Background:
Evidence is increasingly accumulating with regard to the negative impact of environmental toxicants on perinatal health. We conclude that evidence of reproductive and perinatal toxicity has reached a “tipping point” that requires us to ask not only what is hazardous but what can and should be done about it.

Objectives:
This work seeks to address the following questions: 1) How do women and providers perceive environmental risk and its impact on perinatal health? 2) What actions are women taking to avoid risk? 3) What messages are successful?

Methods:
We consider approaches to reducing maternal exposure to hazardous environmental toxicants, focusing on risk communication to pregnant women and providers but also considering identification of environmental toxicants in the community and reduction of environmental toxicants. The importance of applying a life course perspective and considering preconceptional exposures is emphasized.

Results:
We critically examine literature on risk communication, including risk perception and the effectiveness of risk communication messages. Sources of information for women and providers are documented, and gaps are identified. Risk communication after conception may be too late. Preconceptional environmental exposures may persist in body tissues. Reducing first trimester exposures may require preconceptional efforts. “Double jeopardy” may attach for low income, minority, and low literacy women who are both more likely to be exposed and to be missed by risk communication efforts. With respect to policy, we discuss accountability, and the roles of federal, state, and local agencies in MCH and Environmental Health as well as the private sector (i.e., industry, employers, professional education and credentialing organizations) with regard to protecting women from environmentally hazardous exposures. Attention is given to structural, procedural and informational aspects. Strategies employed in other arenas, such as poison control and pharmaceutical safety management, are explored as a backdrop to discussion of systematic and system-wide approaches needed to achieve reductions in hazardous exposures for women.

Conclusion and implications for practice:
Little is known about perceptions of risk and behaviors related to environmental toxicants in the context of childbearing. More work is needed to assess the effectiveness of different approaches to reduce women's exposures. Strategies need to be expanded to include the preconceptional period.