Smoking During Pregnancy
About 20 percent of women between 18 and 44 years old smoke in the United States, with up to 20 percent of them continuing to smoke while pregnant. Nearly 40 percent of women enrolled in Medicaid smoke while pregnant. Women who smoke during pregnancy have higher rates of miscarriages, premature and low birthweight babies. There is also a higher risk of cleft lip or palate, cerebral palsy, heart and respiratory conditions, and sudden infant death syndrome (SIDS) among babies of smokers. The costs of births for women who smoke are on average 66 percent higher than non-smokers. Birth complications associated with smoking during pregnancy cost about $2 billion each year, according to the Campaign for Tobacco-Free Kids.
State and Federal Actions
Since October 2010, the Affordable Care Act has required that Medicaid provide coverage for comprehensive tobacco cessation treatment—including counseling, prescriptions and nonprescription treatments—without cost-sharing for pregnant women. Before the federal law, some states already provided this coverage and found that they save lives and money. A Massachusetts study showed a savings of $3.12 for every Medicaid dollar spent on tobacco cessation services. Many people, however, are unaware of these services. A 2004 study discovered only 36 percent of Medicaid-enrolled smokers knew that these programs were covered under Medicaid.
State officials continue to promote the tobacco cessation services under Medicaid as well as other programs for pregnant women and new mothers, such as home visiting programs and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Tennessee's S.M.A.R.T. Moms trains providers on cessation techniques for pregnant women and targets WIC recipients. North Carolina's You Quit Two Quit aims to decrease infant mortality rates through community education and outreach. The program screens and treats pregnant mothers who use tobacco and targets low-income women of reproductive age. Participants also receive education and services that emphasize prevention of smoking relapse after women give birth.
Sources: National Conference of State Legislatures, 2012; Centers for Disease Control and Prevention; National Partnership to Help Pregnant Smokers Quit; March of Dimes; Letter to State Medicaid Directors, Centers for Medicare and Medicaid Services, June 24, 2011.
Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2010.
Note: Data are not available for American Samoa, Guam and Northern Mariana Islands.
NCSL webpage, May 2010
Tobacco Cessation: State and Federal Efforts
NCSL webpage, February 2012
Tobacco Use and Pregnancy
Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, January 2012
Women and Smoking: A Report of the Surgeon General, March 2001
U.S. Department of Health and Human Services
Women and Tobacco Use
American Lung Association
Smoking and Tobacco Cessation
Association of Maternal & Child Health Programs
Women and Smoking
National Cancer Institute, National Institutes of Health, August 2010
American Society for Reproductive Medicine
Tobacco Use Objectives: Increase Smoking Cessation During Pregnancy
Healthy People 2020, March 2012
This webpage was adapted from an NCSL postcard published in March 2012.