By Military Women
Q: If pregnancy is a normal fact of life, why is it still a big deal in the military?
A: In the June 2020 Military Women column, pregnancy was indeed highlighted as a perfectly normal physiological life event, however pregnancy is also a commonly cited bone fide sex difference that we know can impact military employment and operational effectiveness. Let’s consider some of the unique aspects of pregnancy in the military first within the context of the history of women in Canadian
society.
Did you know that women only became legally recognized as “persons” on October 18th, 1929 (Edwards v Canada)? This constitutional change paved the way for women’s increased participation in public life, a milestone acknowledged annually with the official designation of October 18th as Persons Day.
During both world wars, women were asked to temporarily fill traditionally male military and civilian work roles. However, once World War II was over, married women were expected to return to the home, while unmarried women were pushed back into gender normative civilian positions. Employee pregnancy was not something the male dominated workspaces, military or civilian, expected to be seeing or dealing with.
In 1960, all Canadian women were finally accorded the right to vote. In 1965, due to human resource shortages, the military allowed a handful of gender-appropriate trades to recruit up to 1,500 unmarried women into the regular forces. Military women were still being released upon marriage, in part due to the assumption that they would soon become pregnant. Those assumptions were no longer valid when the oral contraceptive pill was made legal in 1969. The ability of women to control their own reproductive status was a gamechanger.
The pivotal Report of the Royal Commission on the Status of Women (1970), noted that society has “a responsibility for [the] special treatment of women related to pregnancy and childbirth”. The Commission opened the doors for women to potentially return to the workforce after a pregnancy with recommendations for both maternity leave and guaranteed job security. The report also opened up military colleges, gave women access to previously men-only military pensions, and removed marriage and pregnancy as reasons for mandatory military release. Finally, women didn’t have to choose between a family and a military career—at least not on paper.
In the same decade, the Canadian Human Rights Act (1977) prohibited federal workplace discrimination related to sex, marital status and/or family status, and the military conducted a complete personnel policy update review (1978).
Momentum for women to stay in the workforce, both during and after pregnancy, grew in the 1980s. Canada signed the UN Convention on the Elimination of All Forms of Discrimination against Women (1980) that, among other things, called for special workplace protections for women during pregnancy.
The Canadian Charter of Rights and Freedoms (1982), prohibited workplace discrimination based on sex. The Employment Equity Act (1986) required the identification and elimination of unnecessary barriers to employment in federal workspaces for identified groups, including specifically women. The decade ended with the Canadian Human Rights Tribunal (1989) supporting a complaint against the military for employment discrimination based on sex. The result was that the Canadian Armed Forces was ordered to fully integrate women into all jobs within 10 years. Since the 1990s, women have entered with ever growing numbers into the previously male-only military operational combat roles and environments.
The last 100 years have seen the legal barriers to workplace equity for Canadian women removed—including in the military.
However, many employers have put more resources into enrolling women into the previously male-only trades then proactively ensuring their safe retention through enabled, appropriately accommodated workspaces. In the military, the politically driven focus on total numbers of women working in non-traditional and operational military roles continues to overshadow the parallel concurrent need to knowledge generate evidence-based protections and supports for those working women, especially while pregnant or breastfeeding. How to best address that is another discussion for another day.
Part 1 – Pre-conception
Question: Do military women need more workplace considerations to ensure safe pregnancies?
Answer: Last month we discussed whether military women need “special” occupational health and safety (OHS) workplace considerations. We concluded that both military women and men can have biological sex-specific needs, and that these facts of life shouldn’t result in the naming of one sex’s issues as “normal” and the other’s as “special”.
One obvious OHS workplace difference between women and men relates to pregnancy. Pregnancy is a natural life event that all Canadian employers should include as part of their OHS workplace plans and preparations. Ideally, pregnancy and subsequent parenthood should not adversely affect a woman’s health or career progression in any job setting. For many traditionally women-friendly workplaces, the large number of women who have worked while pregnant has already paved the way for reproductive hazard identification and the implementation of required risk mitigation measures.
Women entered with significant numbers into “non-traditional” operational workplaces, such as the military, starting in the 1980s. Since the number of women in these workplaces is relatively small compared to men, and the number of pregnant women is even smaller, there is a dearth of research into women-specific hazard exposures. This means that operational military environments are in a bit of a “research desert”, with little robust science available to base policy or recommendations on. So military women and their employers are left unclear on how to best scientifically quantify and address workplace reproductive hazards.
The military’s present risk management approach to reproductive health hazards requires three different, and sometimes competing, determinations of what is in the best interest of the: (1) woman’s health and career in the short and long-term; (2) pregnancy; and, (3) military’s need to meet OHS and legal standards, while also addressing operational effectiveness and mission success requirements.
One strategy to ensure the health of the mother and baby, while also meeting the needs of the military, is to pre-plan pregnancies whenever possible. In the US military, every medical encounter is viewed as an opportunity to confirm whether or not a military member wishes to conceive in the year ahead. If the answer is no, various ways to decrease the chances of an unintended pregnancy are reviewed. If the answer is yes, a pre-conception counselling medical appointment is booked.
The purpose of a pre-conception counselling session is to maximize a woman’s general health and ability to successfully conceive. Whereas these medical sessions are recommended at least three months prior to conception in civilian healthcare, they are recommended a year ahead for military personnel. Topics to be reviewed include past reproductive history, family history, diet, exercise, folic acid supplement, weight, nicotine use, alcohol use, prescription drug use, cannabis, pets, relationship status, and any anticipated near-term needs for dental work, vaccinations, x-rays and /or surgery.
Unique to military pre-conception counselling, a full workplace reproductive hazard review is also conducted for both current and possible future hazard exposures. Hazard exposures include chemical (gas hut, pesticide exposure), biological (Zika virus, COVID-19, live vaccines, partner’s potential workplace exposures), physical (noise, radiation, hypobaric oxygen, egress training), ergonomics (prolonged standing, shift work), psycho-social (stress levels, available social supports, risk for gender-based violence), and anthropometrics (need for specialized uniforms or equipment while pregnant that might need to be ordered far in advance).
Some of these exposures come with medical recommendations to wait as long as a full year before a planned conception.
To optimize the safety of pregnancies, military women (and men) need more Canadian research and workplace awareness about reproductive hazards, risks and mitigation strategies. One, of many, windows of opportunity for the employer is to ensure the screening and education of all military members before planned conceptions. Other militaries provide generic reproductive information through open source phone apps (e.g., the US Navy’s “Pregnancy and Parenthood” app), followed up with specific individualized information at pre-conception medical counselling sessions. Is there a reason Canada couldn’t do the same?
Part 2: First Trimester
Question: Do women need more military workplace considerations to ensure safe pregnancies?
Answer: In July 2020’s Military Women column we talked about military workplace considerations pre-conception. In this month’s column, we continue that conversation into the first three months, or trimester, of pregnancy.
Pregnancy may be a normal physiological life event but the risks, even in “normal” environments, are different for every person, every time. For example, during the first trimester, up to 70% of pregnant women experience nausea and vomiting that can vary in severity from mild to profound and up to 20% of pregnancies result in threatened or completed miscarriages. Miscarriage symptoms can vary from minor to debilitating uterine cramping, emotional distress and/or bleeding; and can require urgent access to specialized medical care. Ectopic pregnancies, the implanting and growth of the embryo outside of the uterus, affects up to 2% of first trimester pregnancies. Ectopic pregnancies can cause sudden incapacitation and even be life threatening—needing emergency surgical intervention. Other pregnancy-induced physiological changes increase a women’s risk of urine infections, kidney stones, and ear blockages.
So how should workplaces best accommodate for these baseline pregnancy risks for all while concurrently ensuring no additional or new risks? Unfortunately, there is no easy answer.
Workplace standards that ensure safety for the average healthy adult cannot be assumed safe for medically compromised adults, children and/or pregnancies. Specific reproductive hazard research is required to know if pregnancy loss and physical and cognitive birth defects are being kept to baseline “normal” levels or not. Because we can’t deliberately expose pregnant women to potential hazards, it’s not possible to do “gold standard double-blind randomized control trial” types of research. Most workplace reproductive safety standards are therefore determined “after the fact”, using observational studies documenting the workplace exposures of men and women and the final pregnancy outcomes from hundreds, if not thousands, of pregnancies.
Well-studied workspaces, such as office administration and teaching, are generally proven safe to work in while pregnant without limitations. Other large workplace studies, for example hospital nursing and commercial aviation flight attendants, identified the need for decreased exposures while pregnant to operating room anesthetic agents, radiation, circadian rhythm disruptions, and prolonged standing.
Less well-studied workspaces include the many areas women have only recently been entering in significant numbers (e.g., military, first responder services, mining). Given the research gaps of what, if any, sex-specific health impacts these non-traditional environments have on adult non-pregnant women, it’s no surprise even less is known about these workplace’s impact on pregnant women.
To establish pregnant military worker’s safety standards, researchers will need to review literally thousands of pregnancy records. Given the magnitude and complexity involved to study military specific exposures (e.g., military flying, diving, isolated field environments, serving at sea), international collaboration is likely needed. In the meantime, the gap between “what is known to be safe” during pregnancy and “what is known to be unsafe”, in military specific environments remains unacceptably wide.
Thermal, vibrational, biological, chemical, ergonomic or acceleration workplace exposures can negatively impact pregnancies at any stage, but especially so in the first trimester. Workplace reproduction hazard identification and avoidance are therefore especially important to enforce during the first trimester, the time when pregnancies are known to be the most sensitive to them.
The present lack of knowledge surrounding military workplace reproduction safety raises many questions. How can military operational effectiveness be best achieved without any worker discrimination based on sex? What is the employer’s responsibility to identify and minimize potential hazard exposures? What is the right of the military woman to decide the level of workplace risk she is willing to take vis-à-vis her own health and that of the pregnancy? How can informed decisions happen without more information?
One thing we can all agree on, is that more sex-specific (male and female) military workplace reproductive research is needed. When we know better, we can all do better.
