Elise Andaya, "Pregnant at Work: Low-Wage Workers, Power, and Temporal Injustice" (NYU Press, 2024)

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We've done this many times with many academic podcasts and we would like to help you. If you would be interested in talking to us about how we can help you with your podcast, please contact us. Just go to the front page of the new Books Network and you will see a link to NBN Productions. Click that to love the forum and we can talk. Welcome to the new Books Network. Hello everyone and welcome to the new Books Podcast. I'm Deidre Tyler Holtz and we'll be talking with Elise and Daya. Am I pronouncing your name correctly? Yes, that's right. And she's the author of Pregnant Ed Work, Low-Wage Workers, Power, and Temper Injustice. How are you doing today? I'm wonderful. Thanks so much for having me here. Thank you for being on the podcast. Could you tell the audience a few words about yourself and how you got started on this project? Sure. So I'm a cultural anthropologist which means I study human culture and society and my specific interests are in gender and health care and specifically how different societies organize access to reproductive health care, how people get to prenatal care, who's eligible. So my previous work examined access to prenatal care in Cuba and that resulted in a book called Conceiving Cuba, which came out in 2014. And once I completed that book, I was asked to work on a project where I interviewed long-come women in a small city in New York State about why they weren't accessing free reproductive screening like mammograms and pap smears. And one of the biggest obstacles they reported was work schedules, most of the work to low-wage work. And they said that the inability to take time off health appointments was like the biggest issue for them. And that started me thinking, especially given my research background in studying access to prenatal care, if work was such an issue for people trying to get annual screenings, what were the implications of working in these low-wage jobs for women who are pregnant and therefore had to be seen adopted much more often? And so that's where this idea of for this project really got started. Now you begin the book by describing low-wage workers and the issues they face while being pregnant. Can you describe the beginning of the book and more about the woman you interviewed? Yeah, sure. So in the beginning of the book, I tell the story of a woman I call Mary Ann Joseph. And she's pregnant and she's working at a large department store about an hour and a half subway ride from her home. And in her work, the policy as in many places was to post work schedules the Sunday before the work that the work week. So meaning that some Sunday after news, she discovers that she has to work early the next morning, so less than 24 hours of notice. So there's a lot of issues here. Her husband also works early shifts to suddenly she has to engage in all these fun calls, try and find someone to take her two other kids to school. So all of this is really stressful and it's sad. But this last minute notification about her work also means that she might suddenly discover that she's been scheduled to work at a time when she already has a prenatal appointment. So once she discovers this conflict, she has two choices. She could choose to attend prenatal care or she can choose to go to work. If she chooses to attend prenatal care, she has to find someone else to cover her shift. If she can't find someone to cover her shift, she gets a dimaret on her work. And either way, whether she finds someone to cover her shift or not, she induces income for that shift. Maybe income that she's depending on, she might only have four shifts that week. So there's a financial penalty for her for attending prenatal care. Ultimately, she can decide she's going to work her shift and try and reschedule her appointment. But at the safety not hospitals where I did my research, which had large rosters of patients, it's often really difficult to get an appointment the same week that you call. So then you might not get an appointment to the following week or even the week five. But then she runs into the same problem. She doesn't know when she's going to work that week. So maybe she reschedules her appointment and when work schedules are posted, she finds out again that there's a conflict. So this post is a real problem because prenatal care is time-dependent. Let's see, as time-limited, a lot of prenatal care requires tests that have to occur during a particular time period. So you can't keep pushing off care to next week or next month. Or you become like a bad patient or a bad mom, someone who apparently doesn't care enough about their pregnancy to attend prenatal care. So there's a real ongoing conflict here. To mention in the book Procarious Work, please explain this term and the meaning for pregnant women. Sure. And so Procarious work is a term defined by sociologist Arnie Calibur. And he defines it as work that's uncertain, unstable, and insecure, and where employees receive limited benefits or protections from either employees or the government. I'm sorry, either employers or the government. So no wage service work is a perfect example of this precarious work because workers often get their schedules 48 hours, sometimes even less before they have to work. They have often very little flexibility about when they start, when they end. They might have widely varying schedules from week to week, from work eight hours one week and 38 hours the next week. And these jobs usually are ones where there are no employer benefits like paid family leave after you have your baby or paid time to go to, you know, if you're sick, where you need to go to prenatal care. And so, and this is also within the context of the lack of government protection. So as we know, there's no federal law about paid sick leave. And the U.S. is one of the few countries and the only industrialized country that doesn't have any paid maternity leave as well. So for pregnant worker, as pregnant precarious work really brings different kinds of precarity or instability. So there's been a lot of research on economic precarities. So the fact that you're in an unstable job, like a job where you might work eight hours or 40 hours each week makes it really difficult to know how much money you're going to make from week to week and to build a household budget plan for the future. So there's a lot of work on that. And in the last decade or so, researchers have been paying increasing attention to what they call temporal precarity or the fact that these jobs also make it really difficult to predict or plan your time because you don't know when you're going to be scheduled or how many hours you're going to be scheduled. And a lot of these work shows that temporal precarity is actually more associated with employee stress and unhappiness than economic precarity. So that's really interesting. So in terms of its effect on pregnant women, in addition to things like the lack of paid sick leave, lack of maternity leave, temporal precarity makes it really difficult to plan how and when you're going to go into prenatal care and that's kind of the point of this book. And we also know that no income women of color are the ones who are most likely to be working in these jobs. And that these are also the women, particularly not women, who are the most likely to have negatives reproductive outcomes like preterm birth, fetal death, no weight birth. So the suggest that we really should be paying a lot more attention to the problems of temporal precarity and the way that work schedules shape people's ability to get to prenatal care. Now, we're always looking at who's paying for the medical care. We talk about the Affordable Care Act and Medicaid covering many benefits. What about a woman who's undocumented? Does she get coverage? Yeah. So this is so dependent on the state. In terms of federal law, undocumented people are generally in the eligible for health insurance. But in some states, so like New York State as one, undocumented pregnant people are eligible for Medicaid when coverage, when they're pregnant. So they have a special carve out period when they're pregnant from the time that they get them a positive pregnancy test up until 12 months after they that pregnancy ends, whether it ends in a miscarriage or a live birth, they get 12 months from that period. And they can use this time to access prenatal care, postpartum care, take care of other issues, et cetera. And this time was just extended actually in 2023 in New York State. When I was doing my research, undocumented people were only eligible up to 60 days after the end of that pregnancy. But there was mounting evidence that the New York State Department of Health was looking at that 60 days just really wasn't enough. People were not getting the proper postpartum care in 60 days, especially if you have a live birth, it's very exhausting, they weren't getting in to get their contraception, contraceptive appointments, that kind of thing. And so there was a given higher rates of maternal issues, morbidity, for low income people, the decision was made to extend this period of eligibility. And from my perspective, this is a really important benefit. But unfortunately, it is very state dependent. So people would have to look up in their own particular state about within their eligible. Well, let's beg that, tell us about your methods of while doing this research. And how were you able to gain trust among women? Yeah, so as an anthropologist, we place a lot of emphasis in immersive work, so what we, the idea of being present in the place that we're doing, the research to be able to establish relationships with people and to see things that people might not actually think to talk about. So some disciplines, some might just do phone interviews, for example, with pregnant service workers put out flyers, get phone numbers and just pull them for anthropologists. And what I did, I spent a year in a safety net hospital that I called Belmont, and I observed how long people were waiting for prenatal care, their relationships with their health providers, and I interviewed women as they waited for their appointments. And so this was really important, because when I started the research, I thought that I was just going to focus on how work schedules were a problem for pregnant women. But as I spent time in this hospital, both observing and also recruiting women to participate in interviews, I really came to understand that women were caught between two different structures of time. The one was low wage work, which required them to be constantly flexible and available. And the other was the slow pace of safety net hospital care where appointments could take hours. And there was no way of knowing when you might finish the appointment, or whether you could might be late to work. And women were really caught between these two forms of time. And that's something I wouldn't have known. If I hadn't been kind of onsite in the hospital, extracting how long people were waiting there, listening to a woman to plane in the waiting room. And this immersive method, which we call anthropologists called field work, I think was also really important to establishing trust, because many of the women that I talked to came to recognize me, because they saw me month after month, or sometimes weekly, when they came for their appointments. And I also tried to establish myself as someone who is on their side. So I would provide information about policies like the Pregnant Workers Fairness Act, or that were protections that they could draw upon, and providing flyers and offering to follow up with these conversations, whether they agreed to be interviewed. So I think that really helped establish trust. Now you've had a diverse group of people that you study. Tell us about the racial identification of the women. Yeah. So I spoke with 55 women in total, and almost all of us, 52 of those 55 identified as black, the other three identified as Latino or Hispanic. And so this really reflected the demographics of the neighborhood around the safety net hospital, which is a highly, you know, a black and Caribbean area. But as you point out, within that kind of racial category, there was a lot of variation. So only 19 of the women I spoke to were born in the United States. The others were immigrants, and most of them were from the Caribbean, especially Jamaica and Haiti, which again, both reflects the neighborhood, like surrounding the hospital. But it also reflects the fact that in New York City, at least, the people who do the low-wage service work. So the people I was interested in talking with, I predominantly know income women of color and many of those are immigrants. Now give us a description of the income of the women that you studied. Yeah. So one of the things I was interested in was people working on low-wage service work. So I was recruiting women who were making $15 or less. And at the time, the minimum wage in New York City was about $9. So there was kind of a little bit of flexibility. And all of these women were making either minimum wage or near minimum wage. So maybe $10, $11, $12. There's been some big jumps in pace since then. So home health aids, for example, that were making $10 an hour. When I was doing my research, they now make at least $17 an hour. And part of that is because it's just been so much need for their services. But yes, most of all of these people were minimum wage workers or near minimum wage workers. Now you described the women going to work at 7 a.m. It's also about that description. Yeah, I opened one of the chapters with a description of a really typical scene of people going to work, because I think it tells us so much about power, inequality, and the social organization of time. So in this, what drew my field work, I lived in this fairly kind of comfortable middle-class neighborhood in Brooklyn. And I started to notice that around 7 a.m., or even so that's a bit earlier, you could see streams of women, predominantly women of color, emerging from the subway stations around the neighborhood, and heading to their jobs and people's houses as caregivers of young children or elderly people or to staff the local stores. And shortly after these women started emerging, you know, around 8 a.m., you'd start to see a counterflow of mostly white professional people leaving their homes, stopping at coffee stores, and then heading to the subway for their jobs and finance or law offices, etc. And then the evening, the flow reversed, so starting about 5, you'd see all these professional workers come out of the subways, pick up groceries or dry cleaning, and heading home. And only after these professional workers returned and all the kind of local stores closed, could the women who staffed all of these services, so the child care worker, the home health aid, the barista, the grocery cashier, etc., only then could they return home to their own families, often much later into the night, into the night. So this fairly everyday kind of moment, at least every day in many U.S. cities, I think it tells us a lot about how low income individuals and families are forced in order to survive, to structure their time around other, you know, around their employers and more powerful groups and make themselves available till work at times that others might not want to. And that's kind of fundamental to one of the book's arguments about how the time of people with less power and resources is kind of devalued. Now you talk about federal policy in your book, how it entails more about federal policy and how women care for themselves in limited ways. Yeah, so as I mentioned, the United States actually is fairly notorious for having very weak protections for working people, especially compared with other industrialized countries. And this is something that people are often not aware of, that there's only about four countries in the world that don't have paid maternity leave and the United States is one of them. So there really isn't a lot. In terms of pregnancy, the federal government actually did just pass the Pregnant Workers Fairness Act in 2022, and that is a federal law that guarantees reasonable accommodations and time off for prenatal care for pregnant working people. So that's a really important step, but we still don't have any federal law, for example, around paid sick leave or paid family leave as I said. And the only thing we do have in terms of maternity leave or family leave is that federal medical leave that, which was passed in 1993. So a long time ago now, which gives eligible workers an unpaid time to care for sick or dependent family members for up to four months, for about losing their job. But, and there's a huge budget, this is unpaid. So only people who either have significant savings or another earners that can support them can't really take advantage of this for any period of time. And you have to work for at least 12 months at a job where there's at least 50 employees. So there's a very large population of workers who can't take advantage even of this unpaid leave, either for economic issues they kind of fought to or because they just not have to. You talk about working while pregnant and all the conflicts that the people had to navigate, work, pre-near your care, what was your overall finding about this water gauge? Yeah. So I think one of the big takeaways, which of course is not news to any of your listeners who have ever worked in low wage service work, is just how inflexible it can be and how much effort it is for people who work in this huge sector to attend routine care. So I talked about a little bit about the financial penalties that service workers take every time they decide to give up a shift in order to go to prenatal care. And that's really different than the people who have salary jobs where they might be able to take a long lunch break or come to work late to go to prenatal care and they don't lose income as a result of that. But service workers can't just take an hour or two out of a shift, they can't just cause I'm going to be late, they have to call out of their entire shift. So there's this conflict between working prenatal care where they're essentially incurring a financial penalty for attending care, but they also can't miss too many shifts because they risk being fired if they do so. And this choice between either making money or going to prenatal care is a choice that most middle class or professional workers just don't have to make because that's not the way that professional work is structured. And this of course, as I've already mentioned, has implications in terms of prenatal care and reproductive health incomes. So as I've mentioned before, we already know that low income women and women of color have much worse reproductive outcomes than higher income women. And in New York City, maternal mortality rates for black women are 12 times higher than they are for white women. And infant mortality is 3 to 4 times higher. And the US's maternal mortality rate, contrary to most countries where it's decline, has actually increased over the last two decades. So this issue of a really inflexible work environment was driven home to me by one of the women I interviewed. And she was employed on a really physically demanding job in retail, which required her to bend a lot, lift boxes, carry things. And during one of her shifts, she starts to feel contractions. And she's only about six months pregnant. So she asked to go to the ER because her doctor told her that she's at higher risk for pre-temperors. So she should get checked out as she feels contractions. And as supervises, there's no, you're not allowed to go, but her contractions continue. And so she decides to leave work and go get checked out in the emergency. So in the end, the contractions turn out to be Braxton Hicks or what's optical false labor. But the only way you can tell the difference between Braxton Hicks and true labor is that Braxton Hicks contractions gradually subside rather than escalating into a birth. So from her perspective, it was entirely possible that she was in labor. So she was really in a bind, either she left work and she was a bad worker or she stays at work and is a bad patient or bad mom. And as it turned out, even though she grew up a letter from the ER doctor to a supervisor, her supervisor gave her a dimeric for missing work, for leaving work. And the policy at the place was, Edward's place was three dimerits and you're fired. So these are the kind of rigidity that really makes access and care so difficult and that are often invisible to people who don't work in these sectors. In chapter three, you discussed the frustration of both patients and providers because of lack of peer. What type of lack of peer are you described in here? What's happening? Yeah. This is one of the insights that came out of the immersive work and just spending hundreds of hours at the hospital. So safety net hospitals in New York City, like safety net public hospitals in much of the U.S. have been steadily deprioritized for funding over the decades, a lot of funding cuts. And this has resulted in healthcare and working conditions where it's just not great. Computers and equipment don't work reliably so the providers were always talking about the computers that kept crashing. It's uncomfortably hot, but cold depending on the season. And there's too few providers often for the number of patients that are there. So this just sets up a situation where everyone feels frustrated and unpaired for. Patients feel frustrated because they're waiting hours for an appointment that might last only about 10 minutes. And providers feel frustrated because they feel overworked and under time pressure to see lots of patients. So these temporal regimes are the way that time is organized in the clinic. As everybody is annoyed and everybody is frustrated. But what's often hidden when I realized when I was talking to patients as providers is the fact that there are different experiences of time. So patients who are waiting forever and doctors who are rushing around is all created by historic economic system, which has deprioritized funding for these institutions and for the people, the providers who are doing caring for note in comments on your book groups. Now in the conclusion of the book, you asked the question, how do we value care in an unequal society? What were some of the answers you came up with? I guess the short answer is that we don't. That we have really struggled to think about, to even make this care visible, let alone to value it. So there's a long history of undervaluing the caring work that women have traditionally done in the home. And this has been seen as kind of invisible, less important than work that earns money, which is traditionally then the realm of men. And when that undervalued caring work becomes paid work, so when people, when it becomes work for wages like child care workers, home health aids, people who work in nursing homes, it's still undervalued. It is low pay, low status jobs that usually come with very few benefits. So what this means in terms of society is that the very people that we rely to care for us and our loved ones when we are sick or dependent are often the ones that receive least care and value themselves in terms of pay or benefits or even job security. And I think that was something that was made very clear during the pandemic and the national conversation about essential workers who were working so, you know, constantly during the pandemic, and yet had very little job security or pay, pay support. I think the other part of this question about care is what Anne-Marie Slaughter is called the Infrastructure of Care, and we do not have a great infrastructure of care like affordable and universal child care maternity leave flexible job policies for parents. So in other words, or paid sick leave, policies that would allow us to care for ourselves and our loved ones. And so I think that, you know, this has become more on the table recently, these conversations, but I think we still are really, as a society, thinking about how do we value work that doesn't produce much profit but is so essential in creating human relationships and, you know, and caring for people who are vulnerable in our society. Yeah, one message do you want the reader to leave with once they finish your book? Well, I think one of the key points I'd like readers to leave with is how trying structures, social lives, in ways that are often invisible to people with more resources. And so one of the frequent comments I get when I talk about this work is people saying, "Oh, but I had no idea that things were so difficult." But of course, this is because many are talking from a particular position where they protected from these punitive time regimes because they work in professional jobs where they have more flexibility or they have money and resources to, for example, pay a sit-air to pick up their kid when they have a work conflict and they kind of get to school on time or they have private insurance and therefore go to, um, can get health care places where they don't have to wait for hours and hours for care. Um, but for millions of Americans and for people around the world, the kind of time conflicts I write about and the recognition that this is fundamentally about social inequality, I just part of the point. So the second point, so that's one point, I guess, the second point is my real hope for belief that policy and legislation matters and that the protection of time needs to be front and center in our discussion of labor and reproductive rights and that this is really different from now than in the past. So our labor laws are really still based on the kinds of work problems that were happening in the 1930s, so they focus still on things like protecting people from overwork. But now the problems aren't generally about overwork. The problems of the current labor situation is under employment, precarious scheduling and unstable work and we need policy to address that. So we've seen, as I've said, we've seen some movement on this, we've seen the Pregnant Workers Fairness Act, some cities and states have recently passed the Fair Work Week Act, which mandates that employers provide fair notice of scheduling changes to their employees or pay their employees a penalty, and it's still too early at this point to say how extensive the impact of these will be in protecting workers of promoting health, but it's also really clear that low wage employers are not doing this of their own. We need policy to encourage or force employees to do this. So I guess what I'd like Raiders to think about is that we need to make the protection of time a central part in our agenda for social justice and equality, and that actually this benefits everybody. If we have policy protecting people's time, it's not just low income folks that benefit, but everybody does. Well, I'm taking up enough of your time. Can you tell us the next project you're working on? Well, after 20 years or more of working on issues around reproductive health, I'm actually going to switch gears for a little time. So like many people during the pandemic, I became fascinated with the issue of smell, and particularly people's reports about how distressing it was to lose their sense of smell, which was a sense that I hadn't really paid much attention to. And so as a medical anthropologist, I'm really interested in thinking about how people experience this, and access to health care, so I'm at the very, just at the very beginning of thinking about smell and people's experience of physical emotional health when they do sense of smell. But if any of your listeners want to talk to me, have lost this sense of smell, not necessarily due to COVID, but they want to talk to me, I would love to hear from them. And they can reach me through my website at www.anisabiet.com. Now we look forward to that new project, again, within talking with Elise Andrea, the author of Pregnant Edwork, The Wage Workers Power and Temporal Ingestives. Thank you so much for having me.