Incentives to quit smoking in pregnancy

"Smoking during pregnancy remains a major health problem, resulting in the deaths of an estimated 5,000 foetuses and babies each year in the UK. It is responsible for tens of millions of pounds in extra healthcare spending."This extract from a report published today in the British Medical Journal offers clear evidence of a negative externality - not only does the extra healthcare spending carry the opportunity cost of less spending available for other health treatments, but there is also evidence that the babies whose mothers smoke but which survive will have more health problems later in life. This is classic territory for an AS question on the lines of 'Evaluate policies which the government could use to reduce the incidence of smoking during pregnancy." The report also proposes a controversial policy - giving shopping vouchers worth £400 to pregnant smokers who manage to kick the habit.

The vouchers were given over the term of the pregnancy, each time the women attended for tests which showed no evidence of nicotine in their breath and urine. This study was compared with the 'normal' NHS support to quit smoking comprising a face-to-face appointment with a smoking cessation adviser, as well as four follow-up phone calls and free nicotine replacement therapy for 10 weeks. This had a very low success rate of only 9%; when women were re-tested a year later, that had fallen to 4%. By contrast, 20% of the women receiving vouchers had stopped smoking during their pregnancy, and 15% were still non-smokers a year later.

Is this result sufficiently significant to justify the 'bribery' that it represents? A comment piece in The Guardian objects to the 'damaging moral message' that the voucher payments might send out, preferring instead the idea of giving small tax advantages to those who show 'good' habits rather than rewards to those who break bad ones. This article references the ideas of behavioural economics and the government's 'nudge' unit, and is worth filing away to be used when we are covering Behavioural Economics as part of the new syllabus after September.