The Hidden Consequences of Weakening Pregnancy Protections for Women in the Workplace

Policies that shape women’s experiences during pregnancy and postpartum have direct effects on their well-being, safety, and long-term health. In the United States, having reasonable workplace accommodations during pregnancy is needed to help women stay employed without putting their physical or mental health at risk [3,8]. However, recent legal challenges to the Equal Employment Opportunity Commission’s (EEOC) guidance under the Pregnant Workers Fairness Act (PWFA) have weakened the protections that many women rely on [1,2]. These shifts come at a time when the U.S. is already facing troubling maternal morbidity and mortality rates, particularly among women of color [4,5,6].

Taken together, we can deduce that  regulatory instability through small policy changes can have wide effects on women’s health. 

The Pregnant Workers Fairness Act, which was enacted in December 2022 and took effect in June 2023, requires covered employers to provide "reasonable accommodations” for pregnancy, childbirth, and related medical conditions [1]. In April 2024, the EEOC released its final rule and interpretative guidance by implementing the PWFA, clarifying that "pregnancy, childbirth, or related medical conditions”  includes miscarriage recovery, lactation needs, and fertility or IVF treatments [1]. However, legal challenges quickly followed. Seventeen states, led by Tennessee and Arkansas, filed lawsuits claiming the EEOC overstepped its authority in its final rule [2].  Several of these states won court orders that blocked parts of the rule from being enforced. As a result, the rule may be in place on paper, but how fully it applies and how reliably it can be enforced now varies across those states. 

The legal uncertainty has major implications for maternal health. Even prior to the newer rule challenges, many women reported inadequate workplace support.

Artwork by Shea Davis

A 2022 systematic review found that structural barriers like delays in pregnancy-related Medicaid coverage, lack of provider continuity, difficulties with transportation, and difficulties with childcare continue to be major obstacles to accessing prenatal and postpartum care [6].

These barriers make existing maternal health disparities in the United States even more pronounced. For example, pregnancy-related mortality remains significantly higher among Black women than among White women [4]. And  when workplace accommodations such as lighter duties, flexible scheduling, or time for recovery become difficult to obtain, women with medical vulnerabilities are harmed the most, facing a higher risk of preterm birth, pregnancy-related hypertension, and job insecurity.

The impact of this policy change is not confined to the pregnancy period. Conditions covered under “related medical conditions” (for example, miscarriage recovery or lactation) play a key role in women’s reproductive health and recovery. Without consistent accommodation standards, many women feel pressured to return to work before they have fully recovered. This can increase the risk of infection, mental-health setbacks, or delays in follow-up care [1]. 

State-level protections were already uneven. States such as California, New York, and Colorado offered stronger pregnancy-accommodation laws, so parts of the federal rule that were blocked have a smaller impact in those places [8]. However, in states without baseline maternal care, the practical loss is strong. Women in physically demanding or inflexible jobs (e.g., retail, food service, long-term care) face even more vulnerabilities [9]. 

Artwork by Shea Davis

Despite these challenges, there has been progress in other areas. Many states have extended Medicaid postpartum coverage to 12 months, an option made available through the American Rescue Plan Act of 2021. This act has expanded access for new mothers during the recovery period and by mid-2023, more than forty states had adopted or were in the process of adopting this extension [7]. Yet workplace protections, which affect millions of women across their reproductive lives, remain fragmented. 

Overall, the legal and regulatory uncertainty surrounding the PWFA emphasizes how vulnerable workplace protections remain for pregnant and postpartum workers. Delays or rollbacks in accommodations are not just technical issues; they reduce support at a time when maternal health indicators are already troubling. Protecting women's health and economic stability requires clear, enforceable workplace policies that recognize pregnancy and postpartum recovery as legitimate medical needs, rather than optional benefits. A more consistent national framework would help prevent avoidable health complications, strengthen financial stability for families, and ensure that women are not forced to choose between their well-being and employment. 

References

1. https://www.federalregister.gov/documents/2024/04/19/2024-07527/implementation-of-the-pregnant-workers-fairness-act

2. https://www.workforcebulletin.com/eeoc-final-rule-implementing-the-pregnant-workers-fairness-act-ignites-lawsuits-from-19-states

3. https://kffhealthnews.org/news/article/pregnancy-chemicals-occupational-risks-accommodations/

4. https://harvardlawreview.org/print/vol-137/finally-protected-analyzing-the-potential-of-the-pregnant-workers-fairness-act/

5. https://www.kff.org/womens-health-policy/health-policy-101-health-policy-issues-in-womens-health/

6. https://pubmed.ncbi.nlm.nih.gov/35584267/

7. https://www.jognn.org/article/S0884-2175%2822%2900359-8/fulltext

8. https://pregnantatwork.org/wp-content/uploads/State-Pregnancy-Accommodation-Chart.pdf

9. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2821164

10. https://www.bmj.com/content/385/bmj.q926