Paying Pregnant Women Not to Smoke


A study out of John Hopkins University looked at giving incentives to pregnant addicts to drop one of their addictions – tobacco. This is controversial on several fronts, not the least of which is paying people for what they should do anyhow. Still, if the objective is to reduce fetal harm, anything that works is worth examining closely.

Tobacco use is clearly a risk to the unborn. This risk is in addition to risks from other addictions and can actually be more harmful than an addiction to illegal substances when the drug use is managed. According to reporting from UPI, from 77 to 99 percent of women addicted to drugs (drug dependent) also smoke. Furthermore, this known harm to fetuses is usually overlooked at drug treatment facilities. Some of the dangers listed are: spontaneous abortion, early delivery, low birth weights and a higher incidence of SIDS (sudden infant death syndrome) after delivery.

In what is called “contingency management,” drug treatment centers can reward addicts for achieving short term goals – an attempt to make quitting a force as relevant as the addiction itself. In the program mentioned, the reward came in the form of cash payments. Interestingly, this same method is used already to change behavior. Everything from having to put a quarter into a change jar (negative reinforcement) to buying a teen a car when they meet grade targets (positive reinforcement) would fall under the category.

In the study, pregnant women on methadone maintenance treatment were placed into three test groups. Two of the groups earned money for either reducing or abstaining from smoking, while a third group only got counseling about tobacco use. When rewards were paired with a reduction in smoking until abstinence was reached, about a third of the women were able to stop completely, at least for some set period, and 75% achieved a significant reduction in tobacco use.

Notably, for this type of program to work, there has to be a checking mechanism in place. For this study, researchers were able to monitor actual smoking by measuring carbon monoxide (one product of smoking) levels. Other programs would require other types of monitoring to prevent cheating.


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