New figures out last month reporting the small decline in the percentage of women smoking at the time of birth make for an encouraging read. The latest Statistics on Women's Smoking Status at Time of Delivery, England from the Health and Social Care Information Centre (HSCIC) show that just over one in 10 babies are born to mothers who smoke—11.4% of women were recorded as smokers at the time of giving birth in 2014–2015 (HSCIC, 2015); this time last year this figure was 12% (HSCIC, 2014). Every midwife and health professional knows the dangers that smoking during pregnancy has on an unborn baby, and these figures show that the public health message is getting through, albeit very slowly. Although 11.4% is a relatively small percentage, it still represents 70 880 maternities—70 880 too many!
The National Institute for Health and Care Excellence (NICE, 2010) has recommended that all pregnant women are carbon monoxide (CO) tested at their booking appointment. The aim of this is to identify those most at risk and to ensure that advice is targeted to those individuals who need it most. Although this seems untrusting of women and may affect the important midwife–woman relationship, O'Connell and Duaso (page 484) found that the women's reactions in their study were generally positive to CO monitoring. This is good news as evidence has suggested that women who smoke during pregnancy are reluctant to discuss their addiction with their midwives and often fail to admit to smoking when asked during their initial antenatal appointment (Owen and McNeill, 2001).
Unfortunately the HSCIC report, once again, highlighted a significant regional variation in smoking prevalence among Clinical Commissioning Groups, from 2.1% in NHS Central London (Westminster) to 27.2% in NHS Blackpool. These regional variations are a cause for concern and correlate with deprivation. It is well known that people living in poverty are more likely to smoke (Office for National Statistics, 2014), thus it is imperative that stop smoking messages are targeted to those who need them most. The Government must support public health efforts and target resources in areas where rates are still high to help pregnant women and their families quit smoking. Ensuring that all women are routinely CO monitored, and hiring more smoking cessation midwives in these areas, will certainly help bridge this inequality gap and will save the NHS money in the long-term.