Should pregnant women be paid to quit smoking?

Pregnant women and tobacco: a new effective prevention tool?

“In pregnant women, nicotine substitutes are not very effective and medication should be avoided because of the risk of side effects for the pregnancy and the unborn child, so other avenues need to be explored.”, emphasizes Ivan Berlin, a doctor specializing in addictions at the Pitié-Salpêtrière hospital. Their study, conducted with 460 participants in 18 maternity wards in France and published in 2021, found that incentives in the form of vouchers given for six months at each follow-up consultation, depending on smoking cessation, multiplied the degree of abstinence by two . Findings that follow those of a 2015 Scottish study. “We believe financial rewards follow the same circuits in the brain as drugs do”, explains the pharmacologist. So the idea is to replace one treat… with another! Above all, this work shows its effectiveness with women from very humble backgrounds, “while most public health measures don’t work for the poorest”says Florence Jusot, economics professor at the University of Paris Dauphine and co-author of the study.

But would such an approach be financially sustainable if implemented at scale? “What is important is less the amount invested than the relationship between the total investment and the benefit that society and the healthcare system derive from it.”, emphasizes Joachim Marti, specialist in health economics at the University of Lausanne. In this case, the benefits for both the mother’s and the child’s health are undeniable. “The results of our Study shows babies are less likely to be born weighing less than 2.5kg and admitted to intensive care., notes Ivan Berlin. The long-term effects are also remarkable: these infants are more likely to grow into healthy children and adults without the complications caused by maternal smoking, such as the increased risk of asthma, obesity, psychiatric disorders… So many healthcare costs are avoided.

>> Also Read: Does Nicotine Affect Smokers’ Choices and Decision Making?

Are people willing to accept it?

“That is one of the biggest challenges. From one culture to another, this device can be perceived as a form of corruption.”, addresses Joachim Marti. Equity issues also arise in relation to people who quit smoking without compensation. “What is ethically difficult to accept, it is about paying people for what is considered normal behavior, which is the individual and collective responsibility of the company. Punishing bad behavior with a tax may seem more justified.”, observes Florence Jusot. According to a 2015 Ipsos poll, almost 55% of French people said they still support this type of policy, especially when it is aimed at struggling populations.

lb health specialists? “The midwives who took part in the study accepted it very well because they are confronted with the difficulties these women have in quitting smoking on a daily basis.”assures the economist. “I don’t think we can propose paying all smokers. The benefit of confining this device to pregnancy is that it then becomes possible to target a very specific demographic that we can track at a given time and at a limited cost be considered., says Florence Justot. Indeed, it is difficult to imagine a rewarding behavior that is common in a large population, for example in the case of vaccination: the dedicated budget would become too large.

“We also have to consider the perverse effects this could produce. If people get into the habit of being paid for their flu shot every year, for example, there is a risk that their intrinsic motivation will drop.”, emphasizes Joachim Marti. And then the financial incentives are not yet proven for all behaviors. While several American studies have attempted this adherence approach to encourage people with chronic illnesses to seek treatment, they have been unsuccessful.

>> Also read: Why is tobacco carcinogenic?

Maternal smoking in numbers

228 g

This is the lower weight of a baby at birth if their mother smoked 1 to 4 cigarettes a day during pregnancy compared to those whose mother quit in the 1st trimester, according to a study by Mercy-Salpetriere (2017).

€520

This is the maximum amount received during the 2021 French study by pregnant women who remained abstinent at each consultation.

16.4%

It is the proportion of financially assisted pregnant women in this study who quit smoking throughout their pregnancy versus 7.4% in the uncompensated control group.

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