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Smoking during pregnancy is bad for mothers and their babies. Studies show that babies whose mothers smoked while pregnant suffer from serious health risks and are more likely to develop behaviour problems and to become offenders.¹

One of the key promises in the government’s 1998 white paper Smoking Kills was special support to discourage pregnant women from smoking. The government set a target to reduce the number of women who smoke during pregnancy from 23 to 15 per cent by 2010. Measures taken so far include setting up a telephone helpline to support pregnant women stop smoking, a poster advertising campaign, and targeted warnings on cigarette packs. Sure Start local programmes are expected to achieve a 6 per cent reduction in smoking by pregnant women by March 2006 as well as a reduction in smoking among mothers of young children who didn’t stop when they were pregnant.

But how can those working with pregnant women and parents of young children persuade them to kick the habit? Liz Stevenson, a community nurse with the Oxford City Primary Care Trust, offers one-to-one support and advice to pregnant women looking to stop smoking as well as training and advice to GPs and midwives. Pregnant women who have said that they want to stop smoking are referred to her for an intensive programme of support throughout their pregnancy.

She explains that there is a big difference between supporting mothers who want help giving up, and making contact with others in the wider community who may not yet be at that stage. "Reaching low-income groups who haven’t identified the need for change and getting the message across is more difficult. There is no good practice to draw on: it is a relatively new area".

The Department for Education and Skills is due to publish details of Sure Start’s efforts to reduce smoking. We shouldn’t be too surprised if the target hasn’t been met and neither should the government. It is a huge challenge and any progress should be applauded.

Organisations such as the charity Quit have shown the need for more support for practitioners working to help parents give up smoking.

"Encouraging pregnant women to give up smoking is a real challenge," explains Stevenson. "You can’t just tell them that smoking is bad for them: the support needs to be offered in a neutral and non-threatening way as part of a wider package, involving partners, families and friends".

Pregnant smokers often face particular difficulties. Women in households where no one is in work are much more likely to smoke during pregnancy than women with jobs.² For some women, being pregnant can be an additional stress, and given the link between smoking, stress and depression it can be even harder to quit.

Two mothers of young children who smoked throughout their pregnancies and continue to smoke talked to 0-19. The first mother says: "I know I should stop, but I just can’t do it at the moment. My son has got health problems and I am on antidepressants, I can’t give up fags now."

The other mother, with four children aged between one and seven had managed to cut down from 20 to 10 cigarettes a day while pregnant, but went back up to 20 a day after birth. "It’s the only treat that I have just for me".

Stopping smoking programmes with pregnant women run by Sure Start and family centres often focus on delivering the no smoking message as part of a wider, holistic health package.

"Health days enabling pregnant women and parents to try out massage and aromatherapy can be very successful. Advice on smoking is delivered alongside stress management and information on healthy eating, which can make it less threatening and more enjoyable," says Stevenson. Other initiatives have an explicitly "pampering" focus: information on stopping smoking is available with nail-bars and health, beauty and make-up advice.

Some mothers say that a cigarette can function as "time out" from the children. Some initiatives have tried to harness the time out factor by providing a café where parents can have a break while their children are cared for in a crèche. These cafes may also offer housing and money advice, an approach which acknowledges that smoking is part of a wider culture.

"In order to be able to give up, mothers have to reach a point where the things they don’t like about the behaviour outweigh the attractions," explains Stevenson.

Involving a range of agencies also can help to get the message across. One of the many concerns about parents who smoke is the increased risk of fire-related accidents. Consequently, the stop smoking message can be delivered by community fire brigades, which will also offer advice on safety and smoke alarms. Community liaison fire officers can provide home visits for parents of young children.

Stevenson warns that results from such programmes are rarely instant. "Often it takes many attempts before an individual can give up. First of all, they have got to feel able and ready to change their behaviour. Those working with parents may end up spending a lot of time just raising the issue, and trying to start a dialogue that may eventually lead to change".

¹ Department for Education and Skills, Support from the Start, 2002

² Department for Work and Pensions, Families and Children in Britain, 2004

- For further information Supporting Change: A Guide to Helping Lone Parents Quit Smoking is available from Quit at www.quit.org.uk.

Smoking pregnancy and child health

• Women who smoke are at more risk of miscarriage, ectopic pregnancy, premature birth and stillbirth as well as some foetal malformations.
• Stopping smoking in the first three months greatly reduces the risk of low birth weight, and stopping at any stage in pregnancy brings proportional health benefit.
• Babies born to mothers who smoke have poorer lung function, and increased risk of cot death. They may be smaller and lighter. Children exposed to passive smoke are more likely to develop middle ear disease.
• Passive smoke can cause asthma in children and increase the severity of attacks in those already affected.
• A number of reports show children of smokers have a poorer performance at school and some studies suggest links between behavioural problems such as hyperactivity, and maternal smoking.

From: British Medical Association: Smoking and Reproductive Life: The Impact of Smoking on Sexual, Reproductive and Child Health (2004). Available at www.bma.org.uk.