Smoking during pregnancy increases the risk of stillbirth, miscarriage and sudden infant death. Babies born to mothers who smoke are more likely to be underdeveloped and in poor health. Parental smoking after birth is associated with a three-fold increase in the risk of sudden infant death.

Smoking is also a major cause of health inequalities, with smoking rates among pregnant teenagers, and people living in more disadvantaged parts of the country, being considerably higher than in older, more affluent groups.

Supporting more people to have a smoke-free pregnancy and to stay smoke-free after birth will reduce the risk of many smoking-related complications and illnesses, for both the parent and the baby.

Thanks in part to the range of tailored support already offered through maternity and stop smoking services, the most recent statistics on women’s smoking status at time of delivery shows that 7.4% of women in England were known to be smokers at the end of their pregnancy in 2023-24 – down on the previous year, when the rate was 8.8%, and an all-time low. But we are determined to make further progress.

Incentives have been shown to be highly effective in helping people to stay engaged with local stop smoking support throughout pregnancy and to remain smoke-free in the months immediately following delivery, a time when relapse rates are high.

The evidence-based national smoke-free incentive scheme was announced in 2023 and builds on the treatment for tobacco dependence already being delivered. It will be delivered with the Office for Health Improvement and Disparities (OHID) and Accenture and Greater Manchester Integrated Care Board, with rollout between September and December 2024.

We encourage all organisations supporting pregnant smokers to quit smoking to apply to join the national scheme.

What the incentives scheme involves

• The Saving babies’ lives care bundle specifies that pregnant women should receive very brief advice (VBA) on smoking, including carbon monoxide (CO) testing and identification of smoking status, at their first antenatal appointment with a midwife. Their identification as a smoker or recent quitter should trigger an opt-out referral to a local stop smoking support/tobacco dependence treatment service. The new national incentive scheme will continue to work with local referral pathways.
• Pregnant women enrolled on the scheme via a participating organisation will be able to access incentives (in the form of Love2shop vouchers) over the course of their pregnancy and following delivery of their child, providing they continue to attend regular stop smoking appointments and are verified as smoke-free (CO level <4 ppm).
• Vouchers will be paid weekly over the first 4 weeks of the quit attempt and then monthly through to birth. There will be 2 post-partum incentives at month 1 and month 3 after birth. The maximum value of vouchers for those who remain smoke-free throughout pregnancy and post-partum is £400.
• OHID will fund the vouchers, the training and support from Accenture, and a new data collection system. This system will trigger the issuing of incentives.
• Participating organisations will be expected to provide stop smoking behavioural support in line with the NHS Long Term Plan standard treatment and Saving Babies’ Lives Care Bundle.

Which organisations can apply to join the scheme?

Any organisation providing stop smoking support to pregnant women can apply to join the scheme.

This support can be delivered by an in-house NHS maternity-led service, a community stop smoking service, a service where the NHS uses a third party provider or any combination of these.

If integrated care boards want to apply to join on behalf of multiple organisations, then this is also encouraged.

How to apply to join the scheme

We ask every organisation involved in providing stop smoking services and support for pregnant women in England to complete a brief questionnaire by Sunday 15 September, even if not interested in joining the scheme at this stage. This will allow our delivery partners to assess the initial level of demand and system readiness.

Where possible, we ask organisations to try and co-ordinate one response to reduce multiple applications being submitted for the same organisation. This could involve an integrated care board (ICB) responding on behalf of multiple trusts, or ensuring that each trust only submits one response.

The application process will remain open beyond 15 September, but applications received by 15 September will be prioritised initially.

Our delivery partners will carry out an initial assessment to determine an organisation’s readiness to join the scheme, and work with all interested organisations to either rapidly get them onto the scheme or to prepare for rollout by December 2024, providing they have tobacco dependence treatment support in place.

Assessment will be based on factors such as:

• availability of trained local stop smoking/tobacco dependence treatment advisors
• quality and structure of that support
• robustness of current referral pathways for pregnant women
• current/previous participation