Tobacco and Vapes Bill

Written evidence submitted by the Royal College of Midwives (TVB37)

The Royal College of Midwives (RCM) is the trade union and professional organisation that represents most midwives and maternity support workers (MSWs) in the United Kingdom. The RCM is the voice of midwifery, providing excellence in representation, professional leadership, education and influence for and on behalf of midwives and MSWs. We actively support and campaign for improvements to maternity services and provide professional leadership for one of the most established clinical disciplines.

Midwives are the closest clinical leads providing prevention guidance, surveillance and support during pregnancy and birth.

Smoking in Pregnancy

The RCM supports the passage of the Tobacco and Vapes Bill.

Babies born in the UK today will likely live into the 22nd century. Given the clear evidence of the damage that smoking does to newborns, with heath implications that last into later life, driving down the number of people who smoke is a massive contribution not just to the health of the nation today and in the years and even decades to come, but also the health of the nation in and beyond the year 2100.

Smoking during pregnancy is a leading yet preventable cause of adverse prenatal and birth outcomes, with known detrimental health implications during childhood (1).

There is strong evidence that stopping smoking in pregnancy reduces the likelihood of miscarriage, premature birth, stillbirth, low birthweight and Sudden Infant Death Syndrome (SIDS) (2). There have been many policy initiatives previously, including Saving Babies Lives Version 3 Care Bundle (SBLCBv3) which prioritised smoking cessation in pregnancy [1] . Raising the age of sale of tobacco products would appear to be a strong and effective mechanism for eliminating smoking all together.

Not smoking or stopping smoking, according to the NHS, also helps a child later in life. Children whose parents smoke are more likely to suffer from asthma and other serious illnesses that may need hospital treatment.

Smoking is associated with socioeconomic status, with rates of smoking in pregnancy in the most deprived areas of England more than five times those in the least deprived areas (3) . Women living in the most deprived areas are more than twice as likely to die during th e perinatal period than women who live in the least deprived areas; smoking may well be playing a role in that.

T he RCM hope s that this Bill will help with breaking the cycle of addiction and disadvantage.

Midwives are well-placed to help pregnant women quit smoking. They care for women over an extended period of time, and can build up a strong bond of trust with them. Additionally, it is simpler, cheaper and far better for a midwife, MSW or other healthcare professional to help a woman in her twenties or thirties quit smoking, before too much harm has been done, than it is for the NHS to try to help a woman in her fifties or sixties quit after a heart attack or stroke.

One key way to ensure women are healthy going into pregnancy is to drive down the prevalence of smoking among children and young people, and this Bill seeks to achieve that very goal.

Specifically, the Bill would:

· Phase out the sale of tobacco to anyone born in or after 2009

· Give powers to the Government to curb youth vaping through regulations that would:

o Prohibit branding on vapes appealing to children, such as sweet names and bright colours

o Prohibit the handing out of free vapes to children

o Regulate vape contents and flavours

o Regulate vape displays and promotion in shops

These measures, in particular, should help cut the proportion of young women and girls who smoke, helping them lead healthier lives and helping them give their child the best possible start.

Vaping in pregnancy

In its position statement (4) on smoking in pregnancy, the RCM sets out its view on vaping, also known as E-cigarettes. These are used with increasing frequency by smokers wishing to limit or stop smoking. Recent studies have shown that they are helpful for cessation and that there is significantly reduced exposure to harmful toxins if an individual switches completely.

The RCM believes that E-cigarettes are not harmless, as the vapour they produce contains toxins which can adversely affect health. However, the levels of these components are generally much lower than in conventional cigarettes.

As E-cigarettes only entered the international market in 2007, epidemiological data on the health effects of long-term vaping are not fully known (5). A recent systematic review of health outcomes from vaping in pregnancy concluded that while there is no evidence of increased risk of exclusive-vaping compared with non-use and evidence of comparable risk for exclusive-vaping and exclusive-smoking, the quality of the evidence limits conclusions (6) .

The paucity of evidence and the fact that other countries, including Scotland, Wales and Northern Ireland, urge caution by not recommending vaping in pregnancy has been noted by the RCM.

1. Thomson R, Cooper S, Waldron J, Mamuzo E, McDaid L, Emery J, Phillips L, Naughton F, Coleman T. Smoking Cessation Support for Pregnant Women Provided by English Stop Smoking Services and National Health Service Trusts: A Survey. International Journal of Environmental Research and Public Health. 2022 Jan 31;19(3):1634. https://doi.org/10.3390/ijerph19031634 [Accessed 20 December 2024].

2. NHS England. Saving babies’ lives: version 3. A care bundle for reducing perinatal mortality. Version 3.1, July 2023. https://www.england.nhs.uk/long-read/saving-babies-lives-version-3/ [Accessed 20 December 2024].

3. Public Health England. Local Tobacco Control Profiles. Smoking in early pregnancy, England, 2018/19.

4. Royal College of Midwives (RCM). Position statement: Support to quit smoking in pregnancy [Last updated March 2024]. London: RCM; 2022.

RCM_Position-Statement_Conference_2024_smoking_in_pregnancy_2.pdf [Accessed 20 December 2024].

5. Wang L, Wang Y, Chen J, Liu P, Li M. A Review of Toxicity Mechanism Studies of Electronic Cigarettes on Respiratory System. Internathttps://doi.org/10.1186/s12884-024-06633-6 [Accessed 20 December 2024].ional Journal of Molecular Sciences. 2022 May 1;23(9):5030. https://doi.org/10.3390/ijms23095030 [Accessed 20 December 2024].

6. Ussher, M., Fleming, J. & Brose, L. Vaping during pregnancy: a systematic review of health outcomes. BMC Pregnancy Childbirth. 2024 Jun 20;24(1):435.