For two years, well before my home city of Portland, Oregon, passed a paid sick days law, I volunteered twice a month at a neighborhood Planned Parenthood clinic. Part of the position involved informal intake for patients seeking surgical abortions, which often meant asking what they did for a living. Several of the dozens of patients I worked with during this time told me they’d faced professional difficulties as a result of their pregnancies; at least three told me they’d lost their jobs after taking too many days off due to morning sickness. One was scheduled to work at a physically strenuous job that night and said she couldn’t afford to take any downtime—despite the bleeding and cramping that can come as a result of abortion care.

These patients weren’t alone. Although the Equal Employment Opportunity Commission guidelines prohibit discriminating against employees for having an abortion or expressing intent to have one, the policy does not address whether requests for time off for the procedure itself need to be accommodated. And the lack of paid sick time available across the country means that if a worker needs time to address reproductive health needs—including prenatal or abortion care—she may have to risk her livelihood or her paycheck to do so.

According to the Bureau of Labor Statistics, only 61 percent of U.S. private sector workers had access to paid sick leave in 2012. Although that number is up 11 percent from 1992, due in part to city-by-city and state-by-state campaigns to extend paid sick time access to everyone, it still demonstrates a lack of stability felt by an enormous chunk of the American workforce. Survey data compiled by the Institute for Women’s Policy Research (IWPR) suggests that in general, women are just slightly more likely to have access to paid sick days than men of the same race. Still, women—especially women of color—are disproportionately affected by a lack of access to paid sick time, including where their reproductive health is concerned.

The IWPR reports that about 36 percent of white women cannot get time off if they’re sick; nor can 34 percent of Asian women. Forty percent of Black women and 49 percent of Latina women do not have access to paid sick time. Furthermore, some of the industries least likely to offer paid sick time—such as food service and personal care—are ones in which women of color are overrepresented. They’re also industries that pay the least well, meaning workers live with tighter margins and can’t afford to take time off.

For women who need reproductive health care, that time is precious. As states increasingly chip away at abortion access, the likelihood that patients seeking an abortion need time off work increases. A Guttmacher Institute analysis of clinical data from 2008 found that among patients seeking abortion, those living in states with a mandatory counseling requirement, those in rural areas, and those seeking second-trimester procedures were more likely than their counterparts to travel distances of at least 100 miles. Travel time, mandatory waiting periods, and finding a second-trimester provider in states where they’re scarce can all cut into a patient’s schedule. Even in locales where patients have easy access to a clinic and no mandatory waiting period, surgical abortion providers generally recommend waiting until the day after an abortion procedure to resume normal activity, and many recommend taking a second day off to recover. Patients who have medical abortions are also urged to take a day or two off if possible.

Meanwhile, for patients who wish to carry their pregnancies to term, those seeking prenatal care need to make one appointment per month until the 28th week, at which point providers typically step up that frequency; patients carrying high-risk pregnancies may also need more frequent visits so providers can monitor them more closely. Unfortunately, this too can present difficulties for some people. According to a National Partnership for Women and Families (NPWF) survey of U.S. women who gave birth between July 2011 and 2012, 9 percent of pregnant women who requested schedule changes or time off while pregnant (for reasons relating to their pregnancy, such as prenatal appointments) said their requests were denied. Even those who were granted the day off may not have received wages for that day, which can be harmful too. NPWF also notes that for families without paid sick time, 3.1 days’ worth of lost wages can equal a family’s entire health-care budget for the month; 3.5 days of wages is equivalent to its grocery budget. Furthermore, families without paid sick time are more likely to use the emergency room for care.

So what happens, then, when people take time off for care anyway? Sadie Kliner, senior communications manager of workplace programs at the NPWF, notes “there’s a serious lack of data” investigating direct correlations between reproductive health-care necessities and job security. Generally speaking, 12 percent of U.S. adults surveyed by the NPWF have been terminated at some point in their career because they called in sick. In 2013, meanwhile, 3,451 pregnancy discrimination claims were filed with the Equal Employment Opportunity Commission—including at least one regarding a denial of time off to recover from a miscarriage. Beyond those numbers, though, we have very little quantitative information on people fired for reasons relating to their sexual health.

Of course, this paucity of research is closely linked to why explicit legal protections are important to those needing time off for reproductive and sexual health. These are private matters, discussed so infrequently that they often fly under the radar of researchers and data gatherers. Sexual health is also not something most of us are comfortable discussing in any detail with our employers. Even in workplaces that voluntarily offer paid sick leave, many demand doctors’ notes—or ask intrusive questions to establish that the worker’s problem is bad enough to justify staying home—before they’ll excuse the absence.

Things are changing, however, albeit slowly. Earlier this week, Tacoma, Washington, passed an ordinance requiring employers to provide three paid days off for workers, becoming the 16th U.S. city to adopt a paid sick time law. Philadelphia is also considering a paid sick day proposal, and three states—Connecticut, California, and Massachusetts—have adopted similar laws. More state governments are talking about it too: Maryland, New Hampshire, Oregon, Vermont, and Washington all have proposals on the table, and President Obama gave the notion a shout-out in his State of the Union speech. The Healthy Families Act, introduced in 2013 by Rep. Rosa DeLauro (D-CT), would guarantee seven days of paid sick leave per year for regular employees at U.S. companies with more than 15 employees. The bill died in subcommittee in 2014, but since then the Obama administration has publicly called on Congress to re-introduce and pass it.

A huge portion of the U.S. workforce still lacks a living wage and paid parental leave. Post-Affordable Care Act, there are still millions of people without affordable health insurance. Those are, admittedly, tougher problems to solve; paid sick days is a relatively modest ask. If we want to ensure that everyone has control of when and how they become parents—and to best support parents in caring for themselves and their families—we need to ensure they have flexibility and privacy in navigating their health choices.