Sociodemographic and Occupational Factors Influencing Pregnant Workers’ Awareness and Utilization of the New York City Pregnant Workers Fairness Act

Background: The New York City (NYC) Pregnant Workers Fairness Act (PWFA) went into effect in January 2014 to provide greater flexibility for pregnant workers’ accommodations, yet no studies to date have evaluated its effectiveness and utilization. We examined factors associated with pregnant workers’ PWFA awareness, understanding of PWFA, and receipt of accommodations in a lower socioeconomic status population in NYC. Methods: Participants included 481 pregnant workers who attended prenatal visits at Mount Sinai Hospital Obstetrics and Gynecology Clinic in NYC in 2017. Detailed demographic and occupational data were collected via in-person interviews using a pregnancy and work survey. Information on participants’ PWFA awareness, knowledge of six common PWFA-eligible accommodations, and accommodations received was also obtained. Multivariable-adjusted logistic regressions were used to identify the factors influencing PWFA awareness and accommodations received. Zero-inflated Poisson regression assessed the factors associated with the number of accommodations that participants recognized. Results: Only 14% of participants had ever heard of NYC PWFA legislation. Lower educational level (≤12 ^th grade) (Adjusted Odds Ratio [aOR]=0.54, 95% Confidence Interval [CI]=0.30-0.98) and being unsure of workplace maternity leave policies (aOR=0.39, 95% CI=0.18-0.87) were associated with lack of PWFA awareness. Regardless of PWFA awareness, no maternity leave policy and being unsure of maternity leave policy (both p =0.003, vs. paid policy) were associated with not recognizing any PWFA-eligible accommodations. Regardless of their PWFA awareness, women working for ≤5 years (aOR=0.42, 95% CI=0.22-0.83), non-U.S. born (aOR=0.57, 95% CI=0.36-0.90), and high-risk pregnancy clinic patients (aOR=0.59, 95% CI=0.38-0.93) were less likely to receive PWFA-eligible accommodations such as adjustment to lighter duty, compared to their counterparts. Conclusions: Lower educational level, lack of paid workplace maternity leave policy, shorter job tenure, and non-U.S. born were associated with decreased PWFA awareness and/or accommodations received. As more women continue to work during pregnancy, interventions promoting PWFA awareness and utilization are paramount for protecting the maternal and child health of these identified vulnerable groups, especially given that final regulations for a national PWFA recently went into effect across the United States in June 2024.