NICE are proposing that carbon monoxide tests be made obligatory for all pregnant women, as an anti-smoking measure.

Currently it seems that one in five women in the UK smoke during pregnancy. This seems high, but it’s unclear how obligatory smoking tests would help reduce this figure. My problem with it, in particular, is: if you’re prepared to lie to your doctor or midwife about your smoking, are you really going to be open to persuasion about giving up if they catch you out in your lies through an obligatory test?

I would imagine that very few women actually lie to health workers, and that most women are aware of the health risks of smoking during pregnancy (otherwise, why lie?). But treating women like irresponsible children is not the way to bring down the number of pregnant smokers. In general the best way of persuading people to change their behaviour is to make it easier or more attractive for them to change – this seems to guide most NHS anti-smoking treatments, which offer a great deal of flexibility, try and work with the smoker to find the best way for them to quit, and generally work through motivation to stop rather than shame or guilt.

The spokesperson for the Royal College of Midwives said:

“It is crucial that health practitioners, including midwives, focus on being supportive rather than making women feeling guilty, or as though they may not be truthful.

“Use of the monitor has the potential to make women feel guilty and not engaged. We need to look at a range of individualised interventions for women that meet their needs and aspirations.”

In any case this seems like yet another instance of the ways in which pregnant women are treated as less than full adults, as somehow less responsible for their own behaviour and choices, and in need of monitoring or control.

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