Social attitudes towards smoking in pregnancy in East Surrey: A qualitative study of smokers, former smokers and non-smokers

A qualitative study was undertaken to explore social attitudes towards smoking by pregnant women, mothers of preschool children and their partners based in Merstham and Horley, East Surrey. All respondents felt that smoking in pregnancy was associated with considerable social stigma and negative social attitudes. Non-smokers were particularly negative in their views on smoking in pregnancy feeling that it was socially unacceptable. Women who smoked during pregnancy reported various negative social experiences such as receiving criticism from health professionals and community associates. They reported feeling under pressure to quit to achieve social acceptability as much as for health improvements. Some pregnant smokers denied smoking to health professionals, partners and colleagues and used private smoking places out of public view to reduce the chances of detection. Women who smoked or had a partner who smoked were more accepting of smoking in pregnancy than non-smokers and former smokers. Moreover, residents from the more socio-economically deprived area of Merstham were more tolerant of smoking in pregnancy and parenthood, compared to Horley-based respondents, regardless of their personal smoking status. They gave examples of local women they knew who had smoked in pregnancy without apparent complication. While all respondents were aware of health risks associated with smoking, smokers did not feel the risks were personally relevant to them and were exaggerated in an anti-smoking society. Health professionals need to be aware that pregnant women may not disclose smoking activity due to perceived social stigma and may require more intensive smoking cessation support services in socio-economically deprived areas.