This indicator was published in March 2020.

In May 2021 we updated our graphs and charts where new data had been published, and we reviewed our policy recommendations by nation.

Background

• There is no safe level of exposure to tobacco smoke while in the womb. Smoking during pregnancy is a leading factor in poor birth outcomes, including stillbirth and infant (especially neonatal) deaths. Stopping smoking before or during pregnancy will reduce these risks to the child’s health and development.¹
• Progress in reducing rates of smoking in pregnancy has stalled in recent years and variation in rates remain depending on geography, socioeconomic status and age.^2,3,4,5,6
• Women from deprived backgrounds are more likely to be smokers when they become pregnant. They are also less likely to stop smoking during their pregnancy or after the birth of their child. Younger women (particularly those under the age of 20) are most likely to smoke during their pregnancy.⁷
• Smoking in pregnancy is routinely recorded during antenatal and postnatal care, but at different stages among the four nations: from antenatal booking, to time of delivery, to first postnatal review with health visitors.

Key findings

• In Northern Ireland, 13.2% of women reported they were smoking at the time of booking in 2018/19, which has fallen from 15.3% in 2010/11.⁵ A similar falling trend has been seen in Scotland, with 14.6% of women smoking at the time of booking in 2019, compared to 21.0% in 2010.³
• In England and Wales, smoking status is available at the time of delivery:
  • England: Though there has been a steady decline in smoking at time of delivery over the past ten years, data from 2014/15 to 2018/19 shows the trend has stalled, decreasing from only 11.7% to 10.6%.²
  • Wales: 16.0% of women were reported as smoking at the time of delivery in 2017/18.⁶
• In Scotland, the proportion of women reported as smokers at their first health visitor review after birth has increased from 14.8% to 16.7% from 2014/15 to 2018/19.⁴
• There is a notable difference in smoking rates between women in the most and least deprived areas in Scotland and Northern Ireland. Over a quarter of women (26.6%) in the most deprived group were recorded as smoking at the first health visitor review in Scotland, compared to 3.3% in the least deprived group.³ This is mirrored in Northern Ireland.⁵

What does good look like?

Meeting Government targets to create a tobacco free generation, by 2030 in England^10,11 and 2034 in Scotland.¹² We welcome the publication of tobacco control plans in England¹³ and Scotland.¹⁴ The Department of Health and Social Care’s (DHSC) 2017 plan includes an ambitious target to reduce the prevalence of smoking in pregnancy in England to 6% or less by the end of 2022 – five percentage points from the current level in England, and locally a level which only 28 out of 195 Clinical Commissioning Groups (CCGs)meet in 2018/19. Stagnation in progress to reduce rates of smoking during pregnancy indicates the necessity for further action to meet national targets.

Additional support for smoking cessation during pregnancy. A central element of Government tobacco control strategies is offering support through local NHS stop-smoking services. However, stop-smoking services are most commonly commissioned and funded not by the NHS, but local authorities – and total funding for this has fallen by 36% between 2014/15 and 2018/19, with 31% of local authorities offering no stop-smoking services at all.¹⁴ Furthermore, while these services are effective,¹⁵ quit rates continue to be consistently lower among certain groups, including pregnant women with a lower socioeconomic status and younger women. Evidence from Scotland has shown that tailored health promotion programmes designed specifically to reduce tobacco use in pregnant women in deprived areas have been successful in leading to higher quit rates, compared to less-tailored stop-smoking services.

Policy recommendations

What can health professionals do about this?

• Professionals can make use of free NCSCT online training on delivering Very Brief Advice (VBA) and promotingsmoke free homes and cars.¹⁶
• Women who live with a smoker are six times more likely to smoke throughout pregnancy and those who live with a smoker and manage to quit are more likely to start smoking again once the baby is born.¹⁷ Professionals should enquire about the whole household and offer stop smoking services as appropriate. Child health professionals should take the same proactive approach to consultations with adolescents, especially young women.
• Professionals should enquire about other harmful behaviours during pregnancy, such as alcohol and substance use.
• Clinical guidance is available in NICE guidance.¹⁸ Recent evaluation of the Saving Babies Lives Care Bundle has found inconsistent practice in relation to implementing NICE guidance in England.¹⁹

Contributing authors

• Dr Ronny Cheung, RCPCH State of Child Health Clinical Lead
• Alison Firth, RCPCH Policy & External Affairs Division
• Rachael McKeown, RCPCH State of Child Health Project Manager
• Dr Rakhee Shah, RCPCH State of Child Health Clinical Advisor