State of child health 2 - Conception, pregnancy and infancy indicators

This looks at smoking and pregnancy, breastfeeding and immunisation.
Last modified
11 September 2018

Smoking and pregnancy

Proportion of mothers recorded as smokers at time of delivery or at first post-natal visit

Key messages

  • Smoking during pregnancy is one of the most important modifiable risk factors for improving infant health.
  • Despite moderate declines over the past 10 years in England and Scotland, rates of smoking during pregnancy in the UK are higher than in many European countries.
  • Smoking during pregnancy is highest in deprived populations and in mothers under 20 years of age. 
  • Parental smoking increases offspring smoking initiation later in childhood and adolescence.
  • Improved monitoring and management of smoking throughout pregnancy is essential, alongside the development of high-quality and comparable data across countries and reinforcement of smoking reduction efforts across the whole population.

Key actions

  • Strengthen data collection across the UK by ensuring accurate recording of smoking status supplemented with carbon monoxide screening at a woman’s initial booking visit, and at regular intervals throughout pregnancy, including at 36 weeks. Data should be recorded centrally to allow for local, regional and national comparisons.
  • Commissioners and providers must ensure widespread implementation of the NICE Guideline, Smoking: Stopping in pregnancy and after childbirth, with a particular emphasis on routine carbon monoxide testing, training of health care staff and the setting of local targets to monitor implementation53.
  • Reinforce population level efforts to reduce smoking, particularly amongst deprived populations. This will be the most effective way of reducing smoking in adults with dependent children. Reducing adolescent smoking is the most effective way of reducing smoking amongst the next generation of parents. 


Proportion of mothers recorded as breastfeeding at six to eight weeks post birth

Key messages

  • Breastfeeding is a natural process that is highly beneficial for infant and mother, and benefits the child across its lifespan.
  • Breastfeeding rates in England and Scotland have shown minimal improvement since data collection commenced, and remain lower than in many other comparable high-income countries.
  • New national strategies for infant nutrition are required, along with increased efforts to support women to initiate and maintain breastfeeding, with strengthened data collection across all four nations. 

Key actions

  • National strategies for infant feeding should be developed or refreshed and evaluated.
  • Robust and comparable data should be collected across the UK, measuring breastfeeding initiation, breastfeeding at six to eight weeks, and at suitable intervals up until 12 months of age. Data should be recorded centrally to allow for local, regional and national comparisons and monitoring of trends in different socioeconomic groups.
  • All maternity services should achieve and maintain UNICEF Baby Friendly Initiative accreditation68. All services should provide antenatal education and health promotion regarding breastfeeding to both parents.
  • Local breastfeeding support should be planned and delivered to mothers in the form of evaluated, structured programmes, in line with NICE Postnatal Quality Statement 5: Breastfeeding70.
  • Ensure preservation of universal midwifery and health visiting services to all mothers. 
  • Healthy infant nutrition should be taught as part of statutory personal health and social education in secondary schools.


Proportion of children who received the full course (three doses) of the 5-in-1 vaccination by 12 months

Key messages

  • Vaccinations in early childhood protect children against serious and potentially fatal diseases. By 12 months of age, babies should have received several vaccinations, including three doses of the 5-in-1 vaccination. 
  • Since 2006/2007, the uptake rate of the 5-in-1 vaccine across the UK has increased modestly. 
  • Wales, Northern Ireland and Scotland meet the WHO target of having vaccination rates for the full course of the 5-in-1 vaccine at 12 months above 95%; England falls below this target at 94.2%.

Key actions

  • Maintain high awareness of the importance of immunisation across the UK through national strategies which ensure leadership across all health professional groups.
  • Strengthen implementation of NICE guidance, Reducing differences in the uptake of immunisations (PH21), including, but not limited to, robust local monitoring of the vaccination status of children and young people and adopting multifaceted programmes across different settings86.
  • Recognise the impact of various social factors, including deprivation, on vaccine uptake, developing and evaluating methods to increase uptake within these groups.
  • Further research into methods to improve vaccination uptake amongst families who make a conscious decision not to vaccinate their child.
  • All child health professionals to improve vaccination rates, and, if necessary, to signpost families to register their children with a general practitioner.