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Creating a smokefree generation

In December 2023 the RCOG responded to the UK Government consultation on proposals set out in the Stopping the start: our new plan to create a smokefree generation policy paper. This includes raising the age of sale for tobacco products so that anyone born on or after 1 January 2009 will never be legally sold (and also in Scotland, never legally purchase) tobacco products.

Given the significant harms of smoking to maternal and fetal health, the RCOG is very supportive of this proposal, which has huge potential to improve pregnancy outcomes, reduce health inequalities, and positively impact on women’s health throughout their lives.

Smoking in pregnancy is the single biggest modifiable risk factor for poor birth outcomes, increasing the risks of stillbirth, miscarriage, preterm birth, low birthweight, heart defects and sudden infant death(1). Smoking during pregnancy increases the risk of miscarriage by 24-32%, and secondhand smoke exposure to increase risk by 11%(2), There is evidence that exposure to tobacco smoke during pregnancy and in infancy negatively impacts children even into adulthood. 

Smoking can also impact maternal health. For example, smoking is a risk factor for cardiovascular disease, which is one of the leading causes of maternal deaths in the UK(4).

In England, 8% of women smoke at time of delivery (5).  This hides significant differences by area, with women from the most deprived communities 12 times more likely to smoke during pregnancy than their least deprived counterparts(6).

With women in more deprived areas experiencing persistently higher rates of maternal mortality, stillbirth and neonatal death, the proposal has huge potential to support important Government ambitions to address disparities in maternity care and halve rates of stillbirths, neonatal and maternal deaths by 2025 (7).

The majority of smokers start smoking before the age of 18, and women under the age of 20 years are twice as likely than those of all ages to smoke before and during pregnancy(8).  This group has significantly higher rates of infant mortality than the general population. Raising the age of sale for tobacco products will quickly help reduce smoking prevalence in the age cohort most likely to smoke during pregnancy, and so can quickly show a positive impact on pregnancy outcomes.

In addition, we support:

  • The prohibition of proxy sales – we support the prohibition of proxy sales, similar to existing tobacco age of sale legislation, to prevent others purchasing tobacco products for those born after 1 January 2009, as a way of ensuring this generation is smokefree.
  • The inclusion of all tobacco products, cigarette papers and herbal smoking products in the new legislation – it is important that there are no loopholes left open to the tobacco industry, and so we support this proposal, which mirrors the current scope of age of sale legislation in England and Wales.
  • The UK Government’s commitment to provide additional funding for tobacco enforcement each year, alongside an updated Illicit Tobacco Strategy – it is important that this is designated as recurrent, sustained funding in order to support the implementation of regulations.

Youth vaping


The consultation also asked about strategies to tackle the rise in youth vaping, such as restricting vape flavours, packaging and point of sale displays.  

Vapes or e-cigarettes are currently the most popular aid to quitting smoking in England, and evidence shows that they are considerably less harmful than smoking, though not completely risk free (9).

Although little research exists regarding safety in pregnancy, evidence suggests that they are likely to be significantly less harmful to a pregnant woman and her baby than continuing to smoke (10).  NICE has recommended that if a woman has already chosen to use e-cigarettes to stop or reduce smoking, she should not be discouraged from doing so (11).

This being the case, it is important that the government’s proposed changes in relation to vaping strike the right balance between reducing appeal to children, without unintentionally deterring adults, including pregnant women, from using vapes instead of smoking. We recommend meaningful engagement with women who are pregnant or who have recently given birth in order to inform the option chosen by the UK Government and devolved administrations.

We also support the government’s investigation into the further restriction of non-nicotine vapes, including regulating them in the same way as those that contain nicotine.

References

  1.  National Maternity and Perinatal Audit, Ethnic and Socio-economic Inequalities in NHS Maternity and Perinatal Care for Women and their Babies (2021)
  2.  Action on Smoking and Health, Fact sheet: Smoking, Pregnancy and Fertility (2021)
  3. Action on Smoking and Health, Fact sheet: Smoking, Pregnancy and Fertility (2021)
  4. MBRRACE-UK, Saving Lives, Improving Mothers’ Care, Surveillance of maternal deaths in the UK 2012–14 and lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009–14 (2016); MBRRACE-UK, Saving Lives, Improving Mothers’ Care: Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2018-20 (2022)
  5. NHS Digital, Statistics on Women's Smoking Status at Time of Delivery: England, Quarter 1, 2023-24 (2023)
  6.  National Maternity and Perinatal Audit, Ethnic and Socio-economic Inequalities in NHS Maternity and Perinatal Care for Women and their Babies (2021)
  7. MBRRACE-UK, UK perinatal deaths for births from 1 January 2021 to 31 December 2021 (2023)
  8.  National Maternity and Perinatal Audit, Ethnic and Socio-economic Inequalities in NHS Maternity and Perinatal Care for Women and their Babies (2021);Action on Smoking and Health, Young people and smoking (2019)
  9. Action on Smoking and Health, Fact sheet: Smoking, Pregnancy and Fertility (2021)
  10. Action on Smoking and Health, Fact sheet: Smoking, Pregnancy and Fertility (2021); NICE, Clinical Knowledge Summary on smoking cessation: Scenario: Pregnant or breastfeeding (revised 2023)
  11. NICE, Clinical Knowledge Summary: Smoking cessation:  Scenario: Pregnant or breastfeeding (revised 2023)