According to a report released Tuesday by the National Women’s Law Center (NWLC) and A Better Balance (ABB) pregnant workers face systemic discrimination on a routine basis that significantly affects their ability to do their job.

The report shows that many employers refuse to make even basic accommodations that they routinely give workers with disabilities or on-the-job injuries, such as lifting requirements or the ability to carry a bottle of water. Yet despite the minimal imposition on employers and existing legal protections, albeit scant, discrimination remains intransigent.

As the report notes, three-quarters of women entering the labor force will be pregnant and employed at some point in their lives. While many women will work through their pregnancies with no need for changes or accommodations in their jobs, others will need temporary adjustments to job rules or duties as a result of their pregnancy. These adjustments, such as taking additional bathroom breaks, being allowed to sit instead of stand, or honoring a lifting restriction, can mean the difference between a pregnant worker keeping their job or protecting their health during pregnancy, a choice nobody should ever have to make.

The report describes in detail how pregnant workers, especially those who work in low-wage jobs or jobs traditionally held by men, are all too often fired or forced to take unpaid leave when they request these kinds of temporary, reasonable modifications to job duties so they can continue working. “Women make up almost half of the labor force, but all too often they are forced to make an impossible choice: risk their own health and pregnancy to keep a job or lose their income at the moment they can least afford it,” NWLC Vice President and General Counsel Emily Martin said in a statement.

The reason employers fail to accommodate pregnant workers remains somewhat of a mystery. According to Martin, some employers either misunderstand or ignore their legal obligations to make the same types of accommodations for pregnant women that they do for other similarly situated workers, such as those with disabilities. “Pregnant workers are ready, willing and able to continue working but they are often forced out by employers who refuse to make minor accommodations,” she said. “These women and their families pay a steep price when they’re pushed out of jobs. There’s no reason for pregnancy to be a job-buster.”

The report features personal accounts of women who lost income, their jobs, and their health insurance or continued to work at risk to their health when they were denied temporary accommodations. As the workers note, the types of accommodations denied the pregnant women were frequently given to co-workers with injuries or disabilities. For example, the report tells the story of a  food preparer at a fast food restaurant in Washington, D.C., who describes being fired after she was denied permission to drink water on the job and eat during her breaks. In another example, a cashier at a Dollar Tree store on Long Island recalls not being allowed to sit on a stool, although workers in other Dollar Tree stores did. Instead, she was required to stand on her feet for eight to ten hours at a stretch, which landed her in the emergency room several times. Later, the report details the story of a letter carrier in Minnesota who used up her paid leave when her employer refused to let her work inside on extremely hot days, despite offering that option to employees with on-the-job injuries. By the time her baby was born, her depleted sick leave left her with no income during her maternity leave. When a truck driver in Maryland was denied help with occasional heavy lifting, she was forced to take unpaid leave and lost her health insurance, even though truck drivers with disabilities and on-the-job injuries, or who had lost their commercial driver’s licenses, were accommodated.

“Seeing this many pregnant women denied equal opportunity in the workplace in the year 2013 is shocking,” said Dina Bakst, who is ABB’s co-founder and co-president and the author of the new book Babygate: What You Really Need to Know about Pregnancy and Parenting in the American Workplace. “Providing basic rights should not be a heavy lift. And it just makes good business sense for employers to meet their legal obligations. By keeping their pregnant workers healthy and on the job, they will keep down costs, retain experienced workers and build loyalty among employees. Let’s step out of the dark ages and recognize that pregnant women are an important part of the workforce and are treated accordingly.”

Employers and all too often courts misunderstand the legal protections pregnant people enjoy, scant as they may be. The American Disabilities Act Amendments Act of 2008 expands the definition of those disabilities employers must accommodate to include temporary impairments like pregnancy. Additionally, the Pregnancy Discrimination Act requires employers to treat pregnant women as well as they treat other employees who are similar in their ability to work.

While some protections for pregnant workers at the federal level exist, on the state level, only eight states have laws that expressly require some or all employers to provide certain types of accommodations to some pregnant workers. Those states are Alaska, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, and Texas. The New York legislature has recently considered a Women’s Equality Act, which would include such a provision.

As the report explains, thanks to the seeming widespread confusion in the legal community about the scope of protections afforded pregnant workers and thanks also to an absence of clear federal agency guidance on the matter, pregnant workers are often illegally treated worse than those with similar limitations arising out of disability or injury. For example, in many workplaces, while a back injury preventing a worker from lifting is accommodated, a lifting restriction arising out of pregnancy is a basis for termination.

So what can be done about it? The report outlines recommendations to ensure fair treatment for pregnant workers, including the need for federal agencies, like the Equal Employment Opportunity Commission, to issue strong and clear guidance on employers’ legal obligation to accommodate pregnant workers. The report also calls for passage of the federal Pregnant Workers Fairness Act, which would require employers to extend to their pregnant employees the same commonsense adjustments they already provide workers with disabilities, and expansion of state law protections guaranteeing reasonable accommodations for pregnant workers.

At the state level voters can push their representatives for state anti-discrimination laws to fill in the gaps left behind from the broad federal civil rights protections currently in place. Normally these kinds of legislative recommendations would be considered routine, but in a political climate that is currently debating the value of making emergency contraception widely available, that continues to endorse widespread gender pay discrimination, and where the idea of woman’s economic autonomy is considered outside the norm of conservative ideology, for now we’ve still got a long way to go before many pregnant workers can feel secure in their jobs.