We Must Respect the Wrong Decision

Should pregnant women smoke? OK, that’s a no-brainer but here’s a harder one. When pregnant women do smoke, what should we do about it?

The reality is that 16 per cent of Australian women of childbearing age smoked through their last pregnancy. Most would have less education and a more working-class pedigree than women who have never smoked, or who quit when two lines appeared on their pregnancy test.

Public health experts find these women frustrating and work hard establishing anti-smoking health messages that will convince them to quit.

Because research makes clear that smoking is toxic to both mother and baby, some judge women who smoke while pregnant as bad mothers who, in the words of medical participants at an anti-smoking seminar, should be hanged “from the nearest tree” for smoking.

The theory behind quit smoking campaigns and all public health messages is simple. That people only smoke or undertake other unhealthy activities because they don’t know the risks they are taking. Once they do, they will stop and begin living right.

If only it were so simple. The truth is that we all do things we know are bad for our health. We eat rich food, drink too much grog, eschew exercise and have unprotected sex. Habit, peer pressure, rebellion and cynicism about the claimed cost of transgression are just some of the reasons we do what experts say we must not.

We also sometimes do the wrong thing by our bodies – have ice-cream rather than fruit or salad, stay up late when we need our sleep – because the certain and immediate pleasure overwhelms the possibility of future doom.

Sometimes, in other words, we make an informed and voluntary choice to do the wrong thing. We know what we are doing is bad for us and we decide to do it anyway.

Keeping faith with the informed consent framework behind public health campaigns means we must not only accept that this is the case, but that however ill-advised we think the decisions of others are, they are ones that a person is entitled to make.

Overzealous public health campaigners find this hard. In the United States recently, their frustration with the refusal of their fellow citizens to quit smoking led them to over-egg the evidence against passive smoking. When a long-time anti-smoking researcher, Michael Siegel, called them on it, they slurred his reputation and cut him off from information vital to his work.

Yet Siegel’s point was inarguable – that the use of shoddy science in anti-smoking campaigns will backfire, leading people to distrust future health messages about the negative impact on health caused by smoking.

Which returns us to pregnant smokers. No one is arguing that that smoking does not pose health risks to pregnant women and their developing foetuses. It does and it is vitally important that pregnant women are offered hard scientific facts about the nature of those harms. Should they respond by choosing to quit, they should be offered every practical support available to succeed.

But where women decide to carry on smoking or to just cut back, this decision must be respected. Distortion of the evidence to scaremonger is foul play.

More importantly, the decision of pregnant women to smoke must be understood as a health, not a moral, problem. After all, pregnant women are like all other smokers. People who, regrettably, but like all of us, don’t always do what’s best for their health.

Publication history

We must respect the wrong decision  The Sydney Morning Herald