Should pregnant women be paid to quit smoking?

Pregnant Women and Tobacco: A New Effective Prevention Tool?

“In pregnant women, nicotine substitutes are ineffective and drugs should be avoided because of the risk of adverse effects on pregnancy and the fetus, hence the need to explore other avenues.”, says Ivan Berlin, an addict at the Pitié-Salpêtrière Hospital. Her study, conducted with 460 participants in 18 maternity hospitals in France and published in 2021, found that incentives in the form of vouchers issued for six months at each follow-up consultation, conditional on smoking cessation, doubled the level of abstinence. Results that add to those of a 2015 Scottish study. “We believe that financial rewards follow the same brain circuits as drugs”, explains the pharmacologist. The idea is, therefore, to replace one pleasure … with another! Above all, this work demonstrates its effectiveness in women from very modest backgrounds, “while most public health policies tend not to work for the poorest people”says Florence Jusot, a professor of economics at Paris Dauphine University and co-author of the study.

But would this approach be financially sustainable if applied on a large scale? “What matters is not so much the amount invested as the relationship between the total investment and the benefits to society and the health care system.”, emphasizes Joachim Marti, specialist in health economics at the University of Lausanne. In this case, the benefits are undeniable, both for the health of the mother and the child. “The results of our The study shows that babies are less likely to be born underweight, weigh less than 2.5 kg, and to be transferred to intensive care. “, points out Ivan Berlin. The long-term effects are also noticeable: these babies will be more likely to become healthy children and adults, without the complications of maternal smoking, such as increased risk of asthma, obesity, psychiatric disorders … S ‘avoid so many healthcare costs.

>> Read also: Does nicotine affect smokers’ choices and decisions?

Are people willing to accept that?

“This is one of the main challenges. From one culture to another, this device can be seen as a form of corruption.”, raises Joachim Martí. Equity issues also arise in relation to people who quit smoking on their own, without compensation. “What may be difficult to accept ethically, is to pay people for conduct deemed normal, under individual and collective responsibility, by the company. Punishing misconduct with a tax may seem more justified. “, observes Florence Jusot. According to a 2015 Ipsos survey, almost 55% of French people say they are in favor of such policies, especially if they are aimed at people in difficulty.

What health professionals? “The midwives who participated in the study accepted it very well, because they face every day the difficulties that these women face in quitting smoking.”assures the economist. “I don’t think we can offer to pay all smokers. The advantage of limiting this device to pregnancy is that it can then be targeted to a very specific population, which we can follow at a certain time and for a limited cost. on the other hand, it could be considered for weight gain, for certain people with significant comorbidities. “, says Florence Jusot. In fact, 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 be too large.

“We also need to consider the perverse effects that this could have. If people get used to being charged each year for getting the flu shot, for example, this runs the risk of reducing their intrinsic motivation.”, points out Joachim Martí. And then financial incentives have not yet been demonstrated in all behaviors. In fact, several American studies have tested this approach to therapeutic adherence, to encourage people with chronic illnesses to undergo treatment, but without success.

>> Read also: Why is tobacco carcinogenic?

Maternal smoking in figures

228 g

That’s the least weight a baby weighs at birth when his mother smokes 1 to 4 cigarettes a day during pregnancy, compared to those his mother stopped during the first trimester, according to a study by Mercy- Salpetriere (2017).

€ 520

This is the maximum amount obtained, during the French study of 2021, by pregnant women who had remained abstinent at each consultation.

16.4%

This study shows the proportion of economically encouraged pregnant women who stopped smoking throughout the pregnancy, compared to 7.4% in the control group without compensation.

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