# Implementation of the Pregnant Workers Fairness Act

> Briefs, arguments, decisions, and more.

URL: https://www.frixlaw.com/law-library/documents/fr%3A2024-07527

## Record

- **Collection:** Federal Register
- **Document type:** Rule
- **Published:** April 19, 2024
- **Citation:** 89 FR 29096

## Text

EQUAL EMPLOYMENT OPPORTUNITY COMMISSION
29 CFR Part 1636
RIN 3046-AB30
Implementation of the Pregnant Workers Fairness Act

AGENCY:

Equal Employment Opportunity Commission.

ACTION:

Final rule and interpretive guidance.

SUMMARY:

The Equal Employment Opportunity Commission is issuing this final rule and interpretive guidance to implement the Pregnant Workers Fairness Act, which requires a covered entity to provide reasonable accommodations to a qualified employee's or applicant's known limitations related to, affected by, or arising out of pregnancy, childbirth, or related medical conditions, unless the accommodation will cause an undue hardship on the operation of the business of the covered entity.

DATES:

This final rule and interpretive guidance is effective on June 18, 2024.

FOR FURTHER INFORMATION CONTACT:

Sharyn Tejani, Associate Legal Counsel, Office of Legal Counsel at 202-900-8652 (voice), 1-800-669-6820 (TTY),
sharyn.tejani@eeoc.gov.
Requests for this final rule and interpretive guidance in an alternative format should be made to the Office of Communications and Legislative Affairs at (202) 921-3191 (voice), 1-800-669-6820 (TTY), or 1-844-234-5122 (ASL video phone).

SUPPLEMENTARY INFORMATION:

Introduction

The Pregnant Workers Fairness Act (PWFA)
1

requires a covered entity to provide reasonable accommodations to a qualified employee's or applicant's known limitations related to, affected by, or arising out of pregnancy, childbirth, or related medical conditions, absent undue hardship on the operation of the business of the covered entity. The PWFA at 42 U.S.C. 2000gg-3(a) directs the Equal Employment Opportunity Commission (EEOC or Commission) to promulgate regulations to implement the PWFA.

1
Consolidated Appropriations Act, 2023, Public Law 117-328, Div. II, 136 Stat. 4459, 6084 (2022) (codified at 42 U.S.C. 2000gg to 2000gg-6).

The Commission issued its notice of proposed rulemaking (NPRM) on August 11, 2023, and invited public comment on this proposal from August 11, 2023, through October 10, 2023.
2

Members of the public submitted approximately 98,600 comments to the EEOC during this 60-day period. Several of those comments were signed by multiple individuals; thus, the total number of comments was over 100,000.
3

2
88 FR 54714-94 (proposed Aug. 11, 2023) (to be codified at 29 CFR part 1636).

3
The vast majority of the comments were form comments that were identical or slightly altered versions of a few base form comments.

Pursuant to 42 U.S.C. 2000gg-3(a), the Commission is issuing this final regulation and an appendix entitled “Appendix A to Part 1636—Interpretive Guidance on the Pregnant Workers Fairness Act” (Interpretive Guidance). As explained in the NPRM, the Interpretive Guidance (a proposed version of which was included in the NPRM) will become part of 29 CFR part 1636.
4

The Interpretive Guidance represents the Commission's interpretation of the issues addressed within it, and the Commission will be guided by the regulation and the Interpretive Guidance when enforcing the PWFA.
5

4
88 FR 54719.

5

Id.

General Information on Terms Used in the Regulation and Interpretive Guidance

The PWFA at 42 U.S.C. 2000gg(3) uses the term “employee (including an applicant)” in its definition of “employee.” Thus, throughout the statute, this preamble, the final regulation, and the Interpretive Guidance, the term “employee” should be understood to include “applicant” where relevant. Because the PWFA relies on Title VII of the Civil Rights Act of 1964 (Title VII), as amended by the Pregnancy Discrimination Act of 1978 (PDA), 42 U.S.C. 2000e
et seq.
for its definition of “employee,” that term also includes “former employee,” where relevant.
6

6

Robinson
v.
Shell Oil Co.,
519 U.S. 337, 346 (1997).

The PWFA defines “covered entity” using the definition of “employer” from different statutes, including Title VII.
7

Thus “covered entities” under the PWFA include public and private employers with 15 or more employees, unions, employment agencies, and the Federal Government.
8

In this preamble, the final regulation, and the Interpretive Guidance, the Commission uses the terms “covered entity” and the term “employer” interchangeably.

7
42 U.S.C. 2000gg(2)(A), (B)(i), (B)(iii), (B)(iv). The other statutes are the Congressional Accountability Act of 1995 and 3 U.S.C. 411(c).

8
The statute at 42 U.S.C. 2000gg(2) provides that the term “covered entity” “has the meaning given the term `respondent'” under 42 U.S.C. 2000e(n) and includes employers as defined in 42 U.S.C. 2000e(b), 2000e-16c(a), and 2000e-16(a). The statute at 42 U.S.C. 2000gg-5(b) provides as a rule of construction that “[t]his chapter is subject to the applicability to religious employment set forth in section 2000e-1(a) of this title [section 702(a) of the Civil Rights Act of 1964].”

To track the language of the statute more closely and improve readability, the Commission made three global changes from the proposed rule and proposed appendix to the final rule and Interpretive Guidance. First, the Commission removed most instances of the words “applicant” and “former employee” from the regulation and the Interpretive Guidance; based on the statute and Title VII, the term “employee” covers “applicant” and “former employee” when relevant. Second, the Commission replaced the word “worker” with the word “employee” throughout the regulation and the Interpretive Guidance. Third, the Commission removed sections of the proposed rule that pertained solely to employees covered by the Congressional Accountability Act of 1995 because the Commission does not have authority to regulate those employees (former §§ 1636.2(c)(2) and 1636.5(b)).

The Interpretive Guidance contains numerous examples to illustrate provisions in the regulation. The Commission received some comments identifying instances where these examples, in an effort to be simple and short, oversimplified situations related to pregnancy, childbirth, or related medical conditions. For example, the Commission used the term “bed rest” in some examples; that is a colloquialism for several actions that would be better described as “rest and reduced activity.”
9

The Commission agrees that in a real situation, there may or may not be more complexity and that describing a restriction may require different or more facts than are in an example. However, the purpose of these examples is to illustrate legal points, to suggest practical actions for covered entities and employees, and to encourage voluntary compliance with the law. Thus, while

the Commission has made some changes to the examples in response to these comments, it also has retained simple language in many examples to allow for ease of reading and to keep the focus of the examples on the PWFA's legal interpretation. The Commission notes that, depending on the facts in the examples, the same facts could lead to claims also being brought under other statutes that the Commission enforces, such as Title VII and the Americans with Disabilities Act of 1990 (ADA), as amended by the ADA Amendments Act of 2008 (ADAAA or Amendments Act), 42 U.S.C. 12101
et seq.
10

Moreover, the situations in specific examples could implicate other Federal laws, including, but not limited to, the Family and Medical Leave Act of 1993, as amended (FMLA), 29 U.S.C. 2601
et seq.;
the Occupational Safety and Health Act of 1970, as amended (OSH Act), 29 U.S.C. 651
et seq.;
and the Fair Labor Standards Act of 1938 (FLSA), 29 U.S.C. 201
et seq.,
as amended by the Providing Urgent Maternal Protections for Nursing Mothers Act (PUMP Act), Public Law 117-328, Div. KK, 136 Stat. 4459, 6093 (2022).
11

Additionally, although some examples state that the described actions “would violate” the PWFA, additional facts not described in the examples could change that determination.

9
Similarly, several examples discuss restrictions on how much an employee can lift. The examples in the Interpretive Guidance generally refer to these restrictions as “lifting restrictions” with a specific pound limit. In some situations, the determination of such restrictions can depend on the frequency of lifting, the height to which the object is lifted, the body position of the person, and the distance between the person and the object.
See, e.g.,
Leslie A. MacDonald et al.,
Clinical Guidelines for Occupational Lifting in Pregnancy: Evidence Summary and Provisional Recommendations,
209 a.m. J. Obstetrics & Gynecology 80-88 (2013),
https://pubmed.ncbi.nlm.nih.gov/23467051/;
U.S. Dep't of Health & Hum. Servs., Ctrs. for Disease Control & Prevention, Nat'l Inst. for Occupational Safety & Health,
Provisional Recommended Weight Limits for Lifting at Work During Pregnancy
(Infographic),
https://www.cdc.gov/niosh/topics/repro/images/Lifting_guidelines_during_pregnancy_-_NIOSH.jpg
(last visited Mar. 18, 2024).

10
References to the ADA throughout the preamble, the regulation, and the Interpretive Guidance are intended to apply equally to the Rehabilitation Act of 1973, as all nondiscrimination standards under Title I of the ADA also apply to Federal agencies under section 501 of the Rehabilitation Act.
See
29 U.S.C. 791(f).

11
To the extent that an accommodation in an example is required under another law, like the OSH Act, the example should not be read to suggest that such a requirement is not applicable.

Finally, the Commission notes that the examples are illustrative. They do not and are not intended to cover every limitation or possible accommodation under the PWFA.
12

12
In the examples, the preamble, the regulation, and the Interpretive Guidance, the Commission uses the terms “leave” or “time off” and intends those terms to cover leave however it is identified by the specific employer. As stated in the proposed rule, the Commission recognizes that different types of employers use different terms for time away from work, including leave, paid time off (PTO), time off, sick time, vacation, and administrative leave, among others. 88 FR 54715 n.19. Similarly, in the examples, the preamble, the regulation and the Interpretive Guidance, the Commission uses the term “light duty.” The Commission recognizes that “light duty” programs, or other programs providing modified duties, can vary depending on the covered entity. As stated in the proposed rule, the Commission intends “light duty” to include the types of programs included in Questions 27 and 28 of the EEOC's
Enforcement Guidance: Workers' Compensation and the ADA
and any other policy, practice, or system that a covered entity has for accommodating employees, including when one or more essential functions of a position are temporarily excused. EEOC,
Enforcement Guidance: Workers' Compensation and the ADA
(1996),
https://www.eeoc.gov/laws/guidance/enforcement-guidance-workers-compensation-and-ada;
88 FR 54715 n.20.

1636.1 Purpose

The Commission made several minor changes to the
Purpose
section of the regulation to follow the language in the statute more closely. Specifically, the phrase “related to, affected by, or arising out of pregnancy, childbirth, or related medical conditions” was added after “known limitations” throughout this paragraph, and the descriptions of the retaliation and coercion provisions were slightly modified.
13

13
For example, the phrase “Prohibits a covered entity from retaliating” was replaced with “Prohibits discrimination” in the discussion of retaliation, and the phrase “Prohibits a covered entity from interfering with any individual's rights” was replaced with “Prohibits coercion of individuals in the exercise of their rights” in the discussion of coercion.

1636.2 Definitions—General

The Commission received numerous comments regarding the proposed general definitions. For example, many comments encouraged the Commission to clarify that restaurant workers are covered by the PWFA. Several comments also suggested the Commission clarify that the requirements for protection under the FMLA (in terms of how long an employee must work for an employer and the number of hours) do not apply under the PWFA and suggested the Commission clarify that employees need not work for an employer for any specific period of time in order to be covered by the PWFA.

The PWFA relies on definitions from Title VII to describe when an employer is covered and who is protected by the law. Employers are covered by the PWFA if they have 15 or more employees, regardless of the industry. Thus, restaurant workers who work for restaurants with 15 or more employees are covered. Because the PWFA's approach to coverage and protection follows Title VII, rather than the FMLA, employees are covered even if they have not worked for a specific employer for a specific length of time.

In the general definitions section of the rule, the Commission added “or the employee of a political subdivision of a State” in § 1636.2(b)(3) and (c)(4) to better describe the employees covered by the Government Employee Rights Act of 1991 (GERA), 42 U.S.C. 2000e-16c(a).

1636.3 Definitions—Specific to the PWFA

1636.3(a) Known Limitation

The rule reiterates the definition of “known limitation” from 42 U.S.C. 2000gg(4) and then provides definitions for the operative terms.

1636.3(a)(1) Known

The Commission did not change the definition of “known” from the proposed rule. Under that definition a limitation is “known” to a covered entity if the employee, or the employee's representative, has communicated the limitation to the covered entity.

1636.3(a)(2) Limitation

The proposed rule restated the definition of limitation from the statute and added that the physical or mental condition may be a modest or minor and/or episodic impediment or problem, that it included when an employee affected by pregnancy, childbirth, or related medical conditions had a need or a problem related to maintaining their health or the health of the pregnancy, and that it included when an employee affected by pregnancy, childbirth, or related medical conditions sought health care related to pregnancy, childbirth, or a related medical condition itself.

The Commission received several comments supporting the definition of “limitation” and suggesting that the word “need” be added to the second sentence (in addition to “impediment” or “problem”) so that it would read: “Physical or mental condition is an impediment, problem, or need that may be modest, minor, and/or episodic.” The Commission declines to make this change because this sentence as it exists (which uses the term “impediment” or “problem”) is sufficiently broad, and the third sentence of the definition of “limitation” covers when the employee has a “need or a problem related to maintaining their health or the health of the pregnancy.”

The Commission received a few comments asserting that this definition was too broad and that it should be more restrictive. The Commission disagrees. As discussed in the NPRM, the PWFA was intended to cover all types of limitations, including those that are minor and those that are needed to maintain the employee's health or the health of the pregnancy.
14

Thus,

creating a higher threshold would not be in keeping with this rationale, would be contrary to congressional intent, and would impede a qualified employee's ability to stay on the job.

14
88 FR 54714-16 (discussing the purpose of the PWFA, including that it helps workers with uncomplicated pregnancies and minor limitations), 54719-20 (explaining that allowing employees to

seek health care related to pregnancy, childbirth, or a related medical condition itself is consistent with the ADA).

A handful of comments asked for clarification as to whether the language in the NPRM required employers to provide reasonable accommodations to an employee when an employee's partner, spouse, or family member—and not the employee themselves—has a physical or mental condition related to, affected by, or arising out of pregnancy, childbirth, or related medical conditions. It does not. To respond to these comments, the Commission has included in the final rule's definition of “limitation” that the limitation must be of the specific employee in question. This is essentially the same language that was in the NPRM with regard to related medical conditions in § 1636.3(b).
15

15
88 FR 54767 (providing that related medical conditions are “as applied to the specific employee or applicant in question”).

The Commission has made one minor change in the language of this provision in the regulation. To track the language of the statute in 42 U.S.C. 2000gg(4), the Commission has changed the last sentence of the definition of “limitation” regarding the ADA so that it now mirrors the language in the statute (“whether or not such condition meets the definition of disability”).

In the Interpretive Guidance, the Commission has added information in section
1636.3(a)(2) Limitation
calling attention to the possible overlap between the PWFA and the ADA and noting that in these situations the qualified employee may be entitled to an accommodation under either statute, as the protections of both may apply. The Commission has added information consistent with the changes in the regulation described above to state that the limitation must be of the specific employee in question and that the PWFA does not create a right to reasonable accommodation based on an individual's association with someone else with a PWFA-covered limitation or provide accommodations for bonding or childcare. To make the language in the Interpretive Guidance consistent with the regulation, the Commission has modified language in the Interpretive Guidance regarding accommodations for health care to clarify that accommodations may be needed to attend health care appointments for a variety of reasons.
16

Finally, the Commission has modified language from the proposed appendix regarding the PWFA and the lack of a “severity” requirement to avoid giving the mistaken impression that the ADA has such a requirement.

16
The proposed appendix stated: “The definition also includes when the worker is seeking health care related to the pregnancy, childbirth, or a related medical condition itself . . . and recognizes that for pregnancy, childbirth, or related medical conditions the proper course of care can include regular appointments and monitoring by a health care professional.” 88 FR 54773. The new language in the Interpretive Guidance in section
1636.3(a)(2) Limitation
states: “Similarly, under the PWFA, an employee may require a reasonable accommodation of leave to attend health care appointments or receive treatment for or recover from their pregnancy, childbirth, or related medical conditions.” The new language more accurately reflects that accommodations are not limited to “regular appointments” or “monitoring,” which is consistent with how leave for health care appointments is described in the regulation and elsewhere in the Interpretive Guidance.

Comments and Response to Comments Regarding the Commission's Proposed Description of “Related to, Affected by, or Arising Out of”

Some comments supported the Commission's reading of the language “related to, affected by, or arising out of,” stating that the Commission's reading was textually accurate in that nothing in the statutory language requires that the pregnancy, childbirth, or related medical conditions be the sole or original cause of the limitation. Other comments stated that the language in the NPRM explaining “related to, affected by, or arising out of,” especially when combined with the definition of “related medical conditions,” could require accommodations for known limitations caused by any physical or mental condition that has any real, perceived, or potential connection to—or impact on—an individual's pregnancy, fertility, or reproductive system. These comments asked the Commission to alter the NPRM language to counter this interpretation. Some comments asked for additional clarification regarding the language “related to, affected by, or arising out of.”

The PWFA uses the language “related to, affected by, or arising out of” to explain the connection between the physical or mental condition and pregnancy, childbirth, or related medical conditions.
17

As such, the statute does not require that pregnancy, childbirth, or related medical conditions be the sole, the original, or a substantial reason for the physical or mental condition, and the Commission does not have the authority to change this term.

17
42 U.S.C. 2000gg(4).

To help respond to these comments, in the Interpretive Guidance in section
1636.3(a)(2)
under
Related to, Affected by, or Arising Out of,
the Commission has added that “related to, affected by, or arising out of” are inclusive terms and that a pregnancy, childbirth, or related medical condition does not need to be the sole, the original, or a substantial cause of the physical or mental condition at issue for the physical or mental condition to be “related to, affected by, or arising out of” pregnancy, childbirth, or related medical conditions. This is in keeping with the dictionary definition of “related to,” which is generally defined as “connected with” or “about” something.
18

It also is consistent with the meaning of “affected by,” as the dictionary definition of the word “affect” is “to cause,” “to produce,” or “to influence” something.
19

Finally, it aligns with the meaning of “arising out of,” because the dictionary definition of “arise” includes “to begin to occur or exist” or “to originate from a source.”
20

18

Relate To, Merriam-Webster.com, https://www.merriam-webster.com/dictionary/related%20to
(last visited Mar. 9, 2024).

19

Affect, Merriam-Webster.com, https://www.merriam-webster.com/dictionary/affect
(last visited Mar. 18, 2024).

20

Arise, Merriam-Webster.com, https://www.merriam-webster.com/dictionary/arising
(last visited Mar. 14, 2024).

The Interpretive Guidance in section
1636.3(a)(2)
under
Related to, Affected by, or Arising Out of
further explains that determining whether a physical or mental condition is “related to, affected by, or arising out of” pregnancy, childbirth, or related medical conditions should typically be straightforward, particularly in cases where an individual is currently pregnant, is experiencing childbirth, or has just experienced childbirth. Pregnancy and childbirth cause systemic changes that not only create new physical and mental conditions but also can exacerbate preexisting conditions and can cause additional pain or risk.
21

Thus, a connection between an employee's physical or mental condition and their pregnancy, childbirth, or related medical conditions will be readily ascertained when an employee is currently pregnant or is experiencing or has just experienced childbirth.

21

See, e.g.,
Danforth's Obstetrics & Gynecology 286 (Ronald S. Gibbs et al. eds., 10th ed. 2008) (“Normal pregnancy entails many physiologic changes . . . .”); Clinical Anesthesia 1138 (Paul G. Barash et al. eds., 6th ed. 2009) (“During pregnancy, there are major alterations in nearly every maternal organ system.”).

The Commission has maintained the list of situations in the Interpretive

Guidance in section
1636.3(a)(2)
under
Related to, Affected by, or Arising Out of
that show the connection between pregnancy, childbirth, or related medical conditions and the limitation with some minor changes.
22

The Interpretive Guidance also maintains the discussion that some conditions (like lifting restrictions) can occur whether or not an employee is affected by pregnancy, childbirth, or related medical conditions and that the Commission anticipates that confirming that a physical or mental condition is related to, affected by, or arising out of pregnancy, childbirth, or related medical conditions will usually be straightforward and can be accomplished through the interactive process. The Commission has added information to the Interpretive Guidance explaining that there may be situations where a physical or mental condition may no longer be related to, affected by, or arising out of pregnancy, childbirth, or related medical conditions, and that in those situations, an employee may seek an accommodation under the ADA. The Commission also has added that there may be situations where the physical or mental condition exacerbates an existing condition that is a disability under the ADA, and in those situations, an employee may be entitled to an accommodation under either the ADA or the PWFA.

22
For example, in the proposed appendix, many of the examples in this paragraph said that the physical or mental condition was “related to” pregnancy. This has been changed to “related to, affected by, or arising out of” to match the language in the statute. The Commission has added that a lifting restriction may be due to lower back pain that may be exacerbated by physical changes associated with pregnancy to connect the lifting restriction to pregnancy in that example. The Commission has added in this paragraph that: “A lactating employee who seeks an accommodation to take breaks to eat has a related medical condition (lactation) and a physical condition related to, affected by, or arising out of it (increased nutritional needs),” in order to include an example about a “related medical condition.” The Commission has changed the language in the proposed appendix from “determining whether” to “confirming whether,” where relevant, in order to match the language used in § 1636.3(l)(2).

1636.3(b) Pregnancy, Childbirth, or Related Medical Conditions

The NPRM explained that the phrase “pregnancy, childbirth, or related medical conditions” appears in Title VII's definition of “sex,” as amended in 1978 by the PDA.
23

Because Congress chose to write the PWFA using the same phrase as in Title VII, as amended by the PDA, and is presumed to have known the meaning given that phrase by the courts and the Commission for over 40 years, the Commission gave the phrase “pregnancy, childbirth, or related medical conditions” the same meaning under the PWFA as under Title VII.
24

When Congress chooses to “use[ ] the same language in two statutes having similar purposes, . . . it is appropriate to presume that Congress intended that text to have the same meaning in both statutes.”
25

23
88 FR 54721.

24

See, e.g., Tex. Dep't of Hous. & Cmty. Affs.
v.
Inclusive Cmtys. Project, Inc.,
576 U.S. 519, 536 (2015) (“If a word or phrase has been . . . given a uniform interpretation by inferior courts . . . , a later version of that act perpetuating the wording is presumed to carry forward that interpretation.”) (omissions in original) (quoting Antonin Scalia & Bryan A. Garner,
Reading Law: The Interpretation of Legal Texts
322 (2012));
Bragdon
v.
Abbott,
524 U.S. 624, 645 (1998) (“When administrative and judicial interpretations have settled the meaning of an existing statutory provision, repetition of the same language in a new statute indicates, as a general matter, the intent to incorporate its administrative and judicial interpretations as well.”);
Lorillard
v.
Pons,
434 U.S. 575, 581 (1978) (“[W]here, as here, Congress adopts a new law incorporating sections of a prior law, Congress normally can be presumed to have had knowledge of the interpretation given to the incorporated law, at least insofar as it affects the new statute.”);
Hall
v.
U.S. Dep't of Agric.,
984 F.3d 825, 840 (9th Cir. 2020) (“Congress is presumed to be aware of an agency's interpretation of a statute. We most commonly apply that presumption when an agency's interpretation of a statute has been officially published and consistently followed. If Congress thereafter reenacts the same language, we conclude that it has adopted the agency's interpretation.”) (internal citations and quotation marks omitted); Antonin Scalia & Bryan A. Garner,
Reading Law: The Interpretation of Legal Texts
323 (2012) [hereinafter Scalia & Garner,
Reading Law
] (“[W]hen a statute uses the very same terminology as an earlier statute—especially in the very same field, such as securities law or civil-rights law—it is reasonable to believe that the terminology bears a consistent meaning.”); H.R. Rep. No. 117-27, pt. 1, at 11-17 (discussing the history of the passage of the PDA; explaining that, due to court decisions, the PDA did not fulfill its promise to protect pregnant employees; and that the PWFA was intended to rectify this problem and protect the same employees covered by the PDA).

25

Smith
v.
City of Jackson,
544 U.S. 228, 233 (2005);
see Northcross
v.
Bd. of Ed. of the Memphis City Schs.,
412 U.S. 427, 428 (1973) (per curiam) (observing that “similarity of language” between statutes is “a strong indication that the two statutes should be interpreted pari passu”).

The PWFA's legislative history supports the Commission's reading of the phrase “pregnancy, childbirth, or related medical conditions” to have the same meaning as the phrase in Title VII. The U.S. House of Representatives Report accompanying the PWFA recounts the legislative steps Congress has taken to protect workers affected by pregnancy, childbirth, or related medical conditions. In 1964, Congress passed Title VII, which included protection from discrimination based on sex. In 1972, the EEOC interpreted the prohibition on sex discrimination to include pregnancy, childbirth, or related medical conditions.
26

In 1976, the Supreme Court determined that pregnancy discrimination was not covered by Title VII.
27

In 1978, responding to that decision, Congress passed the PDA “to codify the EEOC's original interpretation of Title VII.”
28

Courts' subsequent interpretations of the disparate treatment standard in the PDA, however, left “[n]umerous [g]aps” in protections, and the Supreme Court's 2015 decision in
Young
v.
United Parcel Service, Inc.,
575 U.S. 206 (2015), created a standard that did not adequately protect the workers that the PDA covered, according to the PWFA House Report.
29

The House concluded that, “[t]o remedy the shortcomings of the PDA, Congress must step in and act.”
30

Congress' discussion of the PDA and identification of shortcomings in the PDA as a reason for enacting the PWFA show that in the PWFA, Congress sought to protect the same workers who are protected by the PDA. By using Title VII's longstanding definition of “pregnancy, childbirth, or related medical conditions” for the PWFA, the Commission is following both the text of the statute and its legislative history.

26
H.R. Rep. No. 117-27, pt. 1, at 12 (2021); 29 CFR 1604.10(b) (1972); 37 FR 6835, 6837 (1972) (addressing Title VII coverage of “[d]isabilities caused or contributed to by pregnancy, miscarriage, abortion, childbirth, and recovery therefrom”).

27

Gen. Elec. Co.
v.
Gilbert,
429 U.S. 125, 135-36 (1976).

28
H.R. Rep. No. 117-27, pt. 1, at 13;
see also
H.R. Rep. No. 95-948, at 2 (1978),
as reprinted in
1978 U.S.C.C.A.N. 4749, 4750 (providing that the U.S. House of Representatives' version of the PDA “will amend Title VII to clarify Congress' intent to include discrimination based on pregnancy, childbirth or related medical conditions in the prohibition against sex discrimination in employment” and stating that the EEOC's 1972 guidelines—which “state that excluding applicants or employees from employment because of pregnancy or related medical conditions is a violation of Title VII” and “require employers to treat disabilities caused or contributed to by pregnancy, miscarriage, abortion, childbirth and recovery therefrom as all other temporary disabilities”—“rightly implemented the Title VII prohibition of sex discrimination in the 1964 [Civil Rights A]ct”); S. Rep. No. 95-331, at 2 (1977) (explaining that, in implementing Congress' intent in amending Title VII in 1972, the EEOC issued guidelines that “made clear that excluding applicants or employees from employment because of pregnancy or related medical conditions was a violation of [T]itle VII,” and “these guidelines rightly implemented the Congress' intent in barring sex discrimination in the 1964 [Civil Rights A]ct”).

29
H.R. Rep. No. 117-27, pt. 1, at 14-16.

30

Id.
at 17.

Comments Regarding Temporal Proximity to a Current or Recent Pregnancy

Some comments requested that the Commission limit the definition of “pregnancy, childbirth, or related medical conditions” under the PWFA to situations that met their definition of close temporal proximity to a current or recent pregnancy. These comments also

noted that many of the conditions listed in the NPRM as conditions that could qualify as “pregnancy, childbirth, or related medical conditions” also could impact individuals who have never been pregnant or could first arise years before or after pregnancy. Relatedly, several comments suggested that only conditions related to a current or recent pregnancy (which the comments defined as one occurring 6 or fewer months earlier) could be “related medical conditions.”

Response to Comments Regarding Temporal Proximity to a Current or Recent Pregnancy

The Commission declines to adopt the changes suggested by these comments, as they seek to create a definition of “pregnancy, childbirth, or related medical conditions” that is not supported by Title VII case law or the Commission's
Enforcement Guidance on Pregnancy Discrimination and Related Issues.
31

Further, adopting such a bright-line temporal rule would improperly exclude many employees, such as employees with postpartum limitations, who may require pregnancy-related accommodations.
32

That said, “related medical conditions” must be related to the pregnancy or childbirth of the specific employee in question, and whether a specific condition is related to pregnancy or childbirth is a fact-specific determination that will be guided by existing Title VII precedent and prior relevant Commission guidance.

31
EEOC,
Enforcement Guidance on Pregnancy Discrimination and Related Issues,
(I)(A) (2015) [hereinafter
Enforcement Guidance on Pregnancy Discrimination
],
https://www.eeoc.gov/laws/guidance/enforcement-guidance-pregnancy-discrimination-and-related-issues
(providing that the term “pregnancy, childbirth, or related medical conditions” includes current pregnancy, past pregnancy, potential or intended pregnancy, and related medical conditions).

32

See, e.g.,
Am. Coll. of Obstetricians & Gynecologists, Comm. Opinion No. 736,
Optimizing Postpartum Care
(reaff'd 2021),
https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/05/optimizing-postpartum-care
(discussing the importance of postpartum health care, including treatment for disorders arising during pregnancy and chronic medical conditions); Susanna Trost et al., U.S. Dep't of Health & Hum. Servs., Ctrs. for Disease Control & Prevention,
Pregnancy-Related Deaths: Data from Maternal Mortality Review Committees in 36 U.S. States, 2017-2019
(2022),
https://www.cdc.gov/reproductivehealth/maternal-mortality/erase-mm/data-mmrc.html
(30% of pregnancy-related deaths occurred one- and one-half months to one year postpartum).

Comments Regarding the List of Conditions Included in the Regulation as Examples of “Pregnancy, Childbirth, or Related Medical Conditions”

Multiple comments supported the Commission's definition of “pregnancy, childbirth, or related medical conditions” and supported the inclusion of the list of numerous possible “related medical conditions” in the regulation. Comments argued that the Commission's reading of “related medical conditions” best effectuates the purpose and goals of the PWFA; is consistent with longstanding law, legislative history, agency interpretation, medical understanding, and common sense; and appropriately supplements the protections currently afforded under the PDA.

By contrast, several comments stated that the language in the NPRM explaining the term “related medical conditions” could require accommodations for any physical or mental condition that has any real, perceived, or potential connection to—or impact on—an individual's pregnancy, fertility, or reproductive system. These comments asked the Commission to alter the language in the proposed rule to counter this interpretation.

Other comments stated that the broad, non-exhaustive list of “related medical conditions” exceeded the Commission's delegated authority as intended by Congress and that such a list would, based on sex, improperly privilege employees with gynecological conditions, or disadvantage other employees with analogous conditions, and thus potentially illegally discriminate under Title VII or the Equal Protection Clause.

Response to Comments Regarding the List of Conditions Included in the Regulation as Examples of “Pregnancy, Childbirth, or Related Medical Conditions”

Generally, the question of whether a condition constitutes “pregnancy, childbirth, or related medical conditions” in a particular case will be fact-specific and guided by existing Title VII precedent and relevant prior Commission guidance. To assist in making that determination, the Commission made clarifying changes and additions to the language in this section of the regulation and has added more information in the Interpretive Guidance in section
1636.3(b) Pregnancy, Childbirth, or Related Medical Conditions.

First, the Commission removed the phrase “relate to, are affected by, or arise out of” with regard to “related medical conditions” in the proposed § 1636.3(b) in order to track the language of the statute and reflect more closely language in the Commission's prior enforcement guidance that explains the extent of the PDA and the definition of “pregnancy, childbirth, or related medical conditions.”
33

This sentence now says “[r]elated medical conditions are medical conditions relating to the pregnancy or childbirth of the specific employee in question.”

33
42 U.S.C. 2000gg(4);
Enforcement Guidance on Pregnancy Discrimination, supra
note 31, at (I)(A)(4)(a) (“[A]n employer may not discriminate against a woman with a medical condition relating to pregnancy or childbirth.”).

Second, the Commission reorganized the list of conditions in § 1636.3(b) to follow more closely the organization of the Commission's
Enforcement Guidance on Pregnancy Discrimination
explaining the definition of “pregnancy, childbirth, or related medical conditions,” so that the two resources are consistent.
34

34

Enforcement Guidance on Pregnancy Discrimination, supra
note 31, at (I)(A).

Third, the Commission addressed concerns raised in the comments that conditions in the list of “related medical conditions” would “always” be “related medical conditions” and thus limitations related to, affected by, or arising out of those conditions would automatically be entitled to coverage under the PWFA. The Commission responded to these concerns and requests by changing the language in § 1636.3(b) so that the list is now explained as conditions that “are, or may be,” “related medical conditions.”

Fourth, the Commission added that the pregnancy or childbirth must be “of the specific employee in question.” This language was already in the NPRM—in that the NPRM made clear that related medical conditions must be related to the pregnancy or childbirth of the specific employee in question—and has been added to the definition of “limitation” as well.
35

35
Additionally, for consistency, the Commission replaced “menstrual cycles” with “menstruation” because menstruation is the term used elsewhere in the NPRM and also replaced “birth control” with “contraception” because that is the term used in
Enforcement Guidance on Pregnancy Discrimination
cited throughout the NPRM.
Compare
88 FR 54767 (listing “menstrual cycles” in the list of “related medical conditions”),
with
88 FR 54721, 54774 (explaining that the list in the regulation for the definition of “pregnancy, childbirth, or related medical conditions” includes “menstruation”);
Enforcement Guidance on Pregnancy Discrimination, supra
note 31, at (I)(A)(3).

In the Interpretive Guidance in section
1636.3(b) Pregnancy, Childbirth, or Related Medical Conditions,
the Commission has added information

regarding the Commission's expectation that it will be readily apparent that certain medical conditions (
e.g.,
lactation, miscarriage, stillbirth, having or choosing not to have an abortion, preeclampsia, gestational diabetes, and HELLP (hemolysis, elevated liver enzymes and low platelets syndrome)) have a relation to pregnancy or childbirth; and that, similarly, a connection between a medical condition and pregnancy or childbirth will often be evident when a new medical condition occurs or an existing medical condition is exacerbated or poses a new risk during a current pregnancy, childbirth, or postpartum period.

The Commission disagrees that creating a list of potential “related medical conditions” that are or may be related to pregnancy or childbirth exceeds the Commission's authority. The list includes related medical conditions that courts and the Commission, in its
Enforcement Guidance on Pregnancy Discrimination,
have determined can, but are not always required to be, related medical conditions, as well as a non-exhaustive list of other conditions that, depending on the situation, can be related to pregnancy or childbirth.
36

The list clearly states that it consists of examples that “are or may be” related medical conditions in a specific case. In each case, a determination that a medical condition is related to pregnancy or childbirth is fact-specific and contingent on whether the medical condition at issue is related to the pregnancy or childbirth of the specific employee in question. The Commission notes that regardless of whether pregnancy, childbirth, or related medical conditions are at issue, the provision of 42 U.S.C. 2000gg-5(a)(2) stating that nothing in the PWFA shall be construed “by regulation or otherwise, to require an employer-sponsored health plan to pay for or cover any particular item, procedure, or treatment” applies.

36

Enforcement Guidance on Pregnancy Discrimination, supra
note 31.

The Commission also disagrees that accommodations under the PWFA will potentially discriminate based on sex. The PWFA only provides accommodations to qualified employees with limitations related to, affected by, or arising out of pregnancy, childbirth, or related medical conditions. This is in keeping with courts that have found that laws and other policies that provide leave for workers affected by pregnancy do not discriminate based on sex.
37

Additionally, in
Young
v.
United Parcel Service,
38

the Supreme Court found that an employer could be required by the PDA to provide an accommodation for pregnant workers even if the employer's general policy did not provide for accommodations for workers except in certain situations. The accommodations provided under the PWFA are similar in purpose and effect to those that could have been obtained in
Young.
And, just as the accommodations contemplated by the Court in
Young
did not violate Title VII, neither do accommodations under the PWFA.

37

See Cal. Fed. Sav. & Loan Ass'n
v.
Guerra,
479 U.S. 272, 290 (1987) (holding that, without violating Title VII, the State could require employers to provide up to four months of medical leave to pregnant women where “[t]he statute is narrowly drawn to cover only the period of
actual physical disability
on account of pregnancy, childbirth, or related medical conditions”) (emphasis in original);
Johnson
v.
Univ. of Iowa,
431 F.3d 325, 328 (8th Cir. 2005) (“If the leave given to biological mothers is granted due to the physical trauma they sustain giving birth, then it is conferred for a valid reason wholly separate from gender.”).

38
575 U.S. 206 (2015).

Moreover, Congress expressly intended that in some cases, the PWFA would require accommodations for a qualified employee's limitations related to, affected by, or arising out of pregnancy, childbirth, or related medical conditions, even if such accommodations are not available to other employees. In fact, Congress observed that the PDA's comparator requirement “is a burdensome and often impossible standard to meet” and thus is “insufficient to ensure that pregnant workers receive the accommodations they need.”
39

39

See
H.R. Rep. No. 117-27, pt. 1, at 11-12.

Comments and Response to Comments Requesting Deletions, Additions, or Other Modifications to the List of Examples of “Pregnancy, Childbirth, or Related Medical Conditions”

Many comments requested deletions, additions, or other modifications to the list of examples of “pregnancy, childbirth, or related medical conditions” provided in the proposed definition at § 1636.3(b). The Commission declines to modify the provided list. As previously explained, the list of examples of “pregnancy, childbirth, or related medical conditions” is non-exhaustive and includes conditions that are commonly—but not always—associated with pregnancy or childbirth. The list neither requires blanket accommodation for every condition listed nor precludes accommodations for conditions that are not listed. Additionally, because “pregnancy, childbirth, or related medical conditions” has the same definition as in Title VII, as amended by the PDA, this phrase's use in the PWFA necessarily will continue to reflect Title VII case law regarding that phrase.

Comments and Response to Comments Regarding Coverage of Specific Conditions—Menstruation

A number of comments argued for or against the inclusion of menstruation in the list of “related medical conditions.” While the limited number of Federal courts that have addressed the issue of whether menstruation falls within the Title VII definition of “related medical conditions” have not always held that it does, read together, the majority of these cases illustrate that, at a minimum, menstruation is covered under Title VII when it has a nexus to a current or prior pregnancy or childbirth. Accordingly, as with many conditions that can be “related medical conditions,” this determination will be made on a case-by-case basis.
40

40

See EEOC
v.
Houston Funding II, Ltd.,
717 F.3d 425, 429-30 (5th Cir. 2013) (observing, in a case about whether lactation was a “related medical condition,” that “as both menstruation and lactation are aspects of female physiology that are affected by pregnancy, each seems readily to fit into a reasonable definition of `pregnancy, childbirth, or related medical conditions' ”);
Flores
v.
Va. Dep't of Corr.,
No. 5:20-CV-00087, 2021 WL 668802, at *4 (W.D. Va. Feb. 22, 2021) (declining to decide whether heavy menstruation due to perimenopause was a “related medical condition,” but observing that “there is a strong argument that menstruation is a `related medical condition' to pregnancy and childbirth under the PDA”);
but see Jirak
v.
Fed. Express Corp.,
805 F. Supp. 193, 195 (S.D.N.Y. 1992) (stating that menstrual cramps alone were not a medical condition related to pregnancy or childbirth);
Coleman
v.
Bobby Dodd Inst., Inc.,
No. 4:17-CV-00029, 2017 WL 2486080, at *2 (M.D. Ga. June 8, 2017) (stating that the employee's excessive menstruation was “related to pre-menopause, not pregnancy or childbirth”).

However, these and other cases suggest that, even if menstruation (or another condition) is not found to be “pregnancy, childbirth, or related medical conditions” in a particular case, discrimination based on that condition could nevertheless violate Title VII's prohibition on sex discrimination.
See, e.g., Harper
v.
Thiokol Chem. Corp.,
619 F.2d 489, 492 (5th Cir. 1980) (concluding that a policy requiring individuals returning from pregnancy leave to have a normal menstrual cycle violated Title VII because it denied “persons of like qualifications equal employment opportunities because of their sex,” as “company rules which single out certain subclasses of women for disparate treatment constitute unlawful sex discrimination”);
Flores,
2021 WL 668802, at *4 (allowing a Title VII claim to proceed “regardless of applying an expanded definition of `because of sex' or `on the basis of sex' under the PDA” where the plaintiff was fired for suspicion of contraband due to her use of tampons while menstruating);
see also Int'l Union, United Auto., Aerospace & Agric. Implement Workers of Am., UAW
v.
Johnson Controls, Inc.,
499 U.S. 187, 198-99 (1991) (providing that a policy excluding women with childbearing capacity from certain jobs was discrimination based on gender under Title VII; this conclusion was “bolstered” by the PDA, which prohibits discrimination “because of or on the basis of pregnancy, childbirth, or related medical conditions”);
Phillips
v.
Martin Marietta Corp.,
400 U.S. 542, 544 (1971) (per curiam) (opining that an

employer who refused to take applications from women with preschool-age children but hired men with preschool-age children and other women would violate Title VII, absent a defense).

Comments and Response to Comments Regarding Coverage of Specific Conditions—Lactation

One comment claimed there was a split between courts on the issue of whether lactation falls within the scope of the PDA, stating that some courts, including the Fourth and Sixth Circuits, found that it does not, while other courts have found that it does. One case cited by the comment, however, does not address coverage of lactation as a related medical condition under Title VII. The case of
Derungs
v.
Wal-Mart Stores, Inc.,
374 F.3d 428 (6th Cir. 2004), involved a question of whether a store's ban on public breastfeeding was discriminatory under a State public accommodation statute where that statute did not include protection on the basis of “pregnancy, childbirth, or related medical conditions.”
41

Another case cited by the comment,
Barrash
v.
Bowen,
846 F.2d 927 (4th Cir. 1988) (per curiam), is similarly inapposite. In
Barrash,
the Fourth Circuit held that a Federal Government employee who challenged her termination of employment on grounds of unauthorized absence as violative of her constitutional and contractual rights was not entitled to 6 months of leave in order to breastfeed her baby. That court's statement, that “[u]nder the [PDA] . . . , pregnancy and related conditions must be treated as illnesses only when incapacitating,”
42

was subsequently recognized by the same court as “
dicta
without any citation of authority.”
43

By contrast,
EEOC
v.
Houston Funding II, Ltd.,
held that lactation is a related medical condition of pregnancy for purposes of the PDA because it is the “physiological process of secreting milk from mammary glands and is directly caused by hormonal changes associated with pregnancy and childbirth” and is “a physiological result of being pregnant and bearing a child.”
44

Hicks
v.
City of Tuscaloosa
agrees with
Houston Funding
that lactation is a related medical condition and therefore covered under the PDA.
45

Thus,
Derungs
and
Barrash
do not foreclose a finding that lactation can be a “related medical condition” under Title VII and do not undercut the Commission's conclusion that lactation can be a related medical condition under the PWFA.

41
In its analysis,
Derungs
also discussed Title VII coverage for breastfeeding under a comparator analysis and found that breastfeeding would not be covered because of an absence of comparators (
i.e.,
men who could breastfeed).
Derungs,
374 F.3d at 438-39. Independent of the soundness of that analysis, the case did not address whether lactation was or could be a “related medical condition” to pregnancy and noted in its description of the Ohio statute regarding employment that parallels Title VII that “[t]he Legislature made a conscious choice to extend the definition of discrimination to include pregnancy even though there cannot be a class of similarly situated males.”
Id.
at 436.

42

Barrash,
846 F.2d at 931.

43

Notter
v.
North Hand Protection,
89 F.3d 829, at *5 (4th Cir. 1996) (per curiam) (table) (explaining that “[t]he text of the [PDA] contains no requirement that `related medical conditions' be `incapacitating' ”).

44
717 F.3d at 428.

45
870 F.3d 1253, 1259 (11th Cir. 2017).

Comments and Response to Comments Regarding Coverage of Specific Conditions—Infertility and Fertility Treatments

Some comments agreed with the Commission's inclusion of infertility and fertility treatments in the list of covered conditions in the regulation. By contrast, other comments stated that the Title VII case law on infertility is inconsistent and thus infertility and fertility treatments should not be included in the list of potentially covered conditions in the regulation. The Commission concludes that, as with other conditions, and consistent with case law and its prior policy, whether infertility and fertility treatments are covered by the PWFA will be based on the particular circumstances of the situation, thus potentially allowing for reasonable accommodations for treatment for infertility when an employee with the capacity to become pregnant is trying to get pregnant.

In
Johnson Controls,
the Supreme Court struck down an employer policy that discriminated between workers based on childbearing capacity and held that the PDA prohibits discrimination based on potential pregnancy.
46

In accordance with
Johnson Controls,
discrimination based on the potential to be pregnant, not only current pregnancy, is covered by Title VII and the PDA. Because Title VII, as amended by the PDA, can cover potential pregnancy, several courts have found that it protects against discrimination for those undergoing in vitro fertilization (IVF) or infertility treatments related to becoming pregnant because these actions are related to the capacity to become pregnant.
47

By contrast, notably in the insurance context where the challenged restriction excluded all types of infertility treatments from coverage, regardless of the insured employee's capacity to become pregnant, courts have found such policies did not violate the PDA.
48

Those cases do not stand for the proposition that fertility treatments are never covered by the statutory phrase “pregnancy, childbirth, or related medical conditions,” but instead hold that the particular claims in those cases fail based on the lack of differential treatment based on sex. The Commission's
Enforcement Guidance on Pregnancy Discrimination
summarizes the law in this regard:

46
499 U.S. at 204-06;
see also Kocak
v.
Cmty. Health Partners of Ohio,
400 F.3d 466, 470 (6th Cir. 2005) (reasoning that the plaintiff “cannot be refused employment on the basis of her potential pregnancy”).

47

Hall
v.
Nalco Co.,
534 F.3d 644, 649 (7th Cir. 2008) (finding an employer's practice of terminating employees who took leave for IVF treatment violated the PDA because only women undergo IVF);
Erickson
v.
Bd. of Governors of State Colls. & Univs.,
911 F. Supp. 316, 320 (N.D. Ill. 1995) (finding that a plaintiff who underwent infertility treatment, “although infertile, may have been viewed by her employer as potentially pregnant,” and distinguishing between “infertility [that] does not relate to [the] capacity to become pregnant” and that which does relate to the capacity to become pregnant);
Pacourek
v.
Inland Steel Co.,
858 F. Supp. 1393, 1397, 1403-04 (N.D. Ill. 1994) (finding that infertility or its treatment were conditions that fell under the umbrella of pregnancy (including potential pregnancy), childbirth, or related medical conditions).

48

Saks
v.
Franklin Covey, Inc.,
316 F.3d 337, 346 (2d Cir. 2003) (finding that generally, “[i]nfertility is a medical condition that afflicts men and women with equal frequency,” but leaving open the question of whether an individual “would be able to state a claim under the PDA or Title VII for adverse employment action taken against her because she has taken numerous sick days in order to undergo surgical implantation procedures”);
Krauel
v.
Iowa Methodist Med. Ctr.,
95 F.3d 674, 679-680 (8th Cir. 1996) (finding the benefits policy at issue did not violate Title VII, reasoning that “the policy of denying insurance benefits for treatment of fertility problems applies to both female and male workers and thus is gender-neutral”),
abrogated on other grounds by Bragdon
v.
Abbott,
524 U.S. 624 (1998). Notably, because of 42 U.S.C. 2000gg-5(a)(2), nothing in the PWFA can require an employer-sponsored health plan to pay for or cover any particular item, procedure, or treatment. Thus, PWFA accommodation claims will not involve coverage by health care plans.

Employment decisions related to infertility treatments implicate Title VII under limited circumstances. Because surgical impregnation is intrinsically tied to a woman's childbearing capacity, an inference of unlawful sex discrimination may be raised if, for example, an employee is penalized for taking time off from work to undergo such a procedure. In contrast, with respect to the exclusion of infertility from employer-provided health insurance, courts have generally held that exclusions of all infertility coverage for all employees is gender neutral and does not violate Title VII. Title VII may be implicated by exclusions of particular treatments that apply only to one gender.
49

49

Enforcement Guidance on Pregnancy Discrimination, supra
note 31, at (I)(A)(3)(c) (footnotes omitted).

Thus, depending upon the facts of the case, including whether the infertility treatments are sought by an employee with the capacity to become pregnant

for the purpose of becoming pregnant, accommodations for an employee due to physical or mental conditions related to, affected by, or arising out of infertility or fertility treatments may be provided under the PWFA, absent undue hardship.

Comments and Response to Comments Regarding Coverage of Specific Conditions—Contraception

Some comments agreed with the Commission's inclusion of contraception in the regulation. By contrast, some comments stated that the Commission had not properly interpreted Federal case law related to the coverage of contraception and that the Eighth Circuit's holding in
In re Union Pacific Railroad Employment Practices Litigation

50

forecloses accommodations related to contraception under all circumstances.

50
479 F.3d 936, 939, 942 (8th Cir. 2007) (concluding that Union Pacific's insurance policy—which excluded “all types of contraception, whether prescription, non-prescription or surgical and whether for men or women”—did not discriminate against women and therefore did not violate the PDA and distinguishing
Johnson Controls
on the ground that, unlike “potential pregnancy,” “contraception is not a gender-specific term”).

The Commission disagrees that reasonable accommodations regarding contraception for an employee who has the capacity to become pregnant are foreclosed in all cases by
In re Union Pacific.
As stated above, the Supreme Court has held that Title VII “prohibit[s] an employer from discriminating against a woman because of her capacity to become pregnant.”
51

Consistent with this holding, the Eighth Circuit and other courts, like the Commission, have long recognized that the protections of Title VII extend to employees based on the employees' potential or intent to become pregnant.
52

51

Johnson Controls,
499 U.S. at 206.

52

See Walsh
v.
Nat'l Computer Sys., Inc.,
332 F.3d 1150, 1154, 1160 (8th Cir. 2003) (upholding a judgment and award for a plaintiff claiming pregnancy discrimination where the plaintiff provided evidence that her supervisor's discriminatory behavior was based on the supervisor's belief that she was, or was intending to become, pregnant a second time);
see also Kocak,
400 F.3d at 470 (reasoning that the plaintiff “cannot be refused employment on the basis of her potential pregnancy”);
Batchelor
v.
Merck & Co.,
651 F. Supp. 2d 818, 830-31 (N.D. Ind. 2008) (holding that the plaintiff was protected under the PDA where her supervisor allegedly discriminated against her because of her stated intention to start a family);
Cleese
v.
Hewlett-Packard Co.,
911 F. Supp. 1312, 1317-18 (D. Or. 1995) (concluding that the plaintiff, who claimed that the defendant employer discriminated against her because it knew she planned to become pregnant, fell within the PDA's protections and noting that the court agreed with “
Pacourek
that the purpose of the PDA is best served by extending its coverage to women who are trying to become pregnant”).

As stated in the
Enforcement Guidance on Pregnancy Discrimination,
interpreting
In re Union Pacific
as holding that contraception is never related to pregnancy for purposes of the PDA because it is used prior to pregnancy would be inconsistent with
Johnson Controls
and many other cases.

In the Commission's view,
In re Union Pacific
is best understood as a case about a specific health insurance policy that excluded coverage of both prescription and non-prescription contraceptive methods that were used to prevent pregnancy, regardless of the sex of the employee who used them.
53

The gender-neutral nature of the insurance exclusion was central to
In re Union Pacific'
s holding that the insurance policy did not constitute disparate treatment under Title VII. This is similar to the reasoning of courts that have found that denial of insurance coverage for infertility generally, which can affect employees regardless of their capacity to become pregnant, does not violate the PDA, while still leaving open the possibility that the PDA could be violated if an employee was penalized for using leave for IVF treatments.
54

As with infertility, the failure of particular Title VII claims related to contraception based on the lack of gender-based differential treatment does not mean that contraception can never be covered by the statutory phrase “pregnancy, childbirth, or related medical conditions.”

53

See also Newport News Shipbuilding & Dry Dock Co.
v.
EEOC,
462 U.S. 669, 678-79 & n.17, 683-84 (1983) (noting that the legislative history of the PDA demonstrates Congress' intent that it would be facially discriminatory for an employer to discriminate in insurance coverage between persons who face a risk of pregnancy and those who do not, and concluding that the employer unlawfully gave married male employees a benefit package for their dependents that was less inclusive than the dependency coverage provided to married female employees). In
Newport News,
the Court found that the benefits that a male employee and his dependents could receive were less than what a female employee and her dependents could receive, and thus the plan violated the PDA. This rationale further explains the decisions in
In re Union Pacific
and
Krauel.
In those cases, both of which involved insurance benefits, the benefits received by employees and their dependents were the same; thus, there was not a PDA violation.
See Saks,
316 F.3d at 344-345 (describing
Newport News
as “focused on whether male and female employees received equal coverage under their health benefits package” and finding that
Newport News
would not allow exclusions based on pregnancy);
id.
at 345 n.2 (describing the decision in
Saks
as looking at “whether the exclusion of surgical impregnation procedures result in [a] less comprehensive benefits package for female employees”).

54

See Saks,
316 F.3d at 346 & n.4 (concluding that the insurance coverage plan at issue, which did not cover treatments for infertility regardless of capacity to become pregnant, would not violate the PDA, but stating that “[w]e expressly decline to consider whether an infertile female employee would be able to state a claim under the PDA or Title VII for adverse employment action taken against her because she has taken numerous sick days in order to undergo surgical impregnation procedures”).

As stated in the
Commission Decision on Coverage of Contraception,
the PDA can cover discrimination regarding contraception when, unlike the facts in
In re Union Pacific,
the challenged restriction regarding contraception coverage is limited to those who have the capacity to become pregnant.
55

Thus, in the
Commission Decision on Coverage of Contraception,
the exclusion of prescription contraception violated the PDA's prohibition on sex discrimination because prescription contraception could only be used by those who have the capacity to become pregnant.
56

Other courts similarly have concluded that an insurance policy's exclusion of contraception coverage that only can be used by those with the capacity to become pregnant violates the PDA.
57

55
EEOC,
Commission Decision on Coverage of Contraception
(Dec. 14, 2000),
https://www.eeoc.gov/commission-decision-coverage-contraception.

56

Enforcement Guidance on Pregnancy Discrimination, supra
note 31, at (I)(A)(3)(d) nn.37-38.

57

See Cooley
v.
DaimlerChrysler Corp.,
281 F. Supp. 2d 979, 984-85 (E.D. Mo. 2003) (determining that, although the defendant employer's policy was facially neutral, denying a prescription medication that allows an employee to control their potential to become pregnant is “necessarily a sex-based exclusion” that violates Title VII, as amended by the PDA, because only people who have the capacity to become pregnant use prescription contraceptives, and the exclusion of prescription contraceptives may treat medication needed for a sex-specific condition less favorably than medication necessary for other medical conditions);
Erickson
v.
Bartell Drug Co.,
141 F. Supp. 2d 1266, 1271-72 (W.D. Wash. 2001) (determining that the selective exclusion of prescription contraceptives from an employer's generally comprehensive prescription drug plan violated the PDA because only people who have the capacity to become pregnant use prescription contraceptives). Additionally, the Commission notes that those who can and cannot get pregnant face different risks in not having access to contraception in that the individual who may actually become pregnant bears the exclusive risk of experiencing pregnancy-related complications, including a variety of life-threatening conditions. U.S. Dep't of Health & Hum. Servs., Ctrs. for Disease Control & Prevention,
Urgent Maternal Warning Signs
(Nov. 17, 2022),
https://www.cdc.gov/hearher/maternal-warning-signs/index.html
(explaining urgent warning signs and symptoms “during pregnancy and in the year after delivery” that “could indicate a life-threating situation”); U.S. Dep't of Health & Hum. Servs., Ctrs. for Disease Control & Prevention,
Maternal Mortality Rates in the United States, 2021
(March 2023),
https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2021/maternal-mortality-rates-2021.htm
(discussing the high rates of maternal mortality); Am. Coll. of Obstetricians & Gynecologists and Physicians for Reproductive Health,
Abortion Can Be Medically Necessary
(Joint Statement) (Sept. 25, 2019),
https://www.acog.org/news/news-releases/2019/09/abortion-can-be-medically-necessary
(“Pregnancy imposes significant physiological changes on a person's

body. These changes can exacerbate underlying or preexisting conditions, like renal or cardiac disease, and can severely compromise health or even cause death.”).

Finally, Congress chose to write the PWFA using the same phrase as in Title VII, as amended by the PDA, and directed the Commission to issue regulations. Congress is presumed to have known the meaning previously given to “pregnancy, childbirth, or related medical conditions” by courts and the Commission, as well as the established principles of statutory construction.
58

This includes the Commission's interpretation in its 2000
Commission Decision on Coverage of Contraception
and in its 2015
Enforcement Guidance on Pregnancy Discrimination.
Therefore, it is reasonable to conclude that Congress expected the Commission to interpret the language in the PWFA consistently with its interpretation of the same language in the PDA.

58

See supra
note 24.

Thus, under the PWFA, depending on the facts, a limitation related to contraception that affects the individual employee's potential pregnancy can be the basis for a request for an accommodation.
59

Whether a particular set of facts will support the necessary nexus between contraception and an individual employee's potential pregnancy is a determination that will be made on a case-by-case basis.

59

See
H.R. Rep. No. 117-27, pt. 1, at 27 (“Throughout the bill's text, the PWFA ensures that workers have access to reasonable accommodations for conditions connected with a pregnancy, not just a pregnancy itself.”).

Comments and Response to Comments Regarding Coverage of Specific Conditions—Other Conditions

Some comments requested that specific conditions be added to the list in the regulation. However, inclusion on the list does not make it more or less likely that a specific condition in a specific situation will be considered pregnancy, childbirth or a related medical condition—it is a fact-specific determination. Some comments requested that the Commission opine on whether specific conditions (including ones on which neither the courts nor the Commission have yet opined) would be covered under “related medical conditions” under the PWFA. Especially in the situations where the courts and the Commission have not yet spoken, the Commission believes that this is something best left to development on a case-by-case basis within specific factual contexts.

Inclusion of Abortion in the Definition of “Pregnancy, Childbirth, or Related Medical Conditions”

Preliminary Considerations

The Commission received approximately 54,000 comments (most of which were form or slightly altered form comments from individuals) urging the Commission to exclude abortion from the definition of “pregnancy, childbirth, or related medical conditions.” The Commission also received approximately 40,000 comments (most of which were form or slightly altered form comments from individuals or sign-on letters) supporting the inclusion of abortion in the definition of “pregnancy, childbirth, or related medical conditions.”
60

60
The number of comments does not require the EEOC to adopt a specific view.
U.S. Cellular Corp. vs. FCC
, 254 F.3d 78,87 (D.C. Cir. 2001) (“[T]he Commission has no obligation to take the approach advocated by the largest number of commenters . . . ; indeed, the Commission may adopt a course endorsed by no commenter. The Commission's only responsibilities are to respond to comments, 5 U.S.C. 553, and to choose a reasonable approach backed up by record evidence.'') (internal citations omitted).

Many of the comments urging the Commission to exclude abortion from the definition of “pregnancy, childbirth, or related medical conditions” expressed the view that abortion is the destruction of a human life, that it is objectionable for moral or religious reasons, and that it is not health care.
61

The Commission recognizes these are sincere, deeply held convictions and are often part of an individual's religious beliefs. The Commission also received many comments that expressed deeply held beliefs, including religious beliefs, that abortion is a necessary part of health care and that an employer's religious beliefs should not dictate an employee's ability to receive a reasonable accommodation under the PWFA.

61
Some comments also expressed religious and conscience objections to other conditions included in the definition of “pregnancy, childbirth, or related medical conditions,” such as infertility treatments and contraception. The Commission has addressed these other issues,
supra,
in the preamble in section
1636.3(b) Pregnancy, Childbirth, or Related Medical Conditions.
Responses to comments that object to these procedures for religious reasons are addressed
infra
in the preamble in section
1636.7(b) Rule of Construction
and in the preamble in section
1636.7
under
Religious Freedom Restoration Act.

In the final regulation, the Commission includes abortion in its definition of “pregnancy, childbirth, or related medical conditions,” as proposed in the NPRM and consistent with the Commission's and courts' longstanding interpretation of the same phrase in Title VII. The Commission responds to comments regarding this issue below. Preliminarily, the Commission provides the following context to clarify the limits of the PWFA.

First, the PWFA is a workplace anti-discrimination law. It does not regulate the provision of abortion services or affect whether and under what circumstances an abortion should be permitted. The PWFA does not require any employee to have—or not to have—an abortion, does not require taxpayers to pay for any abortions, and does not compel health care providers to provide any abortions. The PWFA also cannot be used to require an employer-sponsored health plan to pay for or cover any particular item, procedure, or treatment, including an abortion.
62

The PWFA does not require reasonable accommodations that would cause an employer to pay any travel-related expenses for an employee to obtain an abortion.
63

Given these limitations, the type of accommodation that most likely will be sought under the PWFA regarding an abortion is time off to attend a medical appointment or for recovery. The PWFA, like the ADA, does not require that leave as an accommodation be paid leave, so leave will be unpaid unless the employer's policies provide otherwise.
64

62
42 U.S.C. 2000gg-5(a)(2) provides that nothing in the PWFA shall be construed “by regulation or otherwise, to require an employer-sponsored health plan to pay for or cover any particular item, procedure, or treatment.”

63
The PWFA does not prohibit an employer from taking these actions, either.

64

See infra
in the preamble in section
1636.3(h)
under
Particular Matters Regarding Leave as a Reasonable Accommodation.

Second, the PWFA provides a mechanism for a qualified employee with a known limitation related to, affected by, or arising out of pregnancy, childbirth, or related medical conditions to receive workplace accommodations. The term “abortion” is included in the regulation's definition of “pregnancy, childbirth, or related medical conditions” for the limited purpose of determining whether an employee qualifies for a workplace accommodation under the PWFA. As shown in the public comments, beliefs about when an abortion may be morally or religiously permissible, even within religious traditions, are not monolithic.

Third, despite the large number of comments that the Commission received, the Commission's historical experience, in more than four decades of enforcing Title VII, is that very few employers have actually faced a situation where an employee is expressly requesting leave for an

abortion and the employer declines to grant the leave on religious or moral grounds. Since 1978, Title VII has required that employers who provide sick leave provide that leave in a non-discriminatory manner to women affected by pregnancy, childbirth, or related medical conditions. This includes, and has included since 1978, allowing employees affected by pregnancy, childbirth, or related medical conditions to use employer-provided leave in order to have time off to have an abortion.
65

Yet the public comments the Commission received did not cite any Title VII cases that ruled against the employer where a request for leave for an abortion was at issue, and the comments did not provide evidence that the Title VII requirement has caused problems for employers in the past. Nonetheless, under the framework of this final rule, accommodations related to abortion—like all accommodations—remain subject to applicable exceptions and defenses, including both those based on religion and undue hardship.

65

See
42 U.S.C. 2000e(k); 124 Cong. Rec. S18,978 (daily ed. Oct. 13, 1978) (statement of Sen. Harrison A. Williams, Jr.) (“The House-passed bill included a provision which would have excluded health insurance benefits, sick leave benefits, and disability leave benefits for abortions altogether, except where the life of the mother would be endangered if the fetus were carried to term, or in case of complications. The legislation which passed this body included no such provision. After lengthy debate, and discussion of this difficult issue, the conferees have adopted a compromise which requires the provision of sick leave and disability benefits in connection with an abortion on the same basis as for any other illness or disabling condition.”);
see also
H.R. Rep. No. 95-1786, at 3-4 (Conf. Rep.) (explaining the differences between the Senate bill, the House amendment, and the substitute agreed to in conference).

Since 1979, the Commission's guidelines have provided that “[a]ll fringe benefits other than health insurance, such as sick leave, which are provided for other medical conditions, must be provided for abortions.” 29 CFR part 1604, appendix, Question 35 (1979). This has been the EEOC's consistent interpretation for over 40 years.

In 2015, the EEOC reaffirmed that “pregnancy, childbirth, or related medical conditions” includes abortions.
Enforcement Guidance on Pregnancy Discrimination, supra
note 31, at (I)(A)(4)(c);
see, e.g., Doe
v.
C.A.R.S. Prot. Plus, Inc.,
527 F.3d 358, 364 (3d Cir. 2008) (“Clearly, the plain language of the statute, together with the legislative history and the EEOC guidelines, support a conclusion that an employer may not discriminate against a woman employee because she has exercised her right to have an abortion. We now hold that the term `related medical conditions' includes an abortion.”);
DeJesus
v.
Fla. Cent. Credit Union,
No. 8:17-CV-2502, 2018 WL 4931817, at *1 (M.D. Fla. Oct. 11, 2018) (denying the employer's motion to dismiss in a Title VII case where an employee used approved leave to have an abortion and was fired shortly thereafter when her supervisor stated that the abortion was not an appropriate excuse for her absence).

With this background, the Commission responds to the comments it received.

Interpretation of “Pregnancy, Childbirth, or Related Medical Conditions” as Consistent With Its Meaning in Title VII

Comments Regarding the Commission's Proposed Definition of “Pregnancy, Childbirth, or Related Medical Conditions” as Reflected in Statutory Text

Comments regarding the Commission's decision to include “abortion” in the definition of “pregnancy, childbirth, or related medical conditions” made several arguments related to the statutory text of the PWFA and Title VII.

Many comments in favor of the Commission's inclusion of abortion in the proposed definition of “pregnancy, childbirth, or related medical conditions” asserted that its inclusion accurately reflects the statutory text of the PWFA; that the phrase “pregnancy, childbirth, or related medical conditions” is taken directly from Title VII and uses identical language; that the identical language in the PWFA and Title VII must be interpreted consistently; that Congress' drafting the PWFA against the backdrop of Title VII strongly suggests that its use of Title VII's language would require the language to have the same meaning in the PWFA, absent a clear indication to the contrary; and that in enacting the PDA, Congress expressly stated that the statute applied to employees who obtained abortions, confirming its statutory intent to prohibit discrimination against employees for obtaining abortion care, and that Congress' use of the term in the PWFA is consistent with that underlying interpretation.

Other comments favoring the Commission's inclusion of abortion in the definition of “pregnancy, childbirth, or related medical conditions” stated that its inclusion is important for consistency and clarity, noting that both employers and employees have relied on the Commission's longstanding inclusion of this interpretation in guidance to understand what constitutes “pregnancy, childbirth, or related medical conditions”; that applying the same definition under the PWFA provides important consistency when litigation is brought under Title VII and the PWFA simultaneously; and that the PWFA's drafters intentionally drew specific terms from Title VII and the ADA to ensure employees and employers would have a clear understanding of the meaning of those terms.

By contrast, many comments opposing the Commission's proposed definition stated that abortion could not be included in the definition of “pregnancy, childbirth, or related medical conditions” because the PWFA's text does not mention abortion; that Congress' intent to include abortion in the definition of “pregnancy, childbirth, or related medical conditions” cannot be inferred simply because the PWFA uses the same language as Title VII; that the PWFA does not direct the Commission to construct a broad definition of “related medical conditions”; and that the inclusion of “pregnant workers” in the statute's title should exclude employees who end their pregnancies via an abortion. Comments also stated that, under canons of statutory interpretation, the general term “or related medical conditions” is best read to cover only those concepts akin to the specific terms it follows—and that abortion is not related to “pregnancy” or “childbirth.”

Comments opposed to the Commission's inclusion of abortion in the proposed definition of “pregnancy, childbirth, or related medical conditions” also asserted that under the text of the PWFA, employers should be required only to accommodate employees who are currently pregnant or who give birth. For instance, comments asserting that under the PWFA a “related medical condition” must be related to a current or recent pregnancy or childbirth analogized the PWFA's accommodation provision to the accommodation provisions under Title VII and the ADA, which apply when an employee has a sincerely held religious belief or practice, or a disability, respectively.

Comments also asserted that abortion is the opposite of pregnancy and childbirth. For instance, comments stated that an abortion is unlike pregnancy because it is a procedure that ends a pregnancy and the possibility of childbirth from that pregnancy; and that pregnancy is not a medical condition to be treated with an abortion.

Comments opposed to the Commission's inclusion of abortion in the definition of “pregnancy, childbirth, or related medical conditions” also maintained that “related medical conditions” should be construed narrowly under the PWFA. For instance, some comments stated that Congress' inclusion of the term “childbirth” meant that abortion could not be included in the regulation; that a broad definition of “related medical conditions” would render the term “childbirth” superfluous; and that the PWFA's definition should only refer to involuntary, detrimental impacts of pregnancy, childbirth, or related

medical conditions. Comments stated that, in including contraception and abortion, the Commission's definition goes beyond medical conditions to cover medical interventions; these comments argued, for example, that the act of obtaining reproductive health care—including contraception and abortion—is not, by definition, a medical, physical, or mental condition, and thus it cannot be a PWFA limitation.

Response to Comments Regarding the Commission's Proposed Definition of “Pregnancy, Childbirth, or Related Medical Conditions” as Reflected in Statutory Text

The Commission agrees with comments expressing support for inclusion of abortion in the proposed definition of “pregnancy, childbirth, or related medical conditions” for which a qualified employee could receive an accommodation, absent undue hardship.

In interpreting a statute, an agency must start with its text. The PWFA does not define the phrase “pregnancy, childbirth, or related medical conditions.” For nearly 45 years, however, consistent with the plain language of the statute, congressional intent, and Federal courts' interpretation of the statutory text, the Commission has interpreted “pregnancy, childbirth, or related medical conditions” in Title VII to include the decision to have—or not to have—an abortion and to prohibit discrimination in employment practices because an employee had or did not have an abortion.
66

Based on well-established rules of statutory interpretation, the Commission properly interprets “pregnancy, childbirth, or related medical conditions” to have the same meaning in the PWFA as it does under Title VII.
67

As the Supreme Court has stated, “When administrative and judicial interpretations have settled the meaning of an existing statutory provision, repetition of the same language in a new statute indicates, as a general matter, the intent to incorporate its administrative and judicial interpretations as well.”
68

The Commission concludes that it would not be consistent with Congress' intent, as expressed in its choice of this statutory language for the PWFA, to construct a broader or narrower definition of “pregnancy, childbirth, or related medical conditions” than under Title VII. Rather, following the canons of statutory interpretation, the Commission is using the definition that already exists for this identical phrase under Title VII. Indeed, it is likely that defining this phrase differently than it has been defined in a parallel statute would exceed the Commission's congressionally delegated authority.

66

See
29 CFR part 1604, appendix, Questions 34 & 35 (1979);
see also Enforcement Guidance on Pregnancy Discrimination, supra
note 31, at (I)(A)(4)(c).

67
These rules include: (1) the Prior-Construction Canon, which states that when judicial interpretations have settled the meaning of an existing statutory provision, repetition of the same language in a new statute is presumed to incorporate that interpretation;
Tex. Dep't of Hous. & Cmty. Affs.,
576 U.S. at 536-37 (“If a word or phrase has been . . . given a uniform interpretation by inferior courts . . ., a later version of that act perpetuating the wording is presumed to carry forward that interpretation.”) (omissions in original) (quoting Scalia & Garner,
Reading Law,
at 322);
Lorillard,
434 U.S. at 581 (“[W]here, as here, Congress adopts a new law incorporating sections of a prior law, Congress normally can be presumed to have had knowledge of the interpretation given to the incorporated law, at least insofar as it affects the new statute.”);
Hall
v.
U.S. Dep't of Agric.,
984 F.3d at 840 (“Congress is presumed to be aware of an agency's interpretation of a statute. We most commonly apply that presumption when an agency's interpretation of a statute has been officially published and consistently followed. If Congress thereafter reenacts the same language, we conclude that it has adopted the agency's interpretation.”) (internal citations and quotation marks omitted); Scalia & Garner,
Reading Law
at 323 (“[W]hen a statute uses the very same terminology as an earlier statute—especially in the very same field, such as securities law or civil-rights law—it is reasonable to believe that the terminology bears a consistent meaning.”); (2) the Related Statutes Canon (
In Pari Materia
), which states that courts do not interpret statutes in isolation, but rather in the context of the body of law of which they are a part, including later-enacted statutes, so statutes addressing the same subject matter generally should be read as if they were one law;
see, e.g., Wachovia Bank
v.
Schmidt,
546 U.S. 303, 305 (2006); (“[U]nder the
in pari materia
canon, statutes addressing the same subject matter generally should be read as if they were one law . . . .”) (internal citations and quotation marks omitted); and (3) the Presumption of Legislative Acquiescence Canon, which states that statutes adopted after certain prior judicial or administrative interpretations may acquiesce in those interpretations;
see, e.g., Johnson
v.
Transp. Agency, Santa Clara Cnty.,
480 U.S. 616, 629 n.7 (1987) (“Congress has not amended the statute to reject [the Court's] construction [of Title VII], nor have any such amendments even been proposed, and we therefore may assume that our interpretation was correct.”).

68

Bragdon,
524 U.S. at 645.

As set out in the NPRM, Congress previously used the phrase “pregnancy, childbirth, or related medical conditions” when, in enacting the PDA, it amended Title VII to explicitly state that Title VII's prohibition against sex discrimination includes a prohibition against discrimination on the basis of “pregnancy, childbirth, or related medical conditions.”
69

The legislative history of the PDA expressly stated that the PDA's protections applied to situations involving abortions, and indeed, the statutory text enacted by Congress explicitly excluded certain abortion procedures from health insurance requirements, since the statute would otherwise have been read to require their coverage, while still requiring coverage in certain limited circumstances.
70

69
42 U.S.C. 2000e(k).

70

See id.
(“This subsection shall not require an employer to pay for health insurance benefits for abortion, except where the life of the mother would be endangered if the fetus were carried to term, or except where medical complications have arisen from an abortion . . . .”); H.R. Rep. No. 95-1786, at 4 (1978) (Conf. Rep.).

Congress' express purpose in enacting the PWFA was to supplement Title VII's protections for qualified employees affected by pregnancy, childbirth, or related medical conditions; in other words, the same employees protected by Title VII, as amended by the PDA.
71

To that end, Congress' approach in both laws was to ensure that employers are not required to pay for abortions for their employees but that employees are not discriminated against in the workplace for having them. Further, the Commission agrees with the comments that using the same definition that the Commission and courts have used for the same phrase in Title VII provides important clarity and consistency for employers and employees.

71

See supra,
preamble section
1636.3(b) Pregnancy, Childbirth, or Related Medical Conditions.

Using the same definition also provides clarity and consistency for courts and harmonizes the two statutory schemes. Title VII and the PWFA cover the same employers and employees. Having two definitions of the same term would cause confusion for courts and potentially require them to reach conflicting decisions. Moreover, as cases under the PWFA may, depending on the circumstances, also be brought under Title VII, courts could be asked to decide cases involving both Title VII's prohibition of discrimination based on “pregnancy, childbirth, or related medical conditions” and the PWFA's reasonable accommodation provision.

Even if the Commission were authorized to ignore the courts' and its own prior longstanding, consistent interpretation of “pregnancy, childbirth, or related medical conditions,” the Commission would reach the same conclusion that the 1978 Congress did—that the phrase “pregnancy, childbirth, or related medical conditions” includes choosing to have or not to have an abortion, based on the plain meaning of the phrase “pregnancy, childbirth, or related medical conditions.” By definition, individuals who are choosing whether or not to have an abortion are pregnant. And the

condition of being pregnant does not depend on the ultimate outcome of the pregnancy, as highlighted by Congress extending coverage to “childbirth” separate from “pregnancy.” Thus, the term “pregnancy” naturally includes all of those limitations arising out of the pregnancy itself, regardless of whether any particular pregnancy ends in miscarriage, live birth, an abortion, or any other potential outcome. If an employee is denied an accommodation because they are seeking an abortion, or not seeking an abortion, that employee has necessarily been denied an accommodation on account of their current pregnancy. Accordingly, the decision to have or not to have an abortion falls squarely within the ordinary meaning of the phrase “pregnancy, childbirth, or related medical conditions.”

Given how courts and the Commission have defined “pregnancy, childbirth, or related medical conditions” in Title VII, the Commission disagrees that the PWFA and its implementing regulation only would apply to qualified employees who are currently pregnant or who recently gave birth, thus implicitly excluding abortion. First, such an interpretation would exclude qualified employees who have had miscarriages or are otherwise no longer pregnant, which appears to be inconsistent with the text of, and does not appear to be the intent of, either the PWFA or the PDA.
72

As stated above, by definition, qualified employees who seek an abortion are either currently or recently pregnant. Finally, the Commission sees no evidence that the inclusion of “childbirth” evinces congressional intent to construct a narrower definition of “related medical conditions” under the PWFA than under Title VII, as both statutes contain this identical language. As stated above, both the legislative history and the explicit exclusion of certain abortion procedures from health insurance requirements under the PDA evince Congress' intent to include abortion in the definition of “pregnancy, childbirth, or related medical conditions” under Title VII.

72

See, e.g.,
H.R. Rep. No. 117-27, pt. 1, at 20 (discussing the need for the PWFA, citing to a case in which an employee's miscarriage was not covered by the ADA, and noting that “[t]here are many cases where courts have found that even severe complications related to pregnancy do not constitute disabilities triggering [ADA] protection”).

Comments Regarding the Commission's Proposed Definition of “Pregnancy, Childbirth, or Related Medical Conditions” as Reflected in the Statutory Intent and Structure of the PWFA

Many comments regarding the Commission's proposed inclusion of abortion in the definition of “pregnancy, childbirth, or related medical conditions” made arguments related to the statutory intent and structure of the PWFA.

Comments in favor of the inclusion of abortion in the definition of “pregnancy, childbirth, or related medical conditions,” including from Members of Congress, asserted that the Commission's inclusion of abortion in the definition is consistent with the PWFA's statutory intent and structure; that Congress' express purpose in enacting the PWFA was to supplement Title VII's protections; that Congress adopted the PWFA to remedy gaps in existing legal protections, including in Title VII, and it understood how “pregnancy, childbirth, or related medical conditions” is interpreted by the courts; that Congress understood that the PWFA could include possible accommodations related to an abortion, as evidenced by the statements of legislators who opposed the PWFA, showing that they understood it could require accommodations related to an abortion; that Congress recognized the PWFA as an opportunity for Congress to finally fulfill a promise of Title VII; and that Congress intentionally included “related medical conditions” in the PWFA to encompass conditions beyond simply pregnancy and childbirth.

Many comments in favor of the inclusion of abortion expressed that including abortion furthers Congress' policy goal of protecting pregnant workers from harm; that it accurately reflects the range of needs and conditions that workers may experience that require reasonable workplace accommodations in relation to pregnancy; that abortion care is a safe, common, and essential component of reproductive health care; that decisions regarding abortion are private medical matters and should be made by patients in consultation with their clinicians and without undue interference by outside parties; and that providing accommodations for abortion would mean that employees would not have to risk their health, lives, or livelihoods to access care. Many such comments focused on specific positive health and social outcomes that employees would enjoy if they had access to accommodations for abortion, such as the ability to maintain personal bodily autonomy; to choose when to have or not have children; to receive necessary health care in the event of intimate partner violence, rape, incest, fetal anomalies, and exposure to teratogenic medications; and to receive necessary health care in the event of pregnancy complications that may be so severe that abortion is the only measure that will preserve a pregnant employee's health or save their life—including placental abruption, bleeding from placenta previa, preeclampsia or eclampsia, and cardiac or renal conditions.

Comments opposed to the inclusion of abortion in the definition of “pregnancy, childbirth, or related medical conditions” asserted that including abortion does not reflect Congress' generally expressed intent for the PWFA. For instance, comments stated that the PWFA's intent only is to ensure that pregnant and postpartum women can receive reasonable accommodations to safely work; that the PWFA's intent only is to support mothers during pregnancy and childbirth and only to protect and benefit the health of mothers and their fetuses, as well as to provide accommodations for miscarriage, stillbirth, treatment of an ectopic pregnancy, or emergency treatment intended to preserve the life of the pregnant employee, but not an abortion; that the Commission's interpretation turns the PWFA into a general reproductive health care statute, defying Congress' intent; that the PWFA was intended by its supporters to be like the ADA, which the comments construed not to require accommodations for abortion; that Congress did not intend to make forays into controversial social policy by enacting the PWFA; that including abortion ignores that Congress cited statistics about working mothers in support of the PWFA and talked about the health of the mother and baby; and that Congress does not hide “elephants in mouseholes,” and abortion is an elephant in the mousehole of “pregnancy, childbirth, or related medical conditions.”

Some comments opposed to the inclusion of abortion also asserted that the definition does not reflect congressional intent as expressed by the PWFA's structure. These comments noted that Congress chose not to amend Title VII by incorporating the PWFA. Such comments inferred from this choice that Congress implicitly declined to import Title VII's definition of “pregnancy, childbirth, or related medical conditions” and its abortion-related requirements into the PWFA. These comments stated that the PWFA

does not specifically require the same definition of “pregnancy, childbirth, or related medical conditions” as Title VII, as it does with other terms from the ADA and Title VII, and if Congress wanted the Commission to provide examples of “related medical conditions” it would have expressly said so.

Finally, some comments opposed to the proposed definition stated that Title VII's insurance exclusion provision, which addresses abortion and has been used to suggest that Title VII otherwise covers abortion, is different from the PWFA's similar exclusion provision.

Response to Comments Regarding the Commission's Proposed Definition of “Pregnancy, Childbirth, or Related Medical Conditions” as Reflected in the Statutory Intent and Structure of the PWFA

As stated above, the Commission's inclusion of abortion in the definition of “pregnancy, childbirth, or related medical conditions” is supported by the plain text of the statute and by statutory intent and structure and is in keeping with the well-established rules of statutory construction.
73

Congress chose to write the PWFA using an identical phrase, “pregnancy, childbirth, or related medical conditions,” from Title VII and did not define the phrase in the PWFA. Nor did it place any limitations or rules of construction on the definition of the phrase in the PWFA. Accordingly, the Commission gives the phrase the same meaning under the PWFA as it has under Title VII for nearly 45 years. The Commission agrees that the PWFA's focus is accommodation, but, as the text of the PWFA and the ADA state and the Supreme Court has reiterated, accommodations are a form of nondiscrimination.
74

Thus, the fact that the PWFA provides accommodations does not make it a different type of statute from Title VII. Additionally, although Congress specifically incorporated certain definitions into the PWFA from the ADA and Title VII, such as those for “reasonable accommodation,” “undue hardship,” “employer,” and “employee,” in those situations, the terms appear in more than one other statute enforced by the Commission, and some of their definitions vary across statutes.
75

In incorporating certain terms, the Commission understands Congress' intent as specifying which definition it chose to adopt in the PWFA to avoid confusion. By contrast, there is only one other statute that the Commission enforces that uses the phrase “pregnancy, childbirth, or related medical conditions,” and that is Title VII, as amended by the PDA. Therefore, Congress' intent to use the Title VII definition in the PWFA is clear.

73

See supra
note 67.

74
42 U.S.C. 2000gg-1 (titled “Nondiscrimination with regard to reasonable accommodations related to pregnancy”); 42 U.S.C. 12112(b)(5)(A) (“[T]he term `discriminate against a qualified individual on the basis of disability' includes . . . not making reasonable accommodations . . . .”);
see also
29 CFR part 1630, appendix, 1630.9 (“The obligation to make reasonable accommodation is a form of non-discrimination.”);
US Airways, Inc.
v.
Barnett,
535 U.S. 391, 396 (2002) (“[T]he ADA says that `discrimination' includes an employer's
not making reasonable accommodations
to the known physical or mental limitations of an otherwise qualified . . . employee,
unless
[the employer] can demonstrate that the accommodation would impose an
undue hardship
on the operation of [its] business.' ”) (citing 42 U.S.C. 12112(b)(5)(A)) (emphasis in original) (omission in original).

75
42 U.S.C. 2000e(b) (defining “employer” under Title VII), (f) (defining “employee” under Title VII), (j) (defining “religion” with regard to an employer's obligation to “reasonably accommodate” an employee's religious observance or practice absent “undue hardship” under Title VII); 42 U.S.C. 12111(4) (defining “employee” under the ADA), (5) (defining “employer” under the ADA), (9) (defining “reasonable accommodation” under the ADA), (10) (defining “undue hardship” under the ADA).

Further supporting the Commission's interpretation of the phrase “pregnancy, childbirth, or related medical conditions” is the fact that the PWFA passed as part of the Consolidated Appropriations Act, 2023 (CAA), in which Congress included several provisions explicitly limiting the use of Federal funds for abortion.
76

Where Congress includes particular language in one section of a law but omits it in another, it is generally presumed that Congress acts intentionally and purposely in including or excluding certain language.
77

Given that Congress explicitly included exclusions regarding abortion in certain sections of the CAA but omitted any such exclusion in the PWFA, the Commission concludes that the omission was an intentional act.

76

See, e.g.,
sec. 613, Public Law 117-328, 136 Stat. 4459, 4699 (2022) (providing that: “No funds appropriated by this Act shall be available to pay for an abortion, or the administrative expenses in connection with any health plan under the Federal employees health benefits program which provides any benefits or coverage for abortions.”).

77

Keene Corp.
v.
United States,
508 U.S. 200, 208 (1993) (quoting
Russello
v.
United States,
464 U.S. 16, 23 (1983)). Of note, in the debate surrounding the PWFA before its passage in the Senate, the Senators discussed abortion.
See
168 Cong. Rec. S7,049-50 (daily ed. Dec. 8, 2022); 168 Cong. Rec. S10,071, S10,081 (daily ed. Dec. 22, 2022). The House Report also discusses abortion.
See
H.R. Rep. No. 117-27, pt. 1, at 60. Thus, both chambers were seemingly aware of this issue, but the law does not include the type of abortion exclusion found in other parts of the CAA.

The Commission's interpretation also is consistent with the legislative history of the PDA, the statute that is the source of the phrase, “pregnancy, childbirth, or related medical conditions.” The Congressional Conference Report accompanying the PDA provides: “Because [the PDA] applies to all situations in which women are `affected by pregnancy, childbirth, and related medical conditions,' its basic language covers decisions by women who chose to terminate their pregnancies. Thus, no employer may, for example, fire or refuse to hire a woman simply because she has exercised her right to have an abortion.”
78

By including the same key phrase in the PWFA and not articulating a different meaning than in the PDA, Congress is presumed to know and intend that the same definition will be applied.
79

And given the longstanding and public interpretation of this phrase, by both the Commission and the courts, the Commission disagrees that adopting the same interpretation as Title VII amounts to Congress “hiding” an elephant in a mousehole.

78

See
H.R. Rep. No. 95-1786, at 4 (1978) (Conf. Rep.).

79

See supra
note 67.

Furthermore, the second sentence of the PDA states that employers do not have to pay for health insurance benefits for abortion, except where necessary to preserve the life of the mother or where medical complications have arisen from an abortion.
80

The inclusion of this limited language regarding abortion coverage, coupled with clear statements in the legislative history, supports the conclusion that Congress intended for Title VII, as amended by the PDA, to protect employees against discrimination based on abortion and that Congress provided an exception, largely motivated by religious freedom concerns, for employers to opt out of providing health benefits to cover the procedure itself.
81

Of note, the PWFA has a similar structure—it requires employers not to discriminate against protected qualified employees by failing to provide them reasonable accommodations, but it does not require, or permit the Commission to

require, “an employer-sponsored health plan to pay for or cover any particular item, procedure, or treatment.”
82

80

See
42 U.S.C. 2000e(k).

81

See
H.R. Rep. No. 95-948, at 7 (1978),
as reprinted in
1978 U.S.C.C.A.N. 4749, 4755 (“Many members of the committee were troubled . . . by any implication that an employer would have to
pay
for abortions not necessary to preserve the life of the mother through medical benefits or other fringe benefit programs, even if that employer—a church organization for example—harbored religious or moral objections to abortion; such a requirement, it was felt, could compromise the religious freedom of such employers. The committee, therefore, amended the language of the bill to deal with the problem, by making clear that such employers will not be required to pay for abortions except where the life of the mother would be endangered if the fetus was carried to term.” (emphasis in original)).

82
42 U.S.C. 2000gg-5(a)(2).

As a matter of the PWFA's plain text, therefore, the Commission determines that the decision to have, or not to have, an abortion is encompassed within the phrase “pregnancy, childbirth, or related medical conditions.” Because this conclusion follows from the statutory text, the Commission does not believe that other concerns raised by commenters are relevant. The Commission's determination is not based on the potential health or social outcomes related to abortion; rather, the Commission's determination is based on the statutory text. Moreover, it bears emphasizing that this rulemaking does not require abortions or affect the availability of abortion; it simply ensures that employees who choose to have (or not to have) an abortion are able to continue participating in the workforce, by seeking reasonable accommodations from covered employers, as needed and absent undue hardship.

Comments Regarding the Commission's Proposed Definition of “Pregnancy, Childbirth, or Related Medical Conditions” and Statements From Members of Congress and the White House About the PWFA

Some comments pointed to statements made by Members of Congress to either support or dispute the idea that the definition of “pregnancy, childbirth, or related medical conditions” in the PWFA includes abortion. Comments also noted the absence of certain statements from Members of Congress and the White House.

First, comments that supported the inclusion of abortion in the definition of “pregnancy, childbirth, or related medical conditions” pointed to statements by opponents of the bill, whose opposition was based on the lawmakers' views that abortion would be covered.
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Some comments also pointed to an amendment proposed by Senator James Lankford that the Senate rejected, which stated that “[t]his division shall not be construed to require a religious entity described in Section 702(a) of the Civil Rights Act of 1964 to make an accommodation that would violate the entity's religion”
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as evidence that Senators knew that abortion would be covered.

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See, e.g.,
168 Cong. Rec. S7049 (daily ed. Dec. 8, 2022) (statement of Sen. Thomas (Thom) Tillis); 167 Cong. Rec. H2325, H2330, H2332 (daily ed. May 14, 2021) (statements of Rep. Julia Letlow, Rep. Robert George (Bob) Good, and Rep. Mary Miller).

84
168 Cong. Rec. S10,069-70 (daily ed. Dec. 22, 2022).

Comments that did not support the inclusion of abortion in the definition of “pregnancy, childbirth, or related medical conditions” pointed to statements made during floor debate by two of the co-sponsors of the PWFA in the Senate, Senator Robert P. Casey, Jr.
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and Senator William Cassidy.
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These comments also mentioned that, in a statement on the House floor, Representative Jerrold Nadler, lead sponsor of the PWFA, explained that the PWFA should be interpreted consistently with Title VII, stating: “The Pregnant Workers Fairness Act aligns with Title VII in providing protections and reasonable accommodations for `pregnancy, childbirth, and related medical conditions,' like lactation.”
87

85
168 Cong. Rec. S7,050 (daily ed. Dec. 8, 2022).

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See, e.g., id.
at S7,049-50.

87
168 Cong. Rec. H10,527-28 (daily ed. Dec. 23, 2022).

Second, comments that disagreed with the Commission's proposed inclusion of abortion in the definition of “pregnancy, childbirth, or related medical conditions” pointed to statements made by Senator Steven Daines and Senator Cassidy after the Senate voted to add the PWFA to the CAA, both of which stated that accommodations related to abortion should not be covered. In addition, comments that disagreed with the Commission's position pointed to the lack of statements by supporters of the bill in Congress and the White House, and by advocacy groups, regarding its coverage of abortion. Comments stated that the PWFA would not have enjoyed bipartisan support, if the intent of the law were to include abortion, and including abortion as a related medical condition in the rule would make the political parties less likely to work together.

Response to Comments Regarding the Commission's Proposed Definition of “Pregnancy, Childbirth, or Related Medical Conditions” and Statements From Members of Congress and the White House About the PWFA

The PWFA's text, structure, and intent support the Commission's proposed definition. Even if the Commission's interpretation were inconsistent with the cited statements of individual Members of Congress during the PWFA's passage, statements made by individual Members of Congress during floor debate do not justify a departure from an interpretation that Congress, courts, and the Commission have consistently adhered to since the PDA was enacted more than four decades ago. Again, the Commission's interpretation must start with the text of the statute. Relying on the text, rather than the individual statements of Members of Congress, follows the Supreme Court's requirements when interpreting a statute; as the Court has noted, “[p]assing a law often requires compromise, where even the most firm public demands bend to competing interests. What Congress ultimately agrees on is the text that it enacts, not the preferences expressed by certain legislators.”
88

88

NLRB
v.
SW Gen., Inc.,
580 U.S. 288, 306 (2017) (citations omitted);
see also March
v.
United States,
506 F.2d 1306, 1314 n.31 (D.C. Cir. 1974) (citing
NLRB
v.
Plasterers' Loc. Union,
404 U.S. 116, 129-30 n.24 (1971) (providing that, where congressional debates “reflect individual interpretations that are contradictory and ambiguous, they carry no probative weight”)).

In addition, the Commission does not agree that the PWFA's legislative history counsels for a different interpretation of “pregnancy, childbirth, or related medical conditions” than in the PDA. For example, according to the House PWFA Committee Report, Members knew that abortion would be covered as a pregnancy-related condition for which some employers would need to provide accommodation.
89

Additionally, the Commission's definition is consistent with the full floor statement of Senator Casey and the comment that the Senator submitted during the public comment period.
90

Consistent with the statutory text and Congress' intent, the PWFA does not impose a categorical mandate on an employer to provide leave for an abortion. Leave, like any accommodation, is subject to applicable exceptions and defenses, including both those based on religion and on undue hardship. Nothing in the PWFA requires an employer to pay for an abortion or provide health care benefits for abortion in violation of State law.
91

89
H.R. Rep. No. 117-27, pt. 1, at 60 (stating under minority views that “if an employee working for a religious organization requests time off to have an abortion procedure, H.R. 1065 could require the organization to comply with this request as a reasonable accommodation of known limitations related to pregnancy, childbirth, or related medical conditions”).

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168 Cong. Rec. S7,050 (daily ed. Dec. 8, 2022); Comment EEOC-2023-0004-98384, Sen. Robert P. Casey, Jr. (Oct. 10, 2023) (stating that in drafting the PWFA, legislators intentionally used terms from other laws, including “pregnancy, childbirth, or related medical conditions,” and supporting the definition in the proposed rule).

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See
42 U.S.C. 2000gg-5(a)(2); 88 FR 54745 (stating that “nothing in the PWFA requires or forbids an employer to pay for health insurance benefits for an abortion”). Covered entities, however, may separately be subject to the PDA's provisions regarding abortion coverage in certain circumstances.
See
42 U.S.C. 2000e(k).

Finally, numerous legislators submitted comments during the public

comment period that supported or opposed the inclusion of abortion in the definition of “pregnancy, childbirth, or related medical conditions.” As these were statements made by Members of Congress after the passage of a bill, the Commission gave them due consideration as statements of the views of each particular Member who signed them.
92

92

Cf. Nat'l Woodwork Mfrs. Ass'n
v.
NLRB,
386 U.S. 612, 639 n.34 (1967) (observing that statements inserted into the record after passage of a bill are regarded as “represent[ing] only the personal views of the[ ] legislators” involved). Senator Patricia Murray, joined by 24 Senators, endorsed the Commission's interpretation regarding the definition of “pregnancy, childbirth, or related medical conditions,” Comment EEOC-2023-0004-98257, Sen. Patricia (Patty) Murray and 24 U.S. Senators (Oct. 10, 2023); as did Representative Jerrold Nadler, joined by 82 House Representatives, Comment EEOC-2023-0004-98470, Rep. Jerrold (Jerry) Nadler and 82 Members of Congress (Oct. 10, 2023); and Representative Robert Scott, Comment EEOC-2023-0004-98339, Rep. Robert C. (Bobby) Scott, Ranking Member of the House Committee on Education and the Workforce (Oct. 10, 2023). By contrast, Senator James Lankford's comment, which was joined by 19 Senators, including Senator Bill Cassidy, and 41 House Representatives, disagreed with the Commission's interpretation. Comment EEOC-2023-0004-98436, Sen. James Lankford, 19 U.S. Senators, and 41 Members of Congress (Oct. 10, 2023). Similarly, Senator Michael Braun's comment disagreed with the Commission's interpretation. Comment EEOC-2023-0004-98486, Sen. Michael (Mike) Braun (Oct. 10, 2023).

In response to the comments regarding the political process, the Commission cannot speculate on counterfactual scenarios such as what might have triggered a filibuster of the PWFA in Congress, nor what would diminish bipartisan support for future legislation. And the Commission cannot reinterpret the definition of “pregnancy, childbirth, or related medical conditions” based on the purported absence of certain statements by Members of Congress, advocates, or the executive branch during the bill's passage.

As explained above, the Commission must rely on the plain text of the statute. Given the meaning of the words that Congress chose to use in the PWFA, and the Commission's and courts' long history of interpreting those identical words to include abortion, the Commission will interpret those words the same way in the PWFA.

Comments Regarding the Commission's Proposed Definition of “Pregnancy, Childbirth, or Related Medical Conditions” and Administrative and Judicial Interpretation

Many comments in favor of the Commission's inclusion of abortion in the definition of “pregnancy, childbirth, or related medical conditions” asserted that the Commission's inclusion of abortion in the definition accurately reflects longstanding judicial and administrative interpretations under Title VII. Comments stated that the Commission's interpretation is correct and consistent with decades of authority under Title VII, including legislative history, Federal case law, and Commission guidance; that existing case law supports the Commission's interpretation that Title VII protects employees from discrimination for contemplating or obtaining an abortion or refusing to submit to an employer's demand that they obtain an abortion; and that the Commission's
Enforcement Guidance on Pregnancy Discrimination
reaffirmed that choosing whether to have or not to have an abortion is covered under the PDA.

Some comments opposed to the Commission's proposed inclusion of abortion in the definition of “pregnancy, childbirth, or related medical conditions” asserted that the Commission's definition is contrary to judicial and administrative interpretations under Title VII.

Some comments disputed the Commission's statement that existing case law under Title VII supports the Commission's definition, claiming that the decisions do not apply to the PWFA and are distinguishable; that there is not a widespread judicial consensus about the meaning of “related medical conditions”; and that the Commission should not rely on lower court decisions.

Some comments took issue with the Commission's reliance on its 2015
Enforcement Guidance on Pregnancy Discrimination
to interpret the phrase “pregnancy, childbirth, or related medical conditions” under the PWFA, as the
Enforcement Guidance on Pregnancy Discrimination
does not receive binding judicial deference; only addresses pregnancy discrimination, not accommodation; and was issued many years after the PDA's enactment.

Response to Comments Regarding the Commission's Proposed Definition of “Pregnancy, Childbirth, or Related Medical Conditions” and Administrative and Judicial Interpretation

The Commission disagrees with the comments that dispute the case law it cited and its reliance on its
Enforcement Guidance on Pregnancy Discrimination.
The Title VII decisions the Commission c

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Source: Frix Law Library, https://www.frixlaw.com/law-library/documents/fr%3A2024-07527. Public record. Not legal advice.