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Elise Andaya examines the experiences of pregnant service sector workers in New York City as they try to navigate the time conflicts between precarious low-wage service labor and safety net prenatal care.

Image courtesy of interviewee. February 6, 2024

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The speaker is a cultural anthropologist specializing in reproductive healthcare, focusing on prenatal care and abortion access. After researching in Cuba, they shifted to studying barriers faced by low-income women in accessing reproductive screenings, notably the impact of unpredictable work schedules in the low-wage service sector on their ability to receive care. This video video exploration was fueled by a notable investigative article on Starbucks' scheduling practices, which highlighted the chaos created for employees' personal lives.

The speaker examined how these scheduling practices adversely affect pregnant workers, who struggle to attend prenatal care due to their inflexible work environments, which often result in choosing between jobs and healthcare. They emphasized the societal and health inequalities produced by these temporal injustices, particularly affecting women of color and low-income women, who historically bear a higher maternal and infant mortality risk.

Through qualitative research, including interviews with pregnant service workers at a safety net hospital in New York City, it was found that many women returned to work shortly after childbirth due to a lack of paid leave. This video video pressure leads them to delay or miss important prenatal appointments, which can have dire consequences for their health and their babies. The speaker argues that these issues arise from a broader context of economic and social inequalities, worsened by legislative gaps regarding workers' rights, particularly around time and scheduling.

The speaker concludes with a call for policy change to recognize and address the ways time is organized within labor systems, advocating that improving the structure of work schedules is essential for social justice and the well-being of marginalized groups.

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X-TIMESTAMP-MAP:LOCAL=00:00:00.000,MPEGTS=900000

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I'm a cultural anthropologist with research,

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research specialties in reproduction

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and reproductive healthcare,

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and particularly in prenatal access

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to prenatal care and abortion care.

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And I previously,

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conducted research in Havana, Cuba on this.

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And when my book conceiving Cuba came out in 2014,

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I was looking for another research project.

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Um, and at the time I was doing some interview work on a

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research project,

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that examined barriers in low income women's access to

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reproductive screenings like mammograms.

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And one of the things that kept coming up

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among this low income sample of women were, was work

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and the problems of, unpredictable work schedules.

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And you're never being sure when you are gonna be scheduled,

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when you are gonna be scheduled.

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So, these are people who are working in retail,

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home healthcare, childcare, food service,

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the low wage service sector.

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And right about this, around this time, coincidentally,

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Jodi Kanter, who, later won a Pulitzer for her work

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and reporting on the Harvey Weinstein,

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Weinstein case published an investigative article on

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Starbucks on the, scheduling practices in Starbucks.

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And she showed how this wreak havoc on the personal lives

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of employees who are basically, who are unable

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to plan their lives, keep social commitments, go to school

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because their schedules were posted at the very last minute

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and were constantly changing.

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So this really, provoked my interest in the social

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organization of time and how time produces

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and reproduces inequality.

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And given my background in reproductive healthcare,

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I decided to focus my attention on how labor

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and the low wage service sector shaped pregnant workers

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access to, prenatal care

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and their experiences of pregnancy.

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Like any project, there's many ways

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that you could have done this work.

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Um, as a cultural anthropologist,

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my primary research methods are qualitative, so I wanted

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to look for places where I could recruit women

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to do interviews and where I could watch them interact

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with the healthcare system.

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Um, so I quickly ascertained

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that it was gonna be really difficult

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to recruit pregnant workers at their workplace.

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Um, part of this was, you know,

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because it's difficult to just approach someone at their

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workplace and also

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because, the number

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of pregnant people at any workplace at any given time

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is probably fairly low.

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So I was really lucky at the very beginning point in my

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research to meet this fabulous OB GYN

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who worked in a safety net hospital in New York City.

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And she facilitated my entree into these, prenatal care.

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And for those non-US folks, when we,

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when we say safety net, we mean hospitals that are committed

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to caring for patients regardless of their ability to pay

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or their insurance status.

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So they carry a high burden,

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or high load, I should say, of low wage,

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low income patients.

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So I, a year thanks to her, I, interviewing,

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eventually interviewed 55 pregnant service workers,

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spending time in the hospital doing things like tracking

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how long people waited for care,

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how long did their appointments take,

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what were their interactions with staff.

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Um, like I also looked at policy.

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So at the time of my research, New York City was either

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debating or rolling out various forms of legislation

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directed at protecting, low wage workers.

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So the Pregnant Workers' Fairness Act, the Paid Leave Act,

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paid Family Leave Act, US has no universal paid leave,

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and Fair Work Week, which, which, legislated scheduling.

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So I, attended lobbying events, talked to advocates,

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tracked campaigns,

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and all of this became part

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of the background for my research.

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The low wage service sector in the US is disproportionately

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comprised of women and particularly women of color.

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And this is both economically and ideologically rooted.

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And just to give a very, very brief thumbnail sketch,

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what happened was in the 1970s,

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in the US traditional manufacturing sectors like auto work

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moved to, overseas to countries

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where labor costs were lower

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and there was less regulatory oversight.

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And so the loss of these living wage jobs

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that were traditionally masculine jobs pushed women from

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these families into the workforce.

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And there they were working in jobs, primarily,

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in the service sector, that was at that time exploding

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because women from middle class,

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families were also going out to work and were

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therefore not able to care for children or do elder care

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or prepare three meals a day.

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So what we see is women in general going out to

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to work at much higher numbers starting in the 1970s,

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but with this labor is really racialized.

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So what, given the intersection of race

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and class in the United States, white

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or whiter, women are more likely

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to be going into middle class professional work.

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Um, whereas women of color are more likely

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to be going into low wage service work that support,

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middle class families.

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And so this is an example

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what sad Hartman calls the afterlife of slavery, where women

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of color are seen as the appropriate, suitable people

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to do the intimate

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and low status of labor, of caring

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for other people's bodies and families.

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So what this means is that you have this large influx

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of women and particularly women of color

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into the service sector where they're,

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which is characterized not only by economic, precarity

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by low wages, but also temporal precarity.

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So our workers have little control over their schedules.

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They don't, they can't negotiate the start

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or end time of a shift.

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Schedules are often posted as little as 24 hours

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before the start of a shift. And so this

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Temporal regime, what I what I really mean by

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that is just a social organized organization of time,

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socially produced patterns of time.

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This is gonna be difficult for anyone,

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but it's particularly problematic for pregnant people

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who have to navigate work and prenatal care.

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Um, prenatal care as anyone who has been pregnant

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or knows someone who's been pregnant, knows has

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to happen on a schedule.

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You're supposed to go at particular times,

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increasingly frequently.

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Um, they're not always easy

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to reschedule within the timeframe you're supposed

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to see them, to go to a doctor,

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especially in safety net care, which is overburdened

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and under-resourced.

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Um, and so salaried workers can take a long lunch break

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or leave work early, or come to work late to get care.

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And that's not possible for low wage workers.

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They can't take just an hour or two out of their shift.

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They have to call out of the entire shift.

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So what this means is every time there's a conflict

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between prenatal care and work, they have to decide.

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And if they go to prenatal care,

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they lose an entire day's work.

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And so they're essentially incurring a financial penalty

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for attending prenatal care,

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or if they choose work,

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then they miss a prenatal care appointment that they may

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or may not be able to reschedule.

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So each time that, their schedules come out, they have

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to make this choice about whether to miss work

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or miss, prenatal care.

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And that's a choice that most middle class professional

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people don't ever have to make.

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So this really has implications in terms of prenatal care.

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Um, low income women

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and women of color already have much worse reproductive

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outcomes than white women.

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Uh, in New York City where I do this work,

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black women are more, are 12 times more likely to die,

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to suffer maternal death than white women.

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Um, US uss maternal mortality rate, contrary

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to most countries, has increased over the last two decades.

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Um, infant health

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and breastfeeding rates are also much worse among,

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low income women and women of color.

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Um, and so we know that going, you know, many of,

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many times what's happening is people have go,

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are going back to work much earlier than they would like to

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because they don't have access to paid maternal care,

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paid family leave.

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So we know that that has,

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really negative implications in terms of health of mother

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and baby breastfeeding bonding.

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So we really need a lot more work examining how,

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regime temporal regimes

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of service work shape people's access to prenatal

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and post-partum care, as well as the health implications

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for mothers, babies and families more generally.

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One of the women that I spoke to, for example,

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talked about, the fact that she returned to work

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10 days after, after giving birth,

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and she was working in home healthcare and she was lifting

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and carrying her, bedridden patient

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because she had no access to, to any kind

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of supports social services, paid maternal care.

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I met several women who had started prenatal prenatal care

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in their fifth month of pregnancy.

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Um, and the reason that they had done that was

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that they told me, I have other children at home,

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and if I, if I am missing one day of work,

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I am missing eight hours of paid labor.

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And so I cannot, when I live in such a, tight budget

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where I'm really thinking, you know, I'm paying the

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electricity this week, so that means I have

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to spend less money on food they cannot afford to,

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to be making those kinds of choices.

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And so the, the fact that they don't have access

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or they don't know that they have access to paid leave.

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New York City just, in 2014 made that,

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legislative paid leave meant

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that they were making these choices

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that surely had implications in terms

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of their health and wellbeing.

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What my research has really cl clearly is the role

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of time, in reproducing social inequalities,

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what I call temporal injustices.

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Um, and so a lot of social scientific research has shown,

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for example, how waiting is related to social status.

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Who waits for whom, whose time is considered valuable

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and whose time is not.

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So in the doctor's office, for example,

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everything is structured

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or the hospital to facilitate doctor's time facilit

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and make them work efficiently.

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But in the meantime, there are low, you know,

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low wage workers who the women, pregnant women of color

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who are waiting hours and hours and hours for care.

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There are many women I interviewed

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who are waiting five hours for an appointment

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that might last 10 minutes.

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Um, so what it shows very clearly through looking at these,

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the rhythms of time is the way that high status people

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and institutions time is valued.

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Whereas people of low wage people, people of color,

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people with fewer resources have to reshape the rhythms

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of their own lives in order to accommodate, the demands

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of, of other institutions and people.

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Um, and so I wanna say like

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of course we all experience time conflict,

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like I'm very aware of that.

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But what this also shows, again, is class differentials

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that people who are marginalized by virtue of race,

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ethnicity, economic status, gender, immigration status,

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et cetera, usually have the fewest resources

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to manage these time conflicts.

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They can't, you know, outsource their labor,

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hire somebody to do domestic work in the house.

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Um, they don't, they often work in jobs

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that don't allow much flexibility as I talked about.

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So these temporal injustices are really linked

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to broader inequalities

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and amplify social vulnerabilities

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that people are already experiencing.

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There two major points.

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The first is that I want people to recognize

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how time structured socialize that are often invisible

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to people with more resources.

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So one of the things I, the comments that I get

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so often when I talk about this research is people say,

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my God, I had no idea.

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But then of course, this is

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because people are speaking from a

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particular class position.

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This what I write about is reality is daily life

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for millions of Americans and people around the world.

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So, Benjamin Snyder, who's an a sociologist,

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has this term that I love called rhythm experts.

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And he says, low wage people have to become rhythm experts

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because they have to synchronize these different regimes

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of work when the bills come in, who's available to pick up,

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who for free, you know, all of these different timetables.

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Um, but this is a skill born of inequality

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because people don't have other resources.

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In other words, ability to pay other people

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to do those kind of work.

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So there's a skill

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of being a rhythm expert is really born of the inequality.

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Um, and the, the fact that people have less resources

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to knit together support.

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Um, my second point I is the fact that policy matters

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and that the protection of time needs to be front

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and center in our discussion of labor rights.

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And this is different now from in the past

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in the US at least the legislation

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that exists primarily protects people from overwork.

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But what we are seeing now is actually the opposite problem,

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which is under work, underemployment, precarious schedule,

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people not working enough

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or working, you know, such patchwork, systems of jobs

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that they're not making enough to live.

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Um, and we need policy to address that.

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And so as I talked about

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before, New York City is really, a in the vanguard

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of passing policy, to support and protect workers.

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And while it's, still too early, I think to say

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how extensive that impact will be, it's really clear

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that is necessary.

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Low wage employers are not gonna do this

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on their own accord.

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And so the only way to ameliorate the, social emotional,

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physical effects of temporal inequality is through policy.

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So I'd like, I guess that's what I'd like people

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to take away is that, we all, all of us, no matter

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what our position is, Nika, think about the way

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that control over a time reproduces power inequalities.

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And we need to make the protection of time essential part

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of the agenda for social justice.

Exploring Prenatal Care Access for Low-Wage Workers

00:00:00 - I'm a cultural anthropologist with research, research specialties in reproduction and reproductive healthcare, and particularly in prenatal access to prenatal care and abortion care. And I previously, conducted research in Havana, Cuba on this. And when my book conceiving Cuba came out in 2014, I was looking for another research project. and at the time I was doing some interview work on a research project, that examined barriers in low income women's access to reproductive screenings like mammograms.
00:00:33 - among this low income sample of women were, was work and the problems of, unpredictable work schedules. And you're never being sure when you are gonna be scheduled, when you are gonna be scheduled. So, these are people who are working in retail, home healthcare, childcare, food service, the low wage service sector. And right about this, around this time, coincidentally, Jodi Kanter, who, later won a Pulitzer for her work
00:01:04 - Weinstein case published an investigative article on Starbucks on the, scheduling practices in Starbucks. And she showed how this wreak havoc on the personal lives of employees who are basically, who are unable to plan their lives, keep social commitments, go to school because their schedules were posted at the very last minute and were constantly changing. So this really, provoked my interest in the social organization of time and how time produces
00:01:36 - And given my background in reproductive healthcare, I decided to focus my attention on how labor and the low wage service sector shaped pregnant workers access to, prenatal care and their experiences of pregnancy. Like any project, there's many ways that you could have done this work. as a cultural anthropologist, my primary research methods are qualitative, so I wanted to look for places where I could recruit women to do interviews and where I could watch them interact with the healthcare system.
00:02:07 - that it was gonna be really difficult to recruit pregnant workers at their workplace. part of this was, you know, because it's difficult to just approach someone at their workplace and also because, the number of pregnant people at any workplace at any given time is probably fairly low. So I was really lucky at the very beginning point in my research to meet this fabulous OB GYN who worked in a safety net hospital in New York City. And she facilitated my entree into these, prenatal care.
00:02:41 - when we say safety net, we mean hospitals that are committed to caring for patients regardless of their ability to pay or their insurance status. So they carry a high burden, or high load, I should say, of low wage, low income patients. So I, a year thanks to her, I, interviewing, eventually interviewed 55 pregnant service workers, spending time in the hospital doing things like tracking

Challenges of Low-Wage Workers in Healthcare Access

00:03:12 - how long did their appointments take, what were their interactions with staff. like I also looked at policy. So at the time of my research, New York City was either debating or rolling out various forms of legislation directed at protecting, low wage workers. So the Pregnant Workers' Fairness Act, the Paid Leave Act, paid Family Leave Act, US has no universal paid leave, and Fair Work Week, which, which, legislated scheduling.
00:03:48 - tracked campaigns, and all of this became part of the background for my research. The low wage service sector in the US is disproportionately comprised of women and particularly women of color. And this is both economically and ideologically rooted. And just to give a very, very brief thumbnail sketch, what happened was in the 1970s, in the US traditional manufacturing sectors like auto work moved to, overseas to countries
00:04:17 - and there was less regulatory oversight. And so the loss of these living wage jobs that were traditionally masculine jobs pushed women from these families into the workforce. And there they were working in jobs, primarily, in the service sector, that was at that time exploding because women from middle class, families were also going out to work and were therefore not able to care for children or do elder care or prepare three meals a day.
00:04:50 - to work at much higher numbers starting in the 1970s, but with this labor is really racialized. So what, given the intersection of race and class in the United States, white or whiter, women are more likely to be going into middle class professional work. whereas women of color are more likely to be going into low wage service work that support, middle class families. And so this is an example what sad Hartman calls the afterlife of slavery, where women
00:05:21 - to do the intimate and low status of labor, of caring for other people's bodies and families. So what this means is that you have this large influx of women and particularly women of color into the service sector where they're, which is characterized not only by economic, precarity by low wages, but also temporal precarity. So our workers have little control over their schedules. They don't, they can't negotiate the start
00:05:50 - Schedules are often posted as little as 24 hours before the start of a shift. And so this Temporal regime, what I what I really mean by that is just a social organized organization of time, socially produced patterns of time. This is gonna be difficult for anyone, but it's particularly problematic for pregnant people who have to navigate work and prenatal care. prenatal care as anyone who has been pregnant or knows someone who's been pregnant, knows has

Temporal Inequities in Prenatal Care Access

00:06:20 - You're supposed to go at particular times, increasingly frequently. they're not always easy to reschedule within the timeframe you're supposed to see them, to go to a doctor, especially in safety net care, which is overburdened and under-resourced. and so salaried workers can take a long lunch break or leave work early, or come to work late to get care. And that's not possible for low wage workers. They can't take just an hour or two out of their shift.
00:06:52 - So what this means is every time there's a conflict between prenatal care and work, they have to decide. And if they go to prenatal care, they lose an entire day's work. And so they're essentially incurring a financial penalty for attending prenatal care, or if they choose work, then they miss a prenatal care appointment that they may or may not be able to reschedule. So each time that, their schedules come out, they have
00:07:22 - or miss, prenatal care. And that's a choice that most middle class professional people don't ever have to make. So this really has implications in terms of prenatal care. low income women and women of color already have much worse reproductive outcomes than white women. in New York City where I do this work, black women are more, are 12 times more likely to die, to suffer maternal death than white women. US uss maternal mortality rate, contrary
00:07:54 - infant health and breastfeeding rates are also much worse among, low income women and women of color. and so we know that going, you know, many of, many times what's happening is people have go, are going back to work much earlier than they would like to because they don't have access to paid maternal care, paid family leave. So we know that that has, really negative implications in terms of health of mother and baby breastfeeding bonding.
00:08:27 - regime temporal regimes of service work shape people's access to prenatal and post-partum care, as well as the health implications for mothers, babies and families more generally. One of the women that I spoke to, for example, talked about, the fact that she returned to work 10 days after, after giving birth, and she was working in home healthcare and she was lifting
00:08:57 - because she had no access to, to any kind of supports social services, paid maternal care. I met several women who had started prenatal prenatal care in their fifth month of pregnancy. and the reason that they had done that was that they told me, I have other children at home, and if I, if I am missing one day of work, I am missing eight hours of paid labor.

Temporal Injustices in Low-Wage Workers' Lives

00:09:31 - where I'm really thinking, you know, I'm paying the electricity this week, so that means I have to spend less money on food they cannot afford to, to be making those kinds of choices. And so the, the fact that they don't have access or they don't know that they have access to paid leave. New York City just, in 2014 made that, legislative paid leave meant that they were making these choices that surely had implications in terms
00:10:00 - What my research has really cl clearly is the role of time, in reproducing social inequalities, what I call temporal injustices. and so a lot of social scientific research has shown, for example, how waiting is related to social status. Who waits for whom, whose time is considered valuable and whose time is not. So in the doctor's office, for example, everything is structured or the hospital to facilitate doctor's time facilit and make them work efficiently.
00:10:33 - low wage workers who the women, pregnant women of color who are waiting hours and hours and hours for care. There are many women I interviewed who are waiting five hours for an appointment that might last 10 minutes. so what it shows very clearly through looking at these, the rhythms of time is the way that high status people and institutions time is valued. Whereas people of low wage people, people of color, people with fewer resources have to reshape the rhythms
00:11:06 - of, of other institutions and people. and so I wanna say like of course we all experience time conflict, like I'm very aware of that. But what this also shows, again, is class differentials that people who are marginalized by virtue of race, ethnicity, economic status, gender, immigration status, et cetera, usually have the fewest resources to manage these time conflicts. They can't, you know, outsource their labor,
00:11:37 - they don't, they often work in jobs that don't allow much flexibility as I talked about. So these temporal injustices are really linked to broader inequalities and amplify social vulnerabilities that people are already experiencing. There two major points. The first is that I want people to recognize how time structured socialize that are often invisible to people with more resources. So one of the things I, the comments that I get
00:12:07 - my God, I had no idea. But then of course, this is because people are speaking from a particular class position. This what I write about is reality is daily life for millions of Americans and people around the world. So, Benjamin Snyder, who's an a sociologist, has this term that I love called rhythm experts. And he says, low wage people have to become rhythm experts because they have to synchronize these different regimes

Temporal Inequality and the Need for Policy

00:12:40 - who for free, you know, all of these different timetables. but this is a skill born of inequality because people don't have other resources. In other words, ability to pay other people to do those kind of work. So there's a skill of being a rhythm expert is really born of the inequality. and the, the fact that people have less resources to knit together support. my second point I is the fact that policy matters
00:13:13 - and center in our discussion of labor rights. And this is different now from in the past in the US at least the legislation that exists primarily protects people from overwork. But what we are seeing now is actually the opposite problem, which is under work, underemployment, precarious schedule, people not working enough or working, you know, such patchwork, systems of jobs that they're not making enough to live. and we need policy to address that.
00:13:43 - before, New York City is really, a in the vanguard of passing policy, to support and protect workers. And while it's, still too early, I think to say how extensive that impact will be, it's really clear that is necessary. Low wage employers are not gonna do this on their own accord. And so the only way to ameliorate the, social emotional, physical effects of temporal inequality is through policy.
00:14:29 - to take away is that, we all, all of us, no matter what our position is, Nika, think about the way that control over a time reproduces power inequalities. And we need to make the protection of time essential part of the agenda for social justice.

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