When labor rights activist Gina needed abortion care, she felt she had to hide it from her employer. Blindsided with an unplanned pregnancy despite having an IUD inserted a few months earlier, Gina kept her circumstance a secret.

“I’ve never wanted children,” said Gina, a 35-year-old woman from Lebanon, Missouri whose name has been changed to protect her identity. “That’s why I had an IUD, because it was one of the most effective forms of birth control.”

Gina had recently been approved to take vacation time for a trip abroad and didn’t feel like she could ask for more time off from work. Not only was she dealing with the dilemma of needing to miss work to receive the procedure, but she had to travel several hours to a Planned Parenthood in St. Louis, the only clinic performing abortions in Missouri at the time. She was able to adjust her schedule and take a day off, but she didn’t discuss her situation with anyone at the labor union for which she works. 

“Even though I work for a progressive organization that supports reproductive rights, there is still a culture of shame,” Gina said. “It’s a personal decision with very intense personal feelings and I don’t want that to affect my career. Abortion is stigmatized so heavily. It’s difficult to have these open conversations.”

People face many barriers when accessing abortion, including taking time off work, getting to a clinic that offers abortion services, paying for the procedure, and, in some cases, arranging child care. Many like Gina also fear retaliation at work.

“We know women are being discriminated against in the workplace and in housing when it comes to their reproductive health care choices, and they need to be protected,” said Alison Dreith, executive director of NARAL Pro-Choice Missouri.

The St. Louis City Board in February passed a reproductive health anti-discrimination ordinance protecting people in employment and housing. The ordinance offers protection against discrimination for any reproductive health choice including abortion care, fertility treatments, birth control, and pregnancy.

Despite the ordinance, the work of protecting women in St. Louis isn’t over. The St. Louis Archdiocese is challenging this ordinance in court on the basis that the policy is an infringement on religious liberty, despite the law offering exemptions for religious organizations.

Municipalities nationwide have been slow to act in protecting people from this type of discrimination. Along with St. Louis, only Boston, Washington, D.C., and Delaware have ordinances on the books to protect people from discrimination based on their reproductive health choices. The Democratic-held California General Assembly recently passed a similar ordinance, but it was vetoed by Gov. Jerry Brown (D) on Sunday. 

Gina is protected at her job by a collective bargaining agreement requiring her employer to give her time off for illness or medical procedures, but she thought she may experience repercussions other than termination if she were open about her abortion.

“There are other ways bosses can make your life difficult other than just being fired,” she said, citing examples such as receiving a bad assignment or being moved to a different department.

Not only can stigma cause workers to fear workplace repercussions, but missing work to receive reproductive health procedures can also affect employment.

One 22-year-old mother of four living in Blue Springs, Missouri lost her job after taking three days off work to receive and recover from an abortion. Amanda, whose name has been changed to protect her identity, was working full time as a night closing manager for Dollar Tree when she unexpectedly became pregnant. With four children under the age of five, she knew she couldn’t support a fifth.

She gave her employer two weeks’ notice that she would need time off, made sure her shifts were covered and provided a doctor’s note that mentioned she needed the time off without giving details about the medical procedure. When she showed up for her next shift, she was greeted with the news that she had been fired because she had missed too much work. Despite working at Dollar Tree for six months as an hourly worker, she had not earned enough time to be absent for three days.

“I was infuriated,” Amanda said. “Sometimes women have to take off work for unexpected medical reasons and employers need to be considerate of that.”

Out of work for about five months and reeling financially, Amanda returned to a serving job she had years ago, where she makes $3.75 an hour. Amanda’s situation was not surprising to Dreith of NARAL. “A majority of workers in this country don’t have paid sick leave or paid leave in general,” Dreith said. “It’s the low-wage workers who suffer the most when they have to take time off work. They can get fired even though they should be protected.”

Access to paid sick leave varies widely among employers, said Alex Granovsky, an employment lawyer in New York City who focuses on discrimination cases. Only 13 percent of private industry workers are able to access paid leave through work, according to the Bureau of Labor Statistics. One of the only protections available to many workers is the Family Medical Leave Act (FMLA), which protects a person’s job without pay for up to 12 weeks. Even then the benefits are limited, as FMLA applies to companies with 50 or more employees, and an employee must be working for the same employer for at least a year to qualify.  

“Some states have sick leave protections, but in general there aren’t many protections for employees missing work,” Granovsky said.

It can be hard to distinguish discrimination based on reproductive health choices from employers enforcing a sick leave policy. Granovsky said inconsistent treatment can expose a bigger issue.  “If one employee misses two days due to an illness or medical procedure and it isn’t a big deal, but then someone else misses the same amount of work for a D&C [abortion procedure], and then loses her job, that might be something worth looking into,” he said.  

There are some federal protections for pregnant workers, such as the Pregnancy Nondiscrimination Act and the Americans with Disabilities Act, which require employers to make accommodations for pregnant workers. No such protections exist for people seeking abortion care, leaving many struggling to balance their personal reproductive health choices with their jobs.

“These are the positions we find ourselves in as women,” Gina said. “We might advocate for access to reproductive health care, but when we need it we find ourselves alone.”