In a bid to avoid birth risks and complications, a controversial scheme involves paying pregnant women to quit smoking.
Smoking, a habit that you used to be commonplace is now much more of a rarity thanks to amendments in the smoke-free Environments Act and new 10 per cent a year tax rise. The message on the packaging is clear - smoking is bad for your health - and with the prevalence of smoking in New Zealand declining from 25 per cent in 1996 to 18 per cent in 2013 it seems to have been heard by some.
Although 605,000 New Zealand adults still smoke, over 700,000 have given up and more than 1.9 million of us have never smoked regularly.
This week, research published in the New Zealand Medical Journal showed insights into our nation's smoking habits. Taken from the growing up in New Zealand longitudinal study, the data was obtained by tracking the development of approximately 7000 New Zealand children. Led by Gayl Humphries at the University of Auckland, this new study found that although New Zealanders are lighting up in fewer numbers than before, the smoking rate of pregnant women remains static at 18.4 per cent.
Smoking during pregnancy is associated with a wide range of health risks including birth complications, preterm births, low birth weight babies delivery and adverse fetal development. Nicotine also causes an increase in fetal heart rate and reduced fetal breathing movements during pregnancy and has been found in the breast milk of smoking mothers. The adverse health effects of smoking while pregnant act over the lifetime of the child and increase the long term risk of obesity, metabolic disorders and cardiovascular disease in adulthood.
The research showed that New Zealand's smoking patterns are defined by socioeconomic position with less educated young Maori women coming from more deprived backgrounds being much more likely to smoke and continue to do so during pregnancy. Forty-one per cent of the women studied who had no secondary school qualification smoked while pregnant compared to only 2 per cent of the women with a bachelors degree.
Ethnicity also showed variance with 32 per cent of Maori women smoking during pregnancy compared to 7 per cent of women who identified as New Zealand European and 31 per cent of the pregnant women aged 19 and under were smokers.
Trying to find ways to help these women is a challenge, but the evidence is clear that getting pregnant women to quit smoking before 15 weeks gestation reduces the risk of premature birth and having a low birth weight baby. One controversial scheme which has been used globally is to pay pregnant women to quit. Although critics have labelled it as bribery, research shows that financial incentives can increase long term smoking cessation rates in low income smoker groups.
Recently a South Auckland scheme gave counselling and paid up to $300 in grocery vouchers to pregnant women who were verified to have quit smoking using a carbon monoxide measuring machine. With the average cost of a premature baby staying in hospital being around $3000 a day, the potential benefits of preventing smoking-related birth complications far outweigh the cost of the voucher.
Another scheme in Northland used Māori community health workers, or "Aunties", to provide culturally appropriate smoking cessation support to young pregnant Māori smokers. As 42 per cent of Māori women don't register with a lead maternity carer until after the first trimester of pregnancy, this scheme was highly successful in helping with smoking cessation awareness during early pregnancy.
Although the stats are depressing, what is clear is that the messages around smoking and health are still not reaching some of our most vulnerable New Zealanders. With the strong correlation to a lack of formal education, investment into keeping our girls in school could have a positive long term effect on the health of our country.
1 October 2016
Dr Michelle Dickinson
The New Zealand Herald
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