Some expectant mothers struggle to quit smoking. What can help?
CIGARETTE packets in France will soon carry a logo warning pregnant women of the dangers of smoking. The addition was prompted by recent data finding that 18% of French expectant mothers admit to smoking right through pregnancy—more than in many other rich countries, where fewer women smoke to start with (see chart). The true figure may be higher: blood tests suggest that many pregnant smokers lie about their habit—in studies in Scotland, as many as a quarter.
Most women who smoke give up when they learn that they are pregnant. Getting the rest to follow is hard. The usual approach is to tell them at their first prenatal visit that smoking is bad for the baby, encourage them to call a helpline and offer counselling. Some countries subsidise nicotine patches for pregnant women. The more of these steps are included, the higher the success rate. But even the best programmes get only a tiny fraction of this rump of smokers to break the habit.
Mental-health problems, poverty and domestic abuse all make quitting harder. Poor medical advice may, too: in several countries, including Britain, Bulgaria and France, some women may be told that a few cigarettes a day are better than the stress of cold turkey. That may be the least bad advice for the hopelessly addicted. But it is being given too readily. When health workers smoke themselves they may also be less zealous—and less credible. Surveys in 2009-10 found that a fifth of Spanish and Italian medical students smoked, and almost half of Bulgarian ones.
Some women still believe, despite what they hear, that smoking will not harm their unborn child. They may have smoked during an earlier pregnancy and argue that since the older child seems fine, the younger one will be, too. Such faulty logic can be reinforced by families and peer groups. In some poor areas of Britain a quarter of pregnant women smoke—more than twice the national rate. Just one in a hundred college-educated American women smoke while pregnant, against 17% of high-school dropouts. It is important to help expectant fathers to quit, says Carlo DiClemente of MDQuit, a Maryland smoking-cessation centre. If they keep smoking their partners probably will, too.
One promising approach is paying women to quit. A recent trial in Scotland gave up to £400 ($590) in shopping vouchers for women who stayed off cigarettes until their babies were born, as well as the usual package of counselling and nicotine patches. The success rate rose from 9% to 23%. If further trials show similar results, the scheme may go nationwide. Even smaller amounts may help: the state of Maryland recently started giving pregnant women who call a smoking-cessation service up to $90 in shopping vouchers that can be used to buy items for the baby. To get the full amount they must keep calling after the baby is born. (Figures from many countries suggest that at least half those who quit during pregnancy start again soon after giving birth.)
Such bribery could pay off in the long run. In America smoking-related medical costs for a mother and baby in the first year after birth average well over $1,500. Britain’s National Health Service is estimated to spend between £20m and £88m a year to treat such health problems. But the best way to ensure that women do not smoke when pregnant is to ensure that fewer light up in the first place.
This article appeared in the International section of the print edition under the headline "Huffing and puffing"
