# Too much care? Increasing checkup frequencies and declining role of general practitioners in antenatal care in Norway (2010-2021)

## TL;DR

Norwegian antenatal checkups increased beyond guidelines, with midwives replacing GPs as main providers, raising concerns about overtreatment.

## Contribution

Quantifies rising antenatal checkup frequencies and shifting provider roles in Norway using national registry data.

## Key findings

- Average antenatal checkups increased from 11.1 to 13.0 between 2010 and 2020.
- Midwives replaced GPs as primary providers, with GP checkups decreasing by 1.1.
- Highly educated women had 7% more midwife checkups and 12% fewer GP checkups.

## Abstract

The antenatal care program is a cornerstone of Norway’s national health programs, serving nearly 50 000 women annually. Although usage has risen since the 1980s, with antenatal checkups exceeding recommendations, research on utilization patterns and demography remains limited. Insight is essential for optimizing prenatal care services, containing costs, and avoiding potential overtreatment.

This retrospective descriptive study used registry data from the Control and Payment of Health Reimbursement database, Statistics Norway, and the Norwegian Patient Register, covering 381 092 women giving birth in Norway (2010–2021). Associations were estimated using Poisson regression.

Between Jan 1, 2010, and Dec 31, 2020, the mean number of antenatal checkups increased from 11.1 to 13.0, exceeding guidelines by 5.0. Midwife checkups increased by 2.4, while general practitioner (GP) checkups decreased by 1.1, progressively making midwives the main providers. Compared to women with lower secondary education, highly educated women had 7% more checkups by midwives and 12% fewer with GPs. They also sought GPs less before, during, and after pregnancy (48%, 20%, and 28% less). Women with 16+ checkups (upper quartile) had lower education and 1.6 more GP consultations the year before pregnancy than those with fewer checkups.

From 2010 to 2021, GPs saw a decrease in their role as main providers of antenatal checkups, with midwives now conducting most examinations. The average number of checkups rose by 1.9, not attributable to guideline changes, raising concerns about overutilization among a generally healthy group of women and implications for health system sustainability.

From 2010–2021, general practitioners’ role in antenatal care declined as midwives became primary providers. Still, antenatal checkups increased by 1.9, not attributable to guideline changes, raising concerns about potential overtreatment in a generally healthy group of the population.