Sickness absence during pregnancy

Sammanfattning: The present study represents a series of surveys concerning the variation in rate and average duration of sickness absence during pregnancy from 1978 to 1997 in two Swedish communities, Linköping and Värnamo. The variation observed was related to the obstetrical course and outcome of the pregnancies, the reproductive histories of the women investigated, the occcupations held, the degree of employment, the prevalence of "back-pain during pregnancy" as a cause of sick-listing and the use before delivery of the special social benefits associated with childbearing, i.e. the Parental benefit and the Pregnancy benefit. The attitudes towards the subjective consequences of the state of pregnancy and the concept of being off-work for different reasons while pregnant, were examined by means of a questionnaire. A direct comparison was made between all pregnant women delivered during 1986 in the Värnamo community and the Hamar community in Norway, with special regard to the amounts of sickness absence registered during pregnancy in the two communities. Finally, with the help of two independent data bases, one computerized and based on routine reports and one manually extracted, we estimated the proportion of pregnant women among all sicklisted women, aged 16-44 years, during 1986 in Linköping, and their contribution to the total amount of sickness absence registered within these age strata. In total, 6 628 Swedish and 645 Norwegian pregnant women were included in the surveys.As a main result we found that the mean number of days of sickness absence per pregnant woman, aged 16-44 years, rose by more than 100 per cent, from 1978 to 1986. The corresponding increase for all women aged 16-44, was 20 per cent. Concurrently, there was no evidence of an "obstetric" explanation for these findings. "Back-pain during pregnancy" was the most frequent "complaint "to legitimate the sick-leave spells, increasing to about 30 per cent among employed pregnant women 1986. In 1997 it had decreased to 17 per cent. It was most often found in the younger pregnant women (< 25 years).No relation was observed between the occupation held by the pregnant women and the variation in sickness rate or the average duration of the sickness absence observed between 1978 and 1997. Nor was there any simple relation observed between the degree of unemployment among pregnant women and the amount of sickness absence registered.The variations in the social benefits offered to pregnant women was not found, either, to be related in a simple way to the rate and duration of sickness absence during pregnancy. Thus, when the social benefits, i.e. the Parental and the Pregnancy benefits, were substantially ameliorated in Sweden between 1978 and 1986, the sickness absence among pregnant women rose dramatically. In 1992 and 1997, when a modest reduction in the pregnancy associated social benefits had taken place, a decline in the amount of sickness absence was registered, i.e. down to 0.60 and 0.53. In 1986, 48 per cent of the employed pregnant women in Hamar were sicklisted during pregnancy as compared with 75 per cent in Vlimamo. This was in spite of the fact that the social benefits available to pregnant and employed women were much more favourable in Sweden than in Norway.In the questionnaire study about personal attitudes in 1995 we found, that 74 per cent of the women who had been sick-listed during pregnancy stated that they had enjoyed a "good" or "excellent" health during the whole of their pregnancy. Only 4.2 per cent of the women stated that they had suffered from a clearly pregnancy-related disorder. The present findings may indicate that a change in attitude towards pregnancy and its subjective consequences, together with a sensible adaptation to the prevailing conditions within the social security insurance system, may well be the most plausible explanation to the observed variations in sick-listing during the study period. When data from the two independent data bases were compared, it was found that 5.4 per cent of all sicklisted women aged 16-44, were pregnant. These women contributed as much as 22 per cent of all sickness absence registered. Only 46 per cent of the actually pregnant women could be identified in the computerized data base with the help of "pregnancy-related" diagnoses noted in the sick-leave certificates. To preclude misinterpretations, based on public health statistics, one must be properly informed on the reproductive state of thewomen sick-listed.