Policy changes needed to better support pregnant elite female athletes, say researchers

When a female elite athlete announces her pregnancy, she can prepare herself for a slew of congratulatory messages wishing her well—on her retirement. At least, that was a typical experience for many within a group of 20 female athletes participating in a recent University of Alberta study.

The surveyed athletes, who had either trained or competed at the elite level before and during pregnancy within the last five years, offered a critical first-hand perspective on an issue that has broad implications for women's participation in sport at all levels.

"They're not supported to do both," said Tara-Leigh McHugh. "They have to make that decision between being an athlete and being a mother."

It's a decision nearly every female athlete must reckon with at some point. As Margie Davenport explained, for females, the window of peak performance and the window for fertility overlap. Female athletes interested in having a family essentially face three options: continue to compete and risk missing the window to start a family, retire from their sport to become mothers or attempt to do both with little support and few resources available to them.

"Male athletes don't run into the same issues. The level of stress is unimaginable," said Davenport, an associate professor and former national team athlete whose research in the Faculty of Kinesiology, Sport, and Recreation focuses on maternal and fetal health outcomes.

"I can't imagine a bigger gender equity topic in sport right now than this," added McHugh, a professor whose expertise in qualitative research was integral in gathering data reflecting the underrepresented voices of the female athletes.

"The voices of these women are essential. That is evidence," said McHugh. "It's essential for developing policy that's going to be relevant for these athletes."

Five key areas for better support

The study identified five key areas where actions could be taken to better support pregnant female athletes: pregnancy planning and fertility, pregnancy disclosure and discrimination, training pregnant athletic bodies, safety concerns, and a supportive network and equitable funding.

Davenport, who led the development of the 2019 Canadian Guideline for Physical Activity Throughout Pregnancy, acknowledged there is still research to be done in some of the areas, such as how to train pregnant athletes. Given their high typical training volume, the recommended 150 minutes per week in the guideline simply doesn't apply to elite athletes, but there remains a lack of evidence-based information to guide female athletes, their health-care practitioners and their coaching teams.

However, in other key areas shaped by the athletes' responses, "we already have all the information we need to move forward," according to McHugh.

"There are changes that could be made today that would make significant positive impacts on women and athletes in Canada, particularly around things like maternity leaves and funding supports," said McHugh, who has applied her sport research expertise to a variety of national sport-focused organizations.

Pregnancy or injury?

It's not just a matter of fertility—for many female athletes, pregnancy poses a risk to their entire livelihood because of current policies, or lack thereof. For example, Athletics Canada's Athlete Assistance Program is a source of funding for many Canadian elite athletes, and they use a carding system to determine which athletes receive financial support.

Formerly, athletes who were injured and unable to compete for a period of time could apply for a medical/injury card. The problem is, athletes could only receive that card once—and organizations counted pregnancy as an injury.

Any female athlete who required a card for pregnancy would be ineligible to receive another card if they were to get injured. That's exactly what happened to Canadian middle-distance runner Hilary Stellingwerff in 2015. After receiving a card for her pregnancy, the following year, she needed another for a stress fracture. She was denied.

Stellingwerff sought arbitration from Athletics Canada on the grounds that the policy of considering pregnancy an injury is discriminatory, and won. Even so, the organization expressed that they didn't think she'd make the 2016 Olympics, so they weren't willing to card her, Stellingwerff explained. She did make the Olympics that year and ended up receiving a retroactive card, but the entire process was an ordeal.

"It's really frustrating and scary because you're supposed to be going through one of the most exciting times of your life, being pregnant, but you're holding back from telling people that are supposed to support you because you're worried you might lose that support," said Stellingwerff, who was one of the study participants.

In the seven years since Stellingwerff's battle, some changes have been made, but there's still a long way to go. As McHugh explained, pregnancy still remains classified as an injury in some organizations.

"We're seeing more and more women coming back at a later age or after pregnancy, and we have to get past the old idea that they can't come back and compete," said Stellingwerff, who is now a mother of two and head coach of the University of Victoria's cross-country and track program.

Pregnancy can also jeopardize the ability for some female athletes to attend key events that could bring in sponsorships, prize money and other accolades critical to their career success. "If you're pregnant and you miss a qualifying competition, you just lost that opportunity," said McHugh.

The lack of support and policies make it challenging for athletes to even bring up the subject of pregnancy. As one athlete surveyed said, "I feel like I can't have open communication [with coaches] because I'm so afraid of what will be taken from me. That's not really fair."

"Young girls going through sport need to see it's an opportunity for them, that when they hit their reproductive years, it doesn't mean sport has to end," said McHugh.

"Sporting organizations in Canada and internationally have stated that they have specific goals to improve gender equity in sport," added Davenport. "If you don't have these policies in place, you're essentially excluding women from participating in sport."