During the pandemic smoking in pregnancy fell below 10% for the first time since records began BUT Government still not on track to reach target of 6% or less by 2022

6 July 2021

New NHS data published today [1] shows that smoking in pregnancy fell to 9.5% last year, the first time it has dropped below 10% since records began. Smoking in pregnancy declined six times faster between 2019/20 and 2020/21 than the average for the previous four years. However, in order to reach the Government’s target of 6% or fewer pregnant smokers by 2022 [2] the rate of decline needs to be even greater in the coming year, nearly four times faster again.

Smoking in pregnancy is the single biggest modifiable risk factor for miscarriages, stillbirths, premature birth and birth defects, causing heartbreak and irreparable damage to children and families.

The highest rates of smoking in pregnancy are in the poorest communities and in regions with the highest levels of deprivation. But the good news is that these are the regions where rates have fallen fastest, helping level up the health of the most deprived communities.

Some caution is needed when interpreting figures collected during the COVID-19 pandemic.[3] However, it is clear that the fastest rates of decline in recent years have been seen in places in the north of England where there are comprehensive strategies to tackle smoking in the community, as well as intensive support for pregnant women.

Greater Manchester is a leading example. Smoking at time of delivery has fallen from 12.6% in 2017/18 to 9.8% in 2020/21, following the introduction of shopping vouchers to encourage pregnant women to seek help to quit. In the fourth quarter of last year smoking in pregnancy in Greater Manchester fell to 8.7%, dropping below the national average of 8.9% for the first time. This is a stunning achievement, given that five years ago the rates of smoking in pregnancy in Greater Manchester were 17% higher than the national average (12.9% compared to national average of 11%).

Sarah Price, Chief Officer of Greater Manchester Health and Social Care Partnership said:

“The investment in Greater Manchester hasn’t just been in services to help pregnant women stop smoking, but also in tackling smoking across our most disadvantaged communities and reducing health inequalities.

“We know that parents-to-be are more likely to quit if they get the right support and everyone that meets eligibility criteria is also incentivised to stay smokefree with vouchers to help them prepare for the arrival of their new baby. This approach has proved successful with some of the most addicted smokers, by offering one more reason to quit.

“This is levelling-up in action and brings us closer to Making Smoking History for Greater Manchester and for England. We must keep going with this vital work and deliver a smokefree start for every baby.”

Trends in regional rates of Smoking at time of delivery (SATOD) since 2015/16
Region 15/16 16/17 17/18 18/19 19/20 20/21 Percent point decline from 15/16 – 19/20 Percent point decline from 19/20 – 20/21 Percent point decline needed to reach 6% by 2022
North 14.6% 14.2% 14.2% 13.8% 13.3% 12.1% 1.3 1.2 6.1
Midlands 12.7% 12.4% 12.9% 12.8% 12.7% 11.3% 0.1 1.4 5.3
East of England 10.6% 9.8% 10.3% 9.7% 9.5% 9.2% 1.1 0.3 3.2
London & the Southeast 7.2% 7.1% 7.2% 7.0% 7.0% 6.5% 0.2 0.5 0.5
Southwest 11.4% 11.3% 10.9% 10.9% 11.0% 10.3% 0.4 0.7 4.3
England 11.0% 10.7% 10.8% 10.6% 10.4% 9.5% 0.6 0.9 3.5
Greater Manchester 12.9% 12.5% 12.6% 11.7% 11.1% 9.8% 1.8 1.3 3.8

The Government is set to publish a new Tobacco Control Plan later this year which will set out measures for achieving its ambition to make England smokefree by 2030. In a recent report, MPs from the All-Party Parliamentary Group on Smoking and Health urged the Government to take bold action to deliver this ambition and made several recommendations to tackle maternal smoking.[4] These include:

  • A new target to reduce smoking in pregnancy rates to 5% or less by 2025, on track to deliver a smokefree start for every child by 2030.
  • Vouchers and stop smoking support for pregnant smokers to help them quit.
  • Tougher rules to protect children and young people from becoming smokers, such as raising the age of sale for tobacco to 21.
  • Targeted investment to provide quit support to smokers in communities where smoking does the most damage.

Deborah Arnott, Chief Executive of ASH said:

“The Government are rightly ambitious to end smoking, but it will not be achieved through warm words alone. We need a bold, ambitious strategy that changes the lives of young men and women across the whole country so that every family starts in a smokefree home.”

 Notes to the Editor

Action on Smoking and Health is a health charity working to eliminate the harm caused by tobacco use. For more information see: www.ash.org.uk/about-ash

ASH receives funding for its programme of work from Cancer Research UK and the British Heart Foundation.

ASH staff are available for interview. For more information send an email to press@ash.org.uk or ring Deborah Arnott (Chief Executive, ASH) on 07976 935 987 or Hazel Cheeseman (Deputy Chief Executive, ASH) on 07754 358 593.


[1] NHS Digital. Statistics on Women’s Smoking Status at Time of Delivery: England Quarter 4, 2020-21

[2] Department of Health and Social Care. Towards a smoke-free generation: a tobacco control plan for England. 2017

[3] NHS Digital continue to urge caution when interpreting such datasets during this COVID-19 period. Data quality and coverage is affecting some statistics significantly. This is noticeably the biggest drop in SATOD for some time; however, this is along with the lowest number of maternities.  Therefore, data should be interpreted with care over the COVID-19 period.

[4] APPG on Smoking and Health. Delivering a Smokefree 2030: The All Party Parliamentary Group on Smoking and Health recommendations for the Tobacco Control Plan 2021. June 2021