Part 1: Corporate America's Divided Reproductive Health Landscape
On the night shift at the XPO Logistics warehouse in Memphis, Erica Haynes ran to the bathroom to find her pants drenched in blood. 1 She had miscarried while in the second trimester of her pregnancy – and she wasn’t alone. 2 That same year, three other XPO employees had miscarried, and many more would follow. 3
Their miscarriages were not a coincidence, but the result of XPO’s inflexible work policies for pregnant employees. 4 All of the women 5 had requested lighter work shifts, and none had gotten them. 6 Instead, they were left to hoist 45-pound boxes for up to 12 hours a day, with few breaks and no air conditioning. 7 When one woman asked to leave early after the lifting became too painful, her supervisor told her to get an abortion. 8 Instead, she miscarried the next day. 9
Had these women been able to carry their pregnancies to term, they would have continued to face inflexibility in the workplace. Only 8% of those in the bottom quarter of wage earners have access to flexible work schedules, 10 and just 30% can earn sick days. 11 Low-wage workers are also the least likely to have employer-provided health insurance, 12 and their plans often come with the highest deductibles and premiums. 13 Once these employees do have children, they rarely, if ever, get paid time off, as 93% of low-wage workers have zero access to paid parental leave. 14
Further, many low-wage workers are effectively unable to leave their jobs. At XPO, countless women expressed a financial need to maintain their employment, particularly once they became pregnant. 15 And in Memphis, warehouses provide some of the highest-paying jobs for those without college degrees – and XPO runs them all. 16
If employees do leave these jobs, they can face immense financial repercussions. They frequently don’t get access to unemployment insurance, as they are thought to have “voluntarily quit.” 17 Loss of one’s job often leads to loss of health insurance, too, forcing pregnant employees to shoulder their own labor and delivery costs – which can reach up to $30,000 for a vaginal birth and $50,000 for a C-section 18 – if they don’t qualify for Medicaid. 19
This puts employees in a catch-22 of reproductive decision-making: risk your pregnancy to make a living, or risk your livelihood to have a baby.
In contrast, workers in high-paid, white-collar settings – like XPO’s corporate headquarters in Greenwich, Connecticut – have an array of employer-provided support. White-collar employers are well known for providing generous salaries and health benefits. But more recently, an increasing number of technology companies, consulting firms, investment banks, and other corporate employers have also begun offering a growing suite of reproductive healthcare coverage to help employees choose if, when, and how to have children. 20
These companies offer support at practically every stage of the reproductive process. For employees not yet looking to become pregnant, firms ensure coverage of contraceptive services – like birth control pills, IUDs, and abortion – and will even pay for egg freezing, where a single cycle can cost as much as $20,000. 21 For those struggling with infertility, employers will cover in vitro fertilization (IVF), which costs at least $12,000 a cycle, letting employees rack up six-figure bills until they succeed. 22 There’s coverage for adoption and surrogacy support, too. 23 And, once employees have children, they can get up to six months of paid parental leave to tack on to their already generous allotment of sick leave and vacation days.
In fact, XPO itself brags about having a fertility policy that is “among the most progressive in the industry.” 24 They offer six weeks of paid parental leave, ten days of paid prenatal leave that can be used following the loss of a pregnancy, and job-related flexibility and alternate work arrangements. 25 XPO even grants access to a digital health startup called Maven Clinic, which allows employees to consult with health practitioners across 20 specialties, including fertility, infant sleep, lactation, nutrition, and mental health. 26
However, these benefits apply to less than half of XPO’s workforce – mainly those concentrated in its corporate headquarters – and not to independent contractors, like Erica Haynes and her fellow warehouse workers in Memphis. 27 This illuminates the stark divide in reproductive options for low- and high-wage workers in corporate America, even within a single company.
Part 3: Employee Well-Being As a Mask for Corporate Power
While employees may seem like the primary beneficiaries of reproductive health offerings, these programs are actually designed with shareholders in mind. In fact, reproductive health policies for both low- and high-wage workers directly benefit corporations’ bottom lines.
At the low-wage level, failure to provide suitable healthcare and reproductive benefits is clearly a money-saving tool. Healthcare is a major expenditure for companies, as they typically foot the bill for 70-80% of employees’ coverage. 53 In 2019, this amounted to an average of $5,946 a year for individual employees and $14,561 a year for family plans. 54 Additionally, providing sparse work environments, low wages, and no paid time off are clear cost-cutting strategies – and likely helped XPO secure its spot as the decade’s seventh best-performing stock among the Fortune 500.
Yet, even policies that promote high-wage employees’ well-being are crafted to help a company’s bottom line. Extensive health coverage, paid time off, and IVF stipends provide a number of benefits to corporations.
For one thing, reproductive health benefits have been proven to help companies attract top talent. Women currently comprise more than half of America’s jobholders, with a total of 76 million women in the U.S. workforce. 55 Women’s labor is 40% of annual U.S. gross domestic product, totaling $7.6 trillion. 56 And numerous studies have shown that women are good for business, as gender diversity in the workplace leads to greater profitability. 57 Yet, as Hidden Value explains, “Women’s ability to manage and plan for having children is directly linked to their ability to participate in the labor force.” 58
For example, in the years following the legalization of the birth control pill, contraception accounted for 15% of total labor force growth and 30% of labor force growth in professional careers. 59 Contraception was so important to business that Bloomberg Businessweek listed it as the ninth most disruptive innovation in history, ranking above Amazon, McDonalds, and email for its impact on the corporate world. 60
Providing generous reproductive health coverage can bring more women to the table. PricewaterhouseCoopers found that women consider health benefits as much as salary when deciding where to work, and 83% of women of reproductive age expect employers to cover a full range of reproductive healthcare. 61 This trend is only likely to increase, as 90% of millennials consider reproductive health to be an important personal issue. 62 Additionally, many job seekers are focused on fertility benefits in particular. According to a study by Reproductive Medicine Associates, 68% of employees said they would switch jobs in order to procure better fertility coverage. 63
These benefits can also help retain talent. Comprehensive reproductive health services are directly correlated with enhanced mental and physical health, which can improve employee performance. 64 86% of women cite that control of if and when to became a parent has been important to their career trajectory. 65 And, according to FertilityIQ, employees with IVF coverage were more likely to remain in their jobs for longer periods, more willing to overlook their employers’ shortcomings, and more likely to work harder. 66
Women commonly change their perspectives on their employers after learning they have generous reproductive health benefits. As one woman shared with Good Morning America,
“Finding out that my company and what they offered was so much better than their competitors out there made a difference and made me stay with the company. . . . It’s obviously a company that cares about their employees.” 67
Similarly, another expressed,
“It’s changed my appreciation for a company that makes the choice to offer this, because there’s not really any gain for them, and maybe there will be younger women who come up under me who will benefit. . . . It made me take a step back and realize the type of people I work for.” 68
The financial tradeoffs of these policies are also quite small. While many reproductive health services are cost-prohibitive for employees, they are a drop in the bucket for large corporations. As one Fortune 100 executive explains, “We spend almost $1 billion on healthcare annually.” 69 This makes adding comprehensive reproductive healthcare “a negligible cost.” 70 Studies have shown that covering contraceptives and IVF is surprisingly cheap. 71 The cost of adding contraception to health plans ranges from $0.4–$0.66 per health plan member per month – less than 1% of total health plan costs. 72 In fact, covering contraceptives actually yielded 15-17% cost savings for employers who would have otherwise had to cover medical costs of unintended pregnancies. 73 Similarly, early studies have shown that adding IVF coverage would increase monthly premiums by as little as $0.87. 74 And, though IVF is more expensive than contraception, fewer employees are likely to make use of it 75 76 – while 99% of women use contraception at some point in their lives, only 11% face infertility. 77
In contrast, employee turnover is extremely expensive. The Work Institute estimates that the cost of replacing a departing employee – including recruiting, training, and productivity loss – is roughly 33% of that employee’s annual salary. 78 And, at elite, high-paying corporations, this can easily amount to six figures. Therefore, when you add it all together, reproductive health benefits are not merely intended to promote employee well-being: they’re actually just good business.
Reproductive health coverage offers benefits beyond talent attraction and retention, too. In particular, subsidizing technologies that facilitate delayed parenthood, like egg freezing and IVF, gives employers an added level of control over their employees’ reproductive decision-making. Technologies that enable women to procreate at later dates allow them to stay in the workforce during their prime reproductive years, when corporations need them most. At law firms and consulting companies, these years typically coincide with the push to make partner – a point at which employees are expected to prove their unwavering commitment to the job.
These policies, though masked by an illusion of choice, simply replicate the reproductive inflexibility seen at XPO’s warehouses. As NBC explains, “egg-freezing coverage could be viewed as a ploy to entice women to sell their souls to their employer, sacrificing childbearing years for the promise of promotion.” 79 Similarly, when Facebook and Apple first announced their egg freezing coverage, a Silicon Valley blog described these stipends as a “lavish amenity designed to keep workers in the office and fixated on the job. . . . [F]emale employees will feel pressured to freeze their eggs rather than take time out to have children, just like everyone feels pressured to always be on call to the office, always check email, always have a smartphone in hand.” 80
But this expectation that employees sacrifice reproductive freedom in the name of job loyalty is unique to women:
“In its darkest reading, company-sponsored egg freezing is a pact or pledge of loyalty by which you assert the primacy of work over other areas of your life. The job comes first and I’ll put my ova on ice to prove that. What’s next? Voluntary vasectomies for entry-level male employees that they can have reversed once they’ve hit the six-figure earning threshold or reached age 40, whatever comes first? Something tells me that policy wouldn’t be greeted with quite the same level of enthusiasm.” 81
These gender-based critiques reveal larger issues with the corporate form. As we have already seen, reproductive health programs can benefit a company’s bottom line in a number of ways. But moving beyond that, they also serve an important virtue signaling role. Benefits programs are a relatively cheap and easy way for corporations to signal support for female employees, without making larger structural shifts that would actually make that support a reality.
While reproductive freedom in the workplace is no doubt a positive development, benefits programs will not fix greater structural inequities that run rampant in the corporate world. As it currently stands, “[w]hether women work at Walmart or on Wall Street, getting pregnant is often the moment they are knocked off the professional ladder.” 82 Reproductive health policies “simply timeshift the period when women exit the workforce for child bearing to later in their working life….[They don’t] address workplace harassment, gender discrimination or lack of access to workplace mentors and champions,…[and they won’t] solve the problem of equal opportunities for advancement and career achievement for men and women.” 83
These programs, then, are simply a mask for shareholder primacy, allowing corporations to continue to pursue profit under the guise of employee well-being. In this pursuit, corporations will capture anything and everything that benefits their bottom lines – even biology itself. As a salient critique of Sheryl Sandberg’s Lean In illuminates,
“Pregnancy, by virtue of the body’s physical focus on human reproduction, is humanity’s last, biological stand against the corporate demand for workers’ continuous labor….[but] pregnancy must be converted into a corporate opportunity: a moment to convince a woman to commit further to her job. Human life as a competitor to work is the threat here, and it must be captured for corporate use.” 84