CHANGES IN SICK LEAVE RATES AND THE USE OF PREGNANCY-ASSOCIATED SOCIAL BENEFITS AMONG PREGNANT SWEDISH WOMEN - AN OUTCOMES STUDY

We attempted to determine if an amended social security system has les sened the rate of sickness absence during pregnancy in Sweden over the period 1978-1989. We studied the records of 3998 women who gave birth in 1978, 1986, 1988, and 1989 at the University Hospital in Linkoping and the Varnamo County Hospital. Retrospective collection of all data concerning the rates and durations of sickness absence during pregnan cy, drawing of parental benefit, and use of granted pregnancy benefit was performed from Sweden's standardized social security files. Obstet ric variables concerning the course and outcome of pregnancy and deliv ery, as well as the health status of the newborns, were obtained from standardized and antenatal care and delivery files. Between 1978 and 1 989, the rate of sickness absenteeism during pregnancy increased by al most 100% for periods of absence not supported by a doctor's certifica te and by about 50% for those with a doctor's certificate. During the same time, the average number of days of sick leave per pregnant woman more than doubled. The changes were most apparent among younger pregn ant women. During the decade studied, no significant differences were found with regard to antenatal care, modes of delivery, or the health status of the newborns. In spite of the introduction within the Swedis h social security system of more generous rules for pregnant women, th e changes in the rates of registered sick leave during pregnancy obser ved over time were most unfavorable. The present study indicates that the rate of sick leave during pregnancy reflects a complex social phen omenon and cannot be explained solely by an increase in the rate of ac tual illness or sickness. Such a rate is also likely to depend on gene ral attitudes and expectations among pregnant women, which may vary ov er time. When amendments in social benefits for pregnant women are con sidered to improve the health status of the pregnant population, socie ty ought to clearly define the precise aim pursued and the consequence s expected to escape unintended socioeconomic results.