A recent study conducted in U.K. later looked at the problem of smoking in pregnant women.

The study gave money to pregnant women if women stopped smoking.

The study found that giving money up to 400 pounds made some women stop smoking but sadly, the women stopped smoking only for a short period. After six months, there was NO significant difference between women given money and women given only usual advice about smoking.

The first issue with this study is the principle of “inducing / bribing” people with money to give up unhealthy habits. Shouldn’t the healthcare staff educate women rather than giving money for bad behaviour?

The second issue is no one knows whether the money was used wisely. Pregnant women who smoke are likely to have other vices such as unhealthy diet, physical inactivity, alcohol misuse, use of recreational drugs etc. Unhealthy behaviours cluster.

Giving money may have encouraged the women to stop smoking temporarily but the money could have used by women to replace smoking with other unhealthy behaviours. Unfortunately, the study doesn’t seem to looked at this problem.

In the study, two thirds of adverse events occurred in women given money vouchers. The authors have naively dismissed them as unrelated. The increase in adverse events suggests that women, who were given money, may have used the money unwisely. Perversely this well intentioned attempt to encourage good behaviour seem to have caused harm !

First, do no harm should be motto of healthcare staff .

Finally, most women who smoke during pregnancy are likely to be from lower socioeconomic group. Poverty is the underlying reason for most of their problems in life including unhealthy habits.

The Healthcare staff in UK are dealing with multiple crisis at present. It is beyond the ability of NHS staff to deal with poverty. The government through social services and public-health team should deal with poverty.

Read my reply at BMJ rapid response and contribute your thoughts through BMJ rapid response

References

Sundar S. Clustering of unhealthy behaviours and medicalisation of unhealthy lifestyles.

Effect of financial voucher incentives provided with UK stop smoking services on the cessation of smoking in pregnant women (CPIT III): pragmatic, multicentre, single blinded, phase 3, randomised controlled trial. BMJ 2022; 379 doi: https://doi.org/10.1136/bmj-2022-071522 (Published 19 October 2022)

Jefferies D. The steady crisis across the NHS. BMJ 2022;377:o1566. doi:10.1136/bmj.o1566

Sokol D K. “First do no harm” revisited BMJ 2013; 347 :f6426

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