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Our key recommendations

This page provides a brief overview of the Smoking in Pregnancy Challenge Group's key recommendations for ending smoking during pregnancy.

Our key policy asks

  1. Pass legislation to raise the age of sale for tobacco by one year, every year, to reduce smoking prevalence in the age cohort most likely to smoke during pregnancy and create a smokefree generation.
  2. Introduce a ‘polluter pays’ levy on tobacco manufacturers to raise funding for the measures needed to deliver a smokefree start for every child.
  3. Fully implement the national financial incentive scheme and commit to extending the scheme beyond 2024.
  4. Set out a new target for reducing rates of Smoking Status at Time of Delivery (SATOD) to 4% by 2030, putting England on track to deliver a smokefree start for every child before 2040.
  5. Ensure NHS tobacco dependence treatment services for pregnant women are fully embedded and sustained long-term.
  6. Commit to develop and fund models of care to prevent relapse to smoking postnatally.

Why it matters

Smoking during pregnancy undermines Government goals to improve birth outcomes and child health, and adds to the cost of living:

  • Smoking or exposure to second-hand smoke during pregnancy increases the risk of stillbirth, miscarriage, and sudden infant death. Children born to parents who smoke are more likely to develop health problems including respiratory conditions, learning difficulties, and diabetes, and are more likely to grow up to be smokers.
  • Smoking during pregnancy adds to the cost of living and pushes families into poverty. The average smoker spends £3,000 per year on tobacco, with 31% of households in poverty once spend on smoking is taken into account.
  • The health and economic impacts of smoking lock in disadvantage across the generations.

Increasing quitting among pregnant women will reduce health inequalities and ease the burden on the NHS:

  • Younger women from the most deprived backgrounds/areas are the most likely to smoke and be exposed to secondhand smoke during pregnancy (smoking at booking rates among most deprived are 5x higher than the least). This group has significantly higher rates of infant mortality than the general population.
  • Pregnant smokers require more care and place additional costs the NHS than non-smokers. It is estimated that maternal smoking cost the NHS over £20 million in 2015/16 through 10,032 episodes of admitted patient care.
  • Every person that quits smoking today is a person who won’t need a hospital bed due to smoking-related disease tomorrow.

Without action thousands of families will suffer devastating preventable consequences:

  • 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.
  • The previous Tobacco Control Plan has expired leaving England without a target for reducing smoking during pregnancy.
  • Reducing rates of maternal smoking would contribute to the national ambition to halve stillbirth and neonatal mortality by 2025.


  • The Government has introduced the Tobacco and Vapes Bill which is currently going through parliament. If passed into law, the Bill would raise the age of sale for tobacco products by one year, every year, from 2027 so that anyone born on or after 1 January 2009 will never be legally sold tobacco products. This is alongside measures to tackle youth vaping. For further information see here.
  • 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. This has now been extended to include significant others and partners. This is something the Challenge Group has called for repeatedly and was also recommended by the 2022 Khan review of tobacco policy. 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 NHS Long Term Plan (LTP) commits to delivering an opt-out smokefree pregnancy pathway for expectant mothers. The LTP initially committed to extending the stop smoking support offer for pregnant women to their partners. However, this is no longer the case and partners will instead be referred to existing local authority stop smoking services where available. It is vital that support for pregnant women is fully embedded and sustained long-term.

Impact of smoking and exposure to secondhand smoke during pregnancy

Maternal smokingSecondhand smoke exposure
Low birthweight2 times more likelyAverage 30-40g lighter
Heart defects25% more likelyIncreased risk
Stillbirth47% more likelyPossible increase
Preterm birth27% more likelyPossible increase
Miscarriage32% more likelyIncreased risk
Sudden infant death3 times more likely45% more likely

Sources: Zhao L et al. Parental smoking and the risk of congenital heart defects in offspring: An updated meta-analysis of observational studies. 2020; RCP. Hiding in plain sight: treating tobacco dependency in the NHS. 2018; Pineless BL et al. Systematic review and meta-analysis of miscarriage and maternal exposure to tobacco smoke during pregnancy. 2014; RCP & RCPCH. Passive Smoking and Children. 2010.