In a remarkable development hailed by public health experts, the proportion of women smoking during pregnancy in England has nearly halved over the past decade. This extraordinary reduction—from 11.7% in 2014/15 to just 5.9% by the third quarter of 2024/25—marks one of the most significant public health achievements in recent years. The driving force behind this success has been the introduction and expansion of dedicated stop smoking advisory services integrated into NHS maternity care pathways since 2020. These targeted interventions have profoundly altered the landscape of prenatal care, offering personalized support to expectant mothers keen to quit smoking.
The integration of stop smoking advisers into maternity services represents a paradigm shift in the approach to managing tobacco addiction during pregnancy. Healthcare professionals now play a pivotal role in delivering evidence-based cessation support at key points throughout prenatal care. This model has enabled not only a broader reach among pregnant women who smoke but also timely interventions that capitalize on the healthcare encounters unique to pregnancy. The consequent downward trend in maternal smoking prevalence is directly attributable to this systemic embedding of tobacco cessation frameworks within standard maternity service protocols.
Despite these encouraging strides, experts caution that the remarkable progress is precarious. Recent and proposed cuts to NHS integrated care boards (ICB) budgets, coupled with the loss of ringfenced funding earmarked for tobacco treatment services, jeopardize the sustainability of these gains. Such austerity measures risk dismantling the critical infrastructure that underpins the delivery of specialized smoking cessation support for pregnant women—a demographic uniquely vulnerable to the harms of tobacco exposure. Without continued and potentially increased investment, there is a tangible threat that smoking rates in pregnancy could plateau or even reverse.
The financial constraints facing the NHS have already manifested in tangible service reductions. Several hospitals and mental health facilities have reported curtailments or eliminations of stop smoking services, creating gaps in care precisely where it is most needed. Mental health services, in particular, often cater to populations with higher smoking prevalence, including pregnant women, underscoring the importance of integrated cessation support. The erosion of these programs diminishes the prospects of maintaining the downward trajectory in smoking rates among expectant mothers.
Persistent socioeconomic disparities further complicate the landscape of prenatal smoking cessation. While overall rates have declined, smoking prevalence remains disproportionately high in deprived communities. This stratification underscores a critical public health challenge: the need for innovative, targeted interventions that account for complex social determinants impacting smoking behavior. Such approaches must move beyond one-size-fits-all strategies to address the multifaceted barriers—ranging from stress and mental health issues to accessibility of support services—that hinder successful quit attempts in disadvantaged populations.
The urgency of sustaining investment in tobacco cessation during pregnancy transcends immediate health outcomes; it is foundational to intergenerational wellbeing. Maternal smoking is unequivocally linked to adverse fetal and neonatal outcomes, including low birth weight, preterm birth, and increased risk of sudden infant death syndrome (SIDS). By ensuring every child a smokefree start, health systems are not only preventing immediate harm but also interrupting cycles of tobacco addiction and health inequality that can endure across lifespans.
Esteemed members of the Smoking in Pregnancy Challenge Group—a coalition including the Royal College of Midwives, the Royal College of Obstetricians and Gynaecologists, and the Royal College of Paediatrics and Child Health—emphasize the critical role that cessation services have played and must continue to play. This multi-institutional collaboration brings an evidence-based consensus advocating for governmental and NHS commitment to safeguarding and enhancing tobacco treatment services as a public health priority.
Leading voices in the field underline the risk that reduced funding poses to the integrity of gains made. Professor Caitlin Notley, Professor of Addiction Sciences at the University of East Anglia, highlights how focused efforts by healthcare professionals along the pregnancy care continuum have accelerated progress. Nevertheless, she acknowledges the persistent inequalities that demand innovative, targeted solutions to reach those most resistant to quitting. Maintaining specialized service provision within the NHS is vital to this mission.
Professor Linda Bauld, co-chair of the Smoking in Pregnancy Challenge Group and director of the SPECTRUM Research Consortium, stresses that the evidence base clearly demonstrates the life-saving impact of stop smoking interventions during pregnancy. She warns that without sustained and enhanced financial commitment, the downward trend—so painstakingly achieved—could stall or reverse, with tragic consequences for families nationwide. Her insights reflect a growing consensus around the necessity of embedding smoking cessation as an integral component of maternal healthcare.
Complementing this view, Dr. Clea Harmer, chief executive of Sands and co-chair of the group, advocates for policy momentum aligned with the government’s goal of a smokefree generation. The current context of funding cuts is seen as counterproductive to these ambitions. Rather than retrenchment, a progressive scale-up of dedicated support services is crucial to ensure equitable access and enduring reductions in pregnancy smoking rates.
Adding a policy dimension, John Waldron, policy and public affairs manager at Action on Smoking and Health, underscores commitments made in the 2024 Labour manifesto. The promise to integrate smoking cessation support across all hospital care pathways represents a pivotal opportunity to institutionalize and safeguard these services. It is a call for government accountability to translate visionary pledges into effective, funded healthcare delivery mechanisms.
The synthesis of these expert perspectives highlights an intersection of clinical innovation, public health policy, and social equity in addressing smoking in pregnancy. Ongoing research continues to delineate the complex pathways by which targeted support can ameliorate health inequities while promoting healthier pregnancies. However, such progress is conditional on resilient funding models and policy frameworks that prioritize tobacco cessation services as crucial, non-negotiable elements of prenatal care.
As the healthcare community reflects on nearly a decade of progress, the looming threat of austerity measures sharpens the urgency to protect and enhance these vital programs. The continuation of this downward trend in maternal smoking rates is a key public health success story poised at a crossroads. The coming years will determine whether England consolidates these gains, setting a precedent for other nations, or succumbs to avoidable setbacks with wide-ranging consequences for maternal and child health.
Subject of Research: People
Article Title: NHS Cuts Could Spark Surge in Smoking During Pregnancy, Experts Warn
News Publication Date: 13-May-2025
Keywords: Smoking cessation, pregnancy, maternal health, NHS funding, tobacco addiction, public health policy, health inequalities, prenatal care
