Introduction

Mindy E. Bergman and Vanessa A. Gaskins

Access to abortion care has a profound impact on women’s ability to participate in the workforce (Bernstein & Jones, 2019; Bloom et al., 2009; Kalist, 2004) and appears to be especially profound for Black women (compared to White women), who have greater unmet contraceptive and prenatal care needs (Bernstein & Jones, 2019). An analysis of the US civilian labor force shows that in 1973 (the year that Roe v. Wade was decided by the US Supreme Court), 39% of US women were employed compared to 61% of men. By 2021, the gap had narrowed substantially to 47% of women being employed compared to 53% of men (United States Department of Labor, 2021); women also now outnumber men in earning undergraduate degrees (Parker, 2021). Analysis of international data shows that abortion access increases labor force participation for women and also increases economic growth (Bloom et al., 2009).

Despite their increasing participation in the workforce and educational attainment, women still take on a majority of the household and caregiving responsibilities (Moen et al., 1999; Bianchi, 2011; Bianchi et al., 2012), make less money than their male counterparts for the same work (Jones, 2021), and are often passed over for top leadership positions, as evidenced by the number (32; 6.4%) of female CEOs of S&P 500 companies (Catalyst, 2022). The US needs more women in the workforce. As noted by the National Partnership for Women and Families (2021), the lack of women in the US workforce costs the economy approximately $650 billion per year.

A Brief History of Abortion Access in the United States

Access to abortion care has waxed and waned in the United States. The Comstock Act, passed by the United States (US) Congress exactly 100 years prior to the US Supreme Court’s Roe v. Wade decision in 1973, restricted access to abortion medication and informative literature about birth control. From 1873 to 1973, pregnant people had less access to safe abortions because individual states decided under which circumstances abortion was legal (PBS, n.d.). In states where abortion was illegal, pregnant people had abortions that were unsafe (so-called “back alley” abortions) or traveled long distances, even internationally, for the procedure (Gold & Guttmacher Institute, 2003). Since 1973, people who can become pregnant in the US have had a protected right to abortion as a private health decision by the Roe v. Wade US Supreme Court decision that legalized abortion nationwide while applying a trimester framework.

In 1992, the US Supreme Court decision in Planned Parenthood v. Casey reaffirmed Roe’s essential holding of the right to have an abortion but abandoned Roe’s strict trimester framework in favor of a fetus viability approach. In 2022, the Dobbs v. Jackson Women’s Health Organization decision was handed down by the Supreme Court, reversing the Roe v. Wade decision and returning the US to a patchwork of abortion care laws that mostly vary by state; individual states within the US decide whether abortions should be allowed, and if so, what restrictions should apply based on their own individual formula that typically considers and decides how much each of the following factors should matter for their restrictions: weeks of gestation, rape, incest, and health concerns for the pregnant person and/or embryo/fetus. The status of abortion in each state is an evolving situation, with approximately half of US women at risk of losing abortion access as a result of the Dobbs decision (Cai et al., 2022). Legislation, referenda, and court cases have occurred and are expected to continue occurring over the next months and years (e.g., Collins & Pollard, 2022; Hollingsworth & Hanna, 2022; Mangan, 2023).

Since Roe v. Wade was decided, abortion has been a contentious topic and the focus of many political campaigns in the United States. Generally, there have been “pro-choice” proponents of abortion as a human right and those who are “pro-life” and are opposed to abortion, although this oversimplifies the political positions relative to abortion care as many people support middle ground positions (e.g., abortion on demand until X weeks of gestation, and then after that date only to save the life of the pregnant person). Gallup (2022) polling indicates that in 2022, 67% of Republicans, 48% of Independents, and 38% of Democrats believed abortion should be legal only under certain circumstances, while 10% of Republicans, 36% of Independents, and 57% of Democrats believed abortion should be legal under any circumstances. According to 2019 data from the US Centers for Disease Control and Prevention (2021) there were 629,898 legal abortions in the US, with 93% of abortions occurring in the first trimester of pregnancy, prior to 13 weeks of gestation.

Abortion Access Matters to Well-Being

All of this is happening against a background of evidence that abortion has positive outcomes for the people who seek them out, and when people who seek abortions are denied them, negative outcomes follow. The Turnaway Study is the largest, most comprehensive, and best designed study of abortion access; it followed people seeking abortion from 30 facilities in 21 different states in the US, examining what happens to those who obtain an abortion and those who were turned away (AHISRH, 2020). Turnaways occurred for gestational limits due to various reasons such as unawareness of the pregnancy and issues accessing abortion care earlier (Foster & Kimport, 2013). Abortions were requested for various reasons such as financial concerns of having the child and unsuitable sperm provider/partner to parent the child (Biggs et al., 2013). The Turnaway Study shows that being denied an abortion has negative effects on a person’s well-being and mental health, and that those turned away from getting an abortion were found to be more likely to experience physical violence from their partners than those who received abortions. In addition to the negative effects to the pregnant person denied an abortion, the Turnaway Study found that the existing children have worse child development and are more likely to live below poverty level when their mothers were denied an abortion relative to children of those who were able to receive an abortion. Additionally, the Turnaway Study found that women who gave birth experienced more serious health problems than those who had abortions (e.g., life-threatening complications of birth, long-term headaches and joint pain), and two of the people denied abortions even died after childbirth (ANSIRH, 2020). In contrast, those who received their desired abortions had better financial stability, were able to raise their children in better conditions, and were more likely to have a wanted child in the future (ANSIRH, 2020).

A Note on Gender Identity and Gendered Descriptions of Biology

As we will note further below, throughout this anthology we use terms like “people who can become pregnant.” This is in recognition of the fact that not all people who have the reproductive anatomy that allows for pregnancy identify as women. Nearly all of the people who have the reproductive anatomy that allows for pregnancy would have been assigned female at birth, and most people who become pregnant identify as cisgender (i.e., when the genitalia and reproductive organs of a person matches the societal expectations for gender identity and expression) women.

However, that assignment at birth is merely that: a judgment call made by medical personnel at the time of birth, usually based on an observation of external genitalia. It is only in recent years that intersex birth certificates have been issued anywhere in the United States (Scutti, 2017; note that this first birth certificate was a re-issue of a birth certificate for someone then aged 55). In 2022, the US began issuing passports and other federal documents with “X” as a gender marker rather than only “F” for female and “M” for male (Sganga, 2022). Other vital records and identification, such as birth certificates, driver’s licenses, and state-issued ID cards, are governed by state laws and therefore gender identification information on these documents vary from state to state.

All of this context points to the complex experiences and often precarious rights that people who do not fit the gender binary via cisgender expectations are subjected to. At this early stage in the post-Roe United States, it is difficult to know what effects the end of federally guaranteed rights to abortion will have on the experiences of persons who have uteruses beyond cisgender women, including (but not limited to) a variety of gender expansive identities such as: intersex people, transmen, and non-binary persons. These people already experience widespread stigma (Hughto et al., 2015; Worthen, 2021), increased violence (Wirtz et al., 2020), and worse health and health care access (Kcomt, 2019; Rosenwohl-Mack et al., 2020; Zeeman et al., 2019), compared to their cisgender counterparts. Suffice it to say, we anticipate that as difficult as the post-Roe landscape will be for many cisgender women, these difficulties are likely to be heightened for gender expansive people with uteruses who do not have cisgender privilege.

Aims of this Anthology

Despite the demonstrated importance of access to abortion care to population-wide labor force participation for people who can become pregnant, the occupational health literature has paid little heed to abortion care as a social factor (i.e., rather than a possible medical outcome; e.g., Taskinen, 1990) as part of our understanding of health and well-being in the workplace, even as interest in pregnancy as a social factor in occupational health has increased over the last decade (Jones, 2017; Morgan et al., 2013). This anthology of contributions from 10 experts in occupational health psychology–as a group, generally identified with the broader field of industrial-organizational psychology–open this much needed and long overdue discussion of the role of abortion care access on a variety of workplace and work-related processes, a discussion that has gone from needed to essential to pressing in the last few months.

Reduced access to safe abortion has extensive impacts for people who can become pregnant and their ability to pursue or continue work and contribute fully. Given the recency of the Dobbs decision, research in a post-Roe US is still developing. But many areas of occupational health research provide insight into likely implications for people who can become pregnant and the organizations that employ them, as well as future research on this topic. Ten experts share their perspectives on what the Dobbs decision means for the future, how it will exacerbate existing, well-researched issues, and likely also create new challenges needing investigation. Some contributions are focused on research directions, some focus on implications for organizations, and most include both. All contributions share relevant occupational health literature and describe the effects of the Dobbs decision in context. A short glossary is included to clarify terminology used throughout.

Glossary

Vanessa A. Gaskins and Mindy E. Bergman

As noted above, we provide a brief glossary of key terms that will be useful for the reader.

Roe v. Wade Decision

The United States Supreme Court’s 1973 decision in the Roe v. Wade case that determined that abortion is a private health decision that people should be able to engage in without undue interference from the government; it is generally seen as legalizing abortion or establishing a right to abortion throughout the US, but some restrictions were still permissible.

Dobbs Decision

The United States Supreme Court’s June 2022 decision in the Dobbs v. Jackson Women’s Health Organization, which effectively overturned Roe v. Wade.

Post-Roe/Post-Dobbs

The time after the Dobbs decision effectively overturned Roe v. Wade’s right to abortion, in June 2022.

People who can Become Pregnant

Throughout this document, we attempt to inclusively refer to those most impacted by this decision as people or employees who “can become pregnant,” recognizing that not all people who can become pregnant identify as women (e.g., non-binary people; transmen). Most research to date regarding the impact of pregnancy and caregiving and their impacts on work refers to women or mothers as the population of interest and sample studied. Accordingly, we occasionally refer to women/mothers as the focal group of research, especially to ensure faithful communication of the research cited.

Embryo/Fetus

We use embryo/fetus to refer to the human in development within a pregnant person’s body. This term is not entirely satisfactory, as it does not cover other human prenatal development stages (e.g., zygote, blastocyst). However, the differentiations made across these various stages are not hard-and-fast rules and terms such as “fetal development” or “embryonic development” are sometimes used to encompass other stages. We selected embryo/fetus for a general term to use throughout this anthology because it recognizes that there are different prenatal developmental stages and that these are the developmental stages during which abortion is likely to occur (earlier, pregnancy is often not known). Other terms might be used in various places throughout, for example, to reflect specific terms from the literature (e.g., “maybe baby expectations”; Gloor et al., 2018, 2021) or specific developmental milestones (e.g., fetal viability; human embyros are not viable due to the very early gestational age).

TX SB8

Texas Senate Bill 8, also known as the Texas Heartbeat Act, bans abortion after detection of an embryo/fetus’ heartbeat, typically around 6 weeks of pregnancy.

Pregnancy Discrimination and Implications of the Dobbs Decision

Ho Kwan Cheung

Recent statistics indicated that 60% of women do not feel comfortable disclosing health concerns in the workplace (Simply Health, 2022). This is not surprising, considering women’s biological experiences, especially as they relate to childbirth, are often considered taboo in a professional context (Bergman et al., 2020; Grandey et al., 2020). With the reversal of Roe v. Wade, which ensured federal protection of abortion care, it is alarming the degree to which it may further existing workplace gender inequality created by women’s reproductive health, especially pregnancy (and potential motherhood).

Research on abortion as a stigma, or socially devalued characteristic, is limited, especially within the employment context. Nevertheless, literature suggests that women who had abortions are likely to conceal them due to the fear of social stigmatization (see Hanschmidt et al., 2016 for a review). Yet the abortion stigma may affect not only women who had abortions, but also any pregnant people in the workplace. Social science research has long pointed to the stigmatized nature of pregnancy as one of the most important obstacles faced by working women (see Arena et al., 2022 for a review). Because pregnancy highlights women’s femininity, which is considered misaligned with the more masculine nature of the workplace, pregnant employees are often perceived as less committed and less competent (Cuddy et al., 2004; Hebl et al., 2007). In turn, these stereotypes are related to negative treatment against pregnant women across different employment settings (Botsford-Morgan et al., 2013; Paustian-Underdahl et al., 2019). As a result, women often conceal their pregnancies for as long as they can and, even after disclosure, engage in impression management behaviors to minimize the negative impact of pregnancy on their professional images (King & Botsford-Morgan, 2009; Little et al., 2015). Such behaviors impose tremendous cognitive load on pregnant employees during this already physically and psychologically demanding period of their lives, and can lead to burnout and decreasing physical health (Jones et al., 2016; Little et al., 2015).

Based on this body of research, the stigmatized nature of women’s pregnancy will likely be further exacerbated by the lack of federal protection for the right to abortion. First, pregnancy loss of all kinds are typically considered a taboo subject, especially in the workplace (Mahabir et al., 2022). Abortions are performed not only out of personal choice to terminate the pregnancy, but also out of medical necessity when life-threatening health concerns arise during women’s pregnancies (Finer et al., 2005). Research on women who conceal their past abortions found that they continue to experience psychological distress up to two years post-abortion due to their effort to maintain secrecy (Major & Gramzow, 1999). To the extent that abortion access is made illegal in different states, pregnant people may feel even more compelled than ever to hide their pregnancies in the event that they experience miscarriages or other physical conditions that necessitate abortions, which can further negatively impact their health.

The abortion stigma is not limited to pregnant people who are planning to have a new child. Recent research has found that childless women can experience incivility and are offered fewer job benefits as a result of the “maybe baby expectations”, or future childbearing expectations (Gloor et al., 2018, 2021). Similarly, the stigma toward motherhood is not limited to pregnancy: it extends to postpartum motherhood, as women are expected to be less committed to their work due to the “ideal mother norm” (Hebl et al., 2007), and as a result suffer both interpersonal and formal discrimination (e.g., Budig & England, 2001; Heilman & Okimoto, 2008; Cheung et al., 2022). Given that the Dobbs decision limits access to abortion for many women, working women’s likelihood of having children may increase, which in turn may further the “maybe baby expectation” bias toward childless women.

As detailed above, we can infer from work-pregnancy interface and identity management research that the Dobbs decision is likely to exacerbate workplace gender disparity in health and career outcomes. Nevertheless, there is still much that is unknown, as organizational science research on reproductive health, not the least pregnancy loss, is very limited. One avenue for future research is understanding how the abortion stigma differs from the pregnancy and motherhood stigma. While pregnancy is generally celebrated outside of the workplace, abortion is often considered highly immoral (Norris et al., 2011). Therefore, future research is needed to understand how it intertwines with the workplace gender and maternity bias in order to devise appropriate individual remediation strategies to counter its negative effects. Another future avenue of research is to understand the recovery experience of people after abortion and how organizations can best support these employees before and after this highly emotional and personal event. Altogether, the Dobbs decision is detrimental to any individuals who can become pregnant, and this moment highlights the urgency for both occupational health researchers and practitioners alike to consider how to address this long neglected but prevalent issue.

Abortion Needs Disclosure in the Organizational Context

Rose L. Siuta

In the wake of the Dobbs decision, some organizations were swift to offer a variety of abortion care types of assistance to their employees (e.g., expanding benefits coverage, offering travel fund assistance), but occupational health psychologists should be aware of the potential impediments to accessing this care. Importantly, the Dobbs decision elucidates a persistent hierarchy based in sex of who is afforded power, choice, autonomy, and care for basic health needs. Sex-based power hierarchies occur at a sociocultural level, which are also reflected in organizations, affording those who exhibit a hegemonic masculine ideal with privileges and deviations from this ideal with oppressions (Acker, 1990, 2012; Connell, 1985, 2005). Abortion access is similarly an issue of social power (Ross, 2006), and decisions about abortion disclosure are likewise situated within sex-based power hierarchies. One oppressive process resulting from social power hierarchies is that of abortion stigma (Millar, 2020), which has been defined as a negative attribute that is assigned to individuals who experience abortion that marks them as deviating from ideals of womanhood (Kumar et al., 2009). According to stigma theory, dominant groups utilize stigma to uphold these power systems (Goffman, 1963). As thoroughly described by Cheung herein, the Dobbs decision highlights just one structural process through which abortion has been further publicly stigmatized. For those in need of abortion care, the heightened social context of public stigma may lead to higher concealment of this need.

Who is Trusted with Disclosure?

Selective concealment of abortion decisions has been found in a majority of abortion experiences (Cockrill et al., 2013; Major & Gramzow, 1999; Shellenberg & Tsui, 2012). Research has shown that concealment of abortion status typically occurs as a response to negative emotions about the procedure, as well as to avoid negative reactions from others (Astbury-Ward et al., 2012; Biggs et al., 2020a, b; Cockrill & Nack, 2013; Shellenberg & Tsui, 2012; Shellenberg et al., 2011). While fewer studies directly explore the abortion decisionmaking process, one recent study found that decisions to not discuss one’s abortion needs were influenced by concerns of being judged, wanting to maintain privacy, and an established certainty of their decision (for instance, not desiring any input from others about their body) (Chor et al., 2019). Occupational health practitioners should be aware of these complex processes associated with disclosure of abortion needs when attempting to build support networks within an organization. Given the importance of allyship presented by Hebl in this paper, disclosure decisions are further complicated by the Dobbs decision’s impact on allyship, the criminalization of ally behaviors in some states, and the offering of ‘bounties’ for reports of abortion seekers or those who ‘aid’ those in seeking abortion (as in TX SB8).

On the other hand, disclosure prior to seeking abortion care typically involves partners, family, gynecologic care providers, and clinics (Chor et al., 2016; Foster et al., 2012; Jones et al., 2011). These disclosure decisions are often made because individuals are either seeking information about a specific procedure, guidance in the decision-making process, or support from others as they proceed with obtaining care (Chor et al., 2019). As such, those with abortion needs may be more likely to disclose these needs to those who they are aware have had the same procedure and are equipped with providing information or guidance. Further, those in need of abortion may be more willing to make disclosures to individuals who are supportive of abortion access as well as unlikely to attempt to deter or invalidate the discloser’s abortion decision.

Health Outcomes of Disclosure and Nondisclosure

While disclosure of concealable stigmatized identities, such as is the case with abortion needs, may provide some psychological benefit, there is also evidence that concealment may serve a protective function against harassment and discrimination. Correlational research has suggested that concealment of abortion decisions is related to perceptions of stigma from other individuals, higher suppression of abortion-related thoughts, higher intrusive thoughts, and higher psychological distress (Major & Gramzow, 1999). Concealment is also related to feelings of isolation and loneliness (Cockrill & Nack, 2013). On the other hand, there is also evidence suggesting that disclosure of abortion increases one’s risk for adverse psychological outcomes, with social support being an essential component to mitigating these harmful outcomes (Biggs et al., 2020a, b; Jones et al., 2011; Major et al., 1997). Further, it is likely that barriers to disclosure and abortion care access are steeper for transgender, nonbinary, and gender-expansive individuals seeking abortion. Transgender people often experience barriers to general healthcare that are likely to also impact access to abortion care, including discrimination, refusal of care, deficient provider knowledge, and lower levels of health insurance coverage compared to the cisgender United States population (Coleman et al., 2012; Macapagal et al., 2016; Rodriguez et al., 2018; Safer & Tangpricha, 2019; Safer et al., 2016; Wylie et al., 2016). Based on recent qualitative work, transgender, nonbinary, and gender-expansive individuals reported recommendations for destigmatizing abortion care disclosure and access, including the use of gender and sexual orientation affirming language, and increasing privacy (Moseson et al., 2021). As employees navigate the complex decision to disclose their abortion needs, future research is needed to determine what social support for those with abortion needs looks like in the organizational context.

Whisper Networks and Abortion Needs

It may be useful to look to other disclosure decision networks rooted in sex-based power hierarchies, such as sexual harassment disclosure, in order to predict how disclosure of abortion needs within organizations may be affected by the Dobbs decision. Whisper networks are defined in the popular press as “informal chains of secondhand and sometimes firsthand information about sexual harassers or rapists in a community or industry” (Jeong, 2018). The term “whisper” is important to the conceptualization of these networks, in that it suggests the information shared is not meant to be shared in a more outright manner, is meant to be shared selectively, and is a result of broader network silence around the stigmatized topic of sexual harassment. In particular, the theory of network silence around sexual harassment suggests that the composition of networks and the belief systems these networks adhere to tend to promote silence around the topic of sexual harassment, which in and of itself reinforces a culture of sex-based harassment (Hershcovis et al., 2021). Similarly, discussion of abortion has been found to be met with comparable silencing principles, with disclosure in particular contexts (such as at a party or at work) being categorized by those who have experienced abortion as an interactional impossibility and intrinsically socially problematic (Beynon-Jones, 2017). Concealment of abortion needs in these cases may be a direct reflection of those hegemonic power structures that ignore abortion needs, creating a system of silence for those in need of care.

Just as whisper networks about sexual harassment arise due to silencing forces upheld by sex-based power structures, it is also likely that in a post-Roe United States whisper networks about abortion needs will arise as a subversion of those power structures to support and protect those needing abortion care. Therefore, disclosure of abortion needs may not occur at a “formal” organizational level, but instead occur in smaller personal networks where those with abortion needs feel support, trust, and similarity (e.g., around others who have gone through the same experience or who hold similar opinions). In line with previous research, the use of this form of selective disclosure may be seen as a tool for collecting information, obtaining guidance, and finding support from those who will not pass judgment, violate one’s privacy, or try to change their decision (Chor et al., 2019). While the use of this form of disclosure serves a protective function, it may also further jeopardize those individuals who are not considered a part of the network (e.g., those who are further minoritized by race, sexual orientation, gender identity, etc.) and who remain without access to the information contained within it. This notion is supported by the finding that Black women who have had an abortion score higher on feelings of isolation in comparison to White women who have had an abortion, as defined as speaking to close friends or relatives about their abortion and their perception of resulting social support (Cockrill et al., 2013). Further, for transgender individuals the decision to disclose one’s abortion needs may entail disclosure of their gender identity and sex assigned at birth as well. While it is likely that the consideration of disclosing intersecting stigmatized identities such as these would result in greater nondisclosure, less access to whisper and support networks, and feelings of isolation, future research on abortion disclosure decisions for transgender individuals is needed.

The Dobbs decision makes disclosure of abortion needs even more risky, in particular for areas where abortion access has been restricted or made illegal, and where providing assistance to those needing abortions has been criminalized. In a post-Roe United States, the need to navigate disclosing to only trustworthy and supportive individuals becomes increasingly risky, with the consequences of disclosing to untrustworthy or unsupportive individuals ranging from the ill-effects of stigmatization to hefty fines, legal fees, or possible incarceration. In many states, the decision to restrict the access of abortion or make abortion illegal, makes salient the structural sex-based inequities experienced by those who deviate from the masculine ideal (for instance, any individual who could potentially need future access to abortion).

Future Research

For occupational health scientists there are still many unexplored research questions to ask. Previous research and theorizing suggest that nondisclosure of abortion results from managing a stigmatized identity and is harmful for a person’s well-being (Biggs et al., 2020a, b; Hanschmidt et al., 2016; Major & Gramzow, 1999). Nevertheless, it is also important to study the context-dependent situations in which abortion disclosure becomes more or less risky for a person’s well-being, and ultimately how socio-cultural norms are reflected in these contexts. Being able to understand the contexts in which individuals feel comfortable sharing their abortion needs is essential to building supportive systems for those at work. Further, occupational health scientists should look to social network approaches to study the interplay of power systems inherent in organizations and how this affects decisions related to reproductive healthcare needs, in particular for those holding non-dominant positions in these networks. These methods can help uncover the network level factors related to disclosure of abortion needs, feelings of stigmatization, or subsequent well-being. Future research should also seek a qualitative understanding of the implications of the Dobbs decision on employee disclosure choices, and how disclosure/nondisclosure may affect the use of organizational abortion care policies.

Implications of the Dobbs Decision for Gender and Income Inequality

Eden B. King

When Roe v. Wade was decided in the 1970s, only 43% of women were employed (Bureau of Labor Statistics, 2022). Despite substantial progress in workforce participation (57.4% in 2019), women continue to be segmented in lower-prestige occupations, to attain lower-level jobs, and to earn less money than men (for a review, see Eagly et al., 2007). Lower pay is part of the financially precarious position of many women, including more than 10% who live in poverty (United States Census Bureau, 2021). These gender inequalities are particularly pronounced among mothers; data from the 2019 American Community Survey suggest that mothers earn $15,000 less per year than fathers (National Women in Law Center, 2021) and analyses by the Center for American Progress suggest that nearly 1 in 4 single mothers lives in poverty (Bleiweis et al., 2020). Socioeconomic status is clearly intertwined with gender and maternity, and the decision in Dobbs v. Jackson further worsens women’s economic security.

The Intersections of Income and Reproductive Freedom

People who become pregnant in states where abortion is now banned (or banned for all practical purposes due to restrictions) have three basic paths: (a) continue the pregnancy to childbirth, (b) encounter miscarriage and/or life-threatening complications that result in the loss of pregnancy, or (c) access abortions at great cost (through travel to other states) or at great risk (in illegal clinics and/or unsafe methods). Acknowledging a variety of negative outcomes but focusing only on dollars and cents, all of these paths have detrimental financial consequences. Indeed, from an economic perspective, the Dobbs decision places a substantial financial burden on people who become pregnant.

Moreover, these paths are constrained even further for people who have few financial resources and must weigh expenses such as transportation, lost wages, childcare expenses, and medical fees. People with low income often have little flexibility in schedules and need to work every day and hour possible to earn enough to cover everyday costs such as food and housing; taking time away from work would generate less income at the same time as creating more costs for people who can afford neither. Costs for abortion were prohibitive even before the Dobbs decision (see Higgins et al., 2021a, b), but travel estimates suggest that the distance to the closest abortion facility will increase from 25 to 122 miles, and that 26% of women will have to travel more than 200 miles to access abortion care (Myers et al., 2019). This has direct implications for cost increases (e.g., gas, public transportation) as well as indirect implications (e.g., hotel stays, more lost wages). These financial and practical issues may be insurmountable barriers to abortion services for people without access to financial resources.

Evidence suggests that these dynamics will have compounding effects on income inequality. Data from a longitudinal study of women who received or were turned away for an abortion (Foster et al., 2018) found that the economic status of women in the former group improved and the latter group declined; women who were turned away for abortion services were four times more likely than those who received abortions to be living below the federal poverty line six months and five years later. This is particularly concerning given that, due to a variety of factors such as differences in access to information and contraception, people with lower incomes are those most likely to pursue abortions (see Dehlendorf et al., 2013). If people from low-income backgrounds cannot afford abortions, their financial insecurity may be exacerbated. It is also noteworthy that these burdens will likely be particularly problematic for women of color because of racialized income and healthcare disparities (see Sutton et al., 2021).

Practical Recommendations

Organizations and the individuals who lead them have the opportunity to reduce the severity of the inequalities that emerge as a result of the Dobbs decision. In particular, organizations can: (a) support access to reproductive freedom in political spheres, (b) provide financial and practical support for reproductive care, and (c) develop social support networks for people who might become pregnant. Many organizations are reluctant to engage in politics, yet organizations can be powerful agents of change in the context of social movements (see Edelman et al., 2010). Organizations with employees in states in which abortion is illegal or inaccessible can also directly impact workers by distributing funds for medical costs, travel, and childcare and increasing paid time off to support reproductive freedom (see Siuta, this paper, for concerns as to whether employees will use these options). Finally, attention to the psychological well-being of people who can get pregnant (especially given the potential for increased stigma and legal concerns noted by Cheung) by developing and funding confidential support networks would also be a critical component of effective organizational responses to the changing reproductive freedom landscape. Such efforts may not reach every person who is impacted by the Dobbs decision, but they are necessary to blunt its blow to equality.

Menstruation and Miscarriage: Implications for Employees, Organizations, and Researchers in a post-Dobbs United States

Mindy E. Bergman

News articles have documented the negative impact of abortion restrictions on obstetric care during pregnancy loss, some of which occurred prior to the Dobbs decision because of laws that had already gone into effect that restricted abortion care (Feibel, 2022; Vargas, 2022). This contribution describes two processes related to reproduction–menstruation and miscarriage–and how these are both now more complex for employees, organizations, and researchers to navigate. In the following, I briefly review the processes of menstruation and miscarriage because there is considerable misconception about reproductive processes (Bardos et al., 2015; Lundsberg et al., 2014). Then I discuss the implications of the Dobbs decision for these processes for researchers, workers, and organizations.

Basic Reproductive Information

In order to prepare for pregnancy, bodies with uteruses experience cyclical changes in reproductive hormones that affect the uterine lining. If a pregnancy occurs, then it signals a set of hormones to continue to develop the uterine lining in order to support the pregnancy. However, when a pregnancy does not occur, a different set of hormones cascades, resulting in the shedding of the uterine lining. This shedding of the uterine lining is known as menstruation or menses; colloquially, this is called a “period” because it occurs on a reliable cycle (i.e., periodically) for many people who menstruate.

Abortion disrupts pregnancy. Miscarriage is a form of abortion, called spontaneous abortion; miscarriage occurs is when a pregnancy unintentionally does not continue through the time that a fetus is viable; viability occurs at minimum in the range of 20–28 weeks of gestation (Alves & Rapp, 2022; Quenby et al., 2021; Robinson, 2014). Miscarriage can occur for a variety of reasons, most commonly due to genetic abnormalities in the embryo/fetus, but also due to maternal illness, structural problems with the uterus, and other reasons (Regan & Rai, 2000). Miscarriage is the most common pregnancy complication, with studies estimating 15–25% of clinically diagnosed pregnancies (i.e., those confirmed via pregnancy test or other examination) ending in miscarriage, with much higher estimates for all conceptions including those that are not clinically diagnosed (Robinson, 2014; Shorter et al., 2019). Many miscarriages are uncomplicated and generally treated with little intervention, often at home. However, other interventions can be used including surgical and medical approaches (Robinson, 2014). Expulsion and removal procedures include oral medications, transvaginal medications, and surgical procedures (Adams, 2016; Simmonds et al., 2016).

Importantly, a non-trivial number of miscarriages do not complete themselves on their own and without intervention; the body needs assistance to complete these missed or incomplete miscarriages (Adams, 2016; Alves & Rapp, 2022). This could involve a range of events including a clearly dying embryo/fetus that is not yet dead, a dead embryo/fetus that has not been expelled from the uterus, or other products of conception that are retained in the uterus even when there is no embryo/fetus remaining (e.g., placenta; Adams, 2016; Alves & Rapp, 2022). There are additional pregnancy complications, such as ectopic pregnancy (i.e., a fertility- and life-threatening situation in which implantation occurs outside of the uterus; Murray et al., 2005; Rana et al., 2013; Sivalingam et al., 2011), that require urgent medical and/or surgical intervention in order to save the life of the pregnant person.

Implications for Organizations and Workers

Miscarriage care is likely to become more complicated, at least in the short term until there is clearer guidance to medical practitioners about when they may medically or surgically intervene. This will increase costs related to health care for organizations, including lost days for workers (longer absence for care, greater recovery time) and rising costs in health care insurance (more expensive care). Employees will also see increases in costs of health care (e.g., more costly care for miscarriage, greater recovery time) which could also result in greater lost wages for hourly workers in particular.

Further, organizations might discover that some workers are unwilling to travel to some states due to their abortion laws. For example, people who are pregnant might decide that they should not travel to a state in which abortion is outlawed or banned at a particular stage of gestation due to concerns that they would not get the miscarriage care that they need should they experience a miscarriage. Similarly, people who are trying to conceive–i.e., not yet pregnant but are attempting to become pregnant–might have similar concerns, especially if the work assignment in those states are lengthy. This has wide-ranging implications for work location. Work travel has many forms, including examples like attending a conference, being a regional manager and traveling to sites in different states, working in a transportation industry (e.g., trucking, airlines), or accepting a short- or long-term consulting assignment.

Additionally, this reluctance to physically be in some states could also extend to some people being unwilling to relocate to other business sites. This limits organizations’ ability to deploy talent across the organization and reduces its ability to retain top talent who might seek employment elsewhere rather than relocate for a promotion or other developmental opportunity. Notably, employee concerns about relocation might extend further than their own selves; employees with minor children who are reproductively capable might also want to avoid these states. Employees might also want to avoid these states even when their children are not minors, but are reproductively capable, because it might limit their children’s willingness to travel to their homes, again due to the reproductive risks they would be taking.

Additionally, across the globe there is rising interest in menstrual leave, that is, additional leave or flexible worktime for people who menstruate (Haupt, 2022). While menstrual leave has been expected in some countries for decades (e.g., Japan), others have lagged behind (Hollingsworth, 2020). While the concept of menstrual leave is not yet gaining significant traction in the US, the tension between the need for menstrual care and the now increased need for privacy around menstruation might make companies less likely to provide menstrual leave and workers less likely to use it. That is, it is possible that organizations or workers might not want to provide or use (respectively) menstrual leave because the within-person patterns of using menstrual leave could be indicative of pregnancy and later abortion (spontaneous or induced).

Implications for Researchers

Occupational health researchers often have an interest in reproductive health. Research queries the effects of occupational factors on fertility and pregnancy (Paul, 1997; Schenker et al., 1995) as well as the effects of pregnancy on identity and discrimination in the workplace (Jones, 2017), which appear to have their own effects on important workplace events like accidents (Lavaysse & Probst, 2021).

In the context of these kinds of research areas, it is easy to see the kind of data that researchers might want to obtain. Researchers might ask survey questions as simple as “are you pregnant?” or could measure reproductive hormones across days, weeks, or months. Researchers could ask participants to take a pregnancy test, maybe as part of research that involves x-rays, in order to screen out potential participants who could be at risk from their research participation. Researchers might ask participants to indicate the first day of their last menstrual period. Any of these data could be used to identify pregnancy. When a pregnancy occurs but a birth does not follow in the appropriate time period, then this is indicative of abortion, although whether that abortion is spontaneous or otherwise would likely not be known from these data.

Two methods can generally be used to reduce risk to participants regarding data protections. One is data minimization, that is, the reduction of research methods that involve obtaining this information. This method can be utilized when pregnancy related data are not important to the central question of the study, or when the data do not need to be recorded. For example, a survey researcher could choose not to ask whether a participant is pregnant, or a researcher could choose not to record a positive pregnancy test in an x-ray study (i.e., just mark the potential participant as “unable to participate” rather than record why). This is complicated, however, because as noted above, there are many reasons why these data are important or even necessary. The other approach is de-identification. This is the approach that many researchers take for any research, for example, not collecting personally identifiable information like names, email addresses, or phone numbers. However, there are many studies where this is not possible, such as longitudinal studies in which a person will need to be scheduled and reminded of additional appointments. Although the data itself can be coded (e.g., a combination of letters and numbers that is not associated with personally identifiable information), there will still be a record of participation. A motivated person could possibly cobble together sufficient data combined with a name to identify which row of data belongs to which participant.

Best practices in protecting reproduction-related data are still developing. In the midst of writing this contribution (September 2022), NIH clarified their guidance on Certificates of Confidentiality. These certificates are used to protect participants’ data from Freedom of Information Act requests and other legal actions (including, as now clarified, civil suits; National Institutes of Health) that carry even a very small risk of exposing their personally identifiable and sensitive information. For example, a Certificate of Confidentiality protects information about HIV status, illegal behavior like illicit drug use, physical or mental health diagnoses, and genetic information. Note that it is not necessary that a project be funded by NIH for a researcher to obtain a Certificate of Confidentiality for their data. Certificates of Confidentiality might be able to be used to protect reproductively-relevant data from subpoena, but this is clearly still evolving.

Conclusion

The landscape is still evolving post-Dobbs decision, and it is likely that there will be clearer guidance on miscarriage care in the coming months. But there are other risks that can arise even when the medical risks are reduced. The changes in reproductive rights occurring in the US do not just affect abortion care itself, but all reproductive processes for people who can or are suspected to be able to become pregnant.

Overturning Roe and Violence Against Women

Alexandra I. Zelin and Corrine Wolfe

The World Health Organization (2017) defines domestic violence (DV) as “behavior by an intimate partner or ex-partner that causes physical, sexual, or psychological harm, including physical aggression, sexual coercion, psychological abuse, and controlling behaviors.” Because approximately one in three women and one in ten men experience DV within their lifetime (Huecker & Smock, 2019), the World Health Organization classifies DV as a major public health crisis. However, even these numbers are likely lower than reality: DV is more prevalent than what is represented in national and local statistics due to underreporting, which often occurs due to shame, fear of retaliation from the abuser, or to protect the abuser (Reaves, 2017). Underreporting is common in victims from ethnic minority populations, potentially due to community influence and beliefs, and in more extreme situations, concerns about immigration laws if not a natural-born citizen (Femi-Ajao et al., 2020). And, importantly, DV affects individuals from all backgrounds regardless of race, gender, age, sexual orientation, or religion (World Health Organization, 2017). In short, DV is much more common than numbers can directly state, and DV affects a significant portion of our workforce.

Linking DV and Abortion

Domestic violence is often connected to reasons why people who can become pregnant decide to obtain an abortion. Researchers have found that up to 25% of all people who terminated their pregnancy reported experiencing recent acts of DV (e.g., James et al., 2013; Pallitto et al., 2013; Saftlas et al., 2010). Some terminated their pregnancy for fear of violence harming themselves and/or the embryo/fetus, while others did not want to be tied to their abuser for the long-term (Chibber et al., 2014). In fact, one study on pregnant DV victims found that in comparing people denied an abortion to those who could obtain an abortion, individuals forced to carry the embryo/fetus to term suffered continued physical violence throughout their pregnancy; persons who obtained an abortion experienced reduced physical violence. Furthermore, those who could obtain an abortion were less likely to keep in contact with their abuser and quicker to end the romantic relationship (Roberts et al., 2014). Reproductive coercion (e.g., sabotaging birth control methods) is also a form of DV that can be used to force a victim to stay in a relationship by way of an unplanned pregnancy (Grace & Anderson, 2018).

However, a person’s right in some states to choose a medically safe abortion was taken away with the overturning of Roe v. Wade, leaving many people with uteruses in DV situations unable to access an abortion for themselves or their embryo/fetus’ safety. As a result, the rates and the extent to which someone experiences DV (staying with abuser, exposing children to DV), are likely to rise. As evidenced pre-Roe v. Wade decision, people seeking abortions turned to medically unsafe abortions, risking severe infection, injury, and even death (Ganatra & Faundes, 2016).

Workplace Impact of DV

The mental and emotional health effects of DV on victims are long-lasting and often continue even after the physical effects have disappeared and/or the relationship has ended. DV has been directly linked to depression, posttraumatic stress disorder (PTSD), anxiety, substance abuse, and an increased risk of suicide (Lagdon et al., 2014). In many instances, the effects of DV are often comorbid, meaning that two or more of the effects are present in victims at the same time and often occur together (e.g., a victim might suffer from PTSD and anxiety). Affecting the embryo/fetus, violence during pregnancy is linked to negative pregnancy outcomes such as low birth weight, neonatal death, and preterm delivery (Evans et al., 2008; Sarkar, 2008).

While people may associate DV related to the workplace as being when an abuser is physically present on workplace premises, the effects of DV (e.g., depression, anxiety, substance abuse), do not just disappear when someone “clocks in” to work. Furthermore, victims may need to miss work due to attending legal meetings and/or receiving medical care (e.g., general treatment, hospitalization, counseling services; Arias & Corso, 2005). Financially, Peterson et al. (2018) found that the average cost of productivity losses per woman victim was $36,065 ($14,291 for men victims), numbers that can sway executives into action when the moral argument of employee well-being alone is not enough.

What This Means for Occupational Health Psychologists

With a legal and safe abortion option now unreachable for many, these negative outcomes only stand to increase: many people with uteruses experiencing DV will be forced to carry an unwanted pregnancy to term and are likely to remain in violent relationships. As occupational health psychologists, we have our work ahead of us. We need to do more research on how to support victims of DV within the workplace. A master’s thesis by the second author started this journey, but more research needs to be done on the best way to support victims of DV and pregnant victims of DV at work. To start, we know that physical safety, emotional support, work modifications, and providing resources for access to support were all listed as items victims need from their organization (Wolfe, 2021). We now need to implement organizational policies and practices that enable support for victims of DV.

Practical Recommendations

Logically, we also need to make the case for paid maternal/paternal leave in the United States. With a larger number of people who will be giving birth (whether victims of DV or not), we are about to lose a significant number of the workforce each year as people recover from giving birth. Paid leave should not be limited to those with salaried positions as DV victims can and do work in all sectors.

As Allen, King, and Gaskins each mention in their sections herein, we desperately need more support for working parents. Many victims of DV will now have children that they did not plan for, which also means a significant increase in daily expenses that were also not planned. Free subsidized childcare is needed now more than ever. Some states have also implemented the Healthy Working Families Act requiring organizations to provide sick and safe leave for domestic situations (DV, elder abuse, etc.). Adding this leave as a benefit can be hugely beneficial for victims of DV.

The overturning of Roe v. Wade will make it harder for organizations to turn a blind eye to DV. Organizations have a moral obligation to support their workforce. That support needs to continue even if/when the employee leaves the DV situation, especially if a child is now present.

Work-family Conflict and Seeking Abortion Care

Tammy D. Allen

Work-family conflict refers to a form of interrole conflict in which demands across work and family roles are mutually incompatible so that meeting the demands associated with one role make it difficult to meet the demands associated with another role (Greenhaus & Beutell, 1985). Two directions of work-family conflict are recognized such that work can interfere with family (WIF) and family can interfere with work (FIW). It is a prominent topic within the occupational health sciences literature in that the experience of work-family conflict has been negatively associated with a host of occupational health and wellbeing outcomes (Amstad et al., 2011; Grzywacz, 2016). We also know a great deal about the predictors of work-family conflict. Specifically, work role demands are established predictors of WIF and family role demands are robust predictors of FIW (e.g., Allen et al., 2020; Amstad et al., 2011; Ford et al., 2007). Further, there is an abundant body of literature that indicates support from others is negatively associated with WFC (French & Shockley, 2020; French et al., 2018). While there is no existing research within the work-family literature that has specifically incorporated issues associated with abortion care, we can extrapolate from existing research the impact that the Dobbs decision may have on the work-family experiences of people who can become pregnant.

The experience of a pregnancy that is unintended or that involves health concerns for the carrier and/or the embryo/fetus is a major life disruption that can prompt fear, shock, and worry, and for many may be construed as a crisis event (Crowley et al., 2019). Eby et al. (2016) first advocated for the examination of work-family experiences from a crisis lens, describing crisis events as those in which the demands placed on an individual exceed their coping capacity and thus impact individual wellbeing. Lack of access to abortion care can exacerbate what is already a stressful situation, escalating required coping capacity.

Coping with an unintended pregnancy and restricted abortion access demands the use of time and energy resources in the personal domain that may make it difficult to meet work demands. As such, a personal crisis such as an unintended pregnancy can spillover and impact the individual’s work role. For example, the strain associated with seeking abortion care when living in a location in which it is restricted can result in difficulty performing at work. As another example, having to travel across state lines to obtain an abortion increases the likelihood that the pregnant person will have to miss work, resulting in conflict between work and nonwork roles. Moreover, as noted by Eby et al. (2016) crisis situations can have discontinuous effects on individuals over time. For example, adaptation to the event can occur more rapidly if the individual receives support from others, including the employing organization.

We know from the work-family literature that one of the most powerful ways to help mitigate work-family conflict is through support from the organization and supervisors (French et al., 2018; Kossek et al., 2011). Lack of access to abortion care is not only a personal problem but an organizational problem as well in that it impacts employee health, wellbeing, and performance. Organizational work-family policy and practice can play a significant role in reducing barriers for those whom abortion care is restricted. For example, organizations can provide travel support, paid time off, and flexibility in scheduling to help accommodate employee needs. Moreover, supervisors can be trained to help provide emotional and tangible support (Hammer et al., 2011). As abortion restrictions continue to spread across the U.S., employers may also consider the implementation of fully remote work options. Such a policy would provide employees with greater geographic choice with regard to where to reside and also provide employers with a larger talent pool (Allen et al., 2015).

Addressing the work-family complications posed by a post-Roe world underscores several work-family research needs. It is increasingly recognized that work-family conflict experiences can be viewed as chronic or as acute with chronic experiences commonly assessed through a levels approach and acute through an episodic approach (Shockley & Allen, 2015). However, episodic work-family conflict studies tend to examine the types of daily occurrences that are mildly distressing (e.g., arriving late for a work meeting due to a family interruption) (e.g., French & Allen, 2020). We need to understand conflict episodes prompted by crisis, such as unintended pregnancy and restricted abortion care access that are larger in scope and threat and therefore present greater vulnerability for impact on health and wellbeing. Such research will also need to incorporate theoretical approaches such as the recently introduced stability and change model that enable a better understanding of temporal dynamics involved in acute conflict episodes (Smith et al., 2022). Finally, we know that religion plays a central role in debates about access to abortion care. Research within the post-Roe landscape that examines the issue of how religion impacts work-family experiences is also needed. Recent research by Sitzmann and Campbell (2021) highlighted how and why religiosity widens the gender wage gap. Similar research that dives into the role of religion in individuals daily and longer-term work-family experiences is also needed.

Implications of Dobbs on Allyship

Mikki Hebl

In some states, anti-abortion laws and the Dobbs decision have created situations that fine and imprison those who aid individuals who get abortions, and allow private citizens to earn up to $10,000 by identifying and suing other citizens who get an abortion. These laws focus on denying people their human rights but also ensure that allyship is crushed. Indeed, some forms of allyship, in many states, are outright illegal.

Allyship

An ally is a person (often from an advantaged or privileged group) who works alongside people targeted by injustices to rectify discrimination and oppression (Drury & Kaiser, 2014). By supporting and advocating for equal rights alongside people who are oppressed, allyship is critical in helping others gain power and equal rights. The presence of allyship can serve as a barometer for measuring how supportive a (workplace) culture is and how much (or little) oppression there is within it. Across a number of studies, data reveal that marginalized employees (e.g., LGBT, women, people of color, those with disabilities) who have the support and presence of allies experience a variety of improved outcomes such as higher levels of job satisfaction, safety, belongingness, and favorable workplace cultures, and lower levels of job anxiety (Change Catalyst, 2022; Major et al., 1990; Griffith & Hebl, 2002; Radke et al., 2020).

Impact of Dobbs Decision

Several groups of marginalized individuals have always benefited from allyship but will need particular support following the Dobbs decision. First, those who choose to get an abortion will continue to face mounting stigmatization before and after (see Cockrill et al., 2013; Norris et al., 2011). Fortunately, work by Major et al. (1990) reveals that perceived social support after an abortion can increase self-efficacy in coping, ultimately leading to enhanced adjustment. Those seeking reproductive freedom may face undue stress in getting the resources they need, may have to travel afar to access crucial reproductive healthcare, and may not have the means to travel outside their restrictive state to obtain freedom (Biggs et al., 2020a, b). Still others will continue having backroom abortions as they did prior to Roe v. Wade, which presents a clear danger to those seeking care. Regardless of the legalities, abortions will continue. And so will the need for allyship. However, aiding people in obtaining these resources and/or to access abortion could be illegal – probably is illegal – with laws like TX SB8.

Second, the Dobbs decision will affect people who get pregnant and choose not to have, or are not able to access, an abortion. Research already shows that pregnant people face immense stigmatization in social and professional settings (Hebl et al., 2007; Morgan et al., 2013). This is particularly the case for teen pregnancies, younger (but not teen) parents, older parents, single parents, parents with a large number of children, and pregnant people who are at the intersection of being a racial minority and/or having low socioeconomic status (Ellis-Sloan, 2014; Mantovani & Thomas, 2014; Mehra et al., 2020; Scala & Orsini, 2022; Wiemann et al., 2005; see also Glover, 2018; Zernike, 2009). There is already contempt for pregnant workers – they are perceived as likely to decrease their workload, less competent and committed, and more emotional than non-parents and fathers (Halpert & Burg, 1997; Halpert et al., 1993; Ridgeway & Correll, 2004; see also Morgan et al., 2013). Moreover, in Texas, where abortion has been outlawed after six weeks of pregnancy since late 2021, pregnant people have reported difficulties accessing healthcare for miscarriages and unsurvivable fetal abnormalities due to providers’ concerns of facing prosecution under restrictive abortion laws (Feibel, 2022; Huff, 2022). Thus, even those who wish to carry a pregnancy to term may find their health and lives at risk due to anti-abortion laws.

Understanding Allyship in the Post-Roe World

The landscape for understanding allyship in a post-Roe world is untouched – there is very little research on allyship in general much less than on allies who support abortion seekers and/or allies who support pregnant people who are forced to carry their pregnancy to term. That means that such research is very much needed and might address what the best allyship behaviors are. What is helpful? What is legal? What are the consequences associated with particular sets of allyship behavior? How can coworkers and leaders best support those getting abortions without being criminalized? How can coworkers and leaders best support the larger number of people who will become pregnant? Those who do not want their pregnancies? Those who face health crises?

Many allies continue to coalesce to protest, raise money for procedures, provide rides and services, guide patients past protesters, and offer (if they are medical staff) to travel to people who need their services (see Bruder, 2022). Additionally, there may be specific actions that coworkers can do to provide allyship, although the extent to which this behavior is effective will need both empirical evidence and the test of time. Research that looks at how we can persuade others to be allies (e.g., Corrington et al., 2023) is also critical.

Practical Recommendations for Co-Workers and Organizational Leaders

Both co-workers and organizational leaders have a critical role to play in allyship. And even in the absence of empirical data, we make recommendations. Perhaps most importantly, successful allies must use their voice to protest, speak up, and campaign for the decriminalization of reproductive rights, which have recently had a successful impact in other countries (e.g., Argentina, Columbia, Mexico, Uruguay; see Fernandez Anderson, 2017). These allies must not just be people who can become pregnant; those who cannot also have a significant role to play, not only because they also benefit from reproductive freedom (see Daley, 2022) but also because their voices on gender-related issues are heard in ways that people with marginalized genders are not (Hebl et al., 2022). Members of upper management and HR can do everything in their power to protect the privacy of their employees’ medical histories, which many can presently do now using HIPAA laws (see Buchanan & Stovicek, 2022). Organizational leaders can also expand their health insurance plans to ensure that abortion coverage is included and pledge that their companies will cover travel costs required for out of state abortions (see Gibson, 2022; see also Goldberg, 2022). Some CEOs have told their employees that they could relocate from states with restrictive abortion laws to other states without justification as to why (see Clark & Schiffer, 2022), and other leaders also stated that they will cover the costs to both train and cover bail for those who protest anti-abortion laws peacefully (see Papenfuss, 2022). Ultimately, committees and working groups can be a helpful starting point for long-term solutions, but people who can become pregnant need support and allyship today–in fact, their lives may depend on it.

Co-workers must also be willing to understand that allyship extends not only to those who have chosen to have abortions but also to those who have been prevented from having them. Allies, in this case, may need to identify their pregnancy-related biases; and be willing to advocate, provide psychosocial support, and be ready to take on more of the work if their pregnant colleagues need it (see Eaton, 2019). Leaders can make more workplace accommodations, which will be needed, given the likelihood of increased workplace pregnancies.

A recent article published in APA’s Monitor on Psychology states, “More than 50 years of international psychological research shows that having an abortion is not linked to mental health problems, but restricting access to safe, legal abortions does cause harm.” (Abrams, 2022; p. 40). Given the Dobbs decision and the anticipation of harm to those who need access to comprehensive reproductive healthcare, it is clear that we have a very critical need for enhanced and effective allyship.

Organizations Need Workers, Workers Need Organizational Support in Order to Work in a Post-Roe World

Vanessa A. Gaskins

The Dobbs decision comes at a time when women are already facing significant barriers to being able to contribute fully, and be recognized fully, for their contributions at work. The COVID-19 pandemic led childcare centers and schools to close. As a result, many primary caregivers, the majority of whom were women, left the workforce to take on unexpected caregiving responsibilities (Collins et al., 2020). The loss of childcare was found to be associated with a risk of unemployment for mothers but not fathers (Petts et al., 2020); while most men have returned to the workforce, approximately 2 million women who dropped out of the workforce during the pandemic had not returned by January of 2022 (Gonzales, 2022). This was a predictable outcome as women still take on the majority of household and caregiving responsibilities relative to men, even in dual-career households (Moen et al., 1999; Bianchi, 2011; Bianchi et al., 2012).

The US, in part due to the pandemic and its effects, is experiencing a labor shortage, and there have been more open positions than unemployed workers in the US since the summer of 2021. As of July 2022, there are around 6 million unemployed workers for 11.2 million open jobs (U.S. Bureau of Labor Statistics, 2022). The Dobbs decision is likely to exacerbate the shortage due to increased caregiving demands, health complications from pregnancy and/or childbirth, and deaths of pregnant people due to domestic violence by the sperm provider or during pregnancy or childbirth.

Burnout, Reevaluation of Employment, and Turnover Risk

The pandemic has also been associated with increasing levels of burnout, part of which is likely due to the labor shortage and employees being asked to take on additional work responsibilities and/or work long hours to make up for unfilled positions. Employees have been reevaluating their priorities and the type of work and life they desire, with many leaving their jobs to seek better work-life balance through flexible work arrangements that became common during the pandemic in some labor sectors. Relatedly, turnover intentions have been on the rise. Results from APA’s 2021 Work and Well-being Survey (American Psychological Association, 2022) show more than 2 in 5 employees surveyed indicated that they intend to leave their organizations in the next year, up from 1 in 3 from their 2019 survey.

Lee and Mitchell’s (1994) unfolding model of turnover posits that employees decide to leave organizations through four different pathways, and three of the pathways each begin with a “shock” or event that prompts the employee to make new judgments about their jobs and, in some cases, leave their jobs. By this definition, the pandemic is a shock that has already led many employees to reevaluate their jobs, organizations, and alternative options. The Dobbs decision represents a potential second, closely-timed, additional shock that could lead employees to further reevaluate where they are and how their jobs/organizations fit with their potential futures. For people who can become pregnant and are currently working in organizations not supportive of employees or their needs (including parental leave, access to reproductive healthcare, etc.), this is yet another reason to leave for a company with a better climate and benefits.

Perceived organizational support (POS) is the extent to which employees believe their employing organization values and cares about employees, and provides resources to support them (Eisenberger et al., 1986). Family-supportive organizational perceptions (FSOP) are the extent to which employees feel their employing organization is supportive of families specifically (Allen, 2001). People who can become pregnant may now be forced to birth and care for more children than intended due to the Dobbs decision, with some forced to become parents rather than being voluntarily childless. This lack of reproductive autonomy could prompt these employees (and their affected partners) to refocus their job search criteria to prioritize both POS and the more specific form of FSOP to enable them to have safe and financially feasible access to abortions and/or take on potentially unexpected caregiving responsibilities.

Practical Recommendations for Organizations

Organizations interested in retaining employees in a tight labor market should be attentive to their evolving support needs. Childcare costs have been on the rise. A report by Schulz (2022) determined that the average cost for infant childcare in the U.S. is now $12,411 per year. This price is unaffordable for many, but even those who can afford it may only be able to by spacing their children out and never having more than one in daycare (under the age of 5 years, the typical age at which children are permitted to enter their first year of public school in the US) at any given time. This ability to family plan is limited by the Dobbs decision, likely leading more people to stay at home as full-time caregivers rather than pay childcare costs for several children at one time.

Gender diversity in company leadership is beneficial and has been found to lead to better business and equity outcomes (Glass & Cook, 2017), and more favorable organizational climates for women (Virick & Greer, 2012). Companies will struggle to retain diverse teams of leaders if they do not offer support needed by people who can become pregnant. Most companies in the US do not offer paid parental leave; among companies that do offer it, it is often only provided to a portion of their workforce, typically the salaried/professional segment. The US Family and Medical Leave Act (FMLA) requires organizations to allow 12 weeks of leave each 12-month period following the birth of a child for caring for a newborn to employees who have been employed by them for at least 12 months. However, there is no requirement for this leave to be paid, and many workers are too new in their roles to be covered by FMLA (U.S. Bureau of Labor Statistics, 2020). Organizations investing in paid parental leave would have an upper hand in the labor market given that only 23% companies in the U.S. offer paid parental leave (U.S. Bureau of Labor Statistics, 2021).

Some organizations are hesitant to provide support to employees in response to the Dobbs decision, but this hesitation may be unfounded or misguided. Research indicates that offering family-supportive policies is related to positive work attitudes, regardless of whether employees use the policies themselves (Butts et al., 2013; Grover & Crooker, 1995). Further, employees seek to join organizations that align with their values, and statements of support and benefits are indicators of those values. In addition to supporting employees who can become pregnant with access and financial support for abortions, organizations who want to attract and retain people who can become pregnant and benefit from their contributions should provide FSOPs, such as paying all employees a living wage, offering paid parental leave and healthcare, providing private and sufficiently available lactation spaces, and subsidizing childcare. Further, organizations should require managers to practice family-supportive supervisor behaviors such as encouragement for using family-friendly policies, no meetings during child pickup and drop-off hours, and flexibility to accommodate family needs and priorities. Investing in these benefits and behaviors is essential to attracting and retaining employees in a post-Roe world.

Impacts of Dobbs decision on Medical Personnel

Robert R. Sinclair

Imagine being told that doing your job is now illegal. Healthcare is a challenging profession in the best of times. After 2 years of a pandemic, many providers have been stretched to their breaking point by the increasing demands of patient care. For example, a recent study showed that 50% of nurses responded “yes” or “maybe” to a question asking whether they intended to leave their position in the next six months, with the top three reasons being the impact of work on their health/well-being, insufficient staffing, and lack of support from their employer (American Nurses Foundation, 2021). Now, in this context, many abortion providers, who treat patients in what is often one of their most challenging life circumstances, have been told that their livelihood may be threatened for performing what was once viewed as normalized medical care. In one of the more extreme examples, Texan abortion providers may face life in prison and up to a $100,000 fine (Klibanoff, 2022).

While most of the discussion around the Dobbs decision rightly focuses on its impact on reproductive freedom, OHP researchers also should address potential impacts on healthcare personnel. Studies show that a substantial majority of healthcare providers believe that abortion services should be accessible to patients with few or no restrictions (Dodge et al., 2016; Schmuhl et al, 2021; Higgins et al., 2021a, b). Higgins et al. also found that 83% of a large sample of physician respondents expressed concerns about restrictive abortion laws making it difficult to recruit faculty and 66% reported worrying about effects on trainee recruitment. These data highlight conflicts between healthcare providers’ beliefs about the appropriateness of provision of abortion care and legal mandates that prevent them from providing such care.

How does this connect to OHP literature? The notion of job control as a stressor is fundamental to several OHP theories, most notably Karasek’s (1979) Job Demand Control model which emphasized how decision latitude has protective effects against job strain. A great deal of research supports the notion that workers who have lower control at work are likely to have poorer health outcomes (Kain & Jex, 2010) and it stands to reason that when health care providers experience restrictions on their options to treat patients, they are likely to experience greater job strain as a result.

However, the effects of restricting treatment options likely go deeper than simply a loss of some job control. Abortion access is a sensitive issue reflecting not just opinions about treatment options, but also deeply held moral values. Healthcare research uses the term moral distress to refer to situations where “painful feelings and/or psychological disequilibrium that occurs when nurses are conscious of the morally appropriate action a situation requires but cannot carry out that action because of institutionalized obstacles” (Jameton, 1984, p. 382). Several decades of subsequent research confirm the deleterious effects of moral distress (Thomas & McCullough, 2015). To the extent that health care providers view abortion care as legitimate and necessary treatment, they are likely to experience moral distress when prevented from providing that care and should experience greater job strain as a consequence.

Abortion care restrictions also may be analyzed through the lens of Semmer’s Stress as Offense to Self (SOS) Theory (e.g., Semmer et al., 2007, 2019). Drawing from a Social Identity Theory Perspective on Stress (Thoits, 1991), Semmer proposed that tasks that are viewed as either unreasonable or unnecessary are identity-relevant stressors because they conflict with what people view as legitimate work demands. Fila et al. (in press) expanded SOS theory to describe the stressful effects of illegitimate absence of tasks—instances where a worker feels that they should be performing a particular task, but the task is not part of their work role. They note that because workers are unlikely to accept a work role in which they cannot perform a task they feel they should perform, that this is especially applicable to cases where workers believe they will be performing a particular task but discover that they cannot do so. They propose that the illegitimate absence of tasks affects workers both through threats to their self-esteem and by creating a sense of disrespect. This model, while compelling, has received insufficient empirical attention as of yet; the Dobbs decision highlights the need for further research to understand how being prevented from providing legitimate care impacts occupational health.

State level abortion restrictions affect all providers who offer abortion care in a particular healthcare system. Thus, research might consider how the decision affects employees’ OHP outcomes at the group level. Some research has investigated work stressors at multiple levels of analysis, with results leading to interesting findings that don’t always replicate individual level effects. For example, Tucker, et al. (2005), in a study of military personnel, found that while group level stressors had limited direct effects on individual health outcomes, they had two different patterns of cross-level buffering effects on individual stress-outcome relationships. Some group-level stressors had exacerbating effects, such that the individual stressor had stronger negative effects in a stressful context. However, others had buffering effects such that that individual stress-outcome relationship was weaker in stressful contexts. They interpreted these findings as suggesting that individuals’ work stress may be less impactful when other individuals in their unit share the same experiences. These dual possibilities may be interesting to investigate in units where most individuals share the same negative attitudes about restrictions to their ability to provide abortion care.

It is important to note that while a majority of care providers view abortion care as legitimate, the research cited above illustrates that some do not. Thus, providers in systems with new abortion restrictions in place may experience positive outcomes following the Dobbs decision as their healthcare systems are now prevented from providing care that they do not view as legitimate. Future research should be careful not to assume that the inability to offer abortion care will be stressful for all potential providers.

Finally, the Dobbs decision has made abortion care an even more important political topic than usual (Paris and Cohn, 2022). Changes in abortion care also may stimulate higher levels of political conflict in healthcare systems or in other organizations as employees discuss the wisdom of these changes. Although research has not studied this specifically in relation to abortion care, Miner et al. (2021) found that, during two presidential elections, both the experience of incivility at work and its health impacts depended on the match of the worker’s political orientation (i.e., liberal/conservative) and the orientation of the perpetrator as well as the typical political orientation of the workplace. Such research highlights the potential risks of increased interpersonal conflict about abortion care.

In summary, in states with newly passed abortion restrictions resulting from the Dobbs decision, abortion providers are likely to experience increased job strain as a result of not being able to perform a portion of their job they view as legitimate care. These effects are likely to differ depending on one’s personal values and organizational context. This decision represents just one more threat to the health and well-being of healthcare personnel and highlights the need for employers to continue to find ways to provide support to employees working in such challenging circumstances.