When Damaris Herron-Watkins had a miscarriage in November 2013, she was in the office at a finance job in New York, she said.
After it happened, Herron-Watkins went home early. She didn't want to tell her employers that she lost her pregnancy, so - per company policy - she got a doctor's note saying she needed to take a few sick days.
During those three or four days off, which were paid, Herron-Watkins processed her loss in peace, she said. Now, she couldn't have imagined focusing on doing her job in the immediate aftermath of her miscarriage.
"Being able to not have to go to work was helpful for me to just process what had happened," said Herron-Watkins, 35. "I was sad and I didn't have to explain to people why I was sad or why I was crying."
Herron-Watkins's experience of losing a pregnancy is not uncommon in the United States, where between 10% and 20% of known pregnancies end in miscarriages, according to the nonprofit medical organization Mayo Clinic, which notes that the number is likely to be higher because many miscarriages occur before a person realizes they are pregnant.
But workers often have to return to work following a pregnancy loss, or rely on their employers to grant them time off to grieve. If they don't have paid sick or vacation time saved up, that time could be uncompensated: The Family and Medical Leave Act grants eligible workers who experience miscarriages and other "serious health conditions" up to 12 weeks of unpaid leave, according to A Better Balance, a national workers' advocacy organization. But it only applies to people working at companies with at least 50 employees and who have been there for at least a year.
A new bill introduced in Congress last week seeks to change that: The Support Through Loss Act, introduced by Rep. Ayanna Pressley, D-Mass., and Sen. Tammy Duckworth, D-Ill., would mandate at least three days of paid leave for people who experience pregnancy loss (in the legislation, this includes unsuccessful fertility treatments and failed adoption or surrogacy arrangements). Paid time off would also apply to partners of pregnant people.
The bill would also allocate $45 million in annual funding to the National Institutes of Health to research pregnancy loss and mandate that the Centers for Disease Control and Prevention and the Department of Health and Human Services collect data on pregnancy loss and distribute information to the public and to perinatal health-care workers about the prevalence of pregnancy loss and treatment options, including doula care.
If the bill were to become law, the United States would not be the first country to offer paid time off for pregnancy loss. In March, New Zealand became the most recent country to do so when its Parliament unanimously approved legislation offering three days of paid leave to pregnant people and their partners following pregnancy loss. Taiwan, Mauritius and the Philippines also offer paid leave for miscarriages ranging from five days to four weeks. India has offered six weeks of paid leave for miscarriages since 1961, though the law only applies to people working at companies with at least 10 employees, meaning few benefit from it, according to Quartz.
To Herron-Watkins, the U.S. bill is promising. But she knows firsthand that not everyone may feel comfortable with their employers knowing they had a miscarriage, preferring instead to take sick time without having to explain why.
"Since it's such a personal, painful thing, having to tell someone that you need this time because you had this loss I think would be really difficult for some people," she said.
But advocates say the bill's earmarking of paid time off for pregnancy loss specifically is a crucial first step toward destigmatizing it.
"It's really important both from a policy standpoint and also a symbolic standpoint that lawmakers and people in positions of power are talking about this," said Dana Sussman, deputy executive director of National Advocates for Pregnant Women, an advocacy organization that works with pregnant people in the criminal legal system. "Society has deemed certain things to be private in ways that can be really harmful."
That stigma often stems from false assumptions about the causes of pregnancy loss that can lead pregnant people to be blamed for miscarriages, Sussman said, when in fact most miscarriages occur due to abnormal genes or chromosomes in the fetus rather than from problems passed on from the parent, according to Mayo Clinic.
"Particularly for poor people and people of color, immediately there's suspicion around, 'What did she do or not do?' " Sussman said. "What we see is blame being placed on the parent, or the mom, for where there is a true lack of science around causation."
The millions of dollars that the bill proposes to allocate toward researching the causes of pregnancy loss could go a long way toward filling that gap, and would facilitate finding "the social and political solutions to the impacts of racism, classism and gender oppression that impact the higher rates of miscarriage and stillbirth" for Black women in particular, according to Joia Crear-Perry, a physician, and founder and president of the National Birth Equity Collaborative, an advocacy organization focused on Black maternal and infant health.
Research shows that Black people in particular face higher rates of pregnancy loss compared with other racial groups due to a combination of underlying conditions, stress and environmental factors. A 2020 study from the CDC found that Black mothers were twice as likely to experience stillbirth compared with Hispanic and White mothers.
Cristina, a 34-year-old litigations operations manager based in Virginia, wanted "at least a week" of time off following each of her two miscarriages that occurred within the past year, she said. But after her second miscarriage, in March - which she said occurred during the work day - a representative for her company's human resources department said the company didn't offer leave after pregnancy loss. (Cristina is being identified by her first name out of fear of retaliation by her employer.)
Cristina kept working until her grief caught up with her a month later, when she had a panic attack in the shower, she said. Soon after, at the urging of her husband, she took a week of paid vacation time off work to finally face her sadness, using that time to cry, journal and pack up the baby items she had bought, she said.
"At that point, I was so messed up from everything I was going through, I had no choice - I had to put myself on the bench."
The struggles Cristina said she faced - a lack of time off work, delayed grieving - affect many people who experience pregnancy loss, according to Erica McAfee, a doula and founder of Sisters in Loss, a doula training company and virtual community focused on supporting Black women who lose pregnancies.
"People need the opportunity to sit with their pain and really acknowledge it," she said.
Losses can also be followed by post-traumatic stress disorder and/or postpartum depression, as well as postpartum physical effects - such as lactating - that many people aren't prepared for, according to McAfee.
McAfee counts herself lucky to have had paid time off to grieve following a 2012 stillbirth, for which she took 12 weeks of paid time off from her job as a shift supervisor, and a 2014 miscarriage, after which she took three weeks off, she said, adding that she used a combination of vacation and sick time, and that she had extra recovery time off following the stillbirth given that she had a C-section.
Following her second loss, McAfee began attending group therapy - an experience she credits with preparing her to navigate conversations with co-workers about her loss when she returned to work. As the only Black person in the group, she was inspired to start Sisters in Loss in 2017 so that other Black women would not find themselves similarly alone.
"I knew I needed that community," she said. "I wanted to be around other like-minded women who went through infant loss in all its forms."
Now, Sisters in Loss has more than 7,000 members in its online community, where "people share their stories and ask for advice as they navigate the emotional and mental journey through grief and loss," according to McAfee.
After New Zealand legalized paid leave for miscarriages in March, McAfee asked members in the Sisters in Loss Facebook group if they had paid time off work following their losses. The response was "a resounding no" among about 80% of about 150 respondents, she estimated.
"We need to make our employers more aware that this is happening," McAfee said. "Having that extra time, these three days that they propose in this bill, is what's going to save peoples' mental health."
For McAfee, those three days are only a steppingstone toward what she hopes is eventually a longer paid grieving period. "Ultimately, I would like to see it moved up to a week or two weeks off, no matter where the gestational age is," she said.
But in the meantime, she's happy with what the bill would offer: "Three days is a start."