Smoking and reproductive health: research, action, ICM position statement: widespread smoking habits among both men and women have serious effects on reproductive health: midwives need knowledge and skills to advise and support women.

• Tenlastelegging: Institute for Complementary Medicine

New UK research

'Smoking and reproductive life: the impact of smoking on sexual, reproductive and child health' is the title of a recent report produced by the British Medical Association's Board of Science and Education and the Tobacco Control Resource Centre. Although focused on the UK, data from Europe, the USA and wider international fields have been incorporated and the conclusions are likely to be very widely relevant. The findings reported go further than previous warnings in showing tobacco smoking to have profoundly damaging effects across the spectrum of reproductive health.

The content includes details of the impact of smoking upon male sexual impotence, fertility in both sexes, menstruation, effectiveness of oral contraceptives, incidence of cervical cancer and earlier menopause with more significant side-effects. However the risks arising from smoking are even greater for women who are pregnant. The research results clearly show that for smokers:

* there is an increased risk of ectopic pregnancy * up to 25% increased risk of miscarriage * a three times greater chance of having a low birth-weight baby * risk of stillbirth is increased 40% in smokers compared to non-smokers * in addition, babies born to mothers who smoke are around 40% more likely to die within the first four weeks of life than babies born to non-smokers.

Approaches to addressing the problem are considered, including case studies of anti-smoking campaigns in Canada, Ireland, Sweden and the USA. In the public health area, increased bans on workplace smoking have been successful, and clear messages, including pictorial images, on cigarette packaging seem to reach younger smokers. Among recommendations of relevance to midwives are:

* Healthcare professionals have a responsibility to provide accurate information on the risks smoking poses both to the health of the smoker and to those around them. Smokers should he given clear, firm advice to stop smoking, and offered suitable support, including rescription of pharmacotherapies and referral to specialist services.

* Better support is needed for women who stop smoking during pregnancy, with the aim of preventing and addressing relapse. Among women who do succeed in stopping while pregnant, many relapse when the baby is born.

For more information visit www.bma.org

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