Position Statement
Women's Health and the Environment

Within occupational/environmental medicine, the women's health problems of greatest concern in terms of prevalence or severity are those of reproductive effects of workplace exposures. The entire reproductive cycle may be at risk for exposures to physical and chemical agents in the workplace. Some exposures may also be significant in the home and general environment. Issues of significance include:

	Infertility and hypofertility;
	Spontaneous abortion, including early undetectable abortion;
	Teratogenesis and congenital malformation;
	Mutagenesis and hereditable defects;
	Cancer in offspring (e.g., DES use and cancer); and
	Genital and breast cancer in a occupational exposures.

Established or strongly suspected links to the environment exist in many instances but may be controversial:

	An increased rate of spontaneous abortion in the semiconductor industry has been established--probably due to exposure to glycol ethers and other solvents and may, therefore, carry over to other industries;
	A highly suspected link between video display terminal use and spontaneous abortion has been conclusively disproved;
	Effects of radiation--ionizing (established) and nonionizing (not established);
	Effects of tobacco, alcohol, and drugs (abused or prescribed);
	Effects of exposure to heavy metals; and
	Effects of heavy physical exertion.

In cases where etiologic determinants may be unknown or obscure, it is possible or likely occupational or environmental factors might play a role, though the significance may be difficult to establish. Many exposures may play an active or potential role in many conditions. On the other hand, it is also likely in many cases that occupational and environmental factors may be red herrings. Many supposed household exposures may fall into one of these categories. Many suspected links between women's health problems and environmental exposures exist. Some, like the VDT and spontaneous abortion issues, will not hold up under good scientific research--others may. These would include tobacco smoke, secondhand smoke, household exposures (i.e., radon, solvents, other chemicals), alcohol, and heavy metals. From the occupational and environmental medicine perspective, there are many priority research needs in the area of women's health and environment. Nearly all of the issues above require further scientific documentation. Areas of particular concern include:

	Effects of work in general and the influence of physical exertion and ergonomic factors in particular;
	Effects of tobacco smoke--first and second hand;
	Effects of alcohol and drugs;
	Effects of solvents, other chemicals, and heavy metals;
	Factors influencing fitness for duty in women and the effect of pregnancy on fitness for duty; and
	Issues regarding pregnancy disability and the relationship of the complications of pregnancy.

Approved by the Board of Directors of the American College of Occupational and Environmental Medicine (ACOEM) on April 27, 1993, and submitted to the Scientific Advisory Meeting III.

© Copyright 1997 American College of Occupational and Environmental Medicine