The use of substances that are harmful to reproductive health (“reprotoxins”) is widespread in European workplaces. EU legislation regulates their impacts on consumers, treating them as akin to carcinogens. But it does not take the same approach when it comes to protecting workers.

The use of substances that are harmful to reproductive health (reprotoxinsis widespread in European workplaces. EU legislation regulates their impactson consumers, treating them as akin to carcinogens. But it does not take thsame approach when it comes to protecting workers.

Coincidences sometimes suggest a deeper meaning: two stories from two different countries come together and reveal something fundamental about our world. O24 February 2020, a trial began in the Netherlands, brought by 14 female workers ansupported by the Dutch Federation of Trade Unions (Federatie Nederlandse VakbewegingFNV), against their former employer DuPontThey had worked in a Lycra factory iDordrecht and experienced years of exposure to dimethylacetamide (DMA), a solvent that is reprotoxic.

A small loss for shareholders

In the same month, February 2020, Todd Haynes’ film Dark Waters opened in cinemas. It tells the story of a series of lawsuits against DuPont in the US. Hundreds of workers were exposed to perfluorooctanoic acid (PFOA), a substance with non-stick properties alsknown as C8, in a factory that made Teflon frying pans in Parkersburg, West Virginia. DuPont had known about PFOAs high toxicity since 196but production continued – even though, from 1981, some workers had babies with birth defects. The company simply took women off thaproduction line. In 1989, DuPont became aware that a high number of its workers were dying from leukaemia. A few months later, the incidence of renal cancer was also noted. In addition to workers, people living near the plant were also affected by high concentrations of PFOA in thwater supply. Lawyer Robert Bilott launched a first lawsuit against the company in 1998, seeking compensation for a farmer whose cattle herd had been decimated. People began sharing their experiences, and a large-scale epidemiologicastudy was organised. It found a high incidence of testicular, renal and liver cancers among those who had suffered exposure, and birth defects among their children.

The film follows the story up to 2015. By then, although some lawsuits were still ongoing, hundreds of victims had already received substantial compensation. In February 2017, DuPont paid 671 million dollars to a group o3 550 victims, a sum that represented only a small loss to shareholders. In its best years, Teflon generated a billion dollars per annum for the company.

And so, a trial begins in the Netherlands just as a film comes out depicting the difficulties of a legal saga that has lasted 20 years on the other side of the Atlantic.

"My life would have been different if I hadnt worked in the packing department in DuPonts Lycra factory in Dodrecht," says Romy Hardon,an employee there from 1977 to 1988. She suffered a stillbirth and still visits her childs grave every month. She had severe fertility problems thaeventually required a hysterectomy. Romy began working for DuPont at the age of 17. Her father had worked at the same plant since 1962. He started out producing synthetic Orlon fabric and was then transferred to work on Teflon production. He died of cancer aged 46. In Europe, DuPont has never been investigated over its Teflon production. Another employee, Astrid Musig, is younger than Romy; she worked at the factory from 1989 until 2001, where she was exposed to DMA. Her husband produced Teflon. Their daughter Sandrina was born severely disabled. She is barely able to walk because of muscle weakness and has difficulty speaking. Her mental development is that of a four-year-old child.

Exposure limits to avoid substitution

Romy and Astrid are far from being the only women affected, and men have experienced reproductive health problems too. The union spent four years trying to convince DuPont to compensate victims before launching legal proceedings. DuPont could not have been unaware of thscientific literature showing DMAs reprotoxicity. The company maintained that it had adhered to occupational exposure limits (OELs) antherefore bore no responsibility. A similar argument had been used in the case of PFOA-contaminated water in West Virginia, where a maximum concentration value had been set so high that neither humans nor livestock were protected.

Several aspects link these cases beyond the fact that both involve DuPont.

Why invest in prevention when the risks workplace origin remains invisible to the people affected? The industry knew the toxicity of thesesubstances but claimed it abided by the OELs. The public authorities remained passive. They ascribed the OELs with a magical power to protecthealth, without considering the industrys key role in setting them. The victims were working class or, in the case of local residents, belonged tlow-income groups. It took years for individual cases that had been experienced as personal tragedies to be linked to each other. A chemicacause was then identified in the workplace. But when it was discovered that toxicological studies had existed for years and showed that thsubstance was reprotoxic, it had to backnowledged that the cause was also social and political. Workershealth had been sacrificed for company profit. Both Teflon and Lycra arused to make mass market products. The chemical industry seems all-powerful, improving life with innovative products. Lycra is held up as a symbol of modernity and innovation. It is promoted not as a fabric but the magic ingredient that ensures "a great fit, comfort and freedom ofmovement".

Three generations put at risk through a single exposure

Demeter, a database from the French Na- tional Research and Safety Institute for the Prevention of Occupational Accidents and Diseases (INRS), provides information on almost 200 substances used in workplaces which are reprotoxic, and this list is far from exhaustive.

According to the European Unions harmonised classification, there are 27 substances classed as reprotoxic in category 1A (proven to btoxic to humans), 234 in category 1B (presumed to be toxic) and 150 in category 2 (suspected to be toxic). This classification includes just a smalfraction of the substances on the market; there are an additional 4 700 substances notified as reprotoxic by manufacturers or importers in one othese three categories.

Classification lags far behind the reality in the market. In recent decades, many substances have been brought onto the market withousufficiently sensitive testing to determine their reprotoxicity. The market has been flooded with new substances which have not been adequatelrisk-assessed. Nanoparticles can, for example, cross the placental barrier that protects the embryo. Chinese researchers observed this in mice exposed to nanoparticles of titanium dioxyde, a substance widely used for many different applications (in paint, sun cream, foodstuffs, medicines and toothpaste). A similar effect was observed in quantum dots, tiny semiconductor particles used in solar panels and medical imaging.

Endocrine disruptors also harm reproductive health, but only a minority of them have been classed as reprotoxic. Procedures are slow anhampered by the chemical industrys influence on regulatory bodies. Identifying endocrine disruptors is difficult because the Europeaclassification system does not recognise this category.

These substances can have an impact on the whole human reproductive cycle. They may affect fertility and pregnancy (causing, foexample, stillbirth, miscarriage or premature birth). Parental exposure can also affect the embryo and endanger a childs health before birthraising the risks of conditions such as cancer, immune system problems, neurological and intellectual development, behavioural problems anobesity.

The hormone diethylstilbestrol (DES), once commonly prescribed during pregnancy, had more severe effects on daughters who had been exposed to it than on their mothers. Michael Skinner, an epigenetic researcher, explains: "When a pregnant woman ingests DES, her baby assimilates it too. And the sexual cells for the next generation are already present in the baby. Thats how three generations come to bexposed to the hormone simultaneously and instantly." Skinner says that the structure of DES resembles that of bisphenol A, and it functions inthe same way as DDT. In other words, this medicine works in a similar way to endocrine disruptors that have been very widely used in industrand agriculture.

There is a discrepancy between the attention given to these issues in the public health arena and their neglect in workplace health. Yetworkplace exposure is an impor- tant factor in harm to reproductive health. There is no precise estimate of the number of workers exposed inthe EU: two million seems the lowest probable estimate. The probability of reprotoxin exposure is highest among the most disadvantaged, whicreproduces health inequalities from one generation to the next.

Toxic ignorance

The lack of prevention is often put down to an absence of data, but this explanation is inadequate. Even in the case of substances whose reprotoxicity has long been recognised, prevention has been far from sufficient. The absence of data is in itself the result of a lack of prevention. The lack of a sufficiently stringent legal framework for prevention means data has not been collected. Ignorance is noinevitable.

Toxicology studies substances through laboratory tests, often conducted on animals, but many effects go unnoticed if testing is not extended over two generations. EU regulatiois compulsory only for the highest production volumes (10 000 tonnes per producer per year), so the vast majority of substances on the market arexempt from such tests.

Epidemiology takes recorded ill health as its starting point and looks for its causes. It establishes whether a condition is more common in a group exposed to a risk factor than in a control group. Epidemiological research into the effect of workplace factors on reproductive health needs to be developed. The PELAGIE study conducted in France shows the potential of such research. This is a longitudinal study that has monitorethe state of health of a specific population at differenpoints over a long period. It was set up in Brittany in 2002 and included 3 421 pregnant women. Its objective is to evaluate the longterconsequences for pregnancy and childevelopment of prenatal and childhood exposure to various environmental and workplaccontaminants. Children were assessed at the ages of two and six and are now being followed up as adolescents. A subgroup of children is thsubject of a more detailed study of cognitive and psychological development and brain function. Among various results relating to the effects of maternal workplace exposure, the study has found links between organic solvents and birth defects, and between organophosphate pesticideand childhood respiratory and allergic problems.

There is a third data source with great potential, but it comes up against the problem of the partitioning of public and workplace health.The authorities that maintain records of birth defects do not collect information about parents’ jobs. Cancer records make it straighforwarto identify childhood cancers, but the data is not linked to parental employment history. Collating data from different sources would remedy this. Pioneering studies have shown how far knowledge is being held back by failure to make use of these records. Finnish researchers published a study in 1980 based on an analysis of their countrys register of birth defects. They focused on central nervous system defectand carried out detailed interviews with mothers to investigate their working conditions. Their study revealed the risk posed by organic solventand industrial dust. More than 40 years later, a Danish team worked on cancer records and established a link between childhood cancer and having a parent who worked in the paint industry. Another Danish team showed a linbetween maternal exposure to diesel engine emissions and their childrens incidence of cancers of the central nervous system.

The European Commission ducks the issue

In EU legislation, reprotoxins are classed in the same category as carcinogens and mutagens. In issues of consumer or environmental protectionEU regulations rightly consider that the same rules must be applied to substances that share two essential characteristics: their risk to humahealth is particularly high and often irreversible, and their effects may not present themselves for years, which makes them less visible.

This is the approach adopted by REACH (Registration, Evaluation, Authorisation and Restriction of Chemicals), the main regulatorinstrument for how chemical substances are put on the market, and by many specific regulations for such things as pesticides, cosmetics, biocides and waste.

The only exception is workplace health. An EU Directive on carcinogens has existed since 1990. In 1999, its scope was expanded tinclude mutagens (substances which cause mutations in the human genome). I2002, the European Commission initiated a further revision of this Directive with the aim of bringing reprotoxins within its scope. There waalready a general Directive on chemical agents dating from 1998. The preventative measures it specified wermarkedly less stringent than those on carcinogens. It contained just one mandatory reprotoxin OEL, for lead. This OEL was set at such a highlevel that it offered no protection against reproductive health risks. Dealing with reprotoxins through the provisions of the Chemical AgentDirective goes against the general approach of EU law, which recognises that these substances are a source of great concern and need to bsubject to more stringent legislation.

The blanket blocking of the revision of the Directive on Carcinogens and Mutagens during José Manuel Barrosos presidency of thCommission (2004-2014) wasted a decade. Several times, the European Parliament voted for a revision of the Directive and for bringing reprotoxinwithin its scope. Union organisations and some Member States backed this proposal.

However, when the European Commission finally restarted the revision process in 2016, it performed a surprise about-turn on thquestion of reproductive risks. In May 2016, Marianne Thyssen, the EU Commissioner for Employment and Social Affairs at that time, statethat the impact study requested by the Commission "did not sufficiently clarify the costs and potential benefits" of extending the CMD tinclude reprotoxins.

Using a cost-benefit impact study to justify a political decision of this magnitude is especially shocking, as the study in question wabound to acknowledge the great uncertainty surrounding its calculations.

In 2017, as part of the first phase of the revision of the CMD, the European Parliament passed an amendment that adopted something theCommission itself had proposed some 10 years earlier: the expansion of the scope of the CMD to include reprotoxins. The final approved textthe result of a compromise between the European Parliament and the Council of Ministers, was less clear-cut. It required the Commission treach a decision on the possible inclusion of reprotoxins by no later than 31 March 2019.

Between 2017 and 2019, the Commissions position hardened, in part as a result of internal disagreement. The Directorates-Generaresponsible for regulating chemical risks (DG GROW and DG Environment) considered it logical to ensure that workers benefit from the EU legislation, which applies the same regulation to carcinogens as to reprotoxins. Only the Directorate-General for Employment opposed this.

Faced with a firm deadline from Parliament and the Council, the Commission sidestepped a decision. On the appointed date, it simplypublished a second, heavily biased impact study online to justify its inaction (see inset page 11).

This position is all the more puzzling because there has not been any lobbying from industry against the inclusion of reprotoxins. Far from iin fact. The chemical industry is in favour of it, as long as there are derogations for substances for which a health-based OEL has been madecompulsory at European level. For other issues that would come under the revision to the Directive, such as emissions from diesel engines andcrystalline silica, there has been intense industry lobbying, but not over reprotoxins.

A patriarchal mindset

Aside from the workings of bureaucratic power, which meant that DG Employment was very unhappy that the European Parliament did not bacits stance, there is a bigger question about what underlies the trivialisation of risks to reproductive health in the workplace.

Since the late nineteenth century, concern about the effects of some industrial toxins on future generations has produced laws in whicthe permanent or temporary exclusion of women has taken precedence over eliminating the cause. EU legislation is still in part based on thilogic. Reproductive health in the workplace features only explicitly in one directive, the one which applies to pregnant women. Under thidirective, preventative measures are triggered only when the woman tells her employer she is pregnant. Such a mechanism is ineffective fromthe point of view of prevention and creates discrimination against women. A pregnant woman, not the workplace risk, becomes the problemAs preventative measures currently depend on women communicating in advance, they are rarely put in place before the tenth week opregnancy. It is precisely during this period of gestation that the developing embryo is at greatest risk.

A powerful stereotype endures, which sees reprotoxic risks as a female problem: human reproduction, consigned to the private domainshould not create obstacles for industrial production, the thinking goes. The trivialisation of reprotoxic risk diffuses it within the general mass of chemical risks. No one would claim the birth of a child with serious birth defects is comparable to a skin irritation, but such health problems are considered a personal tragedy, and often experienced without support and even with a sense of guilt.

In reality, reprotoxic risks affect both women and men. They result not from a susceptibility in the individual, but decisions made in thproduction process. Pregnancy itself is a time of particular risk for some types of exposure, but that does not mean that prior periods are risk-free.

Bringing reprotoxic agents within the scope of the Carcinogens Directive would enable better prevention. It would also challenge thesubordination of human reproduction to the imperatives of production. That is the mailesson from the Lycra and Teflon cases.

Further reading

Mengeot M.A. and Vogel L. (2008) Production and Reproduction Stealing the health of future generations, ETUI, Brussels.

Mengeot M.A. in collaboration with Musu T. and Vogel L. (2016) Endocrine disruptors: an occupational risk in need of recognition, ETUI, Brussels.

Musu T. and Vogel L. (2018) Cancer risks in the workplace: better regulation, stronger protection, ETUI, Brussels.

Wriedt H. (2016) Reprotoxins that should be subject to limit values for workers exposure, ETUI, Brussels.

Table of contents

When work affects health from one generation to the next