How to solve the problem of smoking in pregnancy

In October 2015 in the UK a report was published called Smoking Cessation in Pregnancy: A Review of the Challenge. This endeavour was endorsed by no less than twenty-one worthy organisations such as Action on Smoking and Health, Bliss (‘for babies born too soon, too small, too sick’), the Community Practitioners’ and Health Visitors’ Association, and the like.

The report considers how to deal with the serious problem of pregnant women who smoke – an activity, as is well known, that is harmful to the unborn babies as well as to the mothers.

The unnamed authors start by congratulating themselves on their achievements against the Challenge Group’s 2013 recommendations, using a traffic-light rating system. There’s rather a lot of red and amber so there’s more work to be done, and they acknowledge the magnitude of the task: ‘In the region of 70,000 infants every year are born to mothers who smoke [in England].’

Rather than critiquing the whole paper, for this post I shall just consider just the title: why is it merely Smoking Cessation in Pregnancy and not Smoking Prohibition in Pregnancy?

In the UK anyone aged over eighteen, pregnant or not, may go into any shop or supermarket where cigarettes are sold and buy – no questions asked – a packet containing twenty of these dangerous, addictive products.

Now let us suppose – just suppose – that smoking was banned for pregnant women. They would not be allowed to buy cigarettes in the shops or through the internet and other people would be forbidden on pain of instant excommunication knowingly to give cigarettes to a pregnant woman, and let us further suppose that this scheme worked perfectly so that there was no way a woman, once her pregnancy was confirmed, could legally smoke cigarettes or use any nicotine product. What would happen? Would there be an outcry? Would there be  marches in the streets with demonstrators carrying placards saying ‘We demand the right of pregnant women to smoke!’?

I suspect many women would be quite relieved that the dilemma of smoking in pregnancy had been taken away from them. They may well say to themselves, ‘Of course I know it’s bad for me and the baby, but now that I’m not allowed to smoke, well, I’ll just have to accept it.’

This is a fantasy, but at present, pregnant women as long as they are over eighteen, in spite of being strongly discouraged from doing so, may, if they wish, quite legally buy and smoke as many cigarettes as they choose.

Smoking in front of children is rightly discouraged and there are penalties for smoking in cars when children are present. But what about the developing baby in the womb of a smoker?

This absurd and unacceptable situation exists because in a democracy like Britain adults have the right to damage their health by smoking cigarettes. But should they have the right to damage other people’s health – including that of unborn babies – by smoking?

Before my critics start accusing me of being an agent of the Nanny State, let me make something quite clear. There is a big difference between smoking in pregnancy and other harmful behaviours and of course I am not proposing that laws  be enacted to try to save unborn babies from all possible dangers.

Heavy drinking in pregnancy is harmful to the baby: it can produce a serious condition called the foetal-alcohol syndrome. But the occasional glass of wine or beer is probably all right. Nonetheless, where to draw the line is unclear, and I would not advise drinking any alcohol in pregnancy.

But whereas the occasional alcoholic drink in pregnancy is probably safe, pregnant women who smoke do not do it occasionally; they do it every day, repeatedly. There is no question whatsoever that smoking can directly damage the developing baby and that is why is it strongly discouraged and help is offered to pregnant smokers to quit.

The reason that some women smoke when pregnant is the same reason they smoke when they’re not pregnant: nicotine addiction. They may claim they do it for pleasure or relaxation or to relief stress but such claims are illusory – as any smoker can easily demonstrate to himself or herself.

The question, then, comes down to this: because of the high risk of serious harm to the unborn child, should smoking in pregnancy be banned?

Text © Gabriel Symonds

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