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CODE OF GOOD PRACTICE ON PREGNANCY AND AFTERBIRTH
1.
Introduction
1.1 Many women
work during pregnancy and many return to work while they are still
breast-feeding.
1.2 The objective of this code is to provide guidelines for employers and
employees concerning the protection of the health of women against
potential hazards in their work environment during pregnancy, after the
birth of a child and while breast-feeding.
2.
Application of the code
2.1 This code is
issued in terms of section 87(1)(b) of the Basic Conditions of
Employment Act (BCEA) 75 of 1997.
2.2 It is intended to guide all employers and employees concerning the
application of section 26(1) of the BCEA which prohibits employers from
requiring or permitting pregnant- or breast-feeding employees to perform
work that is hazardous to the health of the employee or that of her
child.
2.3 Workplaces may be affected differently depending upon the type of
business and sector they are engaged in and the physical, chemical and
biological hazards to which employees may be exposed in the workplace.
2.4 The norms established by this code are general and may not be
appropriate for all workplaces. A departure from the code may be
justified in the proper circumstances. For example, the number of
employees employed in an establishment may warrant a different approach.
3. Contents
3.1This code:
sets out the legal requirements relevant to the protection of the health
and safety of pregnant and breast-feeding employees;
3.2 sets out a method for assessing and controlling the risks to the
health and safety of pregnant and breast-feeding employees;
3.3 lists the principal physical, ergonomic, chemical and biological
hazards to the health and safety of pregnant and breast-feeding
employees and recommends steps to prevent or control these risks. These
are listed in Schedules One to Four, which are included for guidance and
are not exhaustive.
4. Legal
Requirements
4.1The
Constitution protects the right to bodily and psychological integrity,
which includes the right to make decisions concerning reproduction
[section 12(2)] and gives every person the right to health services,
including reproductive health care [section 27(1)(a).
4.2 No person may be discriminated against or dismissed on account of
pregnancy. The relevant provisions establishing this right are section
9(3) and (4) of the Constitution; section 187(1) of the Labour Relations
Act 66 of 1995 and section 6 of the Employment Equity Act of 1998.
4.3 Employers are required to provide and maintain a work environment that
is safe and without risk to the health of employees. This includes risks
to the reproductive health of employees. These duties are established in
terms of both the Occupational Health and Safety Act (OHSA) 85 of 1993
and the Mine Health and Safety Act (MHSA) 27 0f 1996. Key aspects of
these Acts are –
4.3.1 employers
must conduct a risk assessment, which involves identifying hazards,
assessing the risk that they pose to the health and safety of employees
and recording the results of the risk assessment.
4.3.2 employers must implement appropriate measures to eliminate or
control hazards identified in the risk assessment;
4.3.3 employers must supply employees with information about and train
them in the risks to their health and safety and the measures taken to
eliminate or minimise them;
4.3.4 elected worker health and safety representatives and committees are
entitled to participate in the risk assessment and control of hazards;
4.3.5 employees have a duty to take reasonable steps to protect their own
health and safety and that of other employees.
5. Protecting the health of pregnant and breast – feeding employees
5.1 Section 26(1) of the BCEA prohibits employers from requiring or
permitting a pregnant employee or an employee who is breast-feeding to
perform work that is hazardous to the health of the employee or the
health of her child. This requires employers who employ women of
childbearing age to assess and control risks to the health of pregnant
or breast-feeding employees and that of the foetus or child.
5.2 Employers should identify, record and regularly review –
5.2.1 potential
risks to pregnant or breast-feeding employees within the workplace;
5.2.2 protective measures and adjustments to working arrangements for
pregnant or breast-feeding employees.
5.3 Where
appropriate, employers should also maintain a list of employment
positions not involving risk to which pregnant or breast-feeding
employees could be transferred.2
2. In terms of section 26(2) of the BCEA an employer must offer suitable
alternative employment to an employee during pregnancy if her work poses
a danger to her health or safety or that of her child or if the employee
is engaged in night work (between 18:00 and 06:00, unless it is not
practicable to do so. Alternative employment must be on terms that are
no less favourable than the employee's ordinary terms and conditions of
employment.
5.4 employers should inform employees about hazards to pregnant and breast
feeding employees and of the importance of immediate notification of
pregnancy.
5.5 Workplace policies should encourage women employees to inform
employers of their pregnancy as early as possible to ensure that the
employer is able to identify and assess risks and take appropriate
preventive measures.
5.6 The employer should keep a record of every notification of pregnancy.
5.7 When an employee notifies an employer that she is pregnant her
situation in the workplace should be evaluated. The evaluation should
include -
5.7.1 an
examination of the employee's physical condition by a qualified medical
professional;
5.7.2the employee's job,
5.7.3workplace practices and potential workplace exposures that may affect
the employee.
5.8 If the
evaluation reveals that there is a risk to the health or safety of the
pregnant employee or the foetus, the employer must –
5.8.1 inform the
employee of the risk;
5.8.2 after consulting the employee and her representative, if any,
determine what steps should be taken to prevent the exposure of the
employee to the risk by adjusting the employee's working conditions.
5.9 The employee
should be given appropriate training in the hazards and the preventive
measures taken.
5.10 If there is any uncertainty or concern about whether an employee's
workstation or working conditions should be adjusted, it may be
appropriate in certain circumstances to consult an occupational health
practitioner. If appropriate adjustments cannot be made, the employee
should be transferred to an alternative position in accordance with
section 26(2) of the BCEA.
5.11 Employers must keep the risk assessment for expectant or new mothers
under regular review. The possibility of damage to the health of the
foetus may vary during the different stages of pregnancy. There are also
different risks to consider for workers who are breast-feeding.
5.12 Arrangements should be made for pregnant and breast-feeding employees
to be able to attend antenatal and postnatal clinics as required during
pregnancy and after birth.
5.13 Arrangements should be made for employees who are breast-feeding to
have breaks of 30 minutes twice per day for breast-feeding or expressing
milk each working day for the first six months of the child's life.
5.14 Where there is an occupational health service at a workplace,
appropriate records should be kept of pregnancies and the outcome of
pregnancies, including any complications in the condition of the
employee or child.
6. The identification and assessment of Hazards
6.1 Physical
hazards
The control of physical hazards in the workplace includes the recognition,
evaluation and control of
6.1.1 exposure
to noise, vibration, radiation, electric and electromagnetic fields and
radioactive substances;
6.1.2 work in extreme environments;
6.1.3 control of the thermal environment (heating and air conditioning).
Schedule One describes the extent to which certain of these physical
agents may constitute a hazard to the health and safety of pregnant and
breast-feeding employees and suggests methods to prevent or control
these hazards.
6.2 Ergonomic
hazards
The application of ergonomics involves ensuring that work systems are
designed to meet the employee's needs for health, safety and comfort. A
range of ergonomic risk factors may pose hazards to the health and
safety of pregnant and breast-feeding employees and should be identified
and assessed as part of the risk assessment programme. These include -
6.2.1 heavy
physical work;
6.2.2 static work posture;
6.2.3 frequent bending and twisting;
6.2.4 lifting heavy objects and movements requiring force;
6.2.5 repetitive work;
6.2.6 awkward postures;
6.2.7 no rest;
6.2.8 standing for long periods;
6.2.9 sitting for long periods.
Schedule Two
describes the extent to which some of these factors may constitute a
hazard to the health and safety of pregnant and breast-feeding employees
and suggests methods to prevent or control these hazards.
6.3 Chemical
hazards
Contact with harmful chemical substances may cause infertility and foetal
abnormalities. Some chemicals can be passed to the baby during breast
feeding and could possibly impair the health and the development of the
child.
The Hazardous Chemical Substances Regulations, 1995, issued under OHSA
apply to all employers who carry out activities, which may expose people
to hazardous chemical substances. These employers must assess the
potential exposure of employees to any hazardous chemical substance and
take appropriate preventive steps. The Regulations set maximum exposure
levels for some 700 hazardous chemical substances.
The Hazardous Chemical Substances Regulations require employers to inform
and train employees about, and in any substance to which they are or may
be exposed. This must include information on any potential detrimental
effect on the reproductive ability of male or female employees.
Regulation 7(1) of the General Administrative Regulations, 1996, under
OHSA requires manufacturers, importers, sellers and suppliers of
hazardous chemical substances used at work to supply a Material Safety
Data Sheet (MSDS) which must include information on any reproductive
hazards. Every employer who uses a hazardous chemical substance must be
in possession of the relevant MSDS and must make it available on request
to affected persons.
With the exception of the Lead Regulations, there are no regulations,
which set maximum exposure levels of specific applications for women of
childbearing age or pregnant women.3 In view of the absence of
occupational health standards for the exposure of pregnant or
breast-feeding women to chemical substances, care should be taken to
minimise exposure to chemicals, which can be inhaled, swallowed or
absorbed through the skin. Where this cannot be achieved, employees
should be transferred to other work in accordance with section 26(2) of
the BCEA.
3 European
Council Directive 92/32/EEC classifies some 200 substances and
preparations as falling into one of the following categories:
• possible risks
of irreversible effects (R40)
• may cause cancer (R45)
• may cause heritable genetic damage (R46)
• may cause harm to the unborn child (R61)
• possible risk of harm to the unborn child (R63)
• may cause harm to breasted babies (R64)
The actual risk
to health of these substances can only be determined following a risk
assessment of a substance at a place of work, i.e. although the
substances listed may have the potential to endanger health or safety,
there may be no risk in practice. For example, if exposure is below the
level that might cause harm.
Chemical substances that are known or suspected to constitute a hazard to
pregnant or breast-feeding women and to the foetus or child are listed
in Schedule Three below.
6.4 Biological hazards
Many biological agents, such as bacteria and viruses, can affect the
unborn child if the mother is infected during pregnancy. Biological
agents may also be transferred through breast-feeding or by direct
physical contact between mother and baby. Health workers, including
service workers in health-care facilities and workers looking after
animals or dealing with animal products are more likely to be exposed to
infection than other workers. Employees who have close contact with
young children, such as teachers and ecu-care workers, are at increased
risk of exposure to rubella (German measles) and varicella (chicken
pox).
Universal hygiene precautions are required to prevent disease. These
include high standards of personal hygiene, surveillance of staff in
high-risk areas, appropriate sterilisation and disinfecting procedures,
designation of person to be responsible for health and safety, the use
of protective clothing and gloves and the avoidance of eating or smoking
in laboratories or other risk areas.
Some of the biological agents that are known to constitute a hazard to the
health of breast-feeding or pregnant women are listed in Schedule Four.
7. Aspects of Pregnancy that may affect work
Employers and
employees should be aware of the following common aspects of pregnancy
that may affect work:
7.1 As a result of morning sickness employees may be unable to perform
early shift work. Exposure to nauseating smells may also aggravate
morning sickness.
7.2 Backache and varicose veins may result from work involving prolonged
standing or sitting. Backache may also result from work involving manual
handling.
7.3 More frequent visits to the toilet will require reasonable access to
toilet facilities and consideration of the employee's position if
leaving the work she performs unattended poses difficulties.
7.4 The employee's increasing size and discomfort may require changes of
protective clothing, changes to work in confined spaces and changes to
her work where manual handling is involved. Her increasing size may also
impair dexterity, agility, co-ordination, speed of movement and reach.
7.5 The employee's balance may be affected making work on slippery or wet
surfaces difficult.
7.6 Tiredness associated with pregnancy may affect the employee's ability
to work overtime and to perform evening work. The employer may have to
consider granting rest periods.
SCHEDULE ONE
PHYSICAL HAZARDS
HAZARD:
Vibration and mechanical shocks
WHAT IS THE RISK:
Long-term exposure to vibrations may increase the risk of miscarriage and
stillbirth. Exposure to shocks or whole body vibrations in the later
stages of pregnancy can result in premature labour
HOW TO AVOID THE RISK:
It is advised that pregnant workers and those that have recently given
birth avoid work that is likely to involve uncomfortable, whole body
vibrations, especially at low frequencies, or where the abdomen is
exposed to shocks or jolts.
HAZARD:
Extreme heat
WHAT IS THE RISK:
The exposure of pregnant and breast-feeding employees to extreme heat may
lead to dizziness and faintness, particularly in the case of women
performing standing work. Lactation may be impaired by heat dehydration.
HOW TO AVOID THE RISK:
Employers should limit the exposure of pregnant and breast-feeding workers
to extreme heat. Arrangements for access to rest facilities and
refreshments should be made in conditions of extreme heat.
HAZARD:
Extreme cold
WHAT IS THE RISK:
Work in extremely cold conditions such as cold storage rooms has been
associated with problems in pregnancy.
HOW TO AVOID THE RISK:
Employees must be supplied with thermal protective clothing and their
exposure to cold limited in terms of regulation 2 of the Environmental
Regulations for Workplaces, made under the Occupational Health and
Safety Act (OHSA).
HAZARD:
Noise
WHAT IS THE RISK:
Prolonged exposure to noise can elevate the blood pressure of pregnant
women and lead to tiredness.
HOW TO AVOID THE RISK:
Employers should ensure compliance with regulation 7 of the Environmental
Regulations for Workplaces, OHSA.
HAZARD:
Ionising radiation
WHAT IS THE RISK:
Significant exposure to ionising radiation is known to be harmful to the
foetus. Working with radioactive liquids or dusts can result in exposure
of the foetus (through ingestion or via contamination of the mother's
skin) or a breast-fed baby to ionising radiation.
HOW TO AVOID THE RISK:
Work procedures should be designed to keep exposure of pregnant women as
low as reasonably practicable and below the statutory dose limit for a
pregnant woman.
Pregnant women or breast-feeding mothers should not work where there is a
risk of radioactive contamination.
Employers of registered radiation workers, including radiographers, must
comply with the regulations controlling the use of electronic products
issued under the Nuclear Energy Act 131 of 1993.
HAZARD:
Non-ionising (electromagnetic) radiation
WHAT IS THE RISK:
It has not been established that the levels of non-ionising
electromagnetic radiation likely to be generated by video display units
(VDU's) or other office equipment constitutes a risk to human
reproductive health.
HOW TO AVOID THE RISK:
Women who are pregnant or who are planning children and are worried about
working with VDU's should discuss their concerns with an occupational
health practitioner.
The following practical measures can be adopted to limit exposure to
electromagnetic fields in offices (emfs):
- Workers should sit at arm's length from the computer (70cm) and about
120cm from the backs and sides of co-workers ' monitors.
- Workers should have regular breaks from VDU work, as this reduces
exposure time.
- Radiation-reducing glare screens (or shields) can reduce the electrical
component of the emfs. However, shields that distort the image on the
monitor should not be used.
HAZARD:
Work in compressed air and diving
WHAT IS THE RISK:
People who work in compressed air are at risk of developing the bends. It
is not clear whether pregnant women are more at risk of getting the
bends but potentially the foetus could be seriously harmed by gas
bubbles.
HOW TO AVOID THE RISK:
Pregnant workers should not work in compressed air because of potential
harm to (he foetus from gas bubbles. For those who have recently given
birth there is a small increase in the risk of the bends. The Diving
Regulations, 1991, under OHSA, must be complied with.
SCHEDULE TWO
ERGONOMIC HAZARDS
HAZARD:
Physical and mental strain
WHAT IS THE RISK:
Excessive physical or mental pressure may cause stress and give rise to
anxiety and raised blood pressure during pregnancy.
HOW TO AVOID THE RISK:
Employers should ensure that hours of work and the volume and pacing of
work are not excessive and that, where practical, employees have some
measure of control over how their work is organised. Seating should be
available where appropriate. Longer or more frequent rest breaks will
help to avoid or reduce fatigue.
HAZARD:
Physically strenuous work
WHAT IS THE RISK:
Employees whose work is physically strenuous should be considered to be at
increased risk of injury when pregnant or after the birth of a child.
HOW TO AVOID THE RISK:
Heavy physical exertion, including the lifting or handling of heavy loads,
should be avoided from early pregnancy onwards.
HAZARD:
Prolonged sitting or standing
WHAT IS THE RISK:
Sitting or standing for long periods during pregnancy can have serious
health consequences. Standing for long unbroken periods can result in
complications during pregnancy such as deep vein thrombosis, varicose
veins, premature labour and even miscarriage.
HOW TO AVOID THE RISK:
Workstations should be adjustable to allow for necessary changes in
posture. Pregnant employees who sit for long periods should be provided
with a proper chair with lumbar support rest to prevent lower back pain.
A footrest could alleviate pain and discomfort in the case of both
sitting and standing workers.
Pregnant employees who work in a stationary position should be given
frequent rest breaks. Mobility during breaks should be encouraged to
help prevent swelling of the ankles and improve blood circulation.
Where work organisation permits task rotation, this should be done to
allow the worker to do tasks that involve standing, sitting and moving.
SCHEDULE THREE
CHEMICAL HAZARDS
HAZARD:
Anaesthetic gases
WHAT IS THE RISK:
Exposure to anaesthetic gases during pregnancy can lead to miscarriage.
HOW TO AVOID THE RISK:
Exposure to high concentrations of anaesthetic gases should be avoided
during pregnancy.
HAZARD:
Carbon monoxide
WHAT IS THE RISK:
Risks arise when engines or appliances using petrol, diesel and liquefied
petroleum gas are operated in enclosed areas. Carbon monoxide can result
in the foetus being starved of oxygen.
HOW TO AVOID THE RISK:
Occupational exposure to carbon monoxide should be avoided during
pregnancy and breast-feeding.
HAZARD:
Antimitotic (Cytotoxic) drugs
WHAT IS THE RISK:
Exposure to antimitotic drugs, which are used for treating cancer, damages
genetic information in human sperm and egg cells. Some of these drugs
can cause cancer. Absorption is by inhalation or through the skin.
HOW TO AVOID THE RISK:
Workers involved in the preparation and administration of antimitotic
drugs should be afforded maximum protection. Direct skin contact can be
avoided by wearing suitable gloves and gowns. Pregnant employees
potentially exposed to cancer drugs should be offered the option of
transfer to other duties.
HAZARD:
Ethylene oxide
WHAT IS THE RISK:
Ethylene oxide is used mainly in sterilising procedures in hospital.
Exposure may occur when sterilised goods are transferred to the aerator
after the cycle is complete and when changing the gas tanks.
HOW TO AVOID THE RISK:
Health risks can be minimised by reducing worker exposure during transfer
when the steriliser door is opened Pregnant employees exposed to
ethylene oxide above the acceptable level should be transferred to other
duties.
HAZARD:
Lead
WHAT IS THE RISK:
Exposure of pregnant and breast-feeding employees to lead affects the
nervous system of young children and is detrimental to child
development.
HOW TO AVOID THE RISK:
Contact with lead should be avoided during pregnancy and breast-feeding.
The Lead Regulations issued under OHSA must be complied with. These
Regulations specify levels at which employees must be withdrawn from
exposure to lead.
HAZARD:
Mercury and mercury derivatives
WHAT IS THE RISK:
Organic and inorganic mercury compounds can have adverse effects on the
mother and foetus.
HOW TO AVOID THE RISK:
Women of childbearing age should not be exposed to mercury compounds.
HAZARD:
Polychlorinated Biphenyls (PCBs)
WHAT IS THE RISK:
PCBs can cause deformities in the child. Maternal exposure before
conception can also affect foetal development as PCBs
HOW TO AVOID THE RISK:
No pregnant women should be exposed to PCBs at work.
HAZARD: Organic solvents
WHAT IS THE RISK:
Exposure to organic solvents including aliphatic hydrocarbons, toluene and
tetrachloroethylene can lead to miscarriage and have a detrimental
effect on the foetus.
HOW TO AVOID THE RISK:
Pregnant women should be protected to exposure against these organic
solvents.
HAZARD:
Pesticides and herbicides
WHAT IS THE RISK:
Exposure to certain pesticides and herbicides is associated with an
increased risk of miscarriage and can adversely affect the development
of the child.
HOW TO AVOID THE RISK: Exposure to pesticides and herbicides should be
avoided or minimised.
HAZARD:
Alcohol
WHAT IS THE RISK:
Foetal alcohol syndrome can lead to physical and mental abnormalities in
children. Workers in the beverage, catering and associated industries,
including wine farming, are particularly at risk.
HOW TO AVOID THE RISK:
Where appropriate, employees should be informed of and counselled in the
hazards associated with foetal alcohol syndrome.
HAZARD:
Tobacco smoke
WHAT IS THE RISK: Tobacco smoke contains carbon monoxide and carcinogenic
and other harmful substances. Smoking and the inhalation of
environmental smoke affects foetal blood supply and can lead to retarded
growth and development and more early childhood diseases. Smoking
carries an increased risk of cancer and cardiovascular disease
HOW TO AVOID THE RISK:
Care should be taken to ensure that women employees are able to work
without being exposed to tobacco smoke.
SCHEDULE FOUR
BIOLOGICAL HAZARDS
HAZARD:
Cytomegalovirus
HOW TO AVOID THE RISK:
Employees should be required to maintain high standards of personal
hygiene, wash their hands after each patient contact and use gloves when
handling potentially contaminated wastes in order to minimise the risk
of infection.
HAZARD:
Hepatitis
HOW TO AVOID THE RISK:
General precautions must be taken for all forms of hepatitis. Vaccination
is the most effective means available of preventing hepatitis B.
Workers must take particular care to avoid mucous membranes and skin
coming into contact with potentially contaminated blood or other
secretions.
HAZARD:
HIV
HOW TO AVOID THE RISK:
Universal precaution is important for workers potentially exposed to HIV.
Health care workers should take precautions to prevent needle stick
injuries and exercise care when handling the blood, tissues or mucosal
areas of all patients.
HAZARD:
Rubella (German measles)
HOW TO AVOID THE RISK:
Rubella vaccine is the most effective means of preventing the disease, and
susceptible employees should be immunised. Pregnancy measles should be
avoided for 3 months after vaccination.
HAZARD:
Varicella (chicken pox)
HOW TO AVOID THE RISK:
It is advisable to identify employees who have not previously had chicken
pox. Pregnant employees who are known not to be immune to chicken pox
and who are exposed to an active case should report to a physician.
HAZARD:
Toxoplasmosis gondi
HOW TO AVOID THE RISK: Control measures against toxoplasmosis gondii for
women of reproductive age include high standards of personal and
environmental hygiene; the sanitary disposal of cat faeces and avoiding
contamination by cat faeces of soil to be tilled for agriculture.
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