By Abigail Curtis, Intern, National Commission on Climate and Workforce Health

In June 2023, the Pregnant Workers Fairness Act (PWFA) officially went into effect, marking a long-overdue federal commitment to ensuring workplace accommodations for pregnant employees. For the first time, it became illegal in the U.S. to deny reasonable accommodations to pregnant people in the workplace, aligning pregnancy protections with those offered for other health conditions under the Americans with Disabilities Act. 

While a critical step forward, the fact that such protections were only enshrined in law in the last two years shows just how far the U.S. still has to go in recognizing the needs of pregnant people at work.

Legal protection, however, is only the first step in recognizing and protecting pregnant workers against burgeoning climate risks. Climate change is rapidly exacerbating the challenges already faced by pregnant workers, especially those in frontline industries. From environmental hazards due to pesticide use, to extreme heat, to disrupted care access during disasters, pregnant workers are facing compounding risks that often go unseen and unaccommodated. It’s not just their health that’s at stake, but the health of their babies, who are especially vulnerable and entirely unable to consent to these exposures. 

According to recent guidance from the EPA (2023) and FEMA (2024), climate-linked health threats such as worsening air quality, heatwaves, and intensified storm systems are not just theoretical risks; they are present-day realities affecting the health and safety of vulnerable populations. Pregnant workers sit squarely at the center of this intersection, facing occupational hazards that are uniquely intensified by both their work and their pregnancies.

Below, we explore four industries where climate and occupational risks to pregnant workers are especially pressing, and what employers and institutions must do to respond.

1. Agriculture: Climate Change and Pesticide Use

Agriculture remains one of the most chemically intense industries in America. Pesticides like DCPA (Dacthal), long used to control weeds and invasive species, have recently come under EPA scrutiny due to links with birth defects and developmental issues. The EPA completely banned its use in October 2024. However, other harmful pesticides are still being used regularly.

Currently, a pesticide called Paraquat, used mainly as an herbicide and linked to increasing the risk of developing Parkinson’s disease as well as several birth defects and stillborns, remains approved by the EPA, despite being banned in 70 other countries. It is one of the most commonly used herbicides in the American agricultural industry, placing pregnant workers in situations where they must use it. The continued use and legality of the pesticide not only places all agricultural workers at risk, but pregnant people at an exceptionally high risk, facing the double burden of birth defects and effects on their bodies.

Complicating the issue, climate change is increasing the number of pests and accelerating soil degradation, leading to a greater volume and variety of pesticide use. While these chemicals are dangerous for all workers, they pose particular risks to developing fetuses. A 2022 fact sheet on Pesticides and Pregnancy from the California Environmental Protection Agency highlights how even short-term exposure to pesticides can cause permanent harm to reproductive systems and neurodevelopment. 

Agricultural employers must act now to reduce pesticide exposure by offering protective equipment, rotating tasks to minimize contact with toxins, and providing adequate wash stations and rest breaks. Failing to do so puts pregnant people and unborn lives at real risk.

2. Construction: Heat Stroke and Pregnancy Risk

The percentage of women in construction has consistently increased over the past 10 years to nearly one in seven workers, making accommodating pregnancy in the workplace increasingly more important in construction work. 

Construction workers are on the frontlines of extreme heat exposure, and pregnant workers are four times as likely to experience heat-related illness, including heat stroke, on hot days. Pregnancy naturally raises core body temperature and decreases the body’s ability to cool itself. 

Construction remains one of the most dangerous sectors for heat-related fatalities, and the risks grow each year as heat waves become longer and more intense. Physicians now routinely advise pregnant individuals to limit time outdoors on hot days, avoid heavy lifting, and monitor for dehydration, all of which are challenging in an industry built around physical labor and long hours in direct sun. 

3. Health Care: Disasters, Pathogens, and Midwifery’s Resurgence

Health care workers face a dual burden during climate disasters: They are expected to serve others while navigating personal health risks. Hospitals are essential infrastructure, yet they are not immune to the effects of climate disruptions like flooding, power outages, or storm surges. 

Pregnant health care workers face increased exposure to airborne pathogens like measles and West Nile virus, both of which have seen resurgences tied to shifting climate conditions. Simultaneously, in the aftermath of disasters, hospitals often operate beyond capacity, with reduced staff, power interruptions, and compromised sanitation, especially dangerous conditions during pregnancy. 

In these situations, midwives and doulas have become critical players. With births continuing regardless of crisis, communities need adaptive, community-based care to meet people where they are. During Hurricane Maria and, more recently, in California in response to wildfires, the role of midwives highlights how decentralized care can provide resilience when centralized systems fail. Health care systems must now plan for this by incorporating pregnancy-specific disaster planning, protecting pregnant staff from exposure, and integrating midwifery and community care into emergency preparedness efforts.

4. Food Service: Hidden Strains of Indoor Heat and Rigid Schedules

Food service jobs — and indoor labor in general — are often ignored when we talk about workforce climate risk, but they represent a major sector where pregnant people quietly suffer. 

Long hours on their feet, limited breaks, overheated kitchens, poor ventilation, and exposure to indoor air pollutants can combine to cause exhaustion, dizziness, and even early labor. These jobs often have inflexible schedules and lack formal HR accommodations, meaning pregnant workers must endure unsafe environments or risk losing their income altogether. 

Heat doesn’t have to come from the sun to do harm; indoor heat exposure is equally dangerous, especially when mixed with stress and physical strain. Employers in food service should consider rotating workers into cooler, ventilated areas, mandating regular water and rest breaks, and proactively checking in with pregnant staff.

Protecting Two Lives, Not Just One

Pregnancy at work is not just a matter of comfort; it’s a matter of public health, workplace equity, and climate resilience, along with the health of future generations. The risks of climate change, from toxic exposures to overheating to system-wide disruptions, are no longer distant threats. They’re here now, and the burden is being shouldered by those ill-equipped to fight it alone. 

When employers protect the health and safety of pregnant workers, they also help safeguard another, vulnerable life. The best place to start is by following physician-recommended guidance and integrating climate risk-informed workplace accommodations. Employers should consult National Commission on Climate and Workforce Health's online resources, which help companies understand the emergent climate risks for their employees and adopt proven practices to protect their workforces against climate threats. 

Finally, we encourage employers to explore the EPA’s climate and reproductive health resources, and use the Center for Disease Control’s comprehensive workplace pregnancy guidelines to build more equitable, future-ready workplaces where all workers and their unborn children can thrive.

Abigail Curtis, Intern, National Commission on Climate and Workforce Health 

Abigail Curtis is a junior at Harvard College studying Chemical and Physical Biology and Sociology, with a secondary in Physics. Her academic and research experiences span both lab-based science and community-centered sociology, including projects on microbial imaging, school leadership structures, and health practices within religious enclaves. Outside the classroom, she’s involved at a local homeless shelter, a birth doula for young mothers, and co-leads a science outreach initiative connecting Harvard researchers with local public schools. She is drawn to public health by the challenge of translating knowledge into action, especially in ways that build trust and serve underrepresented communities. This summer, she’s excited to learn from Meteorite about how businesses can meaningfully contribute to health equity and how effective communication strategies can support stronger public health responses.

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The National Commission on Climate and Workforce Health is a group of business, health, and climate leaders who share a mission to protect workers from the health risks posed by extreme weather.

The Commission was created by the Health Action Alliance in partnership with Mercer and with strategic input from the CDC Foundation. Additional support for the initiative is being provided by Elevance Health and The Hartford. Learn more at ClimateHealthCommission.org.