She wasn’t sure what to do; she was only a few weeks into her pregnancy and didn’t know how it would affect her career.

“Women are taught: You aren’t supposed to tell people until after the first trimester,” she said. “But that’s actually a really delicate stage for the formation of the baby.”

Langness did some research online but couldn’t find much information on what kind of extra precautions she should take because of her pregnancy. Without realizing it, she had stumbled upon an often overlooked area of science and medicine: the occupational health of pregnant workers. Those who are pregnant often face hazardous circumstances doing jobs in which they must lift heavy objects, stand for long periods, or, like Langness, work with chemicals.

At the end of last year, Congress approved the , a law that requires employers to provide “reasonable accommodations” to those who are pregnant. But the new law, which , has a big hole in it: Public health experts say not nearly enough is known about which work circumstances are dangerous for pregnancies, especially when chemical exposures are involved. That’s because occupational health studies overwhelmingly have been centered on men, and so have the health and safety standards based on those studies.

“A pregnant person’s physiology is very different from a nonpregnant person,” said , an epidemiologist at the National Institute for Occupational Safety and Health. “A lot of our existing permissible exposure limits date back to 1970. In the studies they based the limits on, there were very few women in general and even fewer pregnant women, if any.”

The American College of Obstetricians and Gynecologists’ during pregnancy says that very few chemical compounds “have been sufficiently studied to draw conclusions about potential reproductive harms.”

Even though the data is sparse, several physiological factors suggest pregnant workers face higher health risks from chemical exposures than other adults, said , a Northeastern University environmental health scientist focused on maternal and child health. And chemical exposures during pregnancy can be dangerous not just for the prospective parent, but also for the fetus, which can absorb toxins through the placenta.

For one thing, blood volume increases during pregnancy because the body is working overtime to supply the fetus with the oxygen and nutrients it needs to develop. Such blood-flow expansion can make those who are pregnant susceptible to developing high blood pressure. Some studies also between exposure to lead during pregnancy and high blood pressure.

Pregnancy also considerably alters a person’s metabolism; the body prioritizes breaking down fats instead of sugars to preserve the sugar for the developing fetus. Especially after the first trimester, those who are pregnant have high blood sugar and must double their insulin production to keep it under control. It’s risky for them to be exposed to chemicals such as PFAS that have been , a condition in which cells don’t respond to insulin anymore.

Finally, those who are pregnant are also to a category of chemicals known as . Estrogen is the hormone responsible for promoting the body’s changes during pregnancy. When endocrine disruptors enter the body, they mimic those hormones and can increase the risk of certain pregnancy-related health conditions, .

But despite these known risks, the occupational health of pregnant women has often been understudied, especially as women have entered more diverse areas of work.

“Occupational health really assumes a neutral body worker,” said , a public health scientist at the at the University of California-San Francisco. By concentrating on this “neutral body worker,” occupational health as a field has overlooked the other stressors workers can face, either internal stressors, such as pregnancy, or external stressors, such as psychosocial stress due to racism or food insecurity, Rayasam said.

It also is tough to study those who are pregnant. It is unethical to expose them to even the slightest amount of chemicals, so research protocols are highly restricted. And very few occupational health surveys include enough pregnant workers to draw reliable conclusions about the unique risks they face.

Langness, the biomedical researcher in California, had a miscarriage while working in the lab. She later decided to change jobs, although she doesn’t know if the chemicals had anything to do with the loss of the baby.

The lack of research doesn’t affect only current pregnancies but also leaves women who have already been exposed with lots of questions. They include Leticia Mendoza, a 38-year-old woman who lives in Oakland, California. She said she was exposed to pesticides when she worked pruning strawberries while pregnant. When her baby was born, he did not crawl until he was 1 year old and started walking after he turned 2.

“I thought he was going to start talking when he was 3, but he still doesn’t, and he is 5,” Mendoza said.

Mendoza’s child has been diagnosed with autism.

Although researchers have studied potential links between pesticide exposure and neurodevelopmental disorders, the evidence is not conclusive, which complicates proving in a court what caused the harm, said , an associate adjunct professor in environmental epidemiology at the University of California-Berkeley.

Advocates hope the new federal law will give workers a little more leverage when they raise concerns about risks on the job. “We really just want them to be able to have a conversation with their employer without facing retaliation or being forced on unpaid leave,” said , a senior staff attorney for , a workers’ advocacy organization that pushed for the Pregnant Workers Fairness Act for over a decade.

But although some of the regulations might lead to better accommodations for pregnant workers, that depends partly on the employer or a union knowing what can represent a risk. “It’s not rocket science, but it does take effort on the employer’s side to understand what in their workplace could be hazardous,” said , a senior staff attorney at the American Civil Liberties Union.

In the past, women have sometimes been , so a delicate balance must be struck between protecting them and their pregnancies and not removing them from the workforce. “It’s tricky because, for many women, this is their livelihood,” said Sagiv.

Some researchers believe studying the enhanced risks faced in pregnancy may result in more protective regulations that would help the wider public.

“If we really try to protect the most vulnerable workers in the workplace, we’re protecting everybody,” Rocheleau said.

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As she was waiting to get her contraceptive intrauterine device replaced at her local clinic, however, the billing nurse told her that her insurance wouldn’t cover the removal — or a new IUD. Chavarría didn’t understand why not.

“Then she said very delicately, ‘Well, people on this insurance typically tend to be older,’” Chavarría recalled.

Although Chavarría is 34, she is enrolled in Medicare, the government insurance program designed for those 65 and older. Chavarría, who lives in Houston, is disabled by fibromyalgia, rheumatoid arthritis, and mental health issues. Medicare automatically enrolls anyone who has received for two years and this was her first time getting an IUD while in the government program.

Without insurance, just removing her expired IUD would cost Chavarría $350 out-of-pocket, exchanging it for a new one would be $2,000. She left the clinic in tears.

Chavarría’s experience is not rare. Medicare was originally intended for people of retirement age. Over the years, the program has evolved to include new populations, such as those who have disabilities or are critically ill, said , a public health expert at Yale University. In 2020, 1.7 million people ages 18 through 44 in Medicare.

An are also eligible for Medicaid, a state and federal program for those with low incomes, which should fill the gap for contraception. It’s not clear how many transgender or nonbinary people — who also might need contraception — are on Medicare or are eligible for Medicaid.

, like the plans offered via the federal Affordable Care Act, mandates coverage of birth control. But those who aren’t eligible for Medicaid are left in the lurch — Medicare’s origins mean it does not require access to birth control.

Traditional Medicare includes two parts: Part A covers hospital costs, while Part B covers physicians’ care and certain other services, such as ambulance rides. Neither ordinarily includes contraception.

People can get contraception through a Medicare Advantage plan or Part D of Medicare, which covers prescription drugs, but those come at a cost. And even people who pay for Part D often aren’t covered for some types of birth control, such as IUDs.

“So, if you are disabled, if you are locked outside of the labor market, if you do not have the means or any other way to financially support yourself, you were likely still on traditional Medicare, which is Part A and Part B,” Huer said. “In which case, your access to contraception is incredibly difficult.”

Contraception for those with traditional Medicare is given on a case-by-case basis, Huer said. It can be covered only if a doctor can make a credible case that the patient needs it for medical reasons — because their body cannot sustain a pregnancy — as opposed to merely wanting to avoid one.

“You have to have a champion physician who’s willing to partner with you and make those arguments,” Huer said.

That’s what Chavarría’s doctor tried to do. Before she left the clinic, staffers there told her they would try to make the case she needed the IUD for medical reasons. The IUD exchange was scheduled almost 10 weeks later, but during those weeks, she got pregnant. Her body couldn’t sustain a pregnancy, so she and her partner rushed to get an abortion just before Sept. 1, 2021.

“If Medicare had just covered the IUD removal or exchange to begin with, none of this would have happened,” Chavarría said. “It would have saved me having to make a really tough decision that I never thought I’d have to make.”

Women with disabilities often face a stigma from health care practitioners, especially when it comes to birth control, said , a public health researcher specializing in disabilities at Oregon Health & Science University. In her research, women with disabilities have described being treated like children or having to go to multiple doctors to find someone with whom they felt comfortable.

“We don’t want to acknowledge that disabled people have sex,” said Miriam Garber, a 36-year-old sex worker who lives in Rhode Island and is also on Medicare because of her disabilities. Garber got an IUD from Planned Parenthood because her insurance wouldn’t cover it.

Even those who pay for Part D to have their prescription drugs covered and have a “champion physician” face difficulties. Liz Moore, a nonbinary person in their 30s who lives in the Washington, D.C., area, could not get Medicare to pay for the Mirena IUD their doctor prescribed for their polycystic ovary syndrome. Moore is disabled with fibromyalgia and dysautonomia, a condition of the autonomic nervous system, which regulates breathing, heart rate, and more.

“After literally months of phone calls, it seemed like my Medicare Part D, and original Medicare could not agree on who should pay for my IUD,” they wrote in a direct message. “Was it a prescription or durable medical equipment?”

When Moore finally learned it would cost $800 upfront, they said, they decided to get a hysterectomy — which Medicare would pay for — instead.

Chavarría’s doctor told her a tubal ligation also was more likely to be approved by Medicare than an IUD, since older people have that procedure more often. Like all surgeries, both come with risks of complications and recovery.

Even for those on both Medicare and Medicaid, getting contraception also isn’t always easy, as in Katie Elizabeth Walsh’s case.

Walsh, 34, who lives in northeastern Connecticut, is disabled by a traumatic brain injury, depression, and chronic fatigue syndrome. She got an IUD at an OB-GYN clinic and was told there her insurance would cover it.

Then she got a bill for nearly $2,000.

Medicaid should cover contraceptive devices for dual-eligibility people, according to , but when Walsh tried to get her bill covered, Medicare and Medicaid could not agree on which of them should pay.

“Every single time I have called one of the insurance offices, they are like, ‘Oh, no, you have to talk to the other one, and we don’t really talk to each other,’” Walsh said.

Walsh said the hassle to get her contraception covered feels like a kick in the stomach: “Like truly you do not have a place in this world, and your insurance is telling you that.”

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This story can be republished for free (details).