Background:
Many toxic substances with unambiguous reproductive and developmental effects are still in regular commercial or therapeutic use and thus present exposure potential to workers. Examples of these include heavy metals ( eg. lead, cadmium), organic solvents (glycol ethers, toluene,) pesticides and herbicides (ethylene dibromide) and sterilants, anesthetic gases and anti-cancer drugs used in healthcare. Thus, workers in the manufacturing sector, electronics and chemical industries, textiles, art and healthcare are at risk of exposure during the preconception period, throughout pregnancy and while breastfeeding. The persistence of some of these substances in the body requires that that the worker be removed from exposure prior to the beginning of pregnancy. These hazards are typically controlled using a combination of approaches which include engineering solutions (such as ventilation), special work practices and administrative procedures and personal protective apparel and equipment (such as gloves or respirators). An administrative practice that is an adjunct to existing hazard control measures for women planning pregnancy is the use of job modification, referred to as alternative duty.

Objectives:
The objectives of this speaker's panel will be to present a more detailed review of the types of work that may require such an accommodation, and the clinical approach to determining the need for and then the implementation of job modification for women in high hazard occupations.

Methods:
The employer perspective will also be presented by a facility which is currently implementing such a policy. A panel presentation by clinician content experts will present an overview of occupations and industries which involve exposure to reproductive and developmental hazards.

Results:
Tools to elicit this history in the clinical encounter will be discussed. Implementation strategies will be described highlighting the interaction between the worker's community-based clinician and her employer. Several case studies will be presented.

Conclusion and implications for practice:
Women work in a number of high hazard industries that present a risk of exposure to reproductive and developmental hazards. Job modification is an important element that clinicians must consider as part of the preconception visit to promote healthy pregnancies.