ANALYSIS: Why four in five Swedes off sick with stress are women

Gender inequality in workplaces, household chores and healthcare prejudices are all factors behind Sweden's gender gap in stress-related sick leave, according to experts.

ANALYSIS: Why four in five Swedes off sick with stress are women
Women are more often than men diagnosed with stress-related illnesses. Photo: Stina Stjernkvist/TT

Sweden has been regarded as a leading example of gender equality around the world, but when it comes to work-related stress, things are far from equal.

Eighty percent of workers on sick leave because of stress between July 2019 and July 2022 were women, statistics by Sweden’s Social Insurance Agency show.

Recent numbers show the amount of women on sick leave increased more than men between October 2021 and October 2022, with a 9.8 percent and 7.2 increase, respectively.

Gender segregation in the workplace

“I think the horizontal segregation of the Swedish labour market, and also in the Scandinavian countries as a whole, is one reason why we find these big gender differences,” says Gunnel Hensing, professor in social medicine at Gothenburg University.

“Women more often work in communication-intensive occupations, occupations where you relate to other people and you are personally involved in the work, while men more often work in administrative and technical occupations.”

Ulrik Lidwall, an analyst at the Social Insurance Agency, agrees, pointing out that the healthcare, welfare and education sectors are dominated by women.

“This kind of work is hard to just drop and they often take the work home with them, becoming a job without ‘limits’,” he says.

The pandemic, as a consequence, impacted women more negatively, since they were less likely to be able to switch to remote working.

“You need to be at the hospital if you work in healthcare, you have to be at the daycare centre if it’s open. That is where women work,” says Hensing.

She mentions that reports suggest that if men work in a female-dominated area, they tend to develop the same type of symptoms as women.

“It’s not particularly that you are a woman or the female biology, but rather that you are exposed to a work environment where it’s easy to develop stress.”

But Lidwall adds: “You can have it easier or more difficult depending on your gender. For instance, in the priest occupation, women have been working against all odds. They face complications and get other tasks than men in the same workplace. Women tend to get the administrative tasks and men the more technical ones.”

Women from minority groups are especially vulnerable, with discrimination, which according to a report by The Swedish Gender Equality Agency affects them more than men, adding an extra layer of stress. And domestic violence towards women often leads to other side effects, like sleeping problems, depression or PTSD, which again increases stress.

Lidwall also points to unequal share of housework as a big cause of stress.

“Women tend to take more responsibility, which contributes to a higher risk of stress-related mental health issues.”

A 2021 report by Hensing for the Equality Agency focusing on women’s unpaid labour at home found that there are connections between unpaid work and sick leave. However, the difficulties when measuring the personal challenges that women face has resulted in a great lack of research in this field.

Ida Ahl, a rehab coordinator at health centres in the Västra Götaland region and a former insurance investigator at the Social Insurance Agency, also mentions housework inequalities as a reason for the increasing gender gap in sick leave.

“We still don’t have an accurate workload in the home. Even if there have been changes, there are probably many families where the woman clearly takes a bigger responsibility when it comes to her private life.”

Differences in treatment within Swedish healthcare

Men and women are treated differently within the healthcare system based on their gender, a report by the Swedish National Audit Office concluded in 2019.

Masculinity norms can cause men to be underdiagnosed, argues Hensing.

“Men do not seek care for their mental health issues, and if they don’t seek help they do not get their diagnosis or sickness absence note,” he says.

Ahl’s experience from Västra Götaland health centre backs up the claim.

“I believe (…) that men seek healthcare less than women. I have noticed that when men seek help at our place, they often refer to a relative, boss or someone else who has pushed them to seek help,” she says.

Extended definition of illness

Ahl includes two other reasons why stress diagnoses are on the rise.

The first one is the patient self-diagnosing before they meet the doctor.

“When they call the health centre for the first time, they are certain they have exhaustion syndrome. That makes it more difficult for us, because it might be that the patient does not at all meet the criteria for the diagnosis, but still have made that conclusion themselves,” she explains.

The second one is an extended definition of illness, which is not always accurate or helpful to the patient.

“A lot of patients seeking help have pretty normal reactions to different kinds of loads in life and maybe a little bit too often put a sickness label on things that don’t have sickness value,” Ahl adds.

Article by Gothenburg University students Anna Hallgren, Mireia Jimenez and Khorambanoo Askari

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What’s the state of Sweden’s maternity wards this summer?

A difficult summer is on the cards for maternity wards across Sweden once again this year. Here's a rundown of the situation in each region in Sweden.

What's the state of Sweden's maternity wards this summer?

Sweden’s maternity wards have issues with midwife shortages all year round, with the situation worsening over the summer period as the staff are all entitled to four consecutive weeks of holiday during the summer under Swedish law.

More babies are usually born during summer, too, meaning that the busiest period on Swedish maternity wards is often the period where they have the least staff.

So, how is the situation in maternity wards across Sweden this summer? Newswire TT asked each of Sweden’s healthcare regions to fill in a questionnaire between May 10th and May 23rd, asking for information on the state of maternity care in the run-up to the summer months. Here are the results.


Situation: Same as last summer

Blekinge region described the situation this year as strained, adding that many shifts have still not been filled.

Staff on parental leave, one hired-in independent midwife, temporary staff on hourly contracts and managers are taking shifts to fill the gaps, and midwives are being offered 7,000 kronor to move a week of holiday.

The region added that there is a small risk that patients will have to give birth in another region, although this is uncommon, and that the biggest challenge is covering midwife shifts and possible absences.


Situation: Worse than last summer

In Dalarna, the region described the situation as “fragile” due to a very small number of staff and no stand-ins for sick cover.

Their greatest concern is that staff won’t be able to cope if they have to cover for each other, according to the survey.

However, it reports that there’s also a low number of births expected, so pressure is not that high. There are around four midwife positions left unfilled, and staffing issues are being resolved by hiring retirees and giving bonuses for extra shifts.


Situation: Better than last summer

Gotland has enough midwives to cover maternity wards over the summer, and some temporary staff have been hired to cover the summer months. The region has not had to hire in any independent midwives and is not offering bonuses for staff to move their holidays.


Situation: Worse in Hudiksvall hospital, same as last year in Gävle.

In Hudiksvall, the region is 3-4 midwives short of the level needed for summer cover. It is trying to cover this with overtime shifts and by offering bonuses of 20,000 kronor a week (up from 15,000) for moving weeks of holiday.

It has had difficulties in finding enough independent midwives to bring in for holiday cover in Hudiksvall, and in Gävle, some wards are running at a reduced capacity.


Situation: Worse than last year

In Halland, capacity has been reduced to around 75 percent of normal capacity, with around 15 midwife positions unfilled. The region is hiring in independent midwives, retirees, and offering bonuses for moving holidays and working overtime. The region says that this is the third year in a row with staffing issues and describes staff as “tired”. 

It says that the biggest challenge is in Halmstad, where the neonatal ward is located.

Jämtland Härjedalen

Situation: Better than last summer

Jämtland Härjedalen’s main challenge is ensuring there are enough senior midwives working when pressure on hospitals is at its highest. It has hired in three independent midwives in part-time positions, is hiring retirees and offering bonuses for moving holidays and extra shifts.

It adds that some staff have moved their holidays and received bonuses which are offered as a certain percent of their salary.


Situation: Differs depending on maternity clinic

Jönköping has 14 empty midwife positions, and is struggling to have enough experienced staff working over the summer. It has hired independent midwives and retired staff, is offering bonuses for moved holiday weeks, but adds that there is still a risk that some patients will have to give birth in a different region.


Situation: Same as last summer

Västervik hospital has a few empty midwife positions and the biggest challenges are staff needing to take sick leave and peaks in workload. Independent midwives and retired staff have been hired, as well as bonuses offered for moving holidays and taking extra shifts. Midwives in other areas (gynaecology, postnatal care) have been moved to maternity wards over summer.


Situation: Same as last summer

Tight situation, if any staff get sick there will be more pressure on others. Two rooms on Växjö maternity ward closed. Independent midwives have been hired in and bonus offered for moving holiday. There’s a risk some patients will have to give birth in other regions.


Situation: Same as last summer

No expected staff shortages on maternity wards. Gaps in staffing have been covered by hourly workers, some new hires and staff hired through a summer recruitment initiative where the region offers to pay for travel and housing. Some staff have moved holiday weeks with a bonus of 25,000 kronor per week moved. Some staff are taking extra shifts, and independent midwives and retirees have been brought in for the summer.


Situation: Same as last summer

Difficult to get enough staff on the maternity ward at Skåne University Hospital as well as neo-natal ward as Helsingborg hospital. In Kristianstad, there are 5 empty midwife positions and they will need to scale down services over summer.

Independent midwives have been hired for the summer as well as retirees. Skåne is also offering bonuses for moving holiday weeks and taking extra shifts, and Kristianstad have brought in assistant nurses and service workers to help lessen the load.


Situation: Better than last summer

Around 50 empty midwife positions, although the region says the situation better than previous years. Two hospitals might need help with referrals. A new maternity ward at S:t Görans hospital as well as fewer expected births means the region believes it has planned well.

Stockholm has also hired in independent midwives and retirees, offering bonuses for moved holidays and for taking extra shifts. It is offering 15,000 kronor for moving one week of holiday or 25,000 kronor for moving two weeks, and adds that there is a risk that patients will have to give birth in other regions.


Situation: Same as last summer

Sörmland doesn’t have enough midwives to cover all of the region’s maternity wards, stating that it’s not possible to say how many midwives it’s missing. Like many other regions, the region has hired in independent midwives and retirees and is offering bonuses for moved holidays and for taking extra shifts.


Situation: Same as last summer

Uppsala also said it had a midwife shortage, but also a shortage of experienced assistance nurses. Around 10 midwife positions are empty this summer, and it is offering 12,000 kronor to midwives for each moved week of holiday. It adds that there is a risk of women giving birth in other regions and is combatting this by hiring in independent midwives and pensioners. It has cut the number of hospital spots available for patients just after giving birth, is offering extra pay for senior midwives during summer and is prioritising treatment that can’t wait.


Situation: Same as last summer

Värmland region said that its biggest problem is not enough experienced staff, as well as the logistics of making sure that there is a good balance of experienced staff working on each shift. It has hired independent midwives and retirees, and offering 20,000 kronor bonuses for moving holiday weeks, as well as bonuses for taking extra shifts. It is also working at minimum capacity.


Situation: Better than last summer

Despite the situation being better this year than last year, Västmanland region said that the situation was still fragile, as it has assistant nurses and midwives working during the summer who don’t work all year round.

Some midwives have been moved from other clinics to handle births, and independent midwives and retired midwives have been brought as extra cover over the summer. Midwives have been offered 15,000 kronor to move a week of holiday.


Situation: Better than last summer

Västerbotten described its biggest challenge as providing safe maternity care with extremely low staff. It has hired independent midwives, midwives working hourly rates, is offering bonuses for moving holidays and taking extra shifts and has also hired midwives from Finland.


Situation: Same as last summer

The region said that it had a shortage of around 12 midwives, which it is covering by hiring independent midwives and by asking employees to work overtime. It has also hired retired midwives, and is offering bonuses for moving holidays and taking extra shifts.

Västra Götaland

Situation: Better than last summer

Midwives, nurses and assistant nurses need to work extra shifts and move holiday weeks. Retired staff have been hired in, as well as staff working on hourly contracts. Midwives are being offered 10,000 kronor per moved week of holiday and bonuses for working overtime.


Situation: Better than last summer

Around 30 midwife positions will be unfilled over the summer, and midwives have been offered 20,000 kronor per moved week of holiday, as well as bonuses for working overtime. The biggest issue is staffing extra shifts. It writes that there is a risk of patients having to give birth in other regions.


Situation: Better than last summer

Östergötland’s biggest issue is covering sick leave or other absences. It has hired independent midwives and retired midwives and is offering bonuses for moving holidays and taking extra shifts. It adds that there is a risk of patients having to give birth in another region.