Cross-posted at RH Reality Check

Health officials in England want to give pregnant women a breath-test. Not for alcohol, but for signs of smoking.

The National Institute for Health and Clinical Excellence (NICE), according to the Telegraph, "...has recommended that all pregnant women should have their breath measured for carbon monoxide levels when they book in with a midwife."

It's unclear to me, however, why. What would this test show? If a pregnant woman smokes, she already knows she smokes so is this just to confirm to the pregnant woman that, yes, her provider now knows she smokes? As an excuse to talk about the fact that smoking is bad for her health as well as the health of her fetus? If that's the case, why not invest in awareness campaigns and smoking cessation programs? Why not invest in provider education to encourage providers to talk to pregnant women about the dangers of smoking?

From the article:

This would establish which women smoke and provide an added incentive for them to quit, the guidance said.

Also for non-smokers it may highlight that the woman is unknowingly exposed to high levels of carbon monoxide from second hand smoke, a faulty boiler or car fumes.

Well, the test would only establish which women smoke if the woman in question didn't already voluntarily provide information to her health care provider about her smoking. And if she didn't want to provide the information, verbally, then taking a test would be invasive and pointless. If a woman didn't want to tell her provider she was smoking, then clearly she knows it's not healthy behavior so what's the point of a test?! As well, why can't providers offer information on the health risks of smoking to all pregnant women without testing all women? And for the "non-smokers", again, why not offer the test as a possibility, along with information about the dangers of second-hand smoke when you're pregnant ("a faulty boiler?!").

This is not to say that I don't fully support encouraging pregnant women to stop smoking. It's a poisonous habit, obviously. But this whole idea seems like an utter waste of time and money. That said, Cara at The Curvature wrote a post that says it all. The entire post frames the issue perfectly and I encourage you to head over and read it, but here's just a peek:

Look, absolutely no one is saying that smoking while you’re pregnant is a good idea. While it’s hardly the automatic death sentence for fetuses that a lot of people make it out to be, evidence suggests that it’s not a great idea for either the woman or future baby. And lots of women do smoke during pregnancy. But it’s rarely because they don’t know the risks (at least in most Western countries), or because they’re careless, stupid women who hate their babies and want bad things to happen.

Women smoke during pregnancy usually because they’re unable to stop. There’s currently a culture in a lot of places that suggests one can drop smoking whenever she wants — that it’s a question of personal choice. We have a tendency to not treat nicotine addiction as a real, serious addiction just like any other. And that’s saying an awful lot, as addictions to other substances are also frequently treated like issues of willpower rather than of physiological and psychological dependency.

It’s also true that a lack of support also tends to factor into why many smokers, pregnant or not, are unable to quit. Clearly, more support is needed. But the way to provide more support isn’t through coerced tests and humiliation. Right now, many pregnant women don’t tell their doctors if they smoke or use other substances. Again, the reason is rarely malicious or negligent, but concern over being judged, guilted, shamed, and/or even punished. The issue is that many women can’t trust their health care providers to react with compassion and care rather than blame and disapproval. And trust is not built by a person in a position of authority expressing a lack of trust in the person in a subordinate position. One would imagine that empathy would go a lot farther than a carbon monoxide test, any day.

While the guidelines don’t seem to make the test mandatory, it’s unlikely to be easy to opt out. Any woman who refuses to take the test, regardless of whether she does so based on principle or any other reason, is likely to be highly suspected of “hiding” something, and lectured by precisely the kind of judgmental health provider that is causing the problem to begin with.