Participants (N=27) were on average 29 years old, majority non-Hispanic black (NHB) (74%), and most often publically insured (70%) (Table1). Participants were involved in diverse fields of employment. Food services, childcare and retail were the most common occupations (Table 2).
Table 1. Participant Characteristics (n=27)
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Age (mean, SD)
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29.1 (5.1)
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Self-Described
Race (n,%)
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Non-Hispanic Black (20, 74%)
Non-Hispanic White (6, 22%)
Mixed race (1, 4%)
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Insurance status (n,%)
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Private (7, 26%)
Public (19, 70%)
Uninsured (1, 4%)
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Table 2. Study Participant Occupations
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Employment
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Study Population
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Most Common Occupations among US Pregnant Women by Rank5
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National
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Black Women
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Food Service
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8 (29%)
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7
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Childcare (Daycare / Preschool)
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5 (19%)
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|
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Retail
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5 (19%)
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3
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1
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Healthcare/Nurse
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3 (11%)
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5
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2
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Customer Service
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2 (7%)
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6
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3
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Real estate/property management
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2 (7%)
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Biology Lab
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1 (4%)
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Hotel Housekeeping
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1 (4%)
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Other top ranked occupations
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1 Elementary teacher
2 Registered nurse
4 Administrative assistant
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4 Personal care aides
5 Registered nurse
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Income Implications
Participants described multiple ways that they felt their income decreased due to their pregnancy. Some of the pay decreases were the result of reduced duty hours, while other participants describe limitations due to unpaid leave (Table 3).
Table 3. Participant employment experiences
Income Implications
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Reduced duty hours
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“They understood I worked another job besides them, so they didn’t want me to overwork myself so they would like have me come like, all the way to [street name] like, two days a week, whatever, which really wasn’t worth my time you know, just to go to the bank or whatever for the what, twenty dollars, ten, twenty dollars. That’s all I really made a week you know, for those two days [food service worker, age 31].”
“That’s why my hours are cut now because I kept having to get off early, like take off on these days just to go to get my [prenatal care]. So that’s really the conflict [retail worker, age 25].”
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Unpaid leave
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“[Taking time off is] pretty much what was interfering and like I told them, I am pregnant, I do gotta receive prenatal care, so if you don’t feel I’m reliable because of that then, go ahead, do what you gotta do…. ‘cause my child’s life is more important than this freaking job. The same way I got this job, I can always find me another one… she tells me, I’m pregnant and I’m not reliable. Okay, that ain’t a good reason to let somebody go. That’s just discrimination on your part… [food service worker, age 31].”
“Oh, it just you know, makes the paycheck a little smaller, but other than that, that’s it [retail worker, age 37].”
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Consequences for non-hourly employees
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“I usually take off, when I have to go in the morning I’ll do like from 9:00 to 11:00, so I try to do like two, three, about two hours. …the only thing it really messed with is like my adherence at work. My adherence and my, basically my adherence and attendance. It kind of messes with those… Adherence is just your time on the phone, time away from the phone, and being on the phone when you’re actually supposed to be on the phone [customer service, age 29].”
“I would say, just because I am being monitored more closely [by my doctor], I do have a fair number of more doctor’s appointments than I did last time. I will say it has been a little tricky with the balance of you know, work and then having my workday kind of interrupted with an appointment. I never would skip my appointment just because I feel like I have to be at work, but there are some times where I feel you know, a little guilty, oh I’m missing that meeting or something like that. But like I mentioned before, my boss has never once said like, no you really need to be here, you can’t go to your doctor’s appointment you know, kind of thing. It’s more of a, I just personally feel a little guilty, yeah [scientist, age 32].”
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Workplace Accommodations
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Collaborative employer/employee accommodations
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”So, it’s usually, it’s a fairly loose working environment. I mean the schedules are pretty flexible and our boss is extremely understanding of just you know, family and personal needs and so we’ve kind of you know, as long as we’re there for you know, our eight hours a day and we’re actually making progress on our work, we kind of the ability to be pretty flexible with what we do [scientist, age 32].”
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Employer initiated accommodations
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“… we talked about when I get further along, closer to my due date, instead of me serving, we’ll move to a different position, it’s hosting, so it would still require me to be on my feet, but I wouldn’t be walking as much and it’s not a lot of lifting like, of trays and food and drinks and things like that. I would just be picking up things and wiping off tables and that stuff [food service worker, age 29].”
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Medically recommended accommodations
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“And I didn’t really work there too much longer after that ‘cause I was like you know, they don’t want to be supportive then, you know, they can just kick rocks and I can be happy with my healthy baby [food service worker, age 20].”
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Reduced Duty Hours
Many of the study participants (n=13) described income reduction due to decreased hours worked that they attributed to their pregnancies. Over half (n=7) of the work hour reductions that were described resulted from participant-initiated requests for a reduced workload. Some (n=4) participants requested to work shorter shifts and some (n=3) chose to leave their jobs. Most often the participant-initiated duty hour reductions or employment terminations were linked to pregnancy discomfort. One of these participants, a food service worker, described reducing her hours at a job that did not allow for much sitting: “I used to work full time, but now I work part time because it’s more of, I work in hospitality so I be on my feet a lot… now that I’m further along I experienced more lower back pain, under my stomach.” Another participant, also working in food service said, “I stopped working [at fast food restaurant] … when like, my back started hurting or I was being like, I was moving slower like, I wasn’t with production time and stuff like that.” The participant also explained that the smells from certain foods cooking at the restaurant made her vomit during her shifts.
Multiple participants (n=6) described supervisors who reduced the number of hours participants worked despite their desire to continue working. For example, a participant working in retail described that her employer responded to her pregnancy by: “Cutting my hours, that’s how she really responded to the whole [pregnancy] thing. She just cut my hours.” Another participant, a food service worker, described a similar experience:
“They didn’t know I was pregnant right away… they was like, ‘you know, you’re showing a little.’ So that’s when that came out. So that’s definitely, [fast food restaurant] changed my schedules, [from 7am to 4pm to] like 8 to 4, whatever you know, 10 to 4. They tried to sneak an 11 to 4.”
There were also participants who expressed positive work experiences prior to their pregnancy, yet during their pregnancy they terminated their employment due to decreased earnings and truncated advancement. A participant working in food service commented, “[Supervisor] was really like communicative and nice, but at the same time she was cutting my hours... so she was really nice about it, but at the same time, she knew that I needed the hours and she was still cutting them. So, that’s why I had to leave because I was not making any money.” Another participant also a food service worker, who was excited for an upcoming promotion, described leaving her job due to unsupportive attitudes towards her pregnancy: “I worked so hard you know, I fought for that spot… ‘cause I love working there, eating there, but [fast food restaurant] weren’t really supportive of pregnant women working there at all you know.”
Unpaid Leave
Less than one-third of the participants in our study were eligible for paid or partially-paid leave from their jobs. One participant, working in real estate, described a finite amount of time she could take off from work to attend prenatal visits before delivery and postpartum recovery. She had to weigh when to use paid time-off:
“I try not to use my PTO because you know you have to use PTO when you go on FMLA, before your short-term disability starts, so sometimes I just have to take the hit and not hit my forty hours, which means a lower check.”
Some participants (n=3) described situations in which unpaid leave was couched as a benefit to employees who were told they could return to work after delivery without having to reapply for their jobs. A food service worker explained she was told: “Just a leave, basically like you’re just quitting and then you just get rehired.” Another food service worker said she knew to expect being removed from the work schedule towards the end of her pregnancy: “…so as far as my due date, I told him that I’m due in September and he knows like, when it gets close to August, he’ll actually be preparing to take me off the schedule until I’m ready to return to work.”
Reduced Income in Non-Hourly Employees
Participants whose time at work was not scheduled in hourly shifts also experienced negative impacts to their take-home pay due to pregnancy. One participant who worked for a small retail business, reported that her supervisor allowed her to make-up the missed work due to prenatal visits at another time so that her take-home pay was not impacted, but only during the business’ “busy season.” Otherwise, she had to take unpaid leave from work to attend prenatal visits. Another participant who works in real estate, had a flexible work schedule. However, since she was paid on commission, time away from work could still impact her take-home pay as she explained, “If I’m not there then I’m just not there [to earn money].”
Many of the participants who worked in childcare reported positive experiences because they were able to balance work with prenatal and postpartum care. For one participant, the timing of her pregnancy meant that she could avoid reduced work hours. As the childcare worker explained, she did not have to take unpaid leave to attend prenatal visits since she disclosed her pregnancy during the summer, prior to the finalization of teaching assignments for the current school year. “I wanted to tell [supervisor] when my schedule was being like, figured out because I wanted to try and build in certain pockets of time when work was easier for me to get away for appointments.” The participant further explained that she was then able to attend healthcare visits during her planning period and make-up the missed work time on her own to avoid any impacts to her take-home pay, since she requested schedule changes before the school year started.
Workplace Accommodations
Participants discussed accommodations that their employers and coworkers made in their workplace environment or within job duties during their pregnancies. These accommodations were sometimes a collaborative effort between the participant and her employer; in other situations they were based on the employer’s perception of safe working conditions during pregnancy, and in other instances accommodations were initiated by a medical provider (Table 3).
Collaborative Employer/Employee Accommodations
Some of the most positive employment experiences recounted were collaborative efforts between the participant and her employer to adjust the workplace environment and job duties allowing the participant to continue performing her job duties while feeling safe and supported. A healthcare worker described: “They were very supportive. They told me that, you know, I wanted to do night shift and I wanted to do like an easier hall, like maybe rehab or something like that, and they were completely open to it; they were fine.”
Another healthcare worker, whose job required several hours of sitting and typing, described how her employer helped to make her workstation more comfortable:
“… if I need to be off or whatever, if I needed any accommodations to my workspace like, I had to buy, I didn’t have to buy it, they reimbursed me for it, but just different, like back supports and footstools and stuff that I started needing later ‘cause I was sitting a lot you know, they reimburse for, but anything I mean anything I needed they were onboard for.”
Employer-Initiated Accommodations
In other situations, the restrictions stemmed from the employer’s perception of safe working conditions during pregnancy. For example, a real estate worker explained that her manager “barely lets me carry the water” even though her medical provider had not recommended any lifting restrictions. Another participant working in food service without any provider-documented restrictions, described how her employer frequently considered her pregnancy: “They were strict with me of doing a lot of things. I couldn’t lift nothing, I couldn’t do too much bending like, kind of you know, they took my health into consideration, most definitely.”
Medically Recommended Accommodations
Participants also described situations where their medical provider recommended modifications to their job duties. These medically recommended restrictions were met with varied reactions at the workplace. A participant working in retail described a very supportive response from her employer. She said, “They’re supportive of me and they’ve been working with my accommodations… right now I’m on a twenty-five-pound weight restriction, so anything that would feel too heavy for me to lift, or to move, they actually do it for me.” Other participants described more negative reactions from their employers upon requesting medically-recommended accommodations during the workday. Two participants recounted experiences in which they perceived that their employment was terminated due to a request for accommodations recommended by a medical provider. One participant shared her experience of being laid off from her job at a grocery store when she shared that her physician had recommended an accommodation to her job duties:
“I was just laid off yesterday… due to my limits and restrictions from the doctors…. I was put on a ten-pound lifting limit, which is very, very small and unfortunately with all the job descriptions at my employer I wasn’t eligible for employment anymore. … I busted my butt at that place and gave it everything that I had, even very sick and ill and not well and they, I feel like they tossed me in the trash.”
When another participant started a new job as a nurse, she found her new employer was unwilling to accommodate job duty recommendations from her healthcare provider:
“I told her like maybe on day seven that I had a nurse’s note and when she told me that she was not going to accommodate it, I just basically let her know like, ‘well I can’t continue to work here. Like I need to,’ you know in the note it says like okay well, ‘I need to be able to take frequent breaks like to sit down, I can’t stand for longer than two hours, I should be able to take water breaks, bathroom breaks and stuff like that.’… She had a whole attitude about it and told me that she was not going to accommodate my nurse’s note so I was like ‘okay, you’re not going to accommodate my nurse’s note like so you want me to put myself and my baby in danger; no thank you, you can keep this job.’”
Ultimately, the participant quit the new job because the employer would not accommodate the requests in her healthcare provider’s note.