Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Smoking is frequently presented as being particularly problematic when the smoker is a pregnant woman because of the potential harm to the future child. This premise is used to justify targeting pregnant women with a unique approach to smoking cessation including policies such as the routine testing of all pregnant women for carbon monoxide at every antenatal appointment. This paper examines the evidence that such policies are justified by the aim of harm prevention and argues that targeting pregnant women in this way is likely to do more harm than good. Routine carbon monoxide testing is particularly problematic as it sends a message to pregnant women that they cannot be trusted either to truthfully answer questions as to whether or not they smoke, or to make decisions in the best interests of themselves and their future children in the way that non-pregnant individuals are. Further, if the aim is to reduce rates of prenatal harm, the evidence suggests that adopting a supportive and empowering approach to prenatal care is the most effective way to achieve this, something that the current policies aimed at pregnant women are in conflict with.
Abel, E. L. (1995). An update on incidence of FAS: FAS is not an equal opportunity birth defect. Neurotoxicology and Teratology, 17(4), 437–443. CrossRef
Abu-Saad, K., & Fraser, D. (2010). Maternal nutrition and birth outcomes. Epidemiologic Reviews, 32(1), 5–25. CrossRef
Adhikari, R., & Sawangdee, Y. (2011). Influence of women’s autonomy on infant mortality in Nepal. Reproductive Health, 8(1), 1. CrossRef
Allen, F., Gray, R., Oakley, L., Kurinczuk, J. J., Brocklehurst, P., & Hollowell, J. (2009). The effectiveness of interventions targeting major potentially modifiable risk factors for infant mortality: A user’s guide to the systematic review evidence. National Perinatal Epidemiology Unit: University of Oxford.
Ashwin, C., Marshall, J., & Standen, P. (2012). Exploring women’s experiences of smoking during pregnancy and the postpartum. Evidence Based Midwifery, 10(4), 112.
Bewley, S. (2002). Restricting the freedom of pregnant women. maternal– fetal medicine, 131.
Bille, C., & Andersen, A.-M. N. (2009). Preconception care. British Medical Journal (Online), 338.
Bingol, N., Schuster, C., Fuchs, M., Iosub, S., Turner, G., Stone, R. K., et al. (1987). The influence of socioeconomic factors on the occurrence of fetal alcohol syndrome. Advances in Alcohol and Substance Abuse, 6(4), 105–118. CrossRef
Blair, P. S., Fleming, P. J., Bensley, D., Smith, I., Bacon, C., Taylor, E., et al. (1996). Smoking and the sudden infant death syndrome: Results from 1993–5 case-control study for confidential inquiry into stillbirths and deaths in infancy. Confidential enquiry into stillbirths and deaths regional coordinators and researchers. British Medical Journal, 313(7051), 195–198. CrossRef
Bloch, M., & Parascandola, M. (2014). Tobacco use in pregnancy: A window of opportunity for prevention. The Lancet Global Health, 2(9), 489–490. CrossRef
Boutwell, B. B., & Beaver, K. M. (2010). Maternal cigarette smoking during pregnancy and offspring externalizing behavioral problems: A propensity score matching analysis. International Journal of Environmental Research and Public Health, 7(1), 146–163. CrossRef
Brazier, M. (1999). Liberty, maternity, responsibility. Current Legal Problems, 52, 359. CrossRef
Brione, R. (2015). To what extent does or should a woman’s autonomy overrule the interests of her baby? A study of autonomy-related issues in the context of caesarean section. The New Bioethics, 21(1), 71–86. CrossRef
Bryce, A., Butler, C., Gnich, W., Sheehy, C., & Tappin, D. M. (2009). CATCH: Development of a home-based midwifery intervention to support young pregnant smokers to quit. Midwifery, 25(5), 473–482. https://doi.org/10.1016/j.midw.2007.10.006. CrossRefPubMed
Button, T. M. M., Maughan, B., & McGuffin, P. (2007). The relationship of maternal smoking to psychological problems in the offspring. Early Human Development, 83(11), 727–732. CrossRef
Campbell, D. (Sunday 26 February, 2017 00.03 GMT). Test all pregnant women for smoking, say NHS chiefs. The Guardian,
Chamberlain, C., O’Mara-Eves, A., Porter, J., Coleman, T., Perlen, S. M., Thomas, J., et al. (2017). Psychosocial interventions for supporting women to stop smoking in pregnancy. Cochrane Database of Systematic Reviews (2).
Coulter, A., & Ellins, J. (2007). Effectiveness of strategies for informing, educating, and involving patients. British Medical Journal, 335(7609), 24–27. CrossRef
Department of Health. (2007). Review of the Health Inequalities Infant Mortality PSA Target. London: Department of Health.
Entwistle, V. A., Cribb, A., & Owens, J. (2018). Why health and social care support for people with long-term conditions should be oriented towards enabling them to live well. Health Care Analysis, 26(1), 48–65. CrossRef
Fresh NE (2017). Major initiative to protect unborn babies from smoking in the North East. http://www.freshne.com/in-the-news/pr/item/1974-major-initiative-to-protect-unborn-babies-from-smoking-in-the-north-east. Accessed 8 November 2017.
FreshSFNE (2017). Smoking in pregnancy. https://www.youtube.com/watch?v=0Icc3NwP-gU&list=UU2lnzX6fEhIckkzI1amNs2Q&index=9. Accessed 8 November 2017.
Friesen, P. (2016). Personal responsibility within health policy: Unethical and ineffective. Journal of Medical Ethics, 44, 53–58. CrossRef
Green, N. S., Damus, K., Simpson, J. L., Iams, J., Reece, E. A., Hobel, C. J., et al. (2005). Research agenda for preterm birth: Recommendations from the March of Dimes. American Journal of Obstetrics and Gynecology, 193(3), 626–635. CrossRef
Greenway, J. C., & Entwistle, V. A. (2013). Ethical tensions associated with the promotion of public health policy in health visiting: a qualitative investigation of health visitors’ views. Primary Health Care Research and Development, 14(2), 200–211. CrossRef
High Quality Midwifery Care (2014). London: The Royal College of Midwives.
Jackson, E. (2001). Regulating reproduction: Law, technology and autonomy. Bloomsbury: Bloomsbury Publishing.
JJ Way - Commonsense Childbirth Inc. http://www.commonsensechildbirth.org/jjway/. Accessed 27 April 2018.
Josephs, L., & Brown, S. E. (2017). The JJ Way: Community-based Maternity Center Final Evaluation Report. Visionary Vanguard Group Inc.
Juárez, S. P., & Merlo, J. (2013). Revisiting the effect of maternal smoking during pregnancy on offspring birthweight: A quasi-experimental sibling analysis in Sweden. PLoS ONE, 8(4), e61734. CrossRef
Kabir, Z., Connolly, G. N., Clancy, L., Cohen, B. B., & Koh, H. K. (2009). Declining maternal smoking prevalence did not change low birthweight prevalence in Massachusetts from 1989 to 2004. The European Journal of Public Health, 19(1), 65–68. CrossRef
Kukla, R. (2008). Measuring mothering. International Journal of Feminist Approaches to Bioethics, 1(1), 67–90. CrossRef
Lumley, J., Chamberlain, C., Dowswell, T., Oliver, S., Oakley, L., & Watson, L. (2009). Interventions for promoting smoking cessation during pregnancy. Cochrane Database of Systematic Reviews (3).
McGowan, A., Hamilton, S., Barnett, D., Nsofor, M., Proudfoot, J., & Tappin, D. M. (2010). ‘Breathe’: The stop smoking service for pregnant women in Glasgow. Midwifery, 26(3), e1–e13. CrossRef
Morgan, H., Treasure, E., Tabib, M., Johnston, M., Dunkley, C., Ritchie, D., et al. (2016). An interview study of pregnant women who were provided with indoor air quality measurements of second hand smoke to help them quit smoking. Bmc Pregnancy and Childbirth, 16(1), 305. CrossRef
National Institute for Health and Clinical Excellence (2010). Weight management before, during and after pregnancy. NICE Guideline PH27.
National Institute for Heath and Clinical Excellence (2010). Smoking: Stopping in pregnancy and after childbirth. NICE Guideline PH26.
Nelson, E. (2013). Law, policy and reproductive autonomy. Bloomsbury: Bloomsbury Publishing.
NHS Health Scotland Ready Steady Baby! Tests and checks you may have. http://www.readysteadybaby.org.uk/you-and-your-pregnancy/antenatal-care/tests-and-checks-you-may-have.aspx. Accessed 15 November 2018.
NHS Smokefree NHS. https://www.nhs.uk/smokefree/help-and-advice. Accessed 8 November 2017.
O’Connell, M., & Duaso, M. (2014). Barriers and facilitators of midwives’ use of the carbon monoxide breath test for smoking cessation in practice: a qualitative study. Midirs Midwifery Digest, 24(4), 453–458.
Pickett, K. E., & Wilkinson, R. G. (2015). Income inequality and health: A causal review. Social Science and Medicine, 128, 316–326. CrossRef
Public Health Wales NHS Trust (2015). Models for access to maternal smoking cessation support. http://www.wales.nhs.uk/sitesplus/documents/888/PHW%20MAMSS%20Report%20E%2003.17.pdf. Accessed 15 November 2018.
Robertson, J. A. (1983). Procreative Liberty and the control of conception, pregnancy, and childbirth. Virginia Law Review, 69(3), 405–464. CrossRef
Salihu, H. M., Aliyu, M. H., Pierre-Louis, B. J., & Alexander, G. R. (2003). Levels of excess infant deaths attributable to maternal smoking during pregnancy in the United States. Maternal and Child Health Journal, 7(4), 219–227. CrossRef
Savitz, D. A., Schwingl, P. J., & Keels, M. A. (1991). Influence of paternal age, smoking, and alcohol consumption on congenital anomalies. Teratology, 44(4), 429–440. CrossRef
Scott, R. (2000). Maternal duties toward the unborn? Soundings from the law of tort. Medical Law Review, 8(1), 1–68. CrossRef
Scott, R. (2002). Rights, duties and the body: law and ethics of the maternal-fetal conflict. Oxford: Hart Publishing.
Sharma, A., & Kader, M. (2013). Effect of women’s decision-making autonomy on infant’s birth weight in rural. Bangladesh: ISRN Pediatrics. CrossRef
Siddique, H. (Wednesday 18 October, 2017). Doctors to breathalyse smokers before allowing them NHS surgery. The Guardian,
South Tees Hospitals NHS Foundation Trust (2013). Major initiative to tackle smoking in pregnancy underway. https://www.southtees.nhs.uk/news/health-improvement/major-initiative-tackle-smoking-pregnancy-underway/. Accessed 15 November 2018.
South Warwickshire NHS Foundation Trust NHS Warwickshire Stop Smoking in Pregnancy Service. https://www.swft.nhs.uk/our-services/adult-hospital-services/maternity/nhs-warwickshire-stop-smoking-pregnancy-service. Accessed 15 November 2018.
Stanton, C., & Cave, E. (2015). Maternal responsibility to the child not yet born. In C. Stanton, S. Devaney, A.-M. Farrell, A. Mullock, & M. Brazier (Eds.), Pioneering healthcare law: Essays in honour of Margaret Brazier. London: Routledge. CrossRef
Tengland, P.-A. (2016). Behavior change or empowerment: On the ethics of health-promotion goals. Health Care Analysis, 24(1), 24–46. CrossRef
The Law Commission (1974). Report on Injuries to Unborn Children (Law Com. No. 60). Advice to the Lord Chancellor under section 3(1)(E) of the Law Commissions Act 1965, 20th Century House of Commons Sessional Papers, 1974, Vol. VII, 1021.
Tominey, E. (2007). Maternal smoking during pregnancy and early child outcomes. CEP Discussion Paper No 828: Centre for Economic Performance, London School of Economics.
Turner-Warwick, M. (1992). Smoking and the young: A report of a working party of the Royal College of Physicians. Tobacco Control, 1(3), 231–235. CrossRef
UK Chief Medical Officer (2016). UK Chief Medical Officers’ Low Risk Drinking Guidelines.
- Are We Justified in Introducing Carbon Monoxide Testing to Encourage Smoking Cessation in Pregnant Women?
- Springer US
Health Care Analysis
An International Journal of Health Care Philosophy and Policy
Print ISSN: 1065-3058
Elektronische ISSN: 1573-3394