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In 2019, when Maia Earle, a firefighter in King County, Washington, decided she wanted to have children, she went to her doctor to get a blood test to get a better sense of her fertility. The results surprised Earle. Her level of anti-Müllerian hormone, which indicates a person’s egg count, was lower than normal.
His levels dropped further the next year when he was in paramedics school, a busy year of training and little sleep. A second test done around that time showed that his anti-Müllerian hormone was virtually non-existent.
“He was basically just telling me that potentially my ovarian reserve, or the number of eggs I had left, was very, very low. And that was a huge shock. It was devastating,” Earle said.
It prompted her to consider options like IVF, an expensive procedure, in order to increase her chances of getting pregnant.
She began to wonder if her profession as a firefighter — something she had been doing for several years by that point — had impacted her reproductive health. Earle was in his 30s and acknowledged that other variables could have been at play. However, it nagged her that this fertility fight could impact other firefighters who wanted to get pregnant.
“I started digging and there wasn’t a lot of research out there,” Earle said. He found a study of Danish men who were firefighters had an increased risk of male infertility. “I’ve deduced that if it’s affecting them, it’s most likely affecting our female firefighters as well.”
Until a few years ago, research into the reproductive health of firefighters who can get pregnant was virtually non-existent. Eighty-five percent of firefighter health research has occurred in the last decade alone, said Sara Jahnke, senior scientist in the Center for Fire, Rescue & EMS Health Research at the National Development & Research Institutes. But even then, most focused on one specific group.
“There’s this huge growth [in research]but the flip side is… that a lot of that has focused on white males, because that’s the largest percentage of people in the fire department.
To remedy this trend, the center began a study of more than 3,000 female firefighters in North America in 2017 (it didn’t include trans or non-binary people, many of whom are also affected). The group of female firefighters, who hailed from the United States and Canada, completed two web-based surveys in 2017 and 2019 and were found through affinity groups and through recruitment and referrals from other participants. The researchers used information from this cohort to produce studies analyzing trends in birth and pregnancy outcomes.
In 2021, a study found that 22% of pregnancies among female firefighters ended in miscarriage, nearly double that of a similar study of nurses, similar occupation for stress levels and long shifts . In May 2022, a study using women from the same group of participants found that, compared with the general population, female firefighters more often had lower anti-Müllerian hormone levels, as did Earle, even when sampling was adjusted for age.
The latest study, published in December in the Journal of Occupational and Environmental Medicine, showed that female firefighters had a 40 percent higher risk of becoming pregnant resulting in preterm birth than the general public. Premature babies are more likely to have health problems and developmental disabilities.
“All of this indicates that there are exposures that may be associated with being a firefighter that have adversely affected these women’s reproductive health,” said Leslie Farland, assistant professor at the University of Arizona college of public health. and one of the co-authors.
While researchers can’t pinpoint which variables affect reproductive health, they do have some ideas, including exposure to high temperatures, which has been shown in other studies to negatively impact maternal and fetal health. The nature of shift work, where firefighters might be working 24 hours a day, could also be a factor. They are also exposed to endocrine disrupting chemicals, such as PFAS, often referred to as forever chemicals, which may also play a role.
“We also know that being a firefighter is incredibly stressful,” Farland said. “They are exposed to traumatic events that can negatively impact reproductive health.”
In the latest study they were able to look at different types of employment status, from career firefighters to volunteers. They also looked at the differences between structural firefighters, who fight fires in buildings, versus forest firefighters, who work primarily seasonally and on wildfires.
Research has found that volunteer firefighters, who make up 65% of the workforce, are at a higher risk of becoming pregnant resulting in preterm birth than career firefighters. The miscarriage study also found that volunteers had a higher risk.
“One hypothesis we’ve been thinking about is the idea that volunteer firefighters may not necessarily have the same equipment or training as career firefighters. And so their exposures, while not as frequent, may be different than career firefighters,” Farland said.
The latest study, however, found no correlation between being a wild firefighter and having a higher risk of preterm delivery. This could be due to exposure to different types of chemicals in structural fires or differences between more seasonal and open space fires. But it could also be due to the makeup of the study participants, who were mostly structural firefighters.
“Wildland is definitely getting attention [in health studies]but we don’t have the data on it yet,” said Jahnke, co-author of the study. “It’s hard to collect data from that group, even capture it for a data collection.”
Earle was able to conceive twins through IVF and had another child afterward. With this early evidence pointing to a correlation between fertility and pregnancy complications, people like Earle are becoming more vocal in their departments about the need for better policies and coverage for treatments like fertility benefits.
“Research shows that we are more likely to suffer from miscarriage or preterm birth, or low birth weight, and for men, reduced sperm count and motility. And I hope they look at it like anything else duty-related,” Earle said. “There’s pretty reasonable evidence, I don’t think it’s a ridiculous thing to offer at least one course of fertility treatment.”
Earle started her own non-profit, the Beltane Guild, named for the Gaelic word associated with both fire and fertility, which helps provide small grants to people who pay for fertility treatments and has focused on creating a improved family planning and reproductive health policies for firefighters.
One obstacle Earle has encountered in Washington is that other city employees are not receiving fertility benefits. “But we also hope they recognize that our job is completely different than someone who works 9 to 5 in the office,” she said.
Earle and Stephanie White, a veteran firefighter who now sits on the Beltane Guild board, have assisted departments across the country in creating family planning policies to better reflect the needs of pregnant firefighters.
White, who has been a firefighter for 17 years, said many departments still don’t have policies, and those that do take a stripped-down approach. Some grapple with what it’s like to have a woman for the first time in their department, he said.
Women didn’t start working in fire departments until the 1970s and today they make up just 5 percent of career firefighters. There is no data available on the number of people who identify as trans or non-binary in that workforce. The number is higher for wildland firefighting, where they make up about 12% of the workforce.
“Since so many people are hiring perhaps their first ever woman, the big conversation is going to be about discrimination,” White said. “What do you do with a solo woman who has no one to talk to?”
Slowly, thanks to new research, the conversation is starting to change.
“There are so many male leaders in the fire department that it wasn’t something they ever considered a necessity,” White said. “Right now we see women standing up on their own and saying, ‘No, this is a need and a right. We deserve to have policies that protect us’”.