National guidance and policy

Here you'll find an overview of national guidance and policy relating to smoking in pregnancy.

NHS England: Three year delivery plan for maternity and neonatal services

NHS England have published a new plan which “sets out how the NHS will make maternity and neonatal care safer, more personalised, and more equitable for women, babies, and families.”

Over the next three years, services are asked to concentrate on four themes:

• Listening to and working with women and families, with compassion
• Growing, retaining, and supporting our workforce
• Developing and sustaining a culture of safety, learning, and support
• Standards and structures that underpin safer, more personalised, and more equitable care

On smoking, the plan states:

“Women receive care that has a life course approach and preventative perspective, to ensure holistic care for women and the best start in life for babies. This includes NHS-led smoke-free pregnancy pathways to provide practical support for pregnant women who are smokers, and evidence-based information about screening and vaccination”.

Read the full plan here

NHS Long Term Plan

The NHS Long Term Plan, published January 2019, made a commitment that by 2023/4, the NHS will

1. Operate an opt-out smokefree pregnancy pathway which will include focused sessions and treatments for expectant mothers with partners referred to external local authority stop smoking services. However, as of 2023, partners will instead be referred to existing local authority stop smoking services where available.
2. Prioritise areas with the greatest level of need

See our dedicated page for resources to support the implementation of the LTP tobacco commitments in maternity settings.

The NHS Futures Platform provides a range of resources from NHS England and maternity teams across the country to support trusts implementing the LTP tobacco commitments in maternity settings.

The Saving Babies' Lives Care Bundle V3

The Saving Babies’ Lives Care Bundle Version 3 was published in 2023. 'Element 1: Reducing smoking during pregnancy' has been updated to include the full Long Term Plan tobacco treatment pathway, in addition to CO testing and opt-out referral.

The Smoking in Pregnancy Challenge Group resources to support implementation of CO testing and opt-out referral here.

You can access free training in VBA from the National Centre for Smoking Cessation Training (NCSCT) here.

NICE Guidance [NG209]

NICE guidance [NG209] provides the evidence-based model for smoking cessation support within maternity settings. NICE recommends all maternity units:

• Provide carbon monoxide testing at all antenatal appointments to assess the women's exposure to tobacco smoke and explain what her carbon monoxide reading means.
• Provide opt-out referrals to receive stop-smoking support for all pregnant women who:
  • Say they smoke or have stopped smoking in the past 2 weeks, or,
  • Have a carbon monoxide reading of 4 parts per million (ppm) or above, or,
  • Have previously been provided with an opt-out referral but have not yet engaged with stop-smoking support
• Consider NRT at the earliest opportunity in pregnancy and continue to provide it after pregnancy if the woman needs it to prevent a relapse to smoking, including if the pregnancy does not continue. Give pregnant women clear and consistent information about NRT and explain:
  • How to use NRT correctly, including how to get a high enough dose of nicotine to control cravings, prevent compensatory smoking and stop successfully.
  • Nicotine levels in NRT are much lower than in tobacco, and the way these products deliver nicotine makes them considerably less addictive than smoking.

• In addition to NRT and behavioural support, offer voucher incentives to support women to stop smoking during pregnancy

Women's Health Strategy for England

The Women’s Health Strategy for England, published July 2020, acknowledges the impact of smoking on women’s health inequalities, however it is limited by a lack of dedicated funding and no delivery plan or measures of success. It states that the Government will consider the recommendations in the Khan review, make sure the Long Term Plan is implemented, and has established the Maternity Disparities Taskforce to look at wider determinants of health such as smoking. The Taskforce will initially focus on the preconception period but this work has been significantly delayed. In response to the Women’s Health Strategy, ASH called for:

• New mandatory training on women’s health to include smoking cessation
• Improved data on smoking rates throughout pregnancy
• New research on women’s health issues with a focus on reducing rates of relapse to smoking postnatally & helping fathers quit

Financial incentives

In April 2023, the Government announced that all pregnant women who smoke will be offered financial incentives in the form of vouchers alongside behavioural support by the end of 2024.

Other measures announced focus on supporting adult smokers to quit smoking through vaping, preventing youth vaping and cracking down on the illicit market for tobacco and vapes.

The Khan Review: Making Smoking Obsolete

The Khan Review: Making Smoking Obsolete was published on 9th June 2022. It is an independent review commissioned by the UK Government and conducted by Javed Khan OBE. The Review sets out recommendations on how the Government’s ambition to reduce the national smoking rate to less than 5% by 2030 can be achieved.

Recommendation 12 of the Khan Review states:

"Invest £15 million per year to support pregnant women to quit smoking in all parts of the country. The NHS should provide treatment at every stage. The government needs to create a national funding pot for evidence-based financial incentives to support all pregnant women to quit. There should be a stop-smoking midwife in every maternity department to provide expert support and advice at the front line."

Within Recommendation 12, Khan recommends the NHS:

• Help more women to start pregnancy smokefree by shifting the social norms that encourage young women to take up smoking at all, possibly through investing in stop smoking marketing campaigns (Recommendation 10).
• Help pregnant smokers to quit during pregnancy through Government-funded financial incentive schemes and enhanced clinical support, including:
  • A senior designated 'smoking in pregnancy champion' at every NHS trust.
  • A ‘stop smoking midwife’, providing expert support, advice and treatment at the front line in every maternity team. In areas with high smoking rates, there should also be a sufficient number of trained advisors to support.
  • Ensuring every clinician has the skills and confidence to lead the conversation with smokers, giving effective but brief VBA advice on quitting.
  • Offering safer alternatives to smoking, such as e-cigarettes, as recommended by the Royal College of Midwives.
  • Regularly checking-in with recent quitters throughout their pregnancy to ensure they are offered support and treatment if they have started smoking again or feel at risk of relapse.

• Provide relapse prevention support post-pregnancy with midwives and health visitors to ensure the continued benefits of quitting for parents and their children’s lives.

Prevention Green Paper: Advancing our health: prevention in the 2020s

On 22nd July 2019, the Government published a consultation on the Prevention Green Paper: Advancing our health: prevention in the 2020s, asking for responses on how the Government can achieve the ambition of a smokefree England by 2030.

The Green Paper recognises it will be “extremely challenging” to reduce the inequalities in smoking rates. It highlights that 1 in 4 pregnant women smoke in Blackpool compared to 1 in 50 in Westminster and goes on to state that:

“Tackling these inequalities is the core challenge in the years ahead. If we are to achieve this vision of a smoke-free future, we need bold action to both discourage people from starting in the first place, and to support smokers to quit.”

The Green Paper also references the commitment in the NHS Long Term Plan to implement “a new smoke-free pregnancy pathway for expectant mothers and their partners” by 2023/2024.

Challenge Group submission to Advancing our Health: Prevention in the 2020s

In October 2019 the Smoking in Pregnancy Challenge Group responded to the Department of Health and Social Care’s consultation ‘Advancing our health: prevention in the 2020s.’ The response calls for a national incentive scheme to support women in high smoking prevalence communities to quit, and greater support for smoking households and families to reduce pregnant women’s exposure to secondhand smoke. You can read the submission here.

2017 Tobacco Control Plan for England

The 2017 Tobacco control plan for England includes an ambition to reduce rates of smoking in pregnancy to 6% or less by 2022.

The Plan further commits Government to a number of specific actions including commitments to:

• Embed CO Screening in Maternity Services Data Set
• Take further action via the Maternity Transformation Programme.

The Government has missed the ambition set in the 2017 Tobacco Control Plan to reduce SATOD rates to 6% by 2022 and isn’t on track to hit 6% until 2030 – currently 8.8% of women (~50,000) smoke during pregnancy.

Response to inquiry on e-cigarettes

In December 2017 the Smoking in Pregnancy Challenge Group submitted its response to the House of Commons Committee on Science and Technology Inquiry into e-cigarettes. You can read the submission here and learn more about the inquiry here.