Tackling smoking during pregnancy in England

smoking during pregnancy
smoking during pregnancy

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An analysis of policy to Prevent Smoking during Pregnancy in England

Executive summary

The incidence rates of smoking during pregnancy, and complications associated with it are still rampant in England. This is attributable to issues such as lack of strong leadership in policy implementation and inadequate infrastructures to raise awareness and training on how to prevent increase of smoking incidences during pregnancy. The proposed projects aims at evaluating the government strategies of tackling direct smoking during pregnancy on unborn child in England, with the aim of evaluating their effectiveness or establish if there is need for review.

Chapter 1: Introduction

 Cigarette smoking carries a threat both to the expecting mother and her newborn. Approximately, 20% of the women smoke through their pregnancy in the UK (Department of Health, 2012). This trend is associated with numerous adverse effects such as premature births, miscarriages and prenatal mortality. Direct smoking during pregnancy is associated with number of respiratory disorders and pregnancy complications (Free et al. 2011). It is also associated with financial crisis. It is estimated that treating mothers and their children on healthcare complications associated with direct smoking during pregnancy is about £20-£87.5 per annum (Bauld,  Hackshaw, and Ferguson, et al 2012).

Given these damages associated with the tobacco used on the unborn child. This paper conducts an analysis of policy to Prevent Smoking during Pregnancy in England.  Although it is the government responsibility to ensure that child has the best start of life, the government policies have done very little in protecting the children from the dangers of tobacco use pre and post-birth (Chen et al. 2012).

Background/Study rationale

It is estimated that approximately 10 million adults in the UK are smokers. In England, 17% females and 22% males are smokers. Research indicates that the prevalence rates ate highest among the young population between the ages 25 and 34 years and lowest among the elderly population (McEwen et al., 2012). Smoking At Time of Delivery (SATOD) indicates that there is high rates of prenatal smoking in England. Although comparative studies indicates some decline in prenatal smoking proportion (from 15.1% to 12.7% in 2006/7 and 2012/13 respectively), the declining rate is very low (Chen et al. 2012).

 Approximately, 12.7% of the women practice prenatal smoking. The national average highlights big disparities on prenatal smoking across the nation. For instance, in Blackpool, one in four  (27.4%) expectant mothers smoke during pregnancy as compared to 1 in every 100 expectant mothers who smoke during pregnancy (0.5%) in Westminster. The tobacco control plan for England has established national ambition to reduce smoking during pregnancy by 11% by end of 2016 (Department of Health 2011).

Smoking has generally been banned in all public places and even in workplaces since July 1, 2007. The implementation of this rule had followed earlier implementation of similar legislation in Scotland, Northern Ireland, and Wales.  Healthy Lives, healthy people tobacco plan, which was published in March 2011. It aimed at stopping promotion of tobacco use through the regulation of tobacco products.

The English government takes these responsibilities very seriously. The NHS England is expected to collect adequate data about smoking throughout pregnancy using the Carbon monoxide (CO) screening strategies. This is not compulsory requirements, indicating that current data on smoking pregnant women may not be the true picture, and may not be the most effective strategy to evaluate the extent of smoking during pregnancy (Department of Health 2011).

To start with, the government has improved its actions to stop the promotion of tobacco. This has been done through the implementation of tobacco displays and regulation of images and portrayals in the entertainment industry. Other measures include the policy of increasing taxes, introduction of initiatives to help quit and increased regulation of the tobacco products. However, the incidence rates of smoking during pregnancy, and complications associated with it are still rampant in England.

This is attributable to issues such as lack of strong leadership in policy implementation, reduced mass media campaigns, poor role models and champions that people can emulate to discredit smoking as well as enlightening the populations about dangers associated with smoking, and inadequate infrastructures to raise awareness and training on how to prevent increase of smoking incidences during pregnancy (Godfrey et al. 2010). Therefore, what are the government’s effective strategies of tackling prenatal smoking in England?

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Aims and objectives


 To critique government policy to prevent Smoking during pregnancy in England

Specific Objectives

  1. To examine the increase in prevalence rate of smoking during pregnancy
  2. To examine government plan to reduce incidence rates of smoking during pregnancy
  3. To examine the effectiveness of the government policy i.e. is there need for review?

 Literature search strategy

The key questions that were used during literature search were structured from the study objectives. This included;

  1. Why is there an increase in prevalence rate of smoking during pregnancy?
  2.  What is government plan or initiatives to reduce incidence rates of smoking during pregnancy?
  3.  Are the established government plans effective? 

The main focus of the literature review was  articles that gave definitive information from the controlled trials, randomized experiments, systematic reviews and any other article that had additional information on research topics.  The inclusion criteria included papers published not more than six years ago, written in English and peer reviewed articles.  Articles written in other languages, Newsletters and articles published more than six years ago were excluded.

The aim of this research was to investigate the impact of government policy on smoking during pregnancy. This aimed at evaluating the government plan to reduce incidence rates of smoking during pregnancy, and to establish if these interventions are effectiveness or there is need for review.

The standard search strategies were applied, which involved querying of the main data bases namely, London Metropolitan University Library MetCat, British Medical Journals, Library Catalogue, Wiley online library, Science Direct, Worldcat.Org, Sage journals online, NHS.Gov, NICE guideline, Parliament UK,  and Local Government Website-Census.   The querying was done using the key words below,

Key Words

 ‘stop smoking’ OR ‘Tobacco control’ OR  AND‘government policy’ OR ‘Pregnant women’ OR
‘Smoking education’  OR ‘Quit smoking’AND  ‘Government strategies’ OR ‘Policy review’

The potentially relevant articles in identified in these databases were those written in English, published less than six years ago and strictly are peer reviewed journals. However, some articles published earlier were included into the study, to build up on the study history to current trends. (Chen et al. 2012).

From the analysis, 218 articles relating to smoking during pregnancy met the inclusion criteria. Three quarters of them were highlighting on the negative health consequences associated with prenatal smoking, only 10% of the articles tackled the issue of English policy on tobacco use. Out of these 21 articles, eight articles were analysed as indicated in Table 1.1

 Ethics and anti-oppressive practice consideration

This paper will deal with ethical concerns that affect indirectly and directly the well-being of the human beings. The issue of maternal autonomy is very important. Irrespective of child’s interest, pregnant women have the right to make their own decision. This is because forcing decisions to pregnant women are ineffective strategies, and are both unconstitutional and unethical in deontological perspectives. If other members of the society have the freedom to   smoke and to drink alcohol; the rights must not disappear with pregnancy (Free et al. 2011).

According to the utilitarian theory, moral imperative must take precedence over the freedom of choice. This is because the pregnant women are carrying another life, whose rights must remain reserved. Despite the increased foes in the newspaper, researchers are obliged under international laws to conduct research in a way that protects and promotes human health, including prenatal and maternal health. All ethical regulations that protect and uphold individuality, the aspects of autonomy and protection of human rights as proposed by the government and other institutions that promote ethics will be observed (Fleming et al. 2012).

Project outline

The proposed proposal consists of four chapters. These chapters help critiquing the England policy on prenatal smoking. Chapter 2 is the literature review, which consist of thematic headings including the overview of prenatal smoking in the UK, the prevalence rates of prenatal smoking in the UK, factors associated with prenatal smoking, impact of smoking to the mother and unborn child and the socio-physiological impact of prenatal smoking. This helps in understanding the general attitudes to smoking during pregnancy, and the identification of the key legislations that help reduce and prevent smoking during pregnancy.

 Chapter 3 explores the theory and practice. This reflects on the government policy initiative- Smoke free legislation: The Health Act 2006. A critical analysis of the policy impact was done. To understand the policy impact better, the agency link identified is Action on Smoking and Health (ASH).  This agency link is chosen because it is mainly concerned with the impact of prenatal smoking on children health, their parents and relatives. 

The programme intervention identified was Framework Convention on Tobacco Control. This programme changes, strengths and weaknesses are analysed (Mackenbach, 2011). The ethical tensions and dilemmas associated with the programme are also described. Chapter 4 is the last chapter and generally consists of study conclusions, reflections, and study recommendations.


Bauld, L., Hackshaw,,L., and Ferguson, J. et al (2012). Implementation of routine biochemical validation and an ‘opt out’ referral pathway for smoking cessation in pregnancy, 2012, Addiction, 107 Supplement 2: 53-60

Chen, y.-F., et al., (2012). Effectiveness and cost-effectiveness of computer and other electronic aids for smoking cessation: a systematic review and network meta-analysis. Health technology Assessment, 16(38).50.

Department of Health (2011). Healthy lives, healthy people: a tobacco control plan for England, London, Department of Health, 2011.

Free, C., et al., (2011). Smoking cessation support delivered via mobile phone text messaging (txt2stop): a single blind, randomized trial, Lancet, 378(9785): 49-55

Godfrey C. et al. (2010). Estimating the costs to the NHS of smoking in pregnancy for pregnant women and infants, 2010. York: Department of Health Sciences, The University of York. Cited in NICE, Guidance aims to protect thousands of unborn babies and small children from tobacco harm’. Available from: http://www.nice.org.uk/

Mackenbach, J. (2011). What would happen to health inequalities if smoking were eliminated?. BMJ, 342(jun28 1), pp.d3460-d3460.

McEwen. A. et al (2012). Evaluation of a programme to increase referrals to stop-smoking services using Children’s Centres and smoke-free families schemes,. Addiction, 2012, 107: 8–17.

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