We need to invest in better smoking cessation services for pregnant women

A good start in life is critical for health—and this story begins before birth. The WHO states that monitoring maternal and child health during pregnancy is critical, and that smoking is one of the most important modifiable lifestyle choices during this period.

That’s why we’ve again included smoking during pregnancy as an indicator in our latest State of Child Health report.

It hardly needs restating, but just to be clear—tobacco smoke contains at least 250 harmful chemicals in addition to nicotine. Many are poisonous and cause cancers. These chemicals can reach an unborn child through the placenta—leading to complications during pregnancy and birth, and further issues once the child is born. Exposure to smoke increases an unborn child’s risk of experiencing ADHD, obesity, anxiety and asthma—and of later becoming a smoker themselves.

Across the UK, rates of smoking during pregnancy range between 10.6 and 17.2%. But in recent years, declining trends have reached a plateau. There is now a fivefold difference in smoking rates across the socioeconomic spectrum. Government aims for a smoke-free generation by 2022 are welcome—but aspirational. They won’t be met without better funding for cessation services. That’s why we’re calling for the government to restore funding to public health budgets.

Reducing smoking rates in struggling socioeconomic groups could even reduce overall inequalities...

We want local authorities to be able to introduce incentive schemes to support pregnant women to stop smoking. There’s strong evidence that they work (pdf)—particularly in deprived areas and with younger women. While there’s an up-front cost, these services ultimately pay for themselves in the form of public health cost savings further down the line.

In England, the government has set smoking reduction targets for pregnant women—these should be monitored on an ongoing basis and approaches adapted accordingly. We urge other UK nations to set targets and do the same. Reducing smoking rates in struggling socioeconomic groups could even reduce overall inequalities, as people in these communities become less affected by the smoking-related outcomes that encourage inequalities to persist. 

Although stopping smoking before pregnancy is best for the child, quitting at any time during pregnancy brings benefits. Evidence suggests that women who smoke are more likely to change their smoking behaviour during pregnancy than at any other time of life. This is an opportunity not to be missed, and healthcare professionals can take advantage by offering advice on appropriate cessation services. There’s even free online training from the NCSCT (National Centre for Smoking Cessation and Training) you can take right now.

Overall, the data presents a challenging picture—progress in reducing rates of smoking in pregnancy has stalled. It’s unsurprising that trends in rising inequality correlate with smoking behaviour. Indeed, this trend is a recurring theme across our new report. This is why we are urging governments to act now—to prioritise public health, reduce health inequalities and give every child the best possible start in life.