Journal of Genetic Counseling, Vol. 3, No. 2, 1994
Book Review
Reproductive Hazards in the Workplace: Mending Jobs, Managing Pregnancies. By Regina Kenen. Harrington Park Press, New York; Norwood, London, 1993
I approach occupational teratogen counseling with a mix of dread and frustration. Let's face it---virtually nothing is known about the reproductive risks of most workplace exposures. And I can't pronounce half the chemicals used in the dry cleaning industry, let alone know what the chemicals are used for or understand the nature of worker exposures. How can one counsel properly under such conditions? Despite our limitations, people are still going to seek information about the pregnancy risks of job exposures. Regina Kenen's book Reproductive Hazards in the Workplace is written for women (with a nod toward men) seeking to gather more knowledge about the reproductive risks of their working environments. Dr. Kenen is a professor of Sociology at Trenton State College in New Jersey and Co-chair of the Occupational and Environmental Health Committee of the National Women's Health Networks. The book is divided into three parts. Part I briefly summarizes the hazardous working conditions faced by women since the Industrial Revolution, followed by a basic biology section which reviews the potential reproductive hazards of the workplace. Part II contains information about the reproductive risks faced by selected sectors of the workforce. Part III discusses the ways scientists assess the reproductive hazards of environmental exposures, followed by recommendations for workers to take a proactive role in making their workplaces safer. Dr. Kenen writes in a clear style that sophisticated patients will find readable. She is an advocate for "protecting all women's occupational health and safety," and her pro-worker stance is made clear throughout the book. In particular, the last chapter reads like a 1960's tract on making the powers-that-be listen to worker demands, closing with a section called "We Shall Overcome." 161 1059-7700D410600--0161507.00/1 © 1994 National Society of Genetic Counselors, Inc.
162
Book Review
To help workers in their quest for a safer work environment, the author provides a 36-page listing of government agencies and resource organizations which provide information about reproductive hazards, employee rights, and implementing changes in the workplace. Dr. Kenen recommends genetic counseling to help couples answer questions, and includes a two-page list of teratogen hotlines, which should keep our phones ringing with questions related to occupational exposures. Although Dr. Kenen's recommendations for workplace improvement are commendable, I suspect that many pregnant women will not be able to follow some of those paths. Nausea, tiredness, job demands, family responsibilities, and the limited duration of pregnancy all interfere with achieving change in a timely fashion. I'm not sure how many pregnant women have the time and energy to get their unions to negotiate new contracts, have state legislatures pass new laws, or to become barefoot epidemiologist. Hopefully, Dr. Kenen's message will fall on the ears of individuals who are in a better position to bring about major improvements in reproductive safety. From a technical standpoint, I found the book's medical information bordering on inaccurate in some places. For example, Dr. Kenen states that the incidence of birth defects has doubled in the last 25 years (p. 4), an increase which snuck right past me. Also she states that workplace exposures "may be responsible for at least part of the association between advancing paternal age and Down's syndrome" (p. 56). And I winced when I read anencephaly described as "a pinhead size brain," or that MS-AFP, ultrasound and amniocentesis "should pick up structural defects that might be due to workplace exposure to chemical substances, radiation and infections" (p. 58). While the book is intended to reassure women, the tone of the book was sometimes unnecessarily alarmist or inflammatory. Thus, despite a discussion about the uncertainty of linkages between exposures and birth defects, a table in Chapter VI lists substances "thought to cause adverse reproductive health effects." However, the phrase "thought to be" in misleading because an agent is listed as potentially dangerous if at least one study in humans showed this effect. If you read enough scientific journals you can find one study that shows almost any exposure during pregnancy might have an adverse reproductive effect. Other examples of inflammatory or misleading statements occur throughout the text. For example, the author states "Protecting Arab oil is apparently a higher priority than protecting America's families" (p. 23). This may or may not be true, but the statement adds nothing to the book. Further, the case for a link between particular exposures and birth defects is sometimes overstated, such as "some researchers think that severe inter-
Book Renew
163
personal tensions may affect the development of the fetus, leading to physical defects, neurological impairment . . ." (p. 89). While some researchers may think this, the evidence to support a link between interpersonal tensions and birth defects is tenuous at best. Dr. Kenen's book is geared toward the general public, though genetic counselors may find the resource list helpful. Publications which may be of more interest to genetic counselors include Robert Blank's Fetal Protection in the Workplace: Women's Rights, Business Interests, and The Unborn (Columbia University Press, New York, 1993), Zalstein and Koren's Occupational Exposure To Chemicals in Pregnancy. Maternal-Fetal Toxicology: A Clinician's Guide (Marcel Dekker, New York, 1990), and the February 1993 issue of Seminars in Perinatology (Vol. 17, No. 1). In summary, Dr. Kenen's book is laudable for making suggestions for creating a workplace that provides minimal risks to reproductive health and offering strategies to help workers achieve this goal. The resources provided were more comprehensive than any list I can remember. However, readers should be cautioned that the accuracy and tone of some of the medical and technical information may itself cause unnecessary alarm among pregnant women or people thinking about having a baby.
Robert G. Resta Division of Perinatal Medicine Swedish Medical Center Seattle P.O. Box 14999 Seattle, Washington 98114-0999.
