Pregnant women who cannot be ensured protection from second-hand smoke at their place of work should be entitled to leave of absence on full pay for the duration of their pregnancy.

The Report by the British Medical Association (BMA) published on 11 February 2004, looks towards Directive 92/85/EEC, which provides health and safety measures for pregnant women at the work-place to provide the necessary protection from passive smoking.

The report concludes that:

- women who smoke take longer to conceive: the chances of conception are reduced by up to 40% per cycle

- men and women who smoke may have a poorer response to fertility treatment

"Smoking and reproductive life - the impact of smoking on sexual, reproductive and child health" is produced by the BMA’s Board of Science and Tobacco Control Resource Centre and is the first report of its kind.

The report states that smoking harms sexual and reproductive health in both men and women. Its damaging effects are seen throughout reproductive life - from puberty, through young adulthood and into middle age.

Smoking can prevent people starting their own family, and parental smoking can have long-term and serious consequences for child health. Exposure to second-hand smoke is a risk during pregnancy, and harms infants and children.

Women who smoke during pregnancy are three times more likely to have a low birth-weight baby. Low birth weight is closely linked to illness and death in infancy. Smoking during pregnancy also increases the risk of miscarriage, stillbirth and death of the newborn.

New evidence that smoking may increase the risk of certain foetal malformations, such as cleft lip and palate, is presented. Smoking can also compromise breastfeeding: women who smoke produce less milk, of poorer quality.

"Smoking and reproductive life" also looks at the effects of passive smoking on reproductive and child health.

Passive smoking is linked to cot death, respiratory infection in children and the development of childhood asthma. There is substantial evidence that links passive smoking to reduced foetal growth and premature birth.

Dr Vivienne Nathanson, the BMA’s Head of Science and Ethics, said today: "The sheer scale of damage that smoking causes to reproductive and child health is shocking. Women are generally aware that they should not smoke while pregnant but the message needs to be far stronger. Men and women who think they might want children one day should bin cigarettes."

She added: "And we’re not just talking about having children. Women who want to protect themselves from cervical cancer should give up smoking. Men who want to continue to enjoy sex should forget about lighting up given the strong evidence that smoking is a major cause of male sexual impotence."

The report also highlights the fact that support from family and friends can help smokers succeed in quitting. But while one in three pregnant smokers succeeds in quitting, just one in twenty of their partners stops too.

Highlighting the impact of men’s smoking on the family, Dr Nathanson stated: "Reproductive health is not just a concern for women. Men also need to accept the challenge to stop smoking to improve their reproductive health, support their partners, and protect their children."

As well as recommendations on pregnant women in the work-place, the report also calls for:

- Pictorial health warnings to be added to tobacco, and they should reflect risks to reproductive life.

- Promotion of tobacco through channels that appeal to younger people - particularly films, sport, television, fashion and role models - remains a grave concern. Media figures, editors, producers and celebrities should not promote or glamorise smoking.

- Government targets to reduce overall smoking rates should be more ambitious.

- The government should introduce legislation to make enclosed public places smoke-free.

Mr James Johnson, Chairman of the BMA welcomed the government’s recognition that smoking is a key factor in health inequalities and poverty, but warned against complacency: "We need more action to tackle the devastation that smoking wreaks on families - especially in our most disadvantaged communities. Health inequalities are a key government concern, yet they continue to pursue a softly, softly approach to smoking in public places. They must act on the evidence and introduce legislation to make all enclosed public places smokefree."

The total costs of smoking-related reproductive ill health in the UK are not known. However, smoking-related illnesses have been estimated to cost the NHS at least £1.5 billion each year.

Exposure to second-hand smoke in childhood is associated with increased hospitalisation. It is estimated that each year, more than 17,000 children under five years old are admitted to UK hospitals because of respiratory illness caused by exposure to other people’s cigarette smoke. The costs of children’s medical care from exposure to second-hand smoke in Great Britain have been estimated at £167 million at 1997 prices.

Dr Sinead Jones, Director of the BMA’s Tobacco Control Resource Centre and author of the report said: "Smoking has a profound impact on every aspect of reproductive life, from puberty through middle-age and beyond. It affects not just our health, but the health of those dearest to us. And, sadly, its lethal legacy reaches beyond this generation, into the next."

New calculations in the report estimate [1] that:

- around 120,000 men aged 30-50 are impotent because of smoking

- every year smoking is implicated in around 1,200 cases of malignant cervical cancer

- smoking is linked to around 3-5,000 miscarriages every year


[1] Estimates of the impact on selected aspects of sexual and reproductive health in the UK are made by the BMA Tobacco Control Resource Centre. These figures should not be regarded as precise measures. However they do provide a reasonable indication of the magnitude of the burden of smoking on reproductive life.

Last modified on February 12 2004.