My work as a smoking cessation midwife involved me directly with the initial national target to reduce smoking in pregnancy from 23% in 1995 to 18% by 2005 and now to 15% by 2010. An additional requirement is to reduce the rate of mothers who are smoking at delivery by 1% year on year, specifically focusing on disadvantaged women to tackle inequalities in infant mortality. There is considerable pressure to meet this target, which the Healthcare Commission is monitoring. Reducing smoking in pregnancy is also a health objective for Sure Start Children’s Centres.

The 1% annual target was set centrally but has not been discussed with key stakeholders involved in its implementation. These stakeholders are now concerned by how realistic the target is and whether it is achievable within the required time scale. How was the target derived? Why has good practice guidance not been issued in support? Each primary care trust has a plan specifying how it intends to decrease the percentage of mothers who are smoking at delivery year on year and this is how their performance is managed. However, there are concerns about the quality of current smoking data, making it difficult to set local targets and baselines and to monitor progress.

Reducing inequalities is proving challenging; the latest infant feeding survey shows marked variations in smoking in pregnancy by mother’s socioeconomic …