PREVES~IVLMIEUICISE7, 394-406 (1978)
Social Policy Considerations of Occupational Health Standards: The Example of Lead and Reproductive Effects’ ANDREA
HRICKO~
Labor Occupational He&h Program, Center for Labor Research and Education, University of California, Berkeley. California 94720
Social policy considerations of occupational health standards are examined, with a specific look at the case of lead exposure and its effects on reproduction. Because the lead standard will be the first to take into account the full range of reproductive effects-and the resulting social, political, and legal issues-it may be precedent setting and could serve as a paradigm for future standards. Historical evidence on the adverse reproduction effects of lead is provided. In addition, data from scientific studies on the effects of lead on both males and females, as well as on the fetus, the nursing infant, and the young child, are also presented. Industry and government responses to the conclusions of these studies are discussed, as well as the social and ethical implications of their current policies regarding protection of the work force. Possible options for the adoption of the lead standard are given, which are considered unacceptable by the author because they discriminate against certain working groups or ignore the evidence at hand and allow for the continuation of unacceptably high levels of lead exposure. An alternate approach is preferred, and it is suggested that such an approach is appropriate for evaluating other toxins in the workplace, as well.
The ability to bear normal, healthy children is recognized as a basic human right in our society. Likewise, today we recognize the right of women to equal employment as one of the most sensitive contemporary social issues. A problem incorporating challenges to both these rights is difficult, indeed. But the problem exists: evidence is mounting that certain substances used on the job can cause miscarriages or birth defects in the offspring of exposed workers. And fertile women working with these substances are being required by many employers to either give up their jobs-or give up their rights to bear children. The policy issues that must be considered in resolving this problem comprise the following: Does society have a responsibility towards future children or is this solely a “woman’s problem?” IS it legitimate to focus concern on the fertile woman? Does a fertile man deserve equal rights to a safe job? Can employers avoid instituting engineering controls to reduce exposures
I Adapted from testimony presented at the Occupational Safety and Health Administration’s Hearing on Occupational Exposure to Lead, March 1977 (unpublished). * Send requests for reprints to: Andrea Hricko, M.P.H., Health Coordinator, Labor Occupational Health Program, Labor Center for Research and Education, University of California, Berkeley, California 94720. 394 0091-7435/78/0073-0394$02.00/O Copyright All rights
0 1978 by Academic Press, Inc. of reproduction in any form reserved.
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by the simple expedient of banning all groups of workers that they deem “susceptible?” Should employers be allowed to make women prove they have been sterilized or are otherwise infertile before they can work in hazardous areas? Does denying women the right to certain jobs violate the letter or spirit of sex discrimination laws? Would mandatory pregnancy tests be an invasion of privacy? When medical reasons dictate that a person not work in hazardous areas, should the worker be offered an equitable transfer? The answers to these policy questions are vital because we have learned from unfortunate experience that chemical threats to reproductive capabilities are not only a theoretical concern. For example, female operating room personnel, who are exposed to waste anesthetic gases, run an abnormally high risk of spontaneous miscarriage and birth defects in their children (1, 18). But, as is often the case, women are not the only workers at risk. Some studies also show risks in the wives or children of male workers exposed to these gases (1,6). Another example: Male workers who formulated the pesticide DBCP have been found to have abnormally low or even zero sperm counts (33). Unfortunately, only a small number of adequate studies concerning adverse reproductive effects have been conducted. Nevertheless, the available studies demonstrate that certain occupational exposures can harm the reproductive system of both males and females by causing genetic, gametotoxic, intrauterine, or extrauterine effects. THE CASE OF LEAD
Although the potential reproductive effects referred to above are of great concern for a number of toxic chemicals, the example of lead exposure is useful to explore in greater detail for a number of reasons. First, lead can affect both male and female reproduction, so all of the policy issues raised herein are relevant. In addition, the way in which the Occupational Safety and Health Administration (OSHA) deals with the reproductive issue in its forthcoming lead standard may be precedent-setting because this standard is the first one where the full range of reproductive effects-and the resulting social, political, and legal issues-have been raised and carefully evaluated. Thus, the policies to be enunciated in the OSHA lead standard can have a resounding impact on many more than the 1.3 million workers exposed to lead. If women are treated differently than men in the standard, the precedent set there may well affect the future of women’s equal employment opportunities. HISTORICAL
EVIDENCE
Historical evidence about reproductive effects of lead exposure is generally based on much higher lead levels than are commonly found today in industrial situations. These historical studies have shown that frank lead poisoning in women has been associated with menstrual disorders, sterility, spontaneous miscarriages, and stillbirths. (In fact, lead has been used at times to self-induce
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abortions.) After withdrawal from high lead exposure, some of the women who had suffered these problems recovered and had normal pregnancies. Infants of mothers with lead poisoning have suffered from decreased birth weights, slower growth, and nervous system disorders and have died at younger ages than would have been expected. As early as 1860, there was also evidence of an unusually large proportion of stillborn children in women whose husbands were exposed to high lead levels. Other studies around the turn of the century revealed an increased number of sterile marriages among men with lead poisoning (7, 13, 17, 28). These early studies on reproductive effects resulted in policies and, in some countries, special regulations prohibiting employment of women in the lead industry. That these exclusionary policies were directed at women is not surprising because they came at a time in history when women’s place was considered to be in the home and when women were considered to be the weaker sex and in need of greater protection. This was the period of special protective legislation for women, including limitations on the number of hours they could work and the weight they could lift. But, times have changed. Today, many women workers recognize that these special “protections” often serve as a guise for discrimination against them; many have urged that those laws that do not provide protection be repealed, and that those which are truly protective be extended to male workers. In an age of equal employment opportunities, courts have upheld the repeal of state labor laws designed to protect only women. Thus, we need to consider the currently available scientific information in light of present social policies and legal mandates in the United States. RECENT SCIENTIFIC
STUDIES
Recent studies, evaluating the effects of much lower lead exposures than those existing at the time of the earlier studies, provide additional evidence of the damage lead can cause to the reproductive processes or to the offspring of males and females. The primary remaining issues are the extent of these effects and the precise blood lead levels at which reproductive damage occurs. In the past, little research on this problem has been conducted; but an analysis of the recent available data from human and animal studies, both United States and foreign, indicates that harmful effects have occurred in both animals and humans at blood lead levels around 30 &IO0 ml. The precise correlation between animal blood levels and those in humans, however, is not well established. Briefly, recent studies show that lead has caused decreased fertility and sperm abnormalities in male animals (15), as well as difficulties in erections and sperm abnormalities in lead storage battery workers (20). The sperm abnormalities in workers included malformed sperm, low sperm counts, and decreased motility. In the latter study, over one-half of all workers with blood lead levels over 40 pg/lOO ml suffered altered spermatogenesis (20). Several other studies (10) have demonstrated chromosome changes in workers exposed to lead, although the available evidence shows conflicting results. A few papers suggest that these or other adverse effects might cease or be reduced sometime after lead exposure stops (IO, 32).
OF POTENTIAL
TABLE
1
Miscarriage, stillbirth, cancer, disease, or birth defects--as a result of substances crossing the mother’s placenta and reaching the developing fetus (e.g., certain drugs, chemicals, viruses, and radiation).
Difficulties in conceiving a child (for example, by interference with the sperm’s ability to fertilize the egg).
ON REPRODUCTION
During Pregnancy
EFFECTS OF JOB EXPOSURES
At Conception
ADVERSE
TO HAVE
Toxic effects on development of baby as a result of chemicals transmitted to child in mother’s breast milk.
On the Newborn
OR ON THE ABILITY
CHILDREN”
Toxic effects on development of child from exposure to substances inadvertently brought home on parents’ workclothes.
On the Child
NORMAL, HEALTHY
’ Hricko, A., and Brunt, M. “Working for Your Life: A Woman’s Guide to Job Health Hazards,” p. C-4. Labor Occupational Health Program and Public Citizen’s Health Research Group, Berkeley, Calif. 1976.
Genetic damage in male and female germ cells can be passed on to children and result in disease or birth defects. Can also caose miscarriage or stillbirth.
Lowered fertilitymen and women
Interference with sexual functions-men
Menstrual disorders-women
Prior to Conception
CHRONOLOGY
s
.$ .
3
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In female animals, lead exposure has altered the estrus (menstrual) cycle and has decreased fertility (15). A community study of pregnant women and their offspring found that the mothers of premature babies had significantly higher mean blood lead levels than did mothers with normal pregnancies (8). Lead can cross the placenta; levels of blood lead found in the human fetus or embryo are often comparable with those found in the mother (2, 11) although some studies found less lead in the fetal blood (8) while others found higher levels in fetal blood (22).
Another study revealed altered enzyme activity (ALAD) in the blood of experimental animals whose mothers were exposed to lead during gestation-even though the mothers had no such biochemical changes in their blood (16). Thus, subclinical changes can be seen in offspring at lead levels that may not affect the parents. The explanation for this phenomenon may be that, because the tissues of the fetus are rapidly developing, they may be more vulnerable to adverse effects of chemicals than are adult tissues. Pregnant animals administered lead have suffered a variety of malformations (9, 12, 21), indicating that lead can have teratogenic effects in several animal species. No specific birth defects, however, have ever been reported in children of leadexposed parents (29). Lead exposure of either parent has been known to affect offspring adversely, e.g., the survival weight of pups past weaning was significantly reduced when either the male or female parent was exposed to lead. The loss was even more dramatic when both parents were exposed (30). Similarly, animal studies show that offspring suffer learning deficiencies when their mothers are exposed to lead (5), but that paternal exposure can also be detrimental (3). Exposed men and women might easily overlook such subtle, neurologic damage (e.g., slight deficits in IQ, short attention span, altered behavior, or faulty motor coordination) if it existed in their children. Finally, lead is known to be secreted in the breast milk (19) and, therefore, nursing infants may also be at risk. Recent news stories have reported increased blood lead levels in children of lead workers, resulting from lead dust being inadvertently carried into the home. Many of these children had blood lead levels greater than 30 pug/100ml. Thus, spouses of lead workers-some of whom may be pregnant-and their children can be unwittingly exposed to lead by contaminated clothing (4). Additional studies are needed to define more accurately the extent of these reproductive hazards as well as to determine whether or not levels lower than 30 pg/lOO ml can also harm workers or their children. Nevertheless, in light of the already existing data on these and other serious health effects, it is obvious that there should be no future delays in reducing exposures. RESPONSE
OF INDUSTRY
The response of some segments of industry to the evidence of the harm to both male and female reproductive capabilities has been to “protect” only women workers from lead’s reproductive hazards-by refusing to hire them or forcing them to prove that they can no longer bear children-while ignoring or disputing
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evidence concerning males. These approaches to a serious problem are obviously unfair. The following case examples are representative of industrial policies that, in some instances, have been implemented on a nationwide scale. Bunker Hill Smelter, Kellogg, Idaho. Thirty-seven women at the Bunker Hill smelter in Kellogg, Idaho, were informed in 1975 that they could no longer work in lead operations at the smelter because of the potential effects of lead on their future children. Women who were fertile were transferred to jobs that the company said were safer, but not all of the transfers were at the same rate of pay (31). St. Joe’s Mineral Corporation, Monaca, Pennsylvania, smelter. Only 27 of the 1500 workers in the zinc smelting division were women. In August, 1974, 17 women were transferred out of “high lead” areas unless they could prove that they could no longer bear children. One woman was sterilized and only then was she allowed to return to her job. The transferred women earned an average of $0.20 per hr less than on their previous jobs (14). General Motors of Canada, Ltd., lead storage battery plant, Oshawa, Ontario. A mother of four who was employed at the lead storage battery
plant was one of six women told they would have to prove they were no longer fertile in order to continue working with lead. She had herself sterilized instead of being transferred to a lower paying position (23). No similar “protections” for the fertile male work force are in effect in industry today. These exclusionary policies are not restricted to lead. A number of other companies have recently issued notices to their female employees advising them that they will no longer be allowed to work with certain other chemicals unless they can prove they are no longer able to bear children (27). Thus several companies have embraced the studies demonstrating harm to women and their offspring, disputing or ignoring the validity of studies involving males. Several reasons for this have been given. Some corporate medical people have explained that they are excluding women because they fear liability if a worker gives birth to a deformed baby (16a, 24a). Because the causal link between a male worker’s lead exposure and the miscarriage of his wife or their inability to conceive a child is more remote, it would be less likely to result in a lawsuit. In addition, the traditional exclusion of women from the lead industry has resulted in a proportionately small number of women working there today as opposed to other occupational situations, e.g., operating room nurses, where females are the majority. Thus, it is easier and cheaper for most companies to remove this small group of women than it is to institute the necessary controls to protect all workers, which would be obligatory if studies showing damage to male reproduction from lead exposure were accepted. EFFECTS OF EXCLUSIONARY
POLICIES
One of the most dramatic changes in the work force in the last 50 years has been the increasing number of women workers, a phenomenon which cannot be ignored when setting OSHA standards. The changing pattern in employment of women reflects a basic transformation in American life. Changes in the economy, wars, a
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move to the cities, advances in technology, educational achievements, changing social attitudes and marriage patterns, legalized contraception and abortion, the rising divorce rate, new equal employment laws, the feminist movement, the growth of day care have all contributed to the changing status of women in the job market. There are now 36 million women workers in the United States; about 65% of them are of childbearing age. Thus, if women in the childbearing years could not work where there was lead exposure, then almost two out of every three female applicants for the estimated 1.3 million lead jobs would be turned away. Because employment opportunities for women are already severely limited by other external factors, closing the door to nearly a million jobs is unacceptable. There are some people who would still argue, however, that women do not need jobs as much as men do. But facts simply do not support this myth. Gone are the days (if they ever really existed) when most women worked for “pin money.” Over half of all women workers are single, widowed, divorced, or separated or have husbands who earn less than $7000 per year. Moreover, one out of ten working women is head of a household; for minority women, the number is one out of five. Thus, women work because they must. Finally, despite equal employment and equal pay laws, women still earn substantially less than their male counterparts. In 1975 the average salary for a woman worker was under $7000, and that for a male, over $12,000. In part, these pay differences result from traditional channeling of women into low-paying, dead-end jobs. The refusal to hire fertile women in certain industrial jobs will help to perpetuate the disparities between male and female earnings. For example, someone working in a lead battery plant might earn $5-7 per hr, a bank teller or file clerk might earn $3.50 per hr, and a waitress, $1.70 an hr plus tips. Moreover, in certain areas where battery plants or smelters are located, there may be few industrial jobs available that don’t involve lead exposure. For example, in Kellogg, Idaho, the main employers are several mines and the Bunker Hill smelter. A woman who applied for a job there and was refused could easily remain unemployed or be forced to accept a lower paying job-a serious economic penalty for being a fertile woman. UNACCEPTABLE
OPTIONS
FOR OSHA IN STANDARDS
SETTING
Few, if any, groups, be they government, industry, labor, or science, appear to dispute the fact that OSHA has a very definite role in protecting workers’ sexual functions and abilities to conceive, father, and raise normal, healthy children. The question is how to implement this mandate when setting standards in order to protect the reproductive capabilities of men and women. Several unsatisfactory alternatives to resolve this problem have been suggested to the Labor Department and some are already in practice by employers. Most of these alternatives, which are described below, place total responsibility for protection on the worker herself when, in fact, the legal responsibility rests with the employer. 1. Fire all current female employees and refuse to hire other females unless they can prove they are no longer fertile. Several serious moral and legal pitfalls of
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this approach arise. First, it violates the stated purpose of the Occupational Safety and Health Act to “assure so far as possible every working man and woman in the Nation safe and healthful working conditions.” The Act does not exclude fertile women from coverage. Second, this policy does not protect male workers from harm. Third, such a policy would cause an objectionable invasion of the woman’s right to privacy by forcing her to answer personal inquiries about her childbearing plans or birth control habits. Fourth, the policy could force women to be sterilized in order to get or keep a job-a most disturbing departure from a woman’s ethical right to keep her body whole. Finally, such a policy would appear to violate the principles of laws forbidding sex discrimination in employment, including Executive Order 11246, covering federal contractors, and Title VII of the 1964 Civil Rights Act. 2. Fire, lay ofJ or transfer to a nonlead job a worker Mthen she becomes pregnant without regard to seniority, fringe benefits, or wages. Again, this option
raises several ethical issues. Employers would most likely require pregnancy testing, an invasion of privacy. Also, if the approach were to take out pregnant workers rather than clean up the workplace by reducing lead exposures, then a woman might have a very high blood level at the time of her transfer. If her level was excessively high, the fetus could be damaged even with the transfer. Thus, for transfers to be effective, the allowable air lead levels would still have to be greatly reduced to insure safety. In addition, if a woman did not receive equal pay on her new work assignment, or if she were to face being fired or laid off, she might feel forced to conceal her pregnancy from her employer because of the severe economic penalties she would otherwise suffer. Finally, some have argued that the issues of seniority, fringe benefits, and equal pay upon transfer should not be considered by OSHA in standard setting but should instead be handled by collective bargaining. Because fewer than one out of five women workers in the United States belongs to a labor union, collective bargaining cannot be viewed as the sole solution to this problem. 3. Inform tive hazards
the female work force and new female job applicants of the reproducof lead and let them decide if they want to keep or take the jobs.
Although informing workers of hazards is a vital component of any occupational disease prevention program, it cannot serve as the only protection for workers. The burden for worker protection is on the employer and cannot be shifted onto the individual. This option, taken in lieu of providing any health protections against exposure, does not allow for informed consent but only presents female workers with a Hobson’s choice: the health of their future children or their livelihood. 4. Have
separate
and different
lead standards
for women and men workers.
For example, men would be allowed to work at any job where the air lead levels were under 100 ,uglm3, whereas women could be employed only in those workplaces where the levels were under 50 &lOO m3. Such a policy would provide little incentive for industry to institute engineering and other controls necessary to lower exposures, because it would be more expedient for an employer simply to
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employ only male workers and avoid the expense of modifying the hazardous environment. Also, a policy which differentiated between men and women on the basis of sex may well violate Title VII. Separate standards would be like a modern version of protective legislation for women that courts have consistently overturned under Title VII. Such a policy would also totally ignore the data on potential reproductive hazards to males exposed to lead. Thus, the result of this alternative: Women get fewer jobs and men get less protection. AN ACCEPTABLE APPROACH TO PROTECTING WORKERS FROM THE REPRODUCTIVE HAZARDS OF LEAD
There appears to be only one approach which is morally, ethically, and legally acceptable. OSHA must set a standard for lead exposure, as well as for any other toxin, based on the best available evidence, that will ensure that both men and women can work safely without harming either’s ability to conceive, father, and raise normal healthy children. If we examine a recent government recommendation on exposure to anesthetic gases, we find that the agency suggested this very same concept, i.e., setting a standard strict enough to protect the man, woman, and fetus. The National Institute for Occupational Safety and Health’s (NIOSH) recommendation to OSHA was that the level of anesthetic gases in operating rooms be reduced to the lowest detectable level-2 ppm (24). Their recommendation was based in large part on a nationwide study of anesthesiologists (1). The study revealed that, when women working in operating rooms are compared with other female workers not exposed to waste anesthetic gases, the former group suffered from significantly more miscarriages, gave birth to more babies with defects, and had a higher incidence of liver disease and cancer. The study also found that male workers and their children suffered adverse effects, too, although the results were not as significant statistically. NIOSH did not conclude that all fertile women be banned from the operating room, nor that women be transferred out of the operating room when they became pregnant. Rather, they recommended that the necessary engineering controls-in this case ventilation systems and scavenging devices-be installed to remove the waste gases and thus reduce the levels of exposure as low as possible. Similarly, when setting a standard for protection against exposure to lead, OSHA must consider the “best available scientific evidence.” Analysis of the evidence indicates that blood lead levels as low as 30 &lo0 ml may exert harmful effects on reproductive processes or on the fetus. Thus, in order to protect against these and numerous other health effects of lead, OSHA must require a dramatic reduction in the allowable air lead exposures. This should be accomplished through engineering and other controls. To ensure safety, reduction in air levels must result in a blood lead level for all exposed workers that does not exceed 30 &lo0 ml.
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FOR THE OSHA STANDARD
The following suggestions concern only what the OSHA standard (25) should contain with regard to special safeguards against the adverse effects of lead on reproduction. The basic concepts concerning medical surveillance, transfers, and record keeping incorporated into these recommendations, however, are also applicable to other chemicals which present reproductive hazards. 1. The OSHA air lead level must be set to ensure that no worker, male or female, has a blood lead level above 30 pg/lOO ml, a level which cannot be exceeded without risking reproductive effects. 2. If OSHA determines that such an air lead level is not technologically feasible at this time, then it must set the strictest standard currently feasible and should develop interim protective procedures to be used until a reduction in air lead levels can be achieved. As an interim measure, transfer provisions to protect fertile workers must be included as part of the final lead standard. Such transfer provisions have been suggested for workers with elevated lead levels in an OSHA proposal on “medical removal protection” for workers exposed to lead (26). Any worker employed in a lead area who is pregnant, breast feeding, or seriously contemplating becoming a parent shall be offered blood tests at least monthly to ensure that blood lead levels do not exceed 30 &lo0 ml. If the level is exceeded, the worker shall immediately be offered a temporary, voluntary transfer to a job without lead exposure, with retention of seniority, wages, and fringe benefits. In the event that such jobs do not exist, the employer shall devise some other administrative controls by which the employees at risk can continue to work with blood levels below 30 pg/lOO ml. This might include shortened shifts with makeup pay, rotation of employees, or longer breaks. In plants or workplaces with collective bargaining agreements, the arrangements for such transfers, rotations, or other administrative controls shall be made with reference to existing local union contracts. 3. The air lead level should be the primary OSHA compliance tool, but during inspections OSHA compliance officers must also review the results of workers’ blood lead tests to determine the adequacy of efforts to control exposure. 4. All workers exposed to lead must have an initial blood lead test and medical examination after the standard goes into effect. Thereafter, they should be offered monthly blood tests whenever the air lead level is above the action level (one-half of the permissible exposure). In addition, workers should have the right to biological monitoring at any time that they suspect their lead exposure has increased. Results of tests must be explained to workers in understandable language. 5. Free optional pregnancy testing and free sperm analysis must be offered to workers. Results of tests, with explanations, must be given to workers. This information should be considered part of the confidential medical record and not be disclosed to employers without the prior written permission of the
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worker. Employees (or job applicants) must not be forced by employers to answer questions about their fertility, sexual or birth control habits, or future plans for a family. 6. Workers should be encouraged to undergo medical examinations and biological monitoring, as well as to report pregnancies, but shall not suffer penalties for refusing to submit to such tests. 7. Employees (and job applicants) must be informed that excessive exposures to lead have resulted in reproductive difficulties, including fertility problems, menstrual disorders, stillbirths, miscarriages, and other hazardous effects, so that they understand the significance of blood, sperm, and pregnancy testing. NIOSH shall develop a summary of such information in lay terms that employers will use in employee training and in preemployment interviews. 8. Occupational physicians contracted with or hired by employers to conduct the medical examinations required by the lead standard should include information on the fertility and pregnancy experiences of employees and their spouses as part of the workers’ medical history. Recorded information should include menstrual difftculties, difficulties conceiving, impotence, miscarriages, stillbirths, and birth defects or learning disabilities in children. OSHA compliance officers should check with physicians to see that medical examinations include this information in medical histories. Summaries of these data on the outcome of pregnancy should be prepared by the occupational physician and be reviewed by NIOSH at j-year intervals after the effective date of the standard. NIOSH shall analyze the data thoroughly to determine any continued adverse effects of lead exposure on reproduction. If any effects are detected, NIOSH shall recommend that the lead standard be reconsidered. 9. As outlined in the proposed standard, additional work practices must be implemented to lessen the possibility of accidentally taking lead home on the worker or his/her clothes, thereby endangering children and spouses. These practices should include required cleanup at the termination of the workday, provision and commercial laundering of work clothes (regardless of the air lead levels), and clean change rooms. When clothes are commercially laundered, the launderers must be advised of the hazards of lead and the precautions that are necessary to protect themselves. CONCLUSION
Additional studies need to be done to determine accurately the risk of low level lead exposures on reproduction. But enough is known at present about potential adverse health effects to justify-and require-reducing the permissible air limits to levels significantly lower than the lOO-mglm3 limit proposed by OSHA. OSHA should set a standard for lead exposure which will protect ALL workers, male and female, including fertile men and women, as well as pregnant workers. Any standard which will result in failure to protect large segments of the workforce or which will discriminate against certain workers on the basis of their sex or fertility does not serve the stated purpose of the Occupational Safety and Health Act--‘&to assure so far as possible every work-
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ing man and woman in the Nation safe and healthful working conditions.” Moreover, such a standard would violate the basic principles behind equal employment opportunity laws, as well as basic social and moral precepts. If such a nondiscriminatory standard is not currently technologically feasible, OSHA should develop interim measures- including transfers and other administrative controls-to protect fertile workers against the harm of lead exposure. REFERENCES 1. Ad HOC Committee on the Effect of Trace Anesthetics, American Society of Anes41, thesiologists. Occupational disease among operating room personnel. Anesthesiology 321-340 (1974). 2. Barltrop, D., and Burland, W. F. (eds.) “Mineral Metabolism in Paediatrics,” pp. 135- 151. Blackwell Scientific, Oxford, 1969. 3. Brady, K., Herrera, Y., and Zenick, H. Influence of parental lead exposure on subsequent learning ability of offspring. Pharmacol. Biochem. Behavior 3, 561-565 (1975). 4. Bronson, G. Study shows children of lead workers are susceptible to lead-dust poinsoning. WulI Street Journal, February 3, 1977, p. 8. 5. Carson, T., and Van Gelder, G. Slowed learning in lambs prenatally exposed to lead. Arch. Environ. Healrh 29, 154-156 (1974). 6. Cohen, E., Bruce, D., Cascorbi, M., Corbett, T., Jones, T., and Whitcher, C. A survey of anesthetic health hazards among dentists. J. Amer. Dent. Ass. 90, 1291-1295 (1975). 7. Committee on Biological Effects of Atmospheric Pollutants. “Lead: Airborne Lead in Perspective.” National Academy of Sciences, Washington, D.C., 1972. 8. Fahim, M., Fahim, Z., and Hall, D. Effects of subtoxic lead levels on pregnant women in the state of Missouri. Clin. Parhol. Pharmacol. 13, 309-323 (1976). 9. Ferm, V., and Carpenter, S. Developmental malformations resulting from the administration of lead salts. Exp. MO/. Patho/. 7, 208-213 (1976). 10. Fomi, A., and Secchi, G. Chromosome changes in preclinical and clinical lead poisoning and correlation with biochemical findings. Proceedings of rhe Internafional Symposium on Environmental Health Aspects of Lead, Amsterdam, October 2-6, 1972. Il. Gershanik, J., Brooks, G., and Little, J. Blood lead values in pregnant women and their offspring. Amer. J. Obsret. Gynecol. 119, 508-511 (1974). 12. Gilani, S. Congenital anomalies in lead poisoning. Obsret. Gynecol. 41, 265-269 (1973). 13. Hamilton, A., and Hardy, H. “Industrial Toxicology,” pp. 119- 121. Publishing Sciences Group, Acton, Mass., 1974. 14. Hendler, H., Affirmative Action Officer, Pennsylvania Human Relations Commission. Interview, June 1976. 15. Hilderbrand, D., Der, G., Griffin, W. and Fahim, M. Effect of lead acetat eon reproduction. Amer. J. Obsret. Gynecol. 115, 1058-1065 (1973). 16. Hubermont, G., and Buchet, J. Effect of short-term administration of lead to pregnant rats. Toxicology 5, 379-384 (1976). 16a. Hyatt, J. Protection for unborn. 7 Work safety issue isn’t as simple as it sounds. Wall Street Journal, August 2, 1977, p. 1. 17. Infante, P., and Wagoner, J. The effects of lead on reproduction. In “Proceedings of the Conference on Women and the Workplace,” pp. 232-242. Society for Occupational and Environmental Health, Washington, D.C., 1977. 18. Knill-Jones, R., Rodrigues, L., Moir, D., and Spence, A. Anesthetic practice and pregnancy. Lancer 1, 1326- 1328 (1972). 19. Kostial, D., and Momcilovic, B. Transport of lead 203 and calcium 47 from mother to offspring. Arch. Environ. Health 29, 28-30 (1974). 20. Lancranjan, I., Popescu, H., Gavanescu, O., Klepsch, I., and Serbanescu, C. Reproductive ability of workmen occupationally exposed to lead. Arch. Environ. Health 30, 396-401 (1975).
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21. McClain, R., and Becker, B. Placental transport and teratogenicity of lead in rats and mice. Fed. Proc. 29, 347 (1970). 22. McLellan, J., Von Smolinski, A., Bederka, J., and Boulos, B. Developmental toxicology of lead in the mouse. Fed. Proc. 33, 289 (1974). 23. Mediccrl World News, June 14, 1976,pp. 57-62. 24. National Institute for Occupational Safety and Health. “Recommendations to OSHAfora Standard on Occupational Exposure to Anesthetic Gases.” February 28, 1977. 24a. Nen~sn~ee~.Job Safety: Women’s Work? June 28, 1976,p. 56. 25. Occupational exposure to lead. Fed. Regist. 40, 45934-45948 (1975). 26. Proposed standard on lead. Fed. Regisf. 42, 46547-46550 (1977). 27. Ricci, L. Chemicals giving birth to human reproductive woes. C/rem. Eng., August 1, 1977, pp. 30-33. 28. Rom, W. Effects of lead on the female and reproduction: A review. Mr. Sinai J. Med. 43, 542-552 (1976). 29. Scanlon, J. Human fetal hazards from environmental pollution with certain non-essential trace elements. C/in. Prtht. 11, 135-141 (1970). 30. Stowe, H., and Goyer, R. The reproductive ability and progeny of F, lead-toxic rats. Fert. Sfer-il. 22, 755-760 (1971). 31. United Steelworkers Local No. 7854, Kellogg, Idaho. Interview, December 1975. 32. Vermande, V., and Meigs, J. Changes in the ovary of the Rhesus monkey after chronic lead ingestion. Ferr. Sreril. 11, 223-234 (1970). 33. Whorton, D., Krauss, R., Marshall, S., and Milby, T. Infertility in male pesticide workers, Lrrncer 2, 1259- 1261 (1977).
Social Policy Considerations of Occupational Health Standards: The Example of Lead and Reproductive Effects’ ANDREA
HRICKO~
Labor Occupational He&h Program, Center for Labor Research and Education, University of California, Berkeley. California 94720
Social policy considerations of occupational health standards are examined, with a specific look at the case of lead exposure and its effects on reproduction. Because the lead standard will be the first to take into account the full range of reproductive effects-and the resulting social, political, and legal issues-it may be precedent setting and could serve as a paradigm for future standards. Historical evidence on the adverse reproduction effects of lead is provided. In addition, data from scientific studies on the effects of lead on both males and females, as well as on the fetus, the nursing infant, and the young child, are also presented. Industry and government responses to the conclusions of these studies are discussed, as well as the social and ethical implications of their current policies regarding protection of the work force. Possible options for the adoption of the lead standard are given, which are considered unacceptable by the author because they discriminate against certain working groups or ignore the evidence at hand and allow for the continuation of unacceptably high levels of lead exposure. An alternate approach is preferred, and it is suggested that such an approach is appropriate for evaluating other toxins in the workplace, as well.
The ability to bear normal, healthy children is recognized as a basic human right in our society. Likewise, today we recognize the right of women to equal employment as one of the most sensitive contemporary social issues. A problem incorporating challenges to both these rights is difficult, indeed. But the problem exists: evidence is mounting that certain substances used on the job can cause miscarriages or birth defects in the offspring of exposed workers. And fertile women working with these substances are being required by many employers to either give up their jobs-or give up their rights to bear children. The policy issues that must be considered in resolving this problem comprise the following: Does society have a responsibility towards future children or is this solely a “woman’s problem?” IS it legitimate to focus concern on the fertile woman? Does a fertile man deserve equal rights to a safe job? Can employers avoid instituting engineering controls to reduce exposures
I Adapted from testimony presented at the Occupational Safety and Health Administration’s Hearing on Occupational Exposure to Lead, March 1977 (unpublished). * Send requests for reprints to: Andrea Hricko, M.P.H., Health Coordinator, Labor Occupational Health Program, Labor Center for Research and Education, University of California, Berkeley, California 94720. 394 0091-7435/78/0073-0394$02.00/O Copyright All rights
0 1978 by Academic Press, Inc. of reproduction in any form reserved.
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by the simple expedient of banning all groups of workers that they deem “susceptible?” Should employers be allowed to make women prove they have been sterilized or are otherwise infertile before they can work in hazardous areas? Does denying women the right to certain jobs violate the letter or spirit of sex discrimination laws? Would mandatory pregnancy tests be an invasion of privacy? When medical reasons dictate that a person not work in hazardous areas, should the worker be offered an equitable transfer? The answers to these policy questions are vital because we have learned from unfortunate experience that chemical threats to reproductive capabilities are not only a theoretical concern. For example, female operating room personnel, who are exposed to waste anesthetic gases, run an abnormally high risk of spontaneous miscarriage and birth defects in their children (1, 18). But, as is often the case, women are not the only workers at risk. Some studies also show risks in the wives or children of male workers exposed to these gases (1,6). Another example: Male workers who formulated the pesticide DBCP have been found to have abnormally low or even zero sperm counts (33). Unfortunately, only a small number of adequate studies concerning adverse reproductive effects have been conducted. Nevertheless, the available studies demonstrate that certain occupational exposures can harm the reproductive system of both males and females by causing genetic, gametotoxic, intrauterine, or extrauterine effects. THE CASE OF LEAD
Although the potential reproductive effects referred to above are of great concern for a number of toxic chemicals, the example of lead exposure is useful to explore in greater detail for a number of reasons. First, lead can affect both male and female reproduction, so all of the policy issues raised herein are relevant. In addition, the way in which the Occupational Safety and Health Administration (OSHA) deals with the reproductive issue in its forthcoming lead standard may be precedent-setting because this standard is the first one where the full range of reproductive effects-and the resulting social, political, and legal issues-have been raised and carefully evaluated. Thus, the policies to be enunciated in the OSHA lead standard can have a resounding impact on many more than the 1.3 million workers exposed to lead. If women are treated differently than men in the standard, the precedent set there may well affect the future of women’s equal employment opportunities. HISTORICAL
EVIDENCE
Historical evidence about reproductive effects of lead exposure is generally based on much higher lead levels than are commonly found today in industrial situations. These historical studies have shown that frank lead poisoning in women has been associated with menstrual disorders, sterility, spontaneous miscarriages, and stillbirths. (In fact, lead has been used at times to self-induce
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abortions.) After withdrawal from high lead exposure, some of the women who had suffered these problems recovered and had normal pregnancies. Infants of mothers with lead poisoning have suffered from decreased birth weights, slower growth, and nervous system disorders and have died at younger ages than would have been expected. As early as 1860, there was also evidence of an unusually large proportion of stillborn children in women whose husbands were exposed to high lead levels. Other studies around the turn of the century revealed an increased number of sterile marriages among men with lead poisoning (7, 13, 17, 28). These early studies on reproductive effects resulted in policies and, in some countries, special regulations prohibiting employment of women in the lead industry. That these exclusionary policies were directed at women is not surprising because they came at a time in history when women’s place was considered to be in the home and when women were considered to be the weaker sex and in need of greater protection. This was the period of special protective legislation for women, including limitations on the number of hours they could work and the weight they could lift. But, times have changed. Today, many women workers recognize that these special “protections” often serve as a guise for discrimination against them; many have urged that those laws that do not provide protection be repealed, and that those which are truly protective be extended to male workers. In an age of equal employment opportunities, courts have upheld the repeal of state labor laws designed to protect only women. Thus, we need to consider the currently available scientific information in light of present social policies and legal mandates in the United States. RECENT SCIENTIFIC
STUDIES
Recent studies, evaluating the effects of much lower lead exposures than those existing at the time of the earlier studies, provide additional evidence of the damage lead can cause to the reproductive processes or to the offspring of males and females. The primary remaining issues are the extent of these effects and the precise blood lead levels at which reproductive damage occurs. In the past, little research on this problem has been conducted; but an analysis of the recent available data from human and animal studies, both United States and foreign, indicates that harmful effects have occurred in both animals and humans at blood lead levels around 30 &IO0 ml. The precise correlation between animal blood levels and those in humans, however, is not well established. Briefly, recent studies show that lead has caused decreased fertility and sperm abnormalities in male animals (15), as well as difficulties in erections and sperm abnormalities in lead storage battery workers (20). The sperm abnormalities in workers included malformed sperm, low sperm counts, and decreased motility. In the latter study, over one-half of all workers with blood lead levels over 40 pg/lOO ml suffered altered spermatogenesis (20). Several other studies (10) have demonstrated chromosome changes in workers exposed to lead, although the available evidence shows conflicting results. A few papers suggest that these or other adverse effects might cease or be reduced sometime after lead exposure stops (IO, 32).
OF POTENTIAL
TABLE
1
Miscarriage, stillbirth, cancer, disease, or birth defects--as a result of substances crossing the mother’s placenta and reaching the developing fetus (e.g., certain drugs, chemicals, viruses, and radiation).
Difficulties in conceiving a child (for example, by interference with the sperm’s ability to fertilize the egg).
ON REPRODUCTION
During Pregnancy
EFFECTS OF JOB EXPOSURES
At Conception
ADVERSE
TO HAVE
Toxic effects on development of baby as a result of chemicals transmitted to child in mother’s breast milk.
On the Newborn
OR ON THE ABILITY
CHILDREN”
Toxic effects on development of child from exposure to substances inadvertently brought home on parents’ workclothes.
On the Child
NORMAL, HEALTHY
’ Hricko, A., and Brunt, M. “Working for Your Life: A Woman’s Guide to Job Health Hazards,” p. C-4. Labor Occupational Health Program and Public Citizen’s Health Research Group, Berkeley, Calif. 1976.
Genetic damage in male and female germ cells can be passed on to children and result in disease or birth defects. Can also caose miscarriage or stillbirth.
Lowered fertilitymen and women
Interference with sexual functions-men
Menstrual disorders-women
Prior to Conception
CHRONOLOGY
s
.$ .
3
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In female animals, lead exposure has altered the estrus (menstrual) cycle and has decreased fertility (15). A community study of pregnant women and their offspring found that the mothers of premature babies had significantly higher mean blood lead levels than did mothers with normal pregnancies (8). Lead can cross the placenta; levels of blood lead found in the human fetus or embryo are often comparable with those found in the mother (2, 11) although some studies found less lead in the fetal blood (8) while others found higher levels in fetal blood (22).
Another study revealed altered enzyme activity (ALAD) in the blood of experimental animals whose mothers were exposed to lead during gestation-even though the mothers had no such biochemical changes in their blood (16). Thus, subclinical changes can be seen in offspring at lead levels that may not affect the parents. The explanation for this phenomenon may be that, because the tissues of the fetus are rapidly developing, they may be more vulnerable to adverse effects of chemicals than are adult tissues. Pregnant animals administered lead have suffered a variety of malformations (9, 12, 21), indicating that lead can have teratogenic effects in several animal species. No specific birth defects, however, have ever been reported in children of leadexposed parents (29). Lead exposure of either parent has been known to affect offspring adversely, e.g., the survival weight of pups past weaning was significantly reduced when either the male or female parent was exposed to lead. The loss was even more dramatic when both parents were exposed (30). Similarly, animal studies show that offspring suffer learning deficiencies when their mothers are exposed to lead (5), but that paternal exposure can also be detrimental (3). Exposed men and women might easily overlook such subtle, neurologic damage (e.g., slight deficits in IQ, short attention span, altered behavior, or faulty motor coordination) if it existed in their children. Finally, lead is known to be secreted in the breast milk (19) and, therefore, nursing infants may also be at risk. Recent news stories have reported increased blood lead levels in children of lead workers, resulting from lead dust being inadvertently carried into the home. Many of these children had blood lead levels greater than 30 pug/100ml. Thus, spouses of lead workers-some of whom may be pregnant-and their children can be unwittingly exposed to lead by contaminated clothing (4). Additional studies are needed to define more accurately the extent of these reproductive hazards as well as to determine whether or not levels lower than 30 pg/lOO ml can also harm workers or their children. Nevertheless, in light of the already existing data on these and other serious health effects, it is obvious that there should be no future delays in reducing exposures. RESPONSE
OF INDUSTRY
The response of some segments of industry to the evidence of the harm to both male and female reproductive capabilities has been to “protect” only women workers from lead’s reproductive hazards-by refusing to hire them or forcing them to prove that they can no longer bear children-while ignoring or disputing
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evidence concerning males. These approaches to a serious problem are obviously unfair. The following case examples are representative of industrial policies that, in some instances, have been implemented on a nationwide scale. Bunker Hill Smelter, Kellogg, Idaho. Thirty-seven women at the Bunker Hill smelter in Kellogg, Idaho, were informed in 1975 that they could no longer work in lead operations at the smelter because of the potential effects of lead on their future children. Women who were fertile were transferred to jobs that the company said were safer, but not all of the transfers were at the same rate of pay (31). St. Joe’s Mineral Corporation, Monaca, Pennsylvania, smelter. Only 27 of the 1500 workers in the zinc smelting division were women. In August, 1974, 17 women were transferred out of “high lead” areas unless they could prove that they could no longer bear children. One woman was sterilized and only then was she allowed to return to her job. The transferred women earned an average of $0.20 per hr less than on their previous jobs (14). General Motors of Canada, Ltd., lead storage battery plant, Oshawa, Ontario. A mother of four who was employed at the lead storage battery
plant was one of six women told they would have to prove they were no longer fertile in order to continue working with lead. She had herself sterilized instead of being transferred to a lower paying position (23). No similar “protections” for the fertile male work force are in effect in industry today. These exclusionary policies are not restricted to lead. A number of other companies have recently issued notices to their female employees advising them that they will no longer be allowed to work with certain other chemicals unless they can prove they are no longer able to bear children (27). Thus several companies have embraced the studies demonstrating harm to women and their offspring, disputing or ignoring the validity of studies involving males. Several reasons for this have been given. Some corporate medical people have explained that they are excluding women because they fear liability if a worker gives birth to a deformed baby (16a, 24a). Because the causal link between a male worker’s lead exposure and the miscarriage of his wife or their inability to conceive a child is more remote, it would be less likely to result in a lawsuit. In addition, the traditional exclusion of women from the lead industry has resulted in a proportionately small number of women working there today as opposed to other occupational situations, e.g., operating room nurses, where females are the majority. Thus, it is easier and cheaper for most companies to remove this small group of women than it is to institute the necessary controls to protect all workers, which would be obligatory if studies showing damage to male reproduction from lead exposure were accepted. EFFECTS OF EXCLUSIONARY
POLICIES
One of the most dramatic changes in the work force in the last 50 years has been the increasing number of women workers, a phenomenon which cannot be ignored when setting OSHA standards. The changing pattern in employment of women reflects a basic transformation in American life. Changes in the economy, wars, a
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move to the cities, advances in technology, educational achievements, changing social attitudes and marriage patterns, legalized contraception and abortion, the rising divorce rate, new equal employment laws, the feminist movement, the growth of day care have all contributed to the changing status of women in the job market. There are now 36 million women workers in the United States; about 65% of them are of childbearing age. Thus, if women in the childbearing years could not work where there was lead exposure, then almost two out of every three female applicants for the estimated 1.3 million lead jobs would be turned away. Because employment opportunities for women are already severely limited by other external factors, closing the door to nearly a million jobs is unacceptable. There are some people who would still argue, however, that women do not need jobs as much as men do. But facts simply do not support this myth. Gone are the days (if they ever really existed) when most women worked for “pin money.” Over half of all women workers are single, widowed, divorced, or separated or have husbands who earn less than $7000 per year. Moreover, one out of ten working women is head of a household; for minority women, the number is one out of five. Thus, women work because they must. Finally, despite equal employment and equal pay laws, women still earn substantially less than their male counterparts. In 1975 the average salary for a woman worker was under $7000, and that for a male, over $12,000. In part, these pay differences result from traditional channeling of women into low-paying, dead-end jobs. The refusal to hire fertile women in certain industrial jobs will help to perpetuate the disparities between male and female earnings. For example, someone working in a lead battery plant might earn $5-7 per hr, a bank teller or file clerk might earn $3.50 per hr, and a waitress, $1.70 an hr plus tips. Moreover, in certain areas where battery plants or smelters are located, there may be few industrial jobs available that don’t involve lead exposure. For example, in Kellogg, Idaho, the main employers are several mines and the Bunker Hill smelter. A woman who applied for a job there and was refused could easily remain unemployed or be forced to accept a lower paying job-a serious economic penalty for being a fertile woman. UNACCEPTABLE
OPTIONS
FOR OSHA IN STANDARDS
SETTING
Few, if any, groups, be they government, industry, labor, or science, appear to dispute the fact that OSHA has a very definite role in protecting workers’ sexual functions and abilities to conceive, father, and raise normal, healthy children. The question is how to implement this mandate when setting standards in order to protect the reproductive capabilities of men and women. Several unsatisfactory alternatives to resolve this problem have been suggested to the Labor Department and some are already in practice by employers. Most of these alternatives, which are described below, place total responsibility for protection on the worker herself when, in fact, the legal responsibility rests with the employer. 1. Fire all current female employees and refuse to hire other females unless they can prove they are no longer fertile. Several serious moral and legal pitfalls of
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this approach arise. First, it violates the stated purpose of the Occupational Safety and Health Act to “assure so far as possible every working man and woman in the Nation safe and healthful working conditions.” The Act does not exclude fertile women from coverage. Second, this policy does not protect male workers from harm. Third, such a policy would cause an objectionable invasion of the woman’s right to privacy by forcing her to answer personal inquiries about her childbearing plans or birth control habits. Fourth, the policy could force women to be sterilized in order to get or keep a job-a most disturbing departure from a woman’s ethical right to keep her body whole. Finally, such a policy would appear to violate the principles of laws forbidding sex discrimination in employment, including Executive Order 11246, covering federal contractors, and Title VII of the 1964 Civil Rights Act. 2. Fire, lay ofJ or transfer to a nonlead job a worker Mthen she becomes pregnant without regard to seniority, fringe benefits, or wages. Again, this option
raises several ethical issues. Employers would most likely require pregnancy testing, an invasion of privacy. Also, if the approach were to take out pregnant workers rather than clean up the workplace by reducing lead exposures, then a woman might have a very high blood level at the time of her transfer. If her level was excessively high, the fetus could be damaged even with the transfer. Thus, for transfers to be effective, the allowable air lead levels would still have to be greatly reduced to insure safety. In addition, if a woman did not receive equal pay on her new work assignment, or if she were to face being fired or laid off, she might feel forced to conceal her pregnancy from her employer because of the severe economic penalties she would otherwise suffer. Finally, some have argued that the issues of seniority, fringe benefits, and equal pay upon transfer should not be considered by OSHA in standard setting but should instead be handled by collective bargaining. Because fewer than one out of five women workers in the United States belongs to a labor union, collective bargaining cannot be viewed as the sole solution to this problem. 3. Inform tive hazards
the female work force and new female job applicants of the reproducof lead and let them decide if they want to keep or take the jobs.
Although informing workers of hazards is a vital component of any occupational disease prevention program, it cannot serve as the only protection for workers. The burden for worker protection is on the employer and cannot be shifted onto the individual. This option, taken in lieu of providing any health protections against exposure, does not allow for informed consent but only presents female workers with a Hobson’s choice: the health of their future children or their livelihood. 4. Have
separate
and different
lead standards
for women and men workers.
For example, men would be allowed to work at any job where the air lead levels were under 100 ,uglm3, whereas women could be employed only in those workplaces where the levels were under 50 &lOO m3. Such a policy would provide little incentive for industry to institute engineering and other controls necessary to lower exposures, because it would be more expedient for an employer simply to
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employ only male workers and avoid the expense of modifying the hazardous environment. Also, a policy which differentiated between men and women on the basis of sex may well violate Title VII. Separate standards would be like a modern version of protective legislation for women that courts have consistently overturned under Title VII. Such a policy would also totally ignore the data on potential reproductive hazards to males exposed to lead. Thus, the result of this alternative: Women get fewer jobs and men get less protection. AN ACCEPTABLE APPROACH TO PROTECTING WORKERS FROM THE REPRODUCTIVE HAZARDS OF LEAD
There appears to be only one approach which is morally, ethically, and legally acceptable. OSHA must set a standard for lead exposure, as well as for any other toxin, based on the best available evidence, that will ensure that both men and women can work safely without harming either’s ability to conceive, father, and raise normal healthy children. If we examine a recent government recommendation on exposure to anesthetic gases, we find that the agency suggested this very same concept, i.e., setting a standard strict enough to protect the man, woman, and fetus. The National Institute for Occupational Safety and Health’s (NIOSH) recommendation to OSHA was that the level of anesthetic gases in operating rooms be reduced to the lowest detectable level-2 ppm (24). Their recommendation was based in large part on a nationwide study of anesthesiologists (1). The study revealed that, when women working in operating rooms are compared with other female workers not exposed to waste anesthetic gases, the former group suffered from significantly more miscarriages, gave birth to more babies with defects, and had a higher incidence of liver disease and cancer. The study also found that male workers and their children suffered adverse effects, too, although the results were not as significant statistically. NIOSH did not conclude that all fertile women be banned from the operating room, nor that women be transferred out of the operating room when they became pregnant. Rather, they recommended that the necessary engineering controls-in this case ventilation systems and scavenging devices-be installed to remove the waste gases and thus reduce the levels of exposure as low as possible. Similarly, when setting a standard for protection against exposure to lead, OSHA must consider the “best available scientific evidence.” Analysis of the evidence indicates that blood lead levels as low as 30 &lo0 ml may exert harmful effects on reproductive processes or on the fetus. Thus, in order to protect against these and numerous other health effects of lead, OSHA must require a dramatic reduction in the allowable air lead exposures. This should be accomplished through engineering and other controls. To ensure safety, reduction in air levels must result in a blood lead level for all exposed workers that does not exceed 30 &lo0 ml.
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FOR THE OSHA STANDARD
The following suggestions concern only what the OSHA standard (25) should contain with regard to special safeguards against the adverse effects of lead on reproduction. The basic concepts concerning medical surveillance, transfers, and record keeping incorporated into these recommendations, however, are also applicable to other chemicals which present reproductive hazards. 1. The OSHA air lead level must be set to ensure that no worker, male or female, has a blood lead level above 30 pg/lOO ml, a level which cannot be exceeded without risking reproductive effects. 2. If OSHA determines that such an air lead level is not technologically feasible at this time, then it must set the strictest standard currently feasible and should develop interim protective procedures to be used until a reduction in air lead levels can be achieved. As an interim measure, transfer provisions to protect fertile workers must be included as part of the final lead standard. Such transfer provisions have been suggested for workers with elevated lead levels in an OSHA proposal on “medical removal protection” for workers exposed to lead (26). Any worker employed in a lead area who is pregnant, breast feeding, or seriously contemplating becoming a parent shall be offered blood tests at least monthly to ensure that blood lead levels do not exceed 30 &lo0 ml. If the level is exceeded, the worker shall immediately be offered a temporary, voluntary transfer to a job without lead exposure, with retention of seniority, wages, and fringe benefits. In the event that such jobs do not exist, the employer shall devise some other administrative controls by which the employees at risk can continue to work with blood levels below 30 pg/lOO ml. This might include shortened shifts with makeup pay, rotation of employees, or longer breaks. In plants or workplaces with collective bargaining agreements, the arrangements for such transfers, rotations, or other administrative controls shall be made with reference to existing local union contracts. 3. The air lead level should be the primary OSHA compliance tool, but during inspections OSHA compliance officers must also review the results of workers’ blood lead tests to determine the adequacy of efforts to control exposure. 4. All workers exposed to lead must have an initial blood lead test and medical examination after the standard goes into effect. Thereafter, they should be offered monthly blood tests whenever the air lead level is above the action level (one-half of the permissible exposure). In addition, workers should have the right to biological monitoring at any time that they suspect their lead exposure has increased. Results of tests must be explained to workers in understandable language. 5. Free optional pregnancy testing and free sperm analysis must be offered to workers. Results of tests, with explanations, must be given to workers. This information should be considered part of the confidential medical record and not be disclosed to employers without the prior written permission of the
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worker. Employees (or job applicants) must not be forced by employers to answer questions about their fertility, sexual or birth control habits, or future plans for a family. 6. Workers should be encouraged to undergo medical examinations and biological monitoring, as well as to report pregnancies, but shall not suffer penalties for refusing to submit to such tests. 7. Employees (and job applicants) must be informed that excessive exposures to lead have resulted in reproductive difficulties, including fertility problems, menstrual disorders, stillbirths, miscarriages, and other hazardous effects, so that they understand the significance of blood, sperm, and pregnancy testing. NIOSH shall develop a summary of such information in lay terms that employers will use in employee training and in preemployment interviews. 8. Occupational physicians contracted with or hired by employers to conduct the medical examinations required by the lead standard should include information on the fertility and pregnancy experiences of employees and their spouses as part of the workers’ medical history. Recorded information should include menstrual difftculties, difficulties conceiving, impotence, miscarriages, stillbirths, and birth defects or learning disabilities in children. OSHA compliance officers should check with physicians to see that medical examinations include this information in medical histories. Summaries of these data on the outcome of pregnancy should be prepared by the occupational physician and be reviewed by NIOSH at j-year intervals after the effective date of the standard. NIOSH shall analyze the data thoroughly to determine any continued adverse effects of lead exposure on reproduction. If any effects are detected, NIOSH shall recommend that the lead standard be reconsidered. 9. As outlined in the proposed standard, additional work practices must be implemented to lessen the possibility of accidentally taking lead home on the worker or his/her clothes, thereby endangering children and spouses. These practices should include required cleanup at the termination of the workday, provision and commercial laundering of work clothes (regardless of the air lead levels), and clean change rooms. When clothes are commercially laundered, the launderers must be advised of the hazards of lead and the precautions that are necessary to protect themselves. CONCLUSION
Additional studies need to be done to determine accurately the risk of low level lead exposures on reproduction. But enough is known at present about potential adverse health effects to justify-and require-reducing the permissible air limits to levels significantly lower than the lOO-mglm3 limit proposed by OSHA. OSHA should set a standard for lead exposure which will protect ALL workers, male and female, including fertile men and women, as well as pregnant workers. Any standard which will result in failure to protect large segments of the workforce or which will discriminate against certain workers on the basis of their sex or fertility does not serve the stated purpose of the Occupational Safety and Health Act--‘&to assure so far as possible every work-
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ing man and woman in the Nation safe and healthful working conditions.” Moreover, such a standard would violate the basic principles behind equal employment opportunity laws, as well as basic social and moral precepts. If such a nondiscriminatory standard is not currently technologically feasible, OSHA should develop interim measures- including transfers and other administrative controls-to protect fertile workers against the harm of lead exposure. REFERENCES 1. Ad HOC Committee on the Effect of Trace Anesthetics, American Society of Anes41, thesiologists. Occupational disease among operating room personnel. Anesthesiology 321-340 (1974). 2. Barltrop, D., and Burland, W. F. (eds.) “Mineral Metabolism in Paediatrics,” pp. 135- 151. Blackwell Scientific, Oxford, 1969. 3. Brady, K., Herrera, Y., and Zenick, H. Influence of parental lead exposure on subsequent learning ability of offspring. Pharmacol. Biochem. Behavior 3, 561-565 (1975). 4. Bronson, G. Study shows children of lead workers are susceptible to lead-dust poinsoning. WulI Street Journal, February 3, 1977, p. 8. 5. Carson, T., and Van Gelder, G. Slowed learning in lambs prenatally exposed to lead. Arch. Environ. Healrh 29, 154-156 (1974). 6. Cohen, E., Bruce, D., Cascorbi, M., Corbett, T., Jones, T., and Whitcher, C. A survey of anesthetic health hazards among dentists. J. Amer. Dent. Ass. 90, 1291-1295 (1975). 7. Committee on Biological Effects of Atmospheric Pollutants. “Lead: Airborne Lead in Perspective.” National Academy of Sciences, Washington, D.C., 1972. 8. Fahim, M., Fahim, Z., and Hall, D. Effects of subtoxic lead levels on pregnant women in the state of Missouri. Clin. Parhol. Pharmacol. 13, 309-323 (1976). 9. Ferm, V., and Carpenter, S. Developmental malformations resulting from the administration of lead salts. Exp. MO/. Patho/. 7, 208-213 (1976). 10. Fomi, A., and Secchi, G. Chromosome changes in preclinical and clinical lead poisoning and correlation with biochemical findings. Proceedings of rhe Internafional Symposium on Environmental Health Aspects of Lead, Amsterdam, October 2-6, 1972. Il. Gershanik, J., Brooks, G., and Little, J. Blood lead values in pregnant women and their offspring. Amer. J. Obsret. Gynecol. 119, 508-511 (1974). 12. Gilani, S. Congenital anomalies in lead poisoning. Obsret. Gynecol. 41, 265-269 (1973). 13. Hamilton, A., and Hardy, H. “Industrial Toxicology,” pp. 119- 121. Publishing Sciences Group, Acton, Mass., 1974. 14. Hendler, H., Affirmative Action Officer, Pennsylvania Human Relations Commission. Interview, June 1976. 15. Hilderbrand, D., Der, G., Griffin, W. and Fahim, M. Effect of lead acetat eon reproduction. Amer. J. Obsret. Gynecol. 115, 1058-1065 (1973). 16. Hubermont, G., and Buchet, J. Effect of short-term administration of lead to pregnant rats. Toxicology 5, 379-384 (1976). 16a. Hyatt, J. Protection for unborn. 7 Work safety issue isn’t as simple as it sounds. Wall Street Journal, August 2, 1977, p. 1. 17. Infante, P., and Wagoner, J. The effects of lead on reproduction. In “Proceedings of the Conference on Women and the Workplace,” pp. 232-242. Society for Occupational and Environmental Health, Washington, D.C., 1977. 18. Knill-Jones, R., Rodrigues, L., Moir, D., and Spence, A. Anesthetic practice and pregnancy. Lancer 1, 1326- 1328 (1972). 19. Kostial, D., and Momcilovic, B. Transport of lead 203 and calcium 47 from mother to offspring. Arch. Environ. Health 29, 28-30 (1974). 20. Lancranjan, I., Popescu, H., Gavanescu, O., Klepsch, I., and Serbanescu, C. Reproductive ability of workmen occupationally exposed to lead. Arch. Environ. Health 30, 396-401 (1975).
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