Study sample
Twenty-four women (aged 21 to 45 years, median of 32 years) participated in the study. No participants refused to participate or dropped out of the study. The gestational age of participant’s pregnancies ranged from 5 to 38 weeks (median of 22.5 weeks). Fourteen participants (58%) were pregnant for the first time. The remaining participants reported having between 1 and 5 children prior to the current pregnancy. For 14 participants, the primary source of financial support at the time of the interview was employment (i.e., the participant, their partner, or a family member was employed); for the remaining 10 participants, the primary source was public assistance benefits. Participants were working or had worked in the following job sectors: retail, education (including universities), healthcare, and government. The topic of pregnancy discrimination and bias in the employment setting was present in n = 13; 54.2% of interviews.
Findings
Participants in our study expressed a desire to “be independent and provide for my child” (first-time pregnant woman in her early 20s who is supported by her family), by giving their child “the best life and opportunities possible” (first-time pregnant, married woman in her early 30s who is employed), and in many cases to provide a life for their infant that improved upon their own. To this end, participants desired to have a job and be financially secure. However, many participants, regardless of their socioeconomic status, reported having difficulty finding or keeping a job both during and after current or prior pregnancies as a result of pregnancy discrimination and bias in the employment context. The following themes were identified (Fig. 1): 1) “You’re a liability”; difficulty seeking employment during pregnancy; 2) “This is not working”; experiences on the job and navigating leave and accommodations while pregnant and parenting; and 3) “It’s really depressing. I wanna work”; the stressors of experiencing pregnancy discrimination and bias. Overall, participants in this study were either experiencing, or planning around, pregnancy discrimination and bias and lack of family-friendly workplace policies throughout their reproductive years in a way that caused immense financial burden and stress.
“You’re a liability”; difficulty seeking employment during pregnancy
Difficulty seeking employment during pregnancy was common for participants in this study and affected both those who were unemployed and looking for work and those who were already employed but desiring to change jobs. Many participants discussed their feelings about anticipating discrimination while looking for work, and a few participants discussed experiencing discrimination while on the job market.
Anticipating pregnancy discrimination and bias
Many participants spoke about the anticipation of pregnancy discrimination and bias while seeking employment. This anticipation of pregnancy discrimination and bias dissuaded some participants from applying for jobs or following up with interviews when they were offered, because they believed that a known pregnancy would render their efforts futile. Participating in job interviews while visibly pregnant was especially challenging. One participant discussed that finding a job was a much more difficult and greater source of stress during a pregnancy than it normally was, especially since her pregnancy had just become more visibly obvious. She said: “I’ve looked online and made appointments, but then I tell myself, ‘Oh gosh, why go?’ Cause they are going to look at me and not hire.” (Mother of 5, single, in her early 40s who is a public assistance recipient.) The visibility of her pregnancy kept her from attending job interviews, despite her need for income. Similarly, many participants were not optimistic about gaining employment while pregnant. One woman had applied for several jobs before becoming pregnant, but the interviews occurred after she became pregnant. She described avoiding any mention of her obvious pregnancy during the interview. However, she felt that her pregnancy was the reason she was not ultimately hired: “[The interviewers] never said anything about the pregnancy. I didn’t mention it in any of the paperwork or anything, umm but I was showing. So, I pretty much think that was the reason.” (First-time pregnant woman in her early-30s who is supported in part by the father.) After three unsuccessful interviews, she concluded that her visible pregnancy was impeding her employment options.
Participants understood that potential employers would view their pregnancy, and by extension the participants themselves, as liabilities. One participant explained this unstated discrimination: “Because a lot of employers don’t want to hire you because you’re a liability to the company. If something happens to you while you’re pregnant on the job, their kinda liable for it.” (First-time pregnant, married woman in her mid-20s who is a public assistance recipient.) While it may have manifested differently for each participant, the understanding that being visibly pregnant was a liability while seeking employment was a common experience for participants in this study.
Experiences of pregnancy discrimination and bias
While less common, several participants discussed specific instances in which they were told directly by the employer that their pregnancy would prevent them from getting a job. The language of liability was used, with the emphasis placed on the legal and economic security of the organization instead of centered on the health of the woman and her fetus. One participant described her experience of a job offer being revoked because of her pregnancy: “[I was] offered a position and then I let them know that I was pregnant and just like, ‘Ah well, I’ll call back’, you know, kind of run around. I kinda know what’s going on.” (First-time pregnant, married woman in her mid-20s who is a public assistance recipient.) Another participant was given weight-bearing restrictions by her healthcare provider due to threatened preterm labor. At the time, she worked as a certified nursing assistant. She was then told by her agency that they could not place her in a position because of her pregnancy: “I was looking for jobs, going to job interviews, but they wouldn’t hire me because I’m pregnant… They said I’m a liability to the company and they said I could like injure myself, I could slip and fall, whatever and I could sue them, and they don’t want that. So, like, that’s not fair, there’s a lot of pregnant women that work. So, they think you are a liability, you’re just too far along.” (First-time pregnant woman in her early 20s who is supported by her family.)
Participants employed in jobs that required a significant amount of manual labor, as noted above, were more likely to describe experiences of pregnancy discrimination and bias. Another participant who worked as a certified nursing assistant had her ability to physically do her job questioned: “And then when I go to some jobs cause I was working through an agency, they’re like, ‘She’s big, well how much could she do?’” (Mother of two in her early 30s who is supported by her partner.) This participant wanted to continue working in her job but faced an employment agency that was unwilling to accommodate potential temporary work limitations related to her pregnancy. When the agency provided no safe alternatives, the participant and her employer jointly made the decision that she should not work for them.
“This is not working”;
experiences on the job and navigating leave and accommodations while pregnant and parenting
Pregnancy discrimination and bias did not just affect participants seeking employment, it also affected how supported they felt in their job and their desire to remain or change jobs in the future, regardless of job sector. One participant discussed how, since her first and second pregnancy, she has been treated drastically different at work. She described the weekly, if not daily, scrutiny she received at work, saying: “I’m making deadlines and doing everything else, but I’m treated kind of as an outsider, or just not a part of the team, or different notably different. So, I don’t know what the contributing factors could be. So, one could be race because I am the only person [of color]. One could be pregnancy.” She described that after having her first child, her work environment had become more racially charged, which was on top of the existing intense and demoralizing situation she felt being judged by her co-workers on the basis of race: “You are judged on your intelligence because of your skin color. You’re judged on your competence because of your skin color.” After becoming pregnant for the second time, she perceived that her co-workers questioned her competence and performance: “[Co-workers] don’t trust that you know what you’re doing or that you’re paying enough attention to detail.” (Mother of one, married, in her mid-30s who is employed.) This scrutiny and stress motivated her to leave a work environment she described as toxic and look for a new job.
Another participant discussed an experience with a prior job not giving her appropriate time off after an emergency operative birth: “I was actually trying to be very cognizant of when we started trying and like when the baby would be due to not put a strain on the department, which in hindsight it sounds awful, but I should not have cared, because they clearly didn’t show me the same respect that I was trying to show to them.” (Mother of one, married, in her early 30s who is employed.) This lack of mutual consideration led her to prioritize finding another job with better benefits and flexibility before having more children. The new job with better benefits and a supportive manager enabled a better work and pregnancy experience with her second child.
Disclosing one’s pregnancy status at work was also a source of stress for many participants early in their pregnancy. The perception of getting special considerations for their pregnancy status, getting unwanted attention, or experiencing harassment made participants more likely to delay the disclosure of their pregnancy to their supervisor or co-workers. One participant, pregnant with her first child, said: “I don’t want nobody to try to feel sorry for me like, you know, I’m pregnant. Oh, you can’t do this and you can’t do that type of thing. And I don’t want that to be, you know, the front line or like I’m trying to take advantage somehow. So, I want to be able to keep it confidential right now with myself before telling them, so that way it’s not like I’m using the pregnancy as, you know, something.” (First-time pregnant woman, single, in her early 20s who is employed.) For this participant, fear of discrimination centered around poor treatment from her co-workers.
Participants also had to manage the birth of their infant within the context of work and family constraints, and this sometimes led to difficult choices that could affect their own health. Participants described balancing their desire to bond with their infant with their desire or need to return to work because of limited family and medical leave policies, with an important deciding factor being the availability of social support. It was so important for one participant to spend more time with her newborn that she planned to have a repeat operative birth due to the longer medical leave associated with an operative birth: “And I just think honestly, I don’t think you get enough time to, you know, six weeks home with the baby, that’s kinda short to me. So, I assume [if] I take a c-section I’m going to be out longer, and I don’t mind… If I could get just a little extra time like an extra month that would mean so much to be home with my baby.” (Mother of one in her early 30s who is employed.) With limited workplace and social support, this participant made medical decisions based not on her own health concerns and priorities but based on getting minimally sufficient time to recover and bond with her infant.
“It’s really depressing. I wanna work”; the stressors of experiencing pregnancy discrimination and bias
For participants in this study, experiences with pregnancy discrimination and bias manifested in many different areas of their life. Because employment is tied not only to income, but also to health insurance and other health benefits, difficulty finding a job or concerns regarding a job during or after pregnancy could be a major life stressor. In particular, participants reported stress related to the financial concerns of pregnancy discrimination and bias. These stressors, in turn, could create or exacerbate mental health issues.
Financial concerns
Participants reported financial stress from pregnancy discrimination and bias regardless of socioeconomic position. However, financial stress was most pronounced for participants who were single or unpartnered. One participant, who was pregnant with her second child, was in the midst of filing for divorce. Additionally, poor treatment perceived as potentially pregnancy and racial discrimination in her current job necessitated her looking for a new job. She explained her situation, saying: “I’m looking for a new job… I take the emotion out of it because it’s, if I didn’t have self-confidence, it would make you cry, it would make you feel like OK what is wrong with me or what am I not doing because I have so much other stuff on my plate. I just can’t afford to expend emotional energy in that area because I’m just balancing and trying to provide for my family. So, it’s like OK if this is not working. I need to find something that will work and continue to perform to the best of my ability but continue to look for something else.” (Mother of one, married, in her mid-30s who is employed.) For this participant, the perceived experience of pregnancy discrimination and bias added to her personal and financial concerns.
A participant who was not given a job after disclosing her pregnancy status reported financial stress at not having the income, but acknowledged: “You know financially it is quite, you know, nerve wracking a little bit, but with the help and support from my husband, I’m maintaining. I’m blessed for what I do have.” (First-time pregnant, married woman in her mid-20s who is a public assistance recipient.) Emotional and financial support from a romantic partner helped ease the stress of job instability during pregnancy. This may not be the experience with other social supports, however. One participant, who was being financially supported by her sister but was unable to work in her job due to pregnancy discrimination and bias, was very worried about her financial support. She wanted to keep her certified nursing assistant job, despite the agency’s concern about her pregnancy, because: “I need the money, I don’t want to depend on my sister because she’s done a lot for me already. I’m trying to be independent.” (First-time pregnant woman in her early 20s who is supported by her family.) She was upset with her inability to support her family and buy necessities, like a crib and baby clothes, that she knew her infant would need, saying: “I can’t do nothing for my child, that hurts me.” Different types of social support, and the absence of support, created different experiences for participants in this study, although some level of financial stress was noted among all three of these participants.
Mental health concerns
For many participants, concerns over their financial security were not only stressful but could also affect their mental health. Participants reported feeling a variety of negative emotions, such as feeling depressed that they could not find a job despite wanting to work, feeling angry and frustrated about not being able to work, and feeling disrespected and offended when they were told by potential employers that they could not do the work. One participant discussed an especially difficult day in which she considered ending her own life. When asked what was going through her mind when she was at her lowest, she said: “[It] probably was the whole job thing. It probably was the whole income thing and me just being depressed about that.” (First-time pregnant woman in her early-30s who is supported in part by the father.) While she received some help from the father, she felt unable to gain control of her circumstances in a way that would allow her to support her growing family.
Many participants spoke of trying to minimize stress because of its possible effects on their pregnancies and infants. A participant in her early 40s who is a public assistance recipient was specifically trying to minimize stress in an effort to avoid gestational hypertension and preterm birth that she experienced with other pregnancies. She was, however, looking for employment while pregnant and found this process very stressful. The participants in this study were keenly aware that despite their best intentions and positive health choices, the stress related to financial concerns compounded by pregnancy discrimination and bias could adversely affect their health during pregnancy and the health of their infant.