In the UK, early pregnancy endings are defined as pregnancies that end before 24 weeks’ gestation. These include miscarriages, abortions (sometimes called terminations), ectopic pregnancies where an embryo implants outside of the womb, and molar pregnancies where an embryo is non-viable. These are very common – and sometimes traumatic – experiences, so they are issues that all employers should be thinking about.
Best estimates suggest that, for every three live births (of which there were 591,072 in England and Wales in 2023), there is approximately one abortion and one miscarriage.
Despite their frequency, these endings are still a taboo subject in the workplace. There are only a handful of academic publications on miscarriage as a workplace issue. Even fewer focus on abortion: we have found only one example, a large survey from Northern Ireland and the Republic of Ireland.
Although some UK employers offer paid leave for pregnancy endings, this entitlement is not widespread practice and usually only covers miscarriages. In the UK, clothes retailer ASOS, broadcaster Channel 4 and online bank Monzo are among the rare examples whose policies cover abortions as well.
Compared with pregnancies ending without a live birth from 24 weeks onwards, there is little statutory protection in the case of early pregnancy endings. Yet research shows these experiences can have significant effects on those who carry the pregnancy in particular.
One study of women who had a miscarriage or ectopic pregnancy found that 29% had PTSD symptoms a month afterwards, with 18% continuing to meet the same diagnostic criteria eight months later. Depression and anxiety were also relatively common among this group.
From the small body of research, we know early pregnancy endings can be especially challenging to talk about at work. Our research highlights the importance of considering their impact beyond physical recovery, as psychological and emotional wellbeing can be affected too.
Importantly though, it also indicates that not all early pregnancy endings are experienced emotionally as losses, whichever category they fall into.
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Our work also covers new ground, including a focus on endings during the first two trimesters – encompassing all ways a pregnancy can end – and the recognition that not everyone who has a pregnancy ending identifies as a woman. Such endings affect partners across genders as well.
We spoke to people who experienced early pregnancy endings (including the partner who was not pregnant) and professionals who support people through these. We also ran a survey for women from a wide range of workplaces and working situations. In the resulting report, produced with our co-researchers Victoria Newton, Katy Schnitzler and Aimee Middlemiss, we identified four key themes.
First, there is not enough awareness or training around pregnancy endings in workplaces across the UK. For example, one respondent who had miscarried twice said that after the first miscarriage, she experienced a total absence of HR knowledge, policy or understanding. The second time, she didn’t bother to tell anyone. Unsurprisingly, her performance at work was badly affected.
Second, there were profound concerns about disclosing at work that a pregnancy had ended, as well as worries about confidentiality and requesting support. The number of people disclosing abortions was considerably lower than those who disclosed miscarriages – we believe because of fear of judgment from others.
Third, when people did disclose that a pregnancy had ended, responses varied significantly, as did the support that was offered. Another respondent told us that when she returned to work, very little had been done to cover her workload in the interim: “It did make me feel quite bitter that I was wanting to support my team and my work, but when I needed them, the office wasn’t there for me. I wasn’t supported by them.”
Finally, where our respondents took leave because of their pregnancy ending, 65% used sick leave, 8% used annual leave, and 6% took unpaid leave – compared with a mere 1% who were able to use leave under a specific pregnancy-ending policy. About a third of our participants needed to take leave for their emotional recovery.
We have compiled a list of best-practice principles for employers, line managers and HR professionals. These should help them in supporting staff affected by an early pregnancy ending.
First, we argue for improved workplace awareness of the issues – this can be done by sharing information and training. Evidence-based policies and guidance are also vital.
Our research emphasises the importance of personalised support for employees, which takes in both their physical and emotional wellbeing. Moreover, policies and procedures must safeguard confidentiality, avoid stigmatising language, and be led by the employee’s preferences for the terms to describe their experiences.
Consistent and fair treatment – regardless of the type of pregnancy ending – is also crucial, as is providing support to everyone who has been affected.
There has been growing interest in reproductive health more generally in UK workplaces, as evidenced in academia, organisational initiatives and government policy. Our Supporting Early Pregnancy Endings in the Workplace initiative offers advice and training to organisations, which we hope will lead to much more focus on the important workplace issue of early pregnancy endings.
Ilaria Boncori receives funding from the British Academy, the Wellcome Trust, the Open University and the University of Essex.
Jo Brewis and Julie Davies do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.
