之间的沟通，旨在了解无意识的偏见是否通过产妇环境中的语言使用起作用，以及沟通是否在维持种族健康不平等方面发挥作用。主要的研究问题是“黑人女性是如何感受没有人倾听的？”附带的问题是“如果数据中存在无意识偏见的表现，它是通过什么机制表现出来的？”以及“在这种情况下，对黑人女性来说，沟通是否会导致不平等？”我将记录黑人母亲与白人助产士的围产期预约，以便进行谈话分析。CA认为沟通是一种联合活动（Sacks, 1984），并且“更关注行为而不是行为”（Stubbe et al, 2003, p354）。这样就可以强调倾听，这是黑人母亲所缺乏的。

This PhD seeks to use conversation analysis (CA) to respond to the urgent real-world issue of racial health inequality in maternal health outcomes. Racial health inequalities in the UK pregnancy-post-partum journey are stark. MBRRACE-UK's November 2021 report identifies a more than four-fold difference in maternal mortality rates between Black and white women in the period 2017-2019. The Royal College of Midwives has acknowledged systemic racism and unconscious bias, launching a 'Race Matters' strategy. Midwives identify that unconscious bias negatively impacts practice (Chitongo et al, 2021) and research shows how pervasive cultural myths, e.g., Black women are less susceptible to pain (Saluja & Bryant, 2021) and more aggressive (e.g., Ashley, 2014), are enacted on the ward. Despite communication being crucial to a mother-midwife relationship (Heys et al, 2021, Nicholls & Webb 2006) and in supporting safe outcomes for mother and baby (Dickson 1997) and despite Black women reporting feeling they are not listened to (Jomeen & Redshaw 2012, MBRRACE-UK, 2021), there is little empirical research in this area. This PhD will examine communication between Black mothers and white midwives, aiming to understand if unconscious bias operates through language use in the maternity setting and whether communication plays a role in sustaining racial health inequality. The primary research question is 'How do Black women experience not being listened to?' with secondary questions of 'If there are presentations of unconscious bias in the data, by what mechanisms does it manifest?' and 'Does communication maintain inequality in this setting for Black women'? I will record perinatal appointments of Black mothers with white midwives for conversation analysis. CA recognises communication as joint activity (Sacks, 1984) and 'is more concerned with perlocutions than with illocutions' (Stubbe et al, 2003, p354). This will allow emphasis on listening, characterised as lacking by Black mothers.