0277-9536/92 $5.00+ 0.00 Copyright@I 1992PergamonPressLtd
Sm. Sci.Med.Vol. 35,No. 12,pp. 148>1495,1992 Printedin GreatBritain.All rightsreserved
FAIR LAW, PROTECTIVE
UNFAIR PRACTICES? BENEFITING FROM LEGISLATION FOR PREGNANT WORKERS IN ITALY AND FRANCE*
PATRIZIA ROMITO’ and MARIE-J• S~PHE SAUREL-CUBIZOLLES*
‘Istituto di Bicovero e Cura a Carattere Scientific0 Burlo Garofolo, Via dell’Istria 65/l, 34100 Trieste, Italy and ‘INSERM U 149, Unite de Recherches Epidemiologiques sur la Mere et l’Enfant, 16 av. P. Vaillant-Couturier, 94807 Villejuif, France Abstract-Protective Maternity Legislation (PML) for pregnant workers is well established in Italy and France, but little is known about the way it fulfils some of its aims, such as the protection of mothers’ and babies’ health and of the rights of women workers. In this paper, we present the results of two surveys, one carried out in Italy and the other in France, concerned with the implementation of these regulations. Results show that women who were regularly employed generally could benefit from PML, while non-eligible workers, most of them holding manual jobs, were not protected at all. Among eligible workers, inequalities existed: women with less qualified jobs and those employed in the private sector were less likely to benefit from the protective measures considered. A number of specific measures, such as the possibility of taking an early maternity leave for work reasons and of being moved to another job within the same firm were underused in both countries. Some limitations of PML are discussed, namely the fact it covers some but not all pregnant workers, that it ignores domestic work and the tendency to remove the pregnant worker rather than to modify her working conditions. Key w&s-pregnant
workers, social inequalities, Protective Maternity Legislation, Italy and France
INTRODUCTION: SOME SHORTCOMINGS OF PROTECTIYE MATERNITY LEGISLATION FOR PREGNANT WORKERS
Protective Maternity Legislation (PML) for pregnant workers, along with many other social regulations, has been developed in the twentieth century in most European countries. The declared aims of PML vary from one country and historical period to another, and may include: the increase of birth rates, the protection of the health of pregnant and childrearing workers and of their offspring, the promotion of women’s equality at work, the strengthening of family bonds and, more generally, an increase in social welfare. In the attempt to bring about its aims, PML has revealed two kinds of limitation: the first lies in the fact that these regulations concern some but not all pregnant women and some but not all the kinds of work they do; the second, in the way concerned women can actually benefit from them. While these limitations exist in all countries, we will discuss a number of those observed specifically in Italy and France. Like most legislation concerned with social security, PML regards only workers employed in the regular labour market. As a consequence, selfemployed women, and those who have short term contracts are only partially covered by protective *This work was carried out during the stay of P.R. at the U 149, the stay was funded by INSERM.
measures, while women who work in the informal economy, and full-time housewives are not covered at all. Women in the informal economy usually have worse working conditions and a lower pay than those employed in the official labour market [l]. Full-time housewives are characterized by unfavourable sociodemographic conditions and by a high rate of perinatal difficulties: a number of studies have shown that they have more pre-term and still-born babies than women in paid employment (for a review and a discussion of these data, see Refs [2] and [3]). So, the large number of women excluded from PML are, if anything, even more in need of being protected since their working conditions and social characteristics are particularly problematic. Furthermore, PML uses the common definition of work, in which unpaid, domestic labour is implicitly ignored. Hence, even regularly employed women are protected only as far as their paid work is concerned. The amount of time spent in domestic and child-care activities may be as high as 64 hr per week for full-time employed mothers (and much higher for full-time housewives) [4]. Women continue to do a good deal of housework and child-care work even when they are pregnant [3,5-81, but PML does not include this work and the fatigue and risks involved in it. Another limit is made apparent with regard to the baby’s health, since this regulation permits to take into account only some of the work-related risk factors. On this issue, a consistent body of results is
1485
1486
PATRIZIAROMITOand MARIE-J•
available. During pregnancy, working conditions such as heavy manual work, standing for a long time, work at the conveyor belt, and being exposed to noise have been associated with negative outcomes such as maternal arterial hypertension, preterm birth and small-for-date birth weight. Among employed women, the occupational categories most exposed to these latter risks are hospital workers, shop assistants, manual skilled and unskilled workers [2,9-l 11. A number of chemicals (such as antimitotics, ionizing radiations, solvents and anaesthetic gases) and of biological agents (such as cytomegalovirus and rubella) have also been associated with negative outcomes, rarer but more severe, such as early miscarriage, still-births and, in surviving children, malformations and developmental problems [12]. In France and Italy, in order to safeguard the foetus’ health, legislation protects the mother, not allowing her to work with a number of dangerous chemicals or to do some strenuous jobs, and giving her some possibility to leave a potentially dangerous job. But, as far as chemicals are concerned, some of them can also be dangerous before conception, and may affect the father’s reproductive capacities too. While both parents are equally accountable for the genetic makeup of their baby, only the mother is protected, and only once she realises she is pregnant, by which time some damage may have already have occurred [13, 141. THE AIM OF THIS PAPER
The aim of this paper is to analyse the practice of PML and the problems and contradictions which may be involved. The results come from two studies, one carried out in Italy and the other in France. While these studies present many common aspects, they were not intended to be comparative, and the choice of samples as well as part of the methodology are different. Besides, the differences between these two countries (see Table 1) and their protective regulations, would make a true comparison impossible. In spite of these differences, similar trends emerged from the results, and it was deemed worthwhile to present and discuss them together. Before presenting these results we will briefly describe curTable 1. Some socio-demonraohic 1986
Population (thousands)’ Total fertility*’ Infant mortality’ ?61 Perinatal mortality’ %O
S~PHE SAUREL-CUBIZOLLES
rent regulations France.
for pregnant
women in Italy and
CURRENT REGULATIONS FOR PREGNANT WORKERS IN ITALY AND FRANCE
In Italy all women workers, as long as they are regularly employed, are eligible for maternity legislation with no other qualifying requirements. They are guaranteed against dismissal from the beginning of pregnancy until the child is one year old (unless they have committed a serious misdemeanour, or if economic conditions make it impossible for the employer to maintain the work contract). Workers with short-term contracts only partially benefit from this legislation. All restrictions on women’s work, except in some cases night work, were removed by the Equality Law in 1977, but many of them were maintained during pregnancy. Throughout this period and until seven months after the birth, it is forbidden to make a woman work nights or engage in strenuous or dangerous activity, such as carrying heavy weights, using specific machines, being exposed to or handling chemicals or ionizing radiation, standing for more than half of the working day, and working on buses, planes and boats, in psychiatric clinics, or in contact with infectious diseases. If her job involves such activities, a woman has to present her employer with a certificate of pregnancy: on receipt of this, the employer has to find her another position within the firm, without any loss of wages. If this proves impossible, early maternity leave (EML) (at the same conditions as maternity leave, see below) must be granted. It has to be underlined that in such a case, a woman can obtain early maternity leave without going through a doctor. A minimum of 5 months maternity leave must be granted and must be taken: 2 months before the birth (3 for women in dangerous or strenuous jobs) and 3 months after. At the end of this time, the woman must be reinstated in the same position she held before. Income replacement during maternity leave corresponds to at least 80% of the woman’s earnings: in the public sector, as well as in many large private firms, it is 100%; this money is not taxable. If the pregnancy is difficult, or if the woman has health problems related to characteristics
in Italv and France Italy
France
57 246 1.4 9.8 12.8
55 394 1.8 8.0 10.4
20.6 Aged 14 and more 33.5 33.8 9.5
9.1 Aged 15 and more 46.2 50.7 23.2
Employment
of self employed among all workers2 Women employment % of employed women’ % of employed among married women’ % of Dart time work amona emoloved women’
%
*Indicator of the average number of children for 1000 women. ‘Eurostat, Demographic Statistics, 1988 [15]. *Agricultural workers excluded. Ocde, Perspectives de I’emploi, September 1986 [16]. ‘Eurostat, Indagine sulla forza lavoro, 1986 [17].
Protective legislation for pregnant workers
pregnancy, EML must be granted immediately: in this case, a medical certificate specifying the problem is needed. The amount of EML, for health or work reasons, may last for a short period, or from early in pregnancy till the beginning of compulsory maternity leave. In France, all women in paid employment, regardless of how long they may have been working for the same employer, are protected against dismissal from the beginning of the pregnancy until 4 weeks after the end of the postnatal maternity leave (with the same exceptions as in the Italian law). Workers with shortterm contracts are not covered by the law. Women, whether pregnant or not, are not allowed to do a number of jobs, such as those involving the use of certain transport vehicles, contact with chemicals such as mercury, silica, and thiophosphoric esters, carrying heavy loads [18] and night shifts (except for those working in managerial positions, in the health care sector, in hotels, restaurants, nightclubs and shops). In addition, pregnant women are excluded from specific jobs, such as working outside when the temperature is below 0°C. At the request of the employer or of the woman herself and with the written consent of the occupational health physician, a pregnant worker can move from one position to another within the same firm without any loss of earnings. But if it is the worker who asks for this move, the employer is not obliged to consent; moreover, she must have worked for at least a year for that employer in order to be paid the same wage. French women are entitled to at least 6 weeks of leave before and 10 weeks after the birth: when the maternity leave is up, they must be re-instated in the same position. If a woman has a difficult pregnancy, if she has twins or if she is carrying her third or subsequent child, maternity leave can be longer (up to a maximum of 30 weeks). In particular, a ‘pathological pregnancy’ will allow a woman two supplementary weeks of leave. No special conditions have to be met in order to resume the same job in the same firm at the end of the leave. Wages during the period of absence from work, reimbursed from the National Insurance, have to be at least 84% of the woman’s usual earnings; this money is not taxable. In the public sector, and in a number of big firms, income replacement is 100%. In order to qualify for this, she has to have paid National Insurance contributions, corresponding to a certain minimum number of worked hours. Furthermore, according to an ordinance of the Health Ministry, women whose working conditions are difficult and incompatible with pregnancy, can ask to stop work on and after the 21st week of pregnancy, with the same conditions as the normal maternity leave. The request for these additional weeks of leave must be approved by the local National Insurance office. These basic rights provided for by national protective legislation may be supplemented by a number of
1487
measures, specific to certain companies and group agreements, such as shorter working hours, the possibility to take time off for prenatal consultations, extra breaks, less standing up and a reduction in the output usually required. Women may also obtain sick leave from a doctor. This is paid for out of National Insurance contributions; if no persona1 insurance scheme is involved, up to 50% of the woman’s salary is paid. THE TWO STUDIES: POPULATION AND METHODOLOGY
Both the Italian and the French samples considered in this paper (respectively N = 200 and N = 433) consist of primipara, having done a paid job during the pregnancy, whose babies were live-born and alive at the time of interview. The Italian study was carried out in a north-eastern town, Trieste: mothers were interviewed at the public hospital (where more than 90% of the births take place), 2 or 3 days after the birth of their first child. Besides being a primipara, the women included in the study all had to have done a paid job of any description during the pregnancy. All the eligible women who gave birth between November 1988 and April 1989 (N = 204) were asked to participate by the same interviewer: 200 accepted. Data were collected by means of a questionnaire. Questions concerned: socio-demographic characteristics of the woman and her partner; characteristics of paid and unpaid work (most questions concerning the former were the same as in the French questionnaire); knowledge and use of protective legislation; relationship with the employer and work-mates; health problems and hospitalizations during pregnancy; communication with the doctor on these issues; type of delivery and baby’s conditions. In the French study, data were collected in a survey conducted between April 1987 and May 1988 in four public maternity hospitals (two near Paris, one in the Nord-Pas-de-Calais and the other in the ChampagneArdennes region): in each hospital, a representative sample of births was selected from a chronological list of deliveries. The women were interviewed during their hospital stay, with a questionnaire: questions concerned social and demographic characteristics, employment before and during the pregnancy, living conditions and housework, obstetrical history and prenatal care. For employed women, information was recorded about occupation, working conditions, and use of protective legislation. Data about delivery and baby’s health status were extracted from medical record. A total of 1949 women were interviewed; 1002 of them had held a paid job during pregnancy; among this subsample, 433 were primipara. For the purpose of this paper, only data concerning these 433 women were analyzed. We studied how protective legislation was actually implemented and which problems pregnant women
1488
PATRIZIA ROMITOand MARE-JO&PEE SAUREL-CUEHZOLLES
encountered. More specifically, we looked at how many pregnant women lost their job; whether they had undergone financial losses because of the pregnancy (because they were dismissed, because their salary replacement was not lOO%, or because they lost some ‘extra’ money); whether they had stopped paid work on the date of the beginning of maternity leave; whether and in what way they took advantage of the different regulations allowing for early maternity leave (either for work or for health reasons) and sick leave; whether the place of work within the same firm changed. A number of indicators of unpaid working conditions were also considered, as well as women’s working conditions and health problems. We analyzed these data according to the women’s position in the labour market (being eligible for protective legislation or not; and, among eligible women, working in the private or in the public sector), and according to occupation. The latter were clustered into two groups. Qualified workers included women with professional, intermediate and skilled occupations such as teachers, scientists, health and social workers, civil service and clerical staff, less qualified workers included women with manual occupations, such as sales, service and factory workers. Statistical analysis was conducted using S.P.S.S. program in Italy and SAS software in France. The X2-test has been used for comparison of percentages; P < 0.05 has been considered statistically significant. RESULTS
Description of the samples Table 2 shows the social, demographic and professional characteristics of the women interviewed in the two studies. In France, women were more often
migrants (10% vs 0), not cohabiting with the baby’s father (11% vs 2%) and young; in Italy, there were more women with a low educational level. More French than Italian workers had the status of employees (which corresponds to the national trends, see Table 1); accordingly, more were eligible for protective legislation (96% vs 76%). In both countries, the sample was composed of around a third of less qualified workers; this proportion was much higher among the non-eligible women. Among eligible workers, more women were employed in the private sector in France than in Italy. Working hours were significantly longer in the private sector in both countries (data not shown). The comparative rates of women exposed to difficult working conditions were fairly similar, although working hours were somewhat longer in France. Inequalities in the practice of the law Results presented in Tables 3-6 show the existence of systematic differences between women concerning the protection during pregnancy. These differences depend on the fact of being eligible or not and, among eligible women, on their occupation and on whether they were employed in the private or in the public sector. Considering the whole sample, 10% of women in France and 8% in Italy lost their job during pregnancy. Non-eligible workers and, among eligible, the less qualified and those employed in the private sector were more likely to have lost their job (Tables 3 and 4). In both countries, more than 40% of women said they had suffered financial losses in this period; this happened more often to non-eligible women and,
Table 2. Social, demographic and occupational characteristics of the Italian and French sample. Primaparas with paid work during pregnancy Italy N=200 Mean (years) SD Women with 40 hr
France N=433
28 4 2%
26 4 6%
21%
12%
14% 16% 10% 24%
91%
34% 22% 70% 48%
32% 30% 64%
56% 17% 2% 16%
54% 28% 1% 19%
36 9 10%
38 8 II%
I% 2% 4%
15%
1489
Protective legislation for pregnant workers Table 3. Protection during pregnancy: inequalities among eligible and “on eligible workers France
Italy N Women who lost their job during pregnancy All women Eligible women Non-eligible women Women who lost money because of pregnancy All women Eligible women Non-eligible women
%
N
%
200 8 153 4 47 23 P < 0.001
426 410 16
10 10 12
200 153 47
384* 45 376 44 8 88 P < 0.05 35th week of pregnancy 424 8 409 7 15 40 P =
Sm. Sci.Med.Vol. 35,No. 12,pp. 148>1495,1992 Printedin GreatBritain.All rightsreserved
FAIR LAW, PROTECTIVE
UNFAIR PRACTICES? BENEFITING FROM LEGISLATION FOR PREGNANT WORKERS IN ITALY AND FRANCE*
PATRIZIA ROMITO’ and MARIE-J• S~PHE SAUREL-CUBIZOLLES*
‘Istituto di Bicovero e Cura a Carattere Scientific0 Burlo Garofolo, Via dell’Istria 65/l, 34100 Trieste, Italy and ‘INSERM U 149, Unite de Recherches Epidemiologiques sur la Mere et l’Enfant, 16 av. P. Vaillant-Couturier, 94807 Villejuif, France Abstract-Protective Maternity Legislation (PML) for pregnant workers is well established in Italy and France, but little is known about the way it fulfils some of its aims, such as the protection of mothers’ and babies’ health and of the rights of women workers. In this paper, we present the results of two surveys, one carried out in Italy and the other in France, concerned with the implementation of these regulations. Results show that women who were regularly employed generally could benefit from PML, while non-eligible workers, most of them holding manual jobs, were not protected at all. Among eligible workers, inequalities existed: women with less qualified jobs and those employed in the private sector were less likely to benefit from the protective measures considered. A number of specific measures, such as the possibility of taking an early maternity leave for work reasons and of being moved to another job within the same firm were underused in both countries. Some limitations of PML are discussed, namely the fact it covers some but not all pregnant workers, that it ignores domestic work and the tendency to remove the pregnant worker rather than to modify her working conditions. Key w&s-pregnant
workers, social inequalities, Protective Maternity Legislation, Italy and France
INTRODUCTION: SOME SHORTCOMINGS OF PROTECTIYE MATERNITY LEGISLATION FOR PREGNANT WORKERS
Protective Maternity Legislation (PML) for pregnant workers, along with many other social regulations, has been developed in the twentieth century in most European countries. The declared aims of PML vary from one country and historical period to another, and may include: the increase of birth rates, the protection of the health of pregnant and childrearing workers and of their offspring, the promotion of women’s equality at work, the strengthening of family bonds and, more generally, an increase in social welfare. In the attempt to bring about its aims, PML has revealed two kinds of limitation: the first lies in the fact that these regulations concern some but not all pregnant women and some but not all the kinds of work they do; the second, in the way concerned women can actually benefit from them. While these limitations exist in all countries, we will discuss a number of those observed specifically in Italy and France. Like most legislation concerned with social security, PML regards only workers employed in the regular labour market. As a consequence, selfemployed women, and those who have short term contracts are only partially covered by protective *This work was carried out during the stay of P.R. at the U 149, the stay was funded by INSERM.
measures, while women who work in the informal economy, and full-time housewives are not covered at all. Women in the informal economy usually have worse working conditions and a lower pay than those employed in the official labour market [l]. Full-time housewives are characterized by unfavourable sociodemographic conditions and by a high rate of perinatal difficulties: a number of studies have shown that they have more pre-term and still-born babies than women in paid employment (for a review and a discussion of these data, see Refs [2] and [3]). So, the large number of women excluded from PML are, if anything, even more in need of being protected since their working conditions and social characteristics are particularly problematic. Furthermore, PML uses the common definition of work, in which unpaid, domestic labour is implicitly ignored. Hence, even regularly employed women are protected only as far as their paid work is concerned. The amount of time spent in domestic and child-care activities may be as high as 64 hr per week for full-time employed mothers (and much higher for full-time housewives) [4]. Women continue to do a good deal of housework and child-care work even when they are pregnant [3,5-81, but PML does not include this work and the fatigue and risks involved in it. Another limit is made apparent with regard to the baby’s health, since this regulation permits to take into account only some of the work-related risk factors. On this issue, a consistent body of results is
1485
1486
PATRIZIAROMITOand MARIE-J•
available. During pregnancy, working conditions such as heavy manual work, standing for a long time, work at the conveyor belt, and being exposed to noise have been associated with negative outcomes such as maternal arterial hypertension, preterm birth and small-for-date birth weight. Among employed women, the occupational categories most exposed to these latter risks are hospital workers, shop assistants, manual skilled and unskilled workers [2,9-l 11. A number of chemicals (such as antimitotics, ionizing radiations, solvents and anaesthetic gases) and of biological agents (such as cytomegalovirus and rubella) have also been associated with negative outcomes, rarer but more severe, such as early miscarriage, still-births and, in surviving children, malformations and developmental problems [12]. In France and Italy, in order to safeguard the foetus’ health, legislation protects the mother, not allowing her to work with a number of dangerous chemicals or to do some strenuous jobs, and giving her some possibility to leave a potentially dangerous job. But, as far as chemicals are concerned, some of them can also be dangerous before conception, and may affect the father’s reproductive capacities too. While both parents are equally accountable for the genetic makeup of their baby, only the mother is protected, and only once she realises she is pregnant, by which time some damage may have already have occurred [13, 141. THE AIM OF THIS PAPER
The aim of this paper is to analyse the practice of PML and the problems and contradictions which may be involved. The results come from two studies, one carried out in Italy and the other in France. While these studies present many common aspects, they were not intended to be comparative, and the choice of samples as well as part of the methodology are different. Besides, the differences between these two countries (see Table 1) and their protective regulations, would make a true comparison impossible. In spite of these differences, similar trends emerged from the results, and it was deemed worthwhile to present and discuss them together. Before presenting these results we will briefly describe curTable 1. Some socio-demonraohic 1986
Population (thousands)’ Total fertility*’ Infant mortality’ ?61 Perinatal mortality’ %O
S~PHE SAUREL-CUBIZOLLES
rent regulations France.
for pregnant
women in Italy and
CURRENT REGULATIONS FOR PREGNANT WORKERS IN ITALY AND FRANCE
In Italy all women workers, as long as they are regularly employed, are eligible for maternity legislation with no other qualifying requirements. They are guaranteed against dismissal from the beginning of pregnancy until the child is one year old (unless they have committed a serious misdemeanour, or if economic conditions make it impossible for the employer to maintain the work contract). Workers with short-term contracts only partially benefit from this legislation. All restrictions on women’s work, except in some cases night work, were removed by the Equality Law in 1977, but many of them were maintained during pregnancy. Throughout this period and until seven months after the birth, it is forbidden to make a woman work nights or engage in strenuous or dangerous activity, such as carrying heavy weights, using specific machines, being exposed to or handling chemicals or ionizing radiation, standing for more than half of the working day, and working on buses, planes and boats, in psychiatric clinics, or in contact with infectious diseases. If her job involves such activities, a woman has to present her employer with a certificate of pregnancy: on receipt of this, the employer has to find her another position within the firm, without any loss of wages. If this proves impossible, early maternity leave (EML) (at the same conditions as maternity leave, see below) must be granted. It has to be underlined that in such a case, a woman can obtain early maternity leave without going through a doctor. A minimum of 5 months maternity leave must be granted and must be taken: 2 months before the birth (3 for women in dangerous or strenuous jobs) and 3 months after. At the end of this time, the woman must be reinstated in the same position she held before. Income replacement during maternity leave corresponds to at least 80% of the woman’s earnings: in the public sector, as well as in many large private firms, it is 100%; this money is not taxable. If the pregnancy is difficult, or if the woman has health problems related to characteristics
in Italv and France Italy
France
57 246 1.4 9.8 12.8
55 394 1.8 8.0 10.4
20.6 Aged 14 and more 33.5 33.8 9.5
9.1 Aged 15 and more 46.2 50.7 23.2
Employment
of self employed among all workers2 Women employment % of employed women’ % of employed among married women’ % of Dart time work amona emoloved women’
%
*Indicator of the average number of children for 1000 women. ‘Eurostat, Demographic Statistics, 1988 [15]. *Agricultural workers excluded. Ocde, Perspectives de I’emploi, September 1986 [16]. ‘Eurostat, Indagine sulla forza lavoro, 1986 [17].
Protective legislation for pregnant workers
pregnancy, EML must be granted immediately: in this case, a medical certificate specifying the problem is needed. The amount of EML, for health or work reasons, may last for a short period, or from early in pregnancy till the beginning of compulsory maternity leave. In France, all women in paid employment, regardless of how long they may have been working for the same employer, are protected against dismissal from the beginning of the pregnancy until 4 weeks after the end of the postnatal maternity leave (with the same exceptions as in the Italian law). Workers with shortterm contracts are not covered by the law. Women, whether pregnant or not, are not allowed to do a number of jobs, such as those involving the use of certain transport vehicles, contact with chemicals such as mercury, silica, and thiophosphoric esters, carrying heavy loads [18] and night shifts (except for those working in managerial positions, in the health care sector, in hotels, restaurants, nightclubs and shops). In addition, pregnant women are excluded from specific jobs, such as working outside when the temperature is below 0°C. At the request of the employer or of the woman herself and with the written consent of the occupational health physician, a pregnant worker can move from one position to another within the same firm without any loss of earnings. But if it is the worker who asks for this move, the employer is not obliged to consent; moreover, she must have worked for at least a year for that employer in order to be paid the same wage. French women are entitled to at least 6 weeks of leave before and 10 weeks after the birth: when the maternity leave is up, they must be re-instated in the same position. If a woman has a difficult pregnancy, if she has twins or if she is carrying her third or subsequent child, maternity leave can be longer (up to a maximum of 30 weeks). In particular, a ‘pathological pregnancy’ will allow a woman two supplementary weeks of leave. No special conditions have to be met in order to resume the same job in the same firm at the end of the leave. Wages during the period of absence from work, reimbursed from the National Insurance, have to be at least 84% of the woman’s usual earnings; this money is not taxable. In the public sector, and in a number of big firms, income replacement is 100%. In order to qualify for this, she has to have paid National Insurance contributions, corresponding to a certain minimum number of worked hours. Furthermore, according to an ordinance of the Health Ministry, women whose working conditions are difficult and incompatible with pregnancy, can ask to stop work on and after the 21st week of pregnancy, with the same conditions as the normal maternity leave. The request for these additional weeks of leave must be approved by the local National Insurance office. These basic rights provided for by national protective legislation may be supplemented by a number of
1487
measures, specific to certain companies and group agreements, such as shorter working hours, the possibility to take time off for prenatal consultations, extra breaks, less standing up and a reduction in the output usually required. Women may also obtain sick leave from a doctor. This is paid for out of National Insurance contributions; if no persona1 insurance scheme is involved, up to 50% of the woman’s salary is paid. THE TWO STUDIES: POPULATION AND METHODOLOGY
Both the Italian and the French samples considered in this paper (respectively N = 200 and N = 433) consist of primipara, having done a paid job during the pregnancy, whose babies were live-born and alive at the time of interview. The Italian study was carried out in a north-eastern town, Trieste: mothers were interviewed at the public hospital (where more than 90% of the births take place), 2 or 3 days after the birth of their first child. Besides being a primipara, the women included in the study all had to have done a paid job of any description during the pregnancy. All the eligible women who gave birth between November 1988 and April 1989 (N = 204) were asked to participate by the same interviewer: 200 accepted. Data were collected by means of a questionnaire. Questions concerned: socio-demographic characteristics of the woman and her partner; characteristics of paid and unpaid work (most questions concerning the former were the same as in the French questionnaire); knowledge and use of protective legislation; relationship with the employer and work-mates; health problems and hospitalizations during pregnancy; communication with the doctor on these issues; type of delivery and baby’s conditions. In the French study, data were collected in a survey conducted between April 1987 and May 1988 in four public maternity hospitals (two near Paris, one in the Nord-Pas-de-Calais and the other in the ChampagneArdennes region): in each hospital, a representative sample of births was selected from a chronological list of deliveries. The women were interviewed during their hospital stay, with a questionnaire: questions concerned social and demographic characteristics, employment before and during the pregnancy, living conditions and housework, obstetrical history and prenatal care. For employed women, information was recorded about occupation, working conditions, and use of protective legislation. Data about delivery and baby’s health status were extracted from medical record. A total of 1949 women were interviewed; 1002 of them had held a paid job during pregnancy; among this subsample, 433 were primipara. For the purpose of this paper, only data concerning these 433 women were analyzed. We studied how protective legislation was actually implemented and which problems pregnant women
1488
PATRIZIA ROMITOand MARE-JO&PEE SAUREL-CUEHZOLLES
encountered. More specifically, we looked at how many pregnant women lost their job; whether they had undergone financial losses because of the pregnancy (because they were dismissed, because their salary replacement was not lOO%, or because they lost some ‘extra’ money); whether they had stopped paid work on the date of the beginning of maternity leave; whether and in what way they took advantage of the different regulations allowing for early maternity leave (either for work or for health reasons) and sick leave; whether the place of work within the same firm changed. A number of indicators of unpaid working conditions were also considered, as well as women’s working conditions and health problems. We analyzed these data according to the women’s position in the labour market (being eligible for protective legislation or not; and, among eligible women, working in the private or in the public sector), and according to occupation. The latter were clustered into two groups. Qualified workers included women with professional, intermediate and skilled occupations such as teachers, scientists, health and social workers, civil service and clerical staff, less qualified workers included women with manual occupations, such as sales, service and factory workers. Statistical analysis was conducted using S.P.S.S. program in Italy and SAS software in France. The X2-test has been used for comparison of percentages; P < 0.05 has been considered statistically significant. RESULTS
Description of the samples Table 2 shows the social, demographic and professional characteristics of the women interviewed in the two studies. In France, women were more often
migrants (10% vs 0), not cohabiting with the baby’s father (11% vs 2%) and young; in Italy, there were more women with a low educational level. More French than Italian workers had the status of employees (which corresponds to the national trends, see Table 1); accordingly, more were eligible for protective legislation (96% vs 76%). In both countries, the sample was composed of around a third of less qualified workers; this proportion was much higher among the non-eligible women. Among eligible workers, more women were employed in the private sector in France than in Italy. Working hours were significantly longer in the private sector in both countries (data not shown). The comparative rates of women exposed to difficult working conditions were fairly similar, although working hours were somewhat longer in France. Inequalities in the practice of the law Results presented in Tables 3-6 show the existence of systematic differences between women concerning the protection during pregnancy. These differences depend on the fact of being eligible or not and, among eligible women, on their occupation and on whether they were employed in the private or in the public sector. Considering the whole sample, 10% of women in France and 8% in Italy lost their job during pregnancy. Non-eligible workers and, among eligible, the less qualified and those employed in the private sector were more likely to have lost their job (Tables 3 and 4). In both countries, more than 40% of women said they had suffered financial losses in this period; this happened more often to non-eligible women and,
Table 2. Social, demographic and occupational characteristics of the Italian and French sample. Primaparas with paid work during pregnancy Italy N=200 Mean (years) SD Women with 40 hr
France N=433
28 4 2%
26 4 6%
21%
12%
14% 16% 10% 24%
91%
34% 22% 70% 48%
32% 30% 64%
56% 17% 2% 16%
54% 28% 1% 19%
36 9 10%
38 8 II%
I% 2% 4%
15%
1489
Protective legislation for pregnant workers Table 3. Protection during pregnancy: inequalities among eligible and “on eligible workers France
Italy N Women who lost their job during pregnancy All women Eligible women Non-eligible women Women who lost money because of pregnancy All women Eligible women Non-eligible women
%
N
%
200 8 153 4 47 23 P < 0.001
426 410 16
10 10 12
200 153 47
384* 45 376 44 8 88 P < 0.05 35th week of pregnancy 424 8 409 7 15 40 P =
