Current blanket flight restrictions during pregnancy are outdated and discriminatory. The Air Force should immediately remove restrictions that limit the period an aviator can fly (12 to 28 weeks of gestation) to be more aligned with FAA and commercial standards, leaving the decision with the member and their and flight surgeon familiar with the aircraft type.
By Jessica Ruttenber
My Air Force pilot training classmate, and I, stared at the T-37 engineering diagram placed before us while an instructor pilot explained we fell outside the parameters for a successful ejection. My classmate was too tall, and I did not meet the minimum weight for which the seat was designed. After explaining the risks, we both decided that the occurrence of an ejection was extremely rare and signed a waiver to continue flying.
To elaborate, in 2019, the chances of dying in an Air Force aircraft was .11 per 100,000 flying hours. To put that in perspective, a pilot would more likely be seriously injured or die in a vehicle accident while driving to work. According to the United States Department of Transportation there were 11.0 deaths per 100,000 driving hours in 2019. Given my ability to make decisions to accept personal risk with my own body in the T-37, one might assume this autonomy would apply in other areas, but not if you are female.
When Airmen become pregnant many decisions are taken away from them with the intent of protecting them. For example, pregnant Airmen are grounded from flying when they report their pregnancy and do not have an option to fly in ejection seat aircraft. The act of sitting in an ejection seat does not cause risk to the Airmen or fetus, the actual act of the ejection is the hazard. Given it is more dangerous to drive to work, why doesn’t the Air Force prohibit Airmen from driving during pregnancy or other factors that have been linked to miscarriage?
This may sound like an oversimplification but the principles are the same. Originally when I was presented the idea of flying pregnant in ejection seats I was adamantly against it. Despite my own personal struggles when members in the service displayed bias and tried to stop me from flying the C-21A and KC-135R, non-ejection seat aircraft, during my three pregnancies I still had a blind spot. I displayed benevolent sexism to my own gender in a knee jerk reaction but it wasn’t until I looked at the data that I could see it.
My first clue was when I found out that pregnant fliers were moving their seat position in the B-52 bomber so they could sit in a non-ejection seat to log instructor hours and contribute to the mission. This made absolutely no sense to me. If the aircraft crashed the other members of the crew had a good chance of survival yet the pregnant Airmen would likely perish in an attempt at a less than ideal manual bailout. There are numerous training missions these Airmen could fly saving the Air Force the cost of their retraining with the loss of their qualifications just as the non-ejection seat aircraft have done for over the last 20 years.
Sitting down with several aviators in the fighter and bomber community that have given birth, I sought to better understand the environmental factors. I assumed they would be exposed to high G forces in combat maneuvers. But in reality, instead of grounding a pregnant fighter or bomber for over a year, allowing them to maintain currencies in a low G environment, less than 3 G, such as take off and landings just like mobility pilots, helps them return to flying postpartum more quickly, prevents the loss of some qualifications, and help preserves their confidence. Accommodations for ejection seat aircraft can easily be made when commanders determine resources are available.
After working at the Air Mobility Command level on pregnancy and flying policies in 2019, I sat down with some of the flight surgeons in the Pentagon to talk about the restrictions that impact 400 female aviators every year in the Air Force. At the time, aviators could only fly in a non-ejection seat aircraft with another pilot below 10,000 feet natural or pressurized between 13 and 24 weeks of gestation with a waiver. I was met with resistance, but to their credit, they expanded the window an additional 5 weeks to span the entire second trimester of 12 to 28 weeks and removed the administrative burden of a waiver for uncomplicated pregnancies. Although this was an improvement this was not what I was asking for. I wanted actual evidence and risk assessments, not a blanket occupational restriction for all Airmen regardless of the environment.
Reviewing the studies listed at the bottom of the policy I realized how outdated the information was. Although some of the studies were from the 1990s if you read them they often referred to studies from the 1960s and 1970s comparing a human fetus to a chicken egg. It was clear the Air Force’s policy was as outdated as the plaid pants worn in the decades in which these policies were based on.
From a retention perspective this is important. The FAA does not consider “pregnancy under normal circumstances (uncomplicated) disqualifying” and most airlines allow their pregnant pilots to fly well into their 3rd trimester. Only 6 percent of Air Force pilots are women and they have a significantly lower continuation rate compared to their male counterparts. While 63 percent of male rated officers continue to serve beyond 13 years of service, just 39 percent of female rated officers remain. In this RAND study, 85 percent of women interviewed discussed difficulty in timing pregnancies to fit within rigid career time lines. For flyers, a long gap in flying has particularly adverse career implications: the loss of flight hours, delayed aircrew upgrades (commander, instructor, evaluator), and lower experience levels. All of these result in significant barriers to career progression. Automatically grounding aircrew perpetuates the stigma around women and flying; that women must choose between motherhood; continued service, or that women are a drain on a unit’s combat capability due to potential for pregnancy.
Fallon Winslow flew until 27 weeks during her first two pregnancies and until the 19th week with her third because of a change in her medical status. (Alaska Airlines)
For aircrew ineligible for flying for the duration or part of pregnancy, this results in the loss of long-term landing; instrument currency and a total flight grounding duration of at least 12 months. To requalify postpartum, these aircrew must return to a formal training course at unit expense or an in-unit training course, taking away resources towards operational requirements. For aircrew eligible to fly in their 2nd trimester, the administrative burden and personal biases often contribute to real; perceived delays; outright denials to returning to fly. The result is loss of combat capability readiness in lost aircrew capacity, avoidable costs in multi-million-dollar requalification training, negative effects on retention morale of women aviators. Process requirements discourage women from even seeking to fly while pregnant.
What is alarming is the legal perspective. Restricting pregnant Airmen from flight duties in their first or third trimester when they are capable and elect to continue, such as a flight attendant or navigator, is more of an administrative convenience and not evidence based. On September 4th, 2020 the Department of Defense updated the Military Equal Opportunity Program DoD Instruction 1350.02 to include Pregnancy. “The DoD, through the DoD MEO Program will ensure that Service members are treated with dignity and respect and are afforded equal opportunity in an environment free from prohibited discrimination on the basis of race, color, national origin, religion, sex (including pregnancy), gender identity, or sexual orientation.” Additionally, the National Defense Authorization Act for Fiscal Year 2021 recognizes the protection for the Pregnancy Discrimination Act apply to military women. Lastly, the Air Force’s own legal review has determined the proposed changes for flying while pregnant pose very low liability risk as long as it remains voluntary and the known and unknown risks are presented, just as they were when I chose to continuing flying the T-37, knowing I was outside of the ejection envelope. In Cleveland Board of Education v. LaFleur, the Supreme Court ruled that school boards’ regulations requiring pregnant teachers to stop working after the fifth month of their pregnancies violated the Fourteenth Amendment’s due process clause and emphasized that the Court extends strong protection to individuals’ freedom of personal choice. Current blanket flight restrictions during pregnancy are outdated and discriminatory.
The Department of the Air Force, Women’s Initiatives Team (WIT), an all-volunteer group that proposes policy changes to help women’s propensity to serve, challenged the current flying policy. In 2019, the Air Force directed a policy review on performing flying duties while pregnant. As a result, the Office of the Deputy Chief of Staff for Operations drafted policy recommendations based on the identified, quantified, and recorded known aviation platform-specific occupational hazard exposures to Air Force aviators. The Surgeon General risk and hazard assessment was provided and should be required to be provided to the pregnant member and their medical team to determine when the member should fly based on the individual and the type of aircraft they fly. However, the new more accurate and fact-based policy attempted to be staffed, but has been held up for over 2 years in the Pentagon’s bureaucracy.
“If the Air Force invested millions of dollars in their aviators training and trusts them to make life or death decisions in combat, they should be trusted to work with their medical team to make decisions on whether they will opt to fly and for how long during pregnancy.”
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– Jessica Ruttenber, retired Air Force pilot and mom of 3 (@JessicaRuttenb2)
Despite the evidence presented, a very small group of senior leaders continue to be a blocker, throwing out vibration concerns for the fetus in the first trimester on non-ejection seat aircraft that have been allowing pregnant service members or pregnant family members to use Space-Available flights, formally known as Military Command or MAC fights – to travel around the country and the world. Yet if the pilot or flight attendant is pregnant even though they have the same exposure as the pregnant passengers they deem it “unsafe”. I guess civilian pregnant bodies are different than active duty pregnant bodies…oh wait, that’s right, they’re not. From what I have observed and researched working this initiative for the past 4 years is that there will be some necessary restrictions for a very small group of individuals but at large the current limits for the weeks eligible to fly are unnecessary, not evidence based, and comes from a place of bias and fear. If the Air Force invested millions of dollars in their aviators training and trusts them to make life or death decisions in combat, they should be trusted to work with their medical team to make decisions on whether they will opt to fly and for how long during pregnancy.
If the Chief of Staff of the Air Force truly believes in his accelerate, change, or lose policies he could see that if half of these aviators opted to fly for half of their pregnancy it would immediately give 22 pilot “man” years in untapped readiness with policy change alone at no cost. The CSAF should immediately implement the 3 proposed changes of (1) remove restrictions that limit the period an aviator can fly (12 to 28 weeks of gestation) to be more aligned with FAA and commercial standards, leaving the decision with the member and their flight surgeon familiar with the aircraft type; (2) removes the requirement for an additional pilot to fly with the pregnant member; and (3) allows pregnant members to fly in ejection seat aircraft but prohibits maneuvers above 3Gs. This policy is long overdue and its time has come.
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Notes:
Air Force aviators can fly until from the 13th to the 28th week of gestation in non-ejection seat aircraft. Air Force Instruction 48-123 (2021, Jun 7) Medical Examinations and Standards
400 pregnant aviators derived from Aeromedical Services Information Management System (ASIMS). ASIMS is a web-based application that provides the Air Force the capability to track medical readiness, including immunization data, through a web portal for all personnel both in fixed or deployed facilities.
Test dummies, which are historically based on the average male stature, are typical examples of a design that neglects women and, consequently, puts their lives at risk. Caroline Criado-Perez discusses in her book, Invisible Women, how women are put at risk on the road. “Men are more likely than women to be involved in a car crash, which means they dominate the numbers of those seriously injured… But when a woman is involved in a car crash, she is 47% more likely to be seriously injured, and 71% more likely to moderate injuries.” It wasn’t until 2011 that the U.S. started using a female crash-test dummy. Even with the addition, there are some that question the testing accuracy. For pregnant women, the consequences are more severe. Although a pregnant crash-test dummy was created back in 1991, testing with it is still not governmentally-mandated (Criado-Perez, 2019).