Advertisement

Implementation, mechanisms and effects of maternity protection legislation: a realist narrative review of the literature

  • Isabelle Probst
  • Alessia Zellweger
  • Maria-Pia Politis Mercier
  • Brigitta Danuser
  • Peggy Krief
Review

Abstract

Purpose

Most industrialized countries have introduced maternity protection legislation (MPL) to protect the health of pregnant workers and their unborn children from workplace exposure. This review aimed to assess this legislation’s level of implementation, barriers and facilitators to it, and its expected or unexpected effects.

Methods

A realist narrative review was conducted. Keyword searches of the PubMed, CINAHL, PsycINFO, MIDIRS, Sociological abstracts and Google Scholar electronic databases were performed in March 2018.

Results

The 42 publications included show that the implementation of MPL is deficient in most countries. Allowing pregnant women to withdraw from work on preventive leave or sick leave is favored over workplace adaptations or worker reassignments. The publications highlight mechanisms which encourage or obstruct the enforcement of legislation at the levels of the individual, the physical and social environment, and the macrosocial context. The delay between the conception and implementation of maternity protection measures appears to be a major barrier to the efficacy of MPL. The literature also suggests that unexpected adverse effects, such as degradation in working relationships or discrimination can obstruct the implementation of protective measures.

Conclusions

This study showed the need for a better implementation of MPL during pregnancy. Further research and recommendations for improvements in MPL should consider the diverse mechanisms and effects of its implementation. Barriers and adverse effects of this implementation do not only ensure a lack of information or awareness about MPL, but are also linked to contradictions between requirements to protect employment and protect pregnancy.

Keywords

Pregnancy Occupational exposure Protective legislation Maternity protection Literature review 

Notes

Acknowledgements

This study was funded by the Swiss National Science Foundation, Grant No. 162713.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. Adair P (2009) Économie non observée et emploi informel dans les pays de l’Union européenne. Une comparaison des estimations et des déterminants. Rev Econ 60(5):1117–1153.  https://doi.org/10.3917/reco.605.1117 CrossRefGoogle Scholar
  2. Adams L et al (2016a) Pregnancy and maternity-related discrimination and disadvantage: experiences of employers. Department for Business, Innovation and Skills and the Equality and Human Rights Commission, LondonGoogle Scholar
  3. Adams L et al (2016b) Pregnancy and maternity-related discrimination and disadvantage: experiences of mothers. Department for Business, Innovation and Skills, Equality and Human Rights Commission, LondonGoogle Scholar
  4. Aellen G, Nicollier L, Outdili Z, Ribeiro K, Stritt K (2013) Application de l’Ordonnance sur la protection de la maternité chez les femmes médecins. Rev Med Suisse 393:1433–1434Google Scholar
  5. Andersen HR et al (2008) Impaired reproductive development in sons of women occupationally exposed to pesticides during pregnancy. Environ Health Perspect 116(4):566–572.  https://doi.org/10.1289/ehp.10790 CrossRefGoogle Scholar
  6. Andersen HR, Debes F, Wohlfahrt-Veje C, Murata K, Grandjean P (2015) Occupational pesticide exposure in early pregnancy associated with sex-specific neurobehavioral deficits in the children at school age. Neurotoxicol Teratol 47:1–9.  https://doi.org/10.1016/j.ntt.2014.10.006 CrossRefGoogle Scholar
  7. Artazcoz L, Borrell C, Cortes I, Escriba-Aguir V, Cascant L (2007) Occupational epidemiology and work related inequalities in health: a gender perspective for two complementary approaches to work and health research. J Epidemiol Community Health 61(Suppl 2):ii39–i45.  https://doi.org/10.1136/jech.2007.059774 CrossRefGoogle Scholar
  8. Aune H (2016) Country report, gender equality: how are EU rules transposed into national law? Norway 2015. Justice and consumer edn. European Commission, Brussels, p 58Google Scholar
  9. Aviles-Palacios C, Lopez-Quero M, Garcia-Lopez M-J (2013) Gender and maternity considerations and techniques in occupational health services: the Spanish case. Saf Sci.  https://doi.org/10.1016/j.ssci.2013.03.011 CrossRefGoogle Scholar
  10. Bay R, Simonetti C (2013) Evaluation des connaissances des mesures légales de protection de la maternité au travail (OProma) chez les femmes enceintes et chez les gynécologues (Travail de Maîtrise universitaire en médecine). Université de Lausanne. Retrieved from https://serval.unil.ch/resource/serval:BIB_85D3B31F5248.P001/REF. Accessed Apr 2017
  11. Belin A, Zamparutti T, Tull K, Hernandez G, Graveling R (2011) Occupational health and safety risks for the most vulnerable workers. European Parliament’s Committee on Employment and Social Affairs, BrusselsGoogle Scholar
  12. Berg RC, Nanavati J (2016) Realist review: current practice and future prospects. J Res Pract 12:1–28Google Scholar
  13. Bilhartz T-D, Bilhartz P (2013) Occupation as a risk factor for hypertensive disorders of pregnancy. J Womens Health 22(2):188a–188i.  https://doi.org/10.1089/jwh.2012.3975 CrossRefGoogle Scholar
  14. Bläuer Herrmann A, Murier T (2016) Enquête suisse sur la population active. Les mères sur le marché du travail. In: Dfdli DFI (ed) Office fédéral de la statistique (OFS) edn, NeuchâtelGoogle Scholar
  15. Blondel B, Lelong N, Kermarrec M, Goffinet F (2012) La santé périnatale en France métropolitaine de 1995 à 2010. Résultats des enquêtes nationales périnatales. J Gynécol Obstétr Biol Reprod 41(2):151–166.  https://doi.org/10.1016/j.jgyn.2011.11.008 CrossRefGoogle Scholar
  16. Bonzini M, Coggon D, Godfrey K, Inskip H, Crozier S, Palmer KT (2009) Occupational physical activities, working hours and outcome of pregnancy: findings from the Southampton Women’s Survey. Occup Environ Med 66(10):685–690.  https://doi.org/10.1136/oem.2008.043935 CrossRefGoogle Scholar
  17. Bouchard P, Turcotte G (1986) La maternité en milieu de travail ou pourquoi les Québécoises sont-elles si nombreuses à demander un retrait préventif? Sociol Soc 18(2):113–128CrossRefGoogle Scholar
  18. Brady S, Monaghan K (2007) Working through pregnancy: the experiences of Irish hospital-based physiotherapists. Physiother Irel 28(2):11–20Google Scholar
  19. Bretin H, De Koninck M, Saurel-Cubizolles M-J (2004) Conciliation travail/famille: quel prix pour l’emploi et le travail des femmes? À propos de la protection de la grossesse et de la maternité en France et au Québec. Santé Soc Solidar 3(2):149–160.  https://doi.org/10.3406/oss.2004.1006 CrossRefGoogle Scholar
  20. Campos-Serna J, Ronda-Perez E, Artazcoz L, Moen BE, Benavides FG (2013) Gender inequalities in occupational health related to the unequal distribution of working and employment conditions: a systematic review. Int J Equity Health 12:57.  https://doi.org/10.1186/1475-9276-12-57 CrossRefGoogle Scholar
  21. Casas M et al (2015) Maternal occupation during pregnancy, birth weight, and length of gestation: combined analysis of 13 European birth cohorts. Scand J Work Environ Health 41(4):384–396.  https://doi.org/10.5271/sjweh.3500 CrossRefGoogle Scholar
  22. Cheng PL et al (2009) Back pain of working pregnant women: Identification of associated occupational factors. Appl Ergon 40(3):19084818.  https://doi.org/10.1016/j.apergo.2008.11.002 ppCrossRefGoogle Scholar
  23. Commission of the European Communities (1999) Report from the Commission on the implementation of Council Directive 92/85/EEC of 19 October 1992 on the introduction of measures to encourage improvements in the health and safety at work of pregnant workers and workers who have recently given birth or are breastfeeding. BrusselsGoogle Scholar
  24. Croteau A, Marcoux S, Brisson C (2006) Work activity in pregnancy, preventive measures, and the risk of delivering a small-for-gestational-age infant. Am J Public Health 96(5):846–855.  https://doi.org/10.2105/ajph.2004.058552 CrossRefGoogle Scholar
  25. Croteau A, Marcoux S, Brisson C (2007) Work activity in pregnancy, preventive measures, and the risk of preterm delivery. Am J Epidemiol 166(8):951–965.  https://doi.org/10.1093/aje/kwm171 CrossRefGoogle Scholar
  26. De Koninck M, Malenfant R (2001) Les rapports sociaux et l’application de mesures sociales. Le cas de la conciliation grossesse/travail. Rech Sociogr 42(1):9–32.  https://doi.org/10.7202/057413ar CrossRefGoogle Scholar
  27. Dixon-Woods M et al (2006) Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups. BMC Med Res Methodol 6:35.  https://doi.org/10.1186/1471-2288-6-35 CrossRefGoogle Scholar
  28. Dørheim SK, Bjorvatn B, Eberhard-Gran M (2013) Sick leave during pregnancy: a longitudinal study of rates and risk factors in a Norwegian population. BJOG 120(5):521–530.  https://doi.org/10.1111/1471-0528.12035 CrossRefGoogle Scholar
  29. Fanello C, Ripault B, Drüker S, Moisan S, Parot E, Fontbonne D (2005) Déroulement des grossesses du personnel d’un établissement hospitalier. Evolution en vingt ans. Arch Mal Prof Environ 66(3):244–251Google Scholar
  30. Figà-Talamanca I (2006) Occupational risk factors and reproductive health of women. Occup Med 56(8):521–531.  https://doi.org/10.1093/occmed/kql114 CrossRefGoogle Scholar
  31. Fowler JR, Culpepper L (2018) Working during pregnancy. UpToDate. Retrieved from UpToDate website. https://www.uptodate.com/contents/working-during-pregnancy. Accessed 23 Mar 2018
  32. Frey G, Schuster M, Oberlinner C, Queiser-Wahrendorf A, Lang S, Yong M (2015) Pregnant employee protection program in a large chemical company. J Occup Environ Med.  https://doi.org/10.1097/JOM.000000000000050526340285 CrossRefGoogle Scholar
  33. Gatchel RJ, Schultz IZ (eds) (2012) Handbook of occupational health and wellness. Springer, New YorkGoogle Scholar
  34. Goldman RH, Wylie JB (2017) Overview of occupational and environmental risks to reproduction in females. UpToDate. Retrieved from UpToDate website: https://www.uptodate.com/contents/overview-of-occupational-and-environmental-risks-to-reproduction-in-females. Accessed 16 May 2018
  35. Gravel AR, Malenfant R (2012) Gérer les risques liés au travail durant la grossesse. Vers un nouveau modèle de gestion de la santé et sécurité des travailleuses enceintes. Perspect Interdiscip Trav Santé.  https://doi.org/10.4000/pistes.2578 CrossRefGoogle Scholar
  36. Gravel AR, Riel J, Messing K (2017) Protecting pregnant workers while fighting sexism: work–pregnancy balance and pregnant nurses’ resistance in Quebec hospitals. New Solut 27(3):424–437.  https://doi.org/10.1177/1048291117724847 CrossRefGoogle Scholar
  37. Greenhalgh T, Thorne S, Malterud K (2018) Time to challenge the spurious hierarchy of systematic over narrative reviews? Eur J Clin Invest.  https://doi.org/10.1111/eci.12931 CrossRefGoogle Scholar
  38. Grolimund-Berset D, Krief P, Praz-Christinaz S (2011) Difficultés pratiques de la mise en application de l’Ordonnance sur la protection maternité (Oproma) en Suisse à la lumière de deux cas cliniques. Arch Mal Prof Environ 73(3):524–525Google Scholar
  39. Hansen M, Thulstrup A, Juhl M, Kristensen J, Ramlau-Hansen C (2015) Occupational exposures and sick leave during pregnancy: results from a Danish cohort study. Scandin 41(4):397–406Google Scholar
  40. Hansson SH, Schenk L (2016) Protection without discrimination: pregnancy and occupational health regulations. Eur J Risk Regul 7(2):404–412.  https://doi.org/10.1017/S1867299X00005808 CrossRefGoogle Scholar
  41. Henrotin JB, Vaissiere M, Etaix M, Dziurla M, Malard S, Lafon D (2017) Exposure to occupational hazards for pregnancy and sick leave in pregnant workers: a cross-sectional study. Ann Occup Environ Med.  https://doi.org/10.1186/s40557-017-0170-3 CrossRefGoogle Scholar
  42. International Labour Organization (2010) Maternity at work: a review of national legislation: findings from the ILO database of conditions of work and employment laws. GenevaGoogle Scholar
  43. Kaerlev L, Jacobsen LB, Olsen J, Bonde JP (2004) Long-term sick leave and its risk factors during pregnancy among Danish hospital employees. Scand J Public Health 32(2):111–117CrossRefGoogle Scholar
  44. Kristensen P, Nordhagen R, Wergeland E, Bjerkedal T (2008) Job adjustment and absence from work in mid-pregnancy in the Norwegian mother and child cohort study (MoBa). Occup Environ Med 65(8):560–566CrossRefGoogle Scholar
  45. Lafon D (2010) Grossesse et travail: quels sont les risques pour l’enfant à naître? EDP Sciences edn. Institut National de recherche et de Sécurité (INRS), Les UlisGoogle Scholar
  46. Legrand E (2015) Santé reproductive et travail: la prévention des risques reprotoxiques. Rapport final dans le cadre du Programme national de recherche Environnement-Santé Travail. Université du Havre, Le HavreGoogle Scholar
  47. Lembrechts L, Valgaeren E (2010) Grossesse au travail. Le vécu et les obstacles rencontrés par les travailleuses en Belgique. Etude quantitative et qualitative. Institut pour l’égalité des femmes et des hommes, BruxellesGoogle Scholar
  48. Lippel K (1998) Preventive reassignment of pregnant or breast-feeding workers: the Quebec model. New Solut 8(2):267–280CrossRefGoogle Scholar
  49. Lippel K et al (2011) Legal protections governing the occupational safety and health and workers’ compensation of temporary employment agency workers in Canada: reflections on regulatory effectiveness. Policy Pract Health Saf 9(2):69–90CrossRefGoogle Scholar
  50. Lupton D (2012) Precious cargo’: foetal subjects, risk and reproductive citizenship. Crit Public Health 22(3):329–340.  https://doi.org/10.1080/09581596.2012.657612 CrossRefGoogle Scholar
  51. Makowiec-Dabrowska T, Hanke W, Radwan-Wlodarczyk Z, Koszada-Wlodarczyk W, Sobala W (2003a) Working condition of pregnant women. Departures from regulation on occupations especially noxious or hazardous to women. Med Pracy 54(1):33–43Google Scholar
  52. Makowiec-Dabrowska T, Hanke W, Sobala W, Radwan-Wlodarczyk Z, Koszada-Wlodarczyk W (2003b) Risk of certain obstetric pathologies in women employed in working conditions non-complying with the current legal status on work load and working conditions appropriate for pregnant women. Med Pracy 54(5):415–425Google Scholar
  53. Malenfant R (1996) Cachez ce ventre… La grossesse en milieu de travail. Lien Soc Polit 36:103–110CrossRefGoogle Scholar
  54. Malenfant R (1998) Risque et gestion du social: le retrait de l’activité professionnelle durant la grossesse. Rech Sociogr 39(1):39–57Google Scholar
  55. Malenfant R (2009) Risk, control and gender: Reconciling production and reproduction in the risk society. Org Stud 30(2–3):205–226CrossRefGoogle Scholar
  56. Malenfant R, De Koninck M (2002) Production and reproduction: the issues involved in reconciling work and pregnancy. New Solut 12(1):61–77CrossRefGoogle Scholar
  57. Malenfant R, Gravel A-R, Laplante N, Plante R (2011) Grossesse et travail: au-delà des facteurs de risques pour la santé. Rev Multidiscip Emploi Synd Trav 6(2):50–72Google Scholar
  58. Marcinkiewicz A, Hanke W (2012) Preventive care of pregnant employees. Is there a need to set rules of cooperation between occupational and gynecologist-obstetricians? Med Pracy 63(5):591–598Google Scholar
  59. McDonald AD (1994) The “retrait préventif”: an evaluation. Can J Public Health 85(2):136–139Google Scholar
  60. Messing K, Boutin S (1997) Les conditions difficiles dans les emplois des femmes et les instances gouvernementales en santé et en sécurité du travail. Ind Rel 52(2):333–363.  https://doi.org/10.7202/051169ar CrossRefGoogle Scholar
  61. Palmer KT, Bonzini M, Bonde J-PE (2013) Pregnancy: occupational aspects of management: concise guidance. Clin Med 13(1):75–79CrossRefGoogle Scholar
  62. Pawson R, Greenhalgh T, Harvey G, Walshe K (2005) Realist review–a new method of systematic review designed for complex policy interventions. J Health Serv Res Policy 10(Suppl 1):21–34.  https://doi.org/10.1258/1355819054308530 CrossRefGoogle Scholar
  63. Plante R (2004) Le retrait préventif de la travailleuse enceinte: le point. Le Med Québec 39(11):71–77Google Scholar
  64. Plante R, Malenfant R (1998) Reproductive health and work: different experiences. J Occup Environ Med 40(11):964–968CrossRefGoogle Scholar
  65. Polanska K, Jurewicz J, Marcinkiewicz A, Makowiec-Dabrowska T, Hanke W (2014) Occupational activity during pregnancy based on the Polish mother and child cohort study. Med Pracy 65(1):65–72Google Scholar
  66. Praz-Christinaz SM, Chouanière D, Danuser B (2008) Protection des travailleuses enceintes et des enfants à naître: ce que doit savoir le médecin. Rev Med Suisse 4:2166–2171Google Scholar
  67. Robert E, Ridde V (2013) L’approche réaliste pour l’évaluation de programmes et la revue systématique: de la théorie à la pratique. Mes Eval Educ 36(3):79–108Google Scholar
  68. Romano D, Moreno N (2010) Barriers for the prevention of chemical exposures in pregnant and breast-feeding workers? J Epidemiol Community Health 64(3):193.  https://doi.org/10.1136/jech.2008.085282 CrossRefGoogle Scholar
  69. Romito P, Saurel-Cubizolles MJ (1992) Fair law, unfair practices? Benefiting from protective legislation for pregnant workers in Italy and France. Soc Sci Med 35(12):1485–1495CrossRefGoogle Scholar
  70. Rudin M, Stutz H, Bischof S, Jäggi J, Bannwart L (2018) Erwerbsunterbrüche vor der Geburt. Bundesamt für Sozialversicherungen (BSV), BernGoogle Scholar
  71. Saurel-Cubizolles MJ, Kaminski M (1987) Pregnant women’s working conditions and their changes during pregnancy: a national study in France. Br J Ind Med 44(4):236–243Google Scholar
  72. Snijder CA et al (2012) Physically demanding work, fetal growth and the risk of adverse birth outcomes. The generation R study. Occup Environ Med 69(8):543–550.  https://doi.org/10.1136/oemed-2011-100615 CrossRefGoogle Scholar
  73. Stocker LJ, Macklon NS, Cheong YC, Bewley SJ (2014) Influence of shift work on early reproductive outcomes: a systematic review and meta-analysis. Obstet Gynecol 124(1):99–110.  https://doi.org/10.1097/AOG.0000000000000321 CrossRefGoogle Scholar
  74. Story M, Kaphingst KM, Robinson-O’Brien R, Glanz K (2008) Creating healthy food and eating environments: policy and environmental approaches. Annu Rev Public Health 29:253–272.  https://doi.org/10.1146/annurev.publhealth.29.020907.090926 CrossRefGoogle Scholar
  75. Tarchi M, Bartoli D, Demi A, Dini F, Farina GA, Sannino G (2007) Emerging problems in enforcement of safe maternity and feeding protection at work: a public prevention service experience. G Ital Med Lavoro ed Ergon 29(3 Suppl):385–386Google Scholar
  76. Taskinen HK, Olsen J, Bach B (1995) Experiences in developing legislation protecting reproductive health. J Occup Environ Med 37:974–979CrossRefGoogle Scholar
  77. Turcotte G (1992) How pregnant workers see their work, its risks and the right to precautionary leave in Quebec. Women health 18(3):79–95CrossRefGoogle Scholar
  78. Wong G, Greenhalgh T, Westhorp G, Buckingham J, Pawson R (2013) RAMESES publication standards: realist syntheses. BMC Med 11:21.  https://doi.org/10.1186/1741-7015-11-21 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.School of Health Sciences (HESAV)University of Applied Sciences and Arts Western Switzerland (HES-SO)LausanneSwitzerland
  2. 2.Institute for Work and Health (IST)Universities of Lausanne and GenevaEpalingesSwitzerland

Personalised recommendations