Debate: Is giving pregnant women shopping vouchers to quit smoking a terrible idea?

Emma Revell and Annabel Denham

June 25, 2021

Emma Revell, Head of Public Affairs at the Institute of Economic Affairs, argues YES

Smoking is not good for your physical health and you would be hard-pushed to find a man, woman or child in the UK who is not already well aware of this fact. Regardless, physical health is not life’s only purpose and for a variety of reasons many people in the UK still choose to smoke, some of them women and some of those will become pregnant.

Everyone wants babies to be born in the best possible health. I am in favour of measures that support mums-to-be to make informed choices about maternal and infant wellbeing but spending taxpayers’ money trying to bribe women into changing their behaviour is the wrong way to go about it. GPs need to support women’s well-being without appearing judgemental or critical – a tricky balancing act – and pregnant women need to have faith that their doctor is on their side, not against them.

We should be very cautious about heading down a route – however well intentioned – which puts the health of a foetus above the rights of the mother, that is the kind of thinking that leads the World Health Organization to recommend all women of child-bearing age abstain from alcohol.

We should be even more reluctant to commit to a scheme of patronising shopping vouchers which has a 17 per cent success rate and more than a whiff of snobbery about it. From junk food to ‘green’ boilers, the state appears to believe it has a duty to cajole, nudge, and bribe its citizens into being “better” people when it should take a step back and let us live our own lives.

Annabel Denham, Head of Communications at the Institute of Economic Affairs, argues NO

Paternalistic measures that reduce people’s choices by making them poorer deserve criticism. Sugar taxes are regressive, inefficient and ineffective. Minimum Unit Pricing disproportionately impacts the poorest in society without significantly cutting the amount they drink. But offering a cash incentive to pregnant women as part of a wider support package to help them quit smoking could increase choice and make them better off.

Given the obvious external cost from smoking during pregnancy, claims that this is yet another example of zealous nanny statists eroding personal freedoms and individual responsibility simply don’t hold water. While there is a dearth of evidence to suggest that drinking in moderation could harm an unborn child, smoking has been shown to increase the risk of health problems for developing babies including preterm birth, low birth weight, damage to the brain and lungs, and birth defects of the mouth and lip.

That the guidance also suggests healthcare staff provide clear information on e-cigarettes to women wanting to use them to quit smoking indicates that someone sensible is behind these proposals. Taxes and regulations that make vaping less attractive to consumers have been repeatedly shown to increase tobacco consumption (including in pregnancy).

This isn’t to say that the scheme isn’t without its downsides. It probably won’t be adequately policed, meaning we’ll be spending taxpayers’ cash with zero regard for effectiveness. Worse, there’s the risk that women start smoking – or claim to – before their first midwife consultation. But according to the research, for every 1,000 pregnant women offered vouchers 177 will quit. Given around 10 per cent of women smoke while expecting, it would be rash and myopic to reject it out of hand.


Written by Emma Revell and Annabel Denham

Emma Revell is Head of Public Affairs at the Institute of Economic Affairs and Annabel Denham is Head of Communications at the Institute of Economic Affairs.

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