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Baby Loss (Public Health Guidelines)

Volume 623: debated on Tuesday 21 March 2017

Motion made, and Question proposed, That this House do now adjourn.—(Steve Brine.)

As my wife will testify, I am rarely early for things, so to be more than three hours early for something is a rare treat indeed. I know that both you, Mr Deputy Speaker, and the Minister will be pleased to know that I intend to take only about two and a half hours of the just over three hours available to me.

As the House knows, I am a passionate campaigner in the area of baby loss. Having unfortunately experienced it myself, I have always been clear that I want to use my position in the House to bring about change so that as few people as possible have to go through this absolute personal tragedy. In the latest year for which figures are available, there were 3,254 stillbirths in England and Wales, with a further 1,762 neonatal deaths shortly after birth. Every single one of those is a personal tragedy, yet perhaps the most galling aspect is that so many of these deaths—reportedly about half—are actually preventable.

I strongly welcome the Government’s plans to cut the stillbirth and neonatal death rate by 20% by 2020 and, furthermore, to reduce it by 50% over the next 15 years, but those are just numbers unless we put in the resources necessary to deliver on this. Trusts have received £4 million to buy better equipment and boost training to cut stillbirth and neonatal death. More than £1 million is also being provided to help develop training packages so that more maternity unit staff have the confidence to deliver safe care. It is hugely positive that the Department of Health has recognised the scale of the challenge and set aside this funding, but we need to focus as much on reducing the risks of stillbirth.

One significant risk factor remains one of the toughest to eliminate and, as a result, carries the greatest reward if we can address it: smoking in pregnancy. Let me be clear that this debate is absolutely not about criticising or demonising women and their partners who smoke during pregnancy. We all know that tobacco is highly addictive and it can be difficult to stop smoking. However, smoking while pregnant is the No. 1 modifiable risk factor for stillbirth. If I may, I will run through a few statistics: one in five stillbirths is associated with smoking; women who smoke are 27% more likely to have a miscarriage; their risk of having a stillbirth is a third higher than that of non-smokers; and mothers who smoke are more likely to have pre-term births and babies are who are small for their gestational age.

Maternal exposure to second-hand smoke during pregnancy is an independent risk factor for premature birth and low birth weight, yet only one man in four makes any change to his smoking habits when his partner is expecting a baby. If, tomorrow, every pregnancy was smoke-free, we would see 5,000 fewer miscarriages, 300 fewer perinatal deaths, and 2,200 fewer premature births every year. Were children not exposed to second-hand smoke, the number of sudden infant deaths could be reduced by 30%.

The previous tobacco control plan set targets for reducing rates of smoking in pregnancy. In 2015-16, the number of women smoking at the time of delivery had fallen to 10.6%—below the Government’s target of 11%—yet the fact that the Government’s target has been met nationally masks geographical variations. Yes, we are seeing rates of 2% in Richmond, 2.2% in Wokingham and 2.4 % in Hammersmith and Fulham, but rates of smoking in pregnancy are 26.6% in Blackpool, 24.4% in South Tyneside and 24.1% in North East Lincolnshire.

Of the 209 clinical commissioning groups, 108 met the national ambition of 11% or less, but that means that 101 did not. It is even more worrying if we look for improvements in the rates of smoking in pregnancy in CCG areas. Yes, 14 CCGs have improved significantly over the past year, but 182 have rates that are about the same and, even more worryingly, 13 have significantly worse maternal smoking rates.

The Government have committed to renewing targets to reduce smoking in pregnancy. Reducing regional variation in smoking during pregnancy and among other population groups is a high priority for the Minister, and I know the Government are focusing on it as they finalise the tobacco control plan. I was pleased to see the recent news that NHS England granted £75,000 of funding to the 26 CCGs that are most challenged on maternal smoking.

How do we achieve the Government ambition for a 50% reduction in stillbirth and neonatal deaths by 2030? First, we need to publish a new tobacco control plan. The previous tobacco control plan for England expired at the end of 2015. The Government have promised that a new one will be published shortly. The publication of the strategy is now a matter of urgency, so will the Minister kindly advise on how shortly “shortly” is?

The strategy needs to include ambitious targets for reducing smoking in pregnancy. The Smoking in Pregnancy Challenge Group—a partnership of charities, royal colleges and academics—has called for a new national ambition to reduce the rate of smoking in pregnancy to less than 6% by 2020. I know the Department of Health is sympathetic to that aim and hope it will be included in the new tobacco control plan.

I congratulate my hon. Friend on securing a three hour and 53 minute debate on this important subject and thank him for all the work he does on baby loss. He may well address this issue later in his speech, but does he agree that the alarming figures for regional differentials also apply to stillbirth rates more generally? Another issue is cultural differences between different sections of our populations with very different outcomes. That, too, must be a priority for the Government, because wherever in the country someone is, surely they are entitled to the same level of support and the same health outcomes.

I thank my hon. Friend for that intervention. He, too, has done a huge amount of work in this area and is hugely supportive of the work of the all-party group on baby loss. He is quite right to highlight the regional variation that exists, and to which the Department is very much alive. I had not intended to focus on the specific demographics, in terms of race, but the figures do show that certain demographics have a higher propensity towards stillbirth. The honest answer is that we do not really know why, so there is a huge need for research in this area. I am not going to discuss that issue, but only because I want to focus specifically on smoking.

My hon. Friend is quite right about that particular demographic, and the reasons behind higher stillbirth and neonatal death rates may well be a public health issue. I hope that the Minister and the Department will look into that independently of this debate.

Secondly, communication to pregnant women must be sensitive and non-judgmental. Qualitative findings from the babyClear programme found that pregnant smokers found the interventions unsettling, but they were receptive to the messages if they were delivered sympathetically. To do that, healthcare professionals must feel able to have conversations about harm and have clear evidence-based resources and support for pregnant women.

Thirdly, the Government should ensure the implementation of guidance from the National Institute for Health and Care Excellence. NICE guidelines recommend that referral for help to stop smoking should be opt-out rather than opt-in. Research published by Nottingham University in April 2016 on opt-out and opt-in referral systems found that adding CO monitoring with opt-out referrals doubled the number of pregnant smokers setting quit dates and reporting smoking cessation.

Further, a recent evaluation of the babyClear programme in the north-east of England found that it delivered impressive results. BabyClear is an intervention to support implementing NICE guidance on reducing smoking in pregnancy. Let me give some background. BabyClear began in late 2012. Since then, smoking at the time of delivery has fallen by 4.0% in the north-east compared with 2.5% nationally. That equates to about 1,500 fewer women smoking during pregnancy in the north-east than in 2012. The cost of implementing the core babyClear package over five years is estimated at £30 per delivery.

Fourthly, we should embed smoking cessation across the maternity transformation plan. There are nine workstreams altogether and smoking cessation is central to achieving success in most of those. As an example, the workstream, “training the workforce”, should include training midwives on CO monitoring and referral, but there is a risk that smoking cessation is siloed into the workstream focused on improving prevention. It is vital that that does not happen.

Finally, the Nursing and Midwifery Council is updating its standards in relation to nurses and midwives. This training must be mandated and have smoking in pregnancy as a key part. These are all steps that can and should be taken by the Department of Health to help maintain the momentum on reducing smoking during pregnancy rates. However, there is one other suggestion that I would like the Minister to take away and discuss with his colleagues in other Departments. All alcohol bought in the UK carries a warning sign making it clear that pregnant women should not consume this product, yet only one packet of cigarettes in six carries a warning about the danger of smoking while pregnant. It is not unreasonable or unrealistic for all tobacco products to carry a similar warning to that seen on alcohol. I would be grateful to the Minister if he looked into the feasibility of introducing such a scheme. I understand that it falls under European law and European regulation, but that may, in the very near future, not be a problem.

This debate is absolutely not about criticising or demonising women and their partners who smoke during pregnancy. I fully appreciate that tobacco is highly addictive and that it is difficult to stop smoking. We also know that all parents want to give their baby the best possible start in life. We want a message to go out loudly and clearly that no matter what stage a woman is in her pregnancy, it is never too late to stop smoking. Yes, that can be difficult, but smoking is much more harmful to a baby than any stress that quitting may bring. Most importantly, we and the Department of Health will give parents all the support and tools to help them to quit.

May I congratulate the hon. Member for Colchester (Will Quince) on securing the debate? As an officer of the all-party group on smoking and health, I must congratulate him on the length of time that he has for this debate. Never in my wildest dreams did I ever think that we would get more than a one-and-a-half hour debate in Westminster Hall for such a matter.

The hon. Gentleman rightly pointed out the dangers of smoking in pregnancy. I do not plan to fill up these three and a half hours—I can see some smiles of relief—but I will pick up one or two issues that he raised. The Minister knows that I and many other Members have been calling for the new tobacco control plan for quite a while, since the last one finished at the end of 2015. The word I would add to that, because things do move on, is “comprehensive”; it ought to be a comprehensive tobacco smoking control plan. There are areas where that could help very much indeed.

Smoking in pregnancy is a massive issue that is obviously caused by nicotine addiction. For many years, the only way that people could meet that addiction, other than with chewing gum and patches, was by using cigarettes. Hon. Members will know that Public Health England published a report on e-cigarettes in August 2015, saying that they were 95% safer than the tobacco in cigarettes as a means of taking in nicotine. It is pretty obvious to me that consumers are moving to e-cigarettes on a vast scale, and the Government are also moving towards e-cigarettes to look into how they can help in certain situations.

I recently tabled the following written question:

“To ask the Secretary of State for Health, what steps are being taken by (a) his Department, (b) the Medicines and Healthcare Products Regulatory Agency and (c) Public Health England to encourage research into the use of e-cigarettes.”

Although the Minister may not have direct responsibility for this, I would like to tell him that I am very pleased with the answer, which I received today and which says that his Department is “working closely” with all the organisations

“to encourage research into the use of electronic cigarettes…and monitor the emerging evidence. PHE’s next updated evidence report on e-cigarettes is expected to be published before the end of the 2017. In addition to the publication…PHE have partnered with Cancer Research UK and the UK Centre for Tobacco and Alcohol Studies to develop a forum that brings together policy makers, researchers, practitioners and the non-governmental organisation representatives to discuss the emerging evidence, identify research priorities and generate ideas for new research projects, thereby enhancing collaboration between forum participants.”

I am sorry for going on about that, but it is a comprehensive answer that talks about identifying research priorities. We could not have a better advocate for such a priority than the statistics on the effects of smoking tobacco in pregnancy read out by the hon. Member for Colchester. The people involved, including PHE, which is doing a magnificent job, ought to be looking at whether smoking in pregnancy could be one area for comprehensive research. Perhaps we could replace the cigarette—a mechanism for satisfying nicotine addiction that we all know is very bad for us—and use something like e-cigarettes to satisfy the addiction in pregnant women without the risk to the individual woman and her child.

I congratulate the hon. Gentleman on bringing this up, and I congratulate the Under-Secretary of State for Health, the hon. Member for Oxford West and Abingdon (Nicola Blackwood), on the answer I received today. We should be ensuring that we look into these areas in some detail to ensure that we can avoid the awful statistics that the hon. Gentleman read out.

I had not intended to speak in this debate—I just wanted to be part of it and perhaps to question the Minister—but you have tempted me, Mr Deputy Speaker, to add my three penn’orth. I, too, will not take up the remainder of the three hours and 50 minutes in making a few comments. I again congratulate my hon. Friend the Member for Colchester (Will Quince) on securing the debate.

The Government have made good progress on the smoking front, and that needs to be recognised, but 10.6% of people still smoke through pregnancy. That figure needs to be brought well down into single figures. My hon. Friend made a good point about the use of advertising messages with regard to alcohol. Of course, unlike alcohol, this issue affects only half the population. The graphic images on cigarette packets of diseased lungs, and those grisly television adverts with pus coming out of lungs and so on, really send home the message about the harm that any smoking can do. Making that clear to women who still take the risk of smoking during pregnancy would help to get the figure down further.

We still have a major problem in this country with high levels of baby loss through stillbirth as well as through the rather less quantifiable form of miscarriage, the true extent of which we do not really know. As I said earlier, it must be a priority for Government to work out why we have regional and cultural differences, and to extend and learn from best practice rather better than we do at the moment. Some of the pilots and experiments that have happened in Scotland are something for the rest of the country to look at and learn from.

Given the title of this debate, we could, strictly speaking, extend it well beyond just smoking, and I am going to take advantage of that. On drinking, there has been a very confused message for some time. I am an officer of the all-party foetal alcohol syndrome group. We produced a report that urged complete abstinence as the only safe way, and that must be the default position. For women who do choose to continue to drink in some form during pregnancy, there need to be very clear health messages, and perhaps lower-alcohol alternatives. If someone has to drink, there are ways of potentially doing less damage to their baby. The Government can be part of that through the differential pricing tax mechanism. We are rather bad at that in this area.

I remember going to Denmark some years ago and visiting a children’s home just outside Copenhagen that specialised in treating children who were the victims of foetal alcohol syndrome—particularly children of mothers from Greenland, where there is a particular problem with heavy drinking. Those children were born with all sorts of disabilities, some of which manifested themselves as the symptoms that we know of in ongoing conditions such as autism.

There may be an understating of the effects of foetal alcohol syndrome because it can appear somewhere on the autistic spectrum as well. We need to do more research into that. There is no more stark example than we see in Denmark of a direct correlation between excessive drinking and giving birth to a child who will bear the effects of that for his or her whole life, with the learning disabilities and other things that go with it. We have lessons to learn from that. We still need stronger messages to go out to women during pregnancy about the potential, and potentially lifelong, harm that can be done by inappropriate drinking.

Although a strong message is important, the delivery of that message is crucial. There is a good argument for saying that the shock-and-awe messaging used in advertisements about driver safety or alcohol, and on cigarette packets, does not have the impact that we believe it should. Many mothers might take cavalier decisions about themselves, as many of us do. I certainly do when it comes to food and its health benefits; I do not follow the guidance. Does the hon. Gentleman agree, however, that a mother would never want to damage the future prospects of her child? The sensitivity of the message, however strong it is, is the most important element.

The hon. Gentleman makes a fair point. We, as grown-ups, can make a conscious decision to be gluttonous or to over-imbibe. That does damage to our bodies and our bodies alone, although there may be a cost to the taxpayer through the national health service. If anyone should be more sensitive and sensible about the damage that could be done to another individual, it is a pregnant woman. A pregnant woman, or a woman considering pregnancy, should be more amenable to good health messages.

It is a question of horses for courses, and I take the point that the hon. Gentleman makes about shock-and-awe tactics. The AIDS adverts in the ’80s could be described as shock and awe, and they were exceedingly effective at the time. We still remember those tombstones. One can go too far, however; members of the public are smart, and they recognise over-emphasis for effect. It hits them in the face, and they say, “I do not need to take any notice of that.” We need smart messaging, which is credible and honed appropriately for its target audience.

That is why when we in the all-party group on foetal alcohol syndrome produced our report, we had a big debate about whether we should recommend complete abstinence or whether that was just not realistic for some people, who were still going to drink. I take the view that the default position must be that drinking harms a woman’s baby, but if someone absolutely has to drink, for whatever reason, there are less harmful—but always harmful—ways of doing so. We need to nuance that message appropriately for different audiences. Of course, different cultures have different attitudes to drinking, foods and so on.

I move on to a subject that is completely different, but still within the scope of this Adjournment debate: perinatal mental health. I declare an interest as the chair of the all-party group for the 1,001 critical days, and as the chairman of Parent Infant Partnership UK, a charity that is all about promoting good attachment among parents and their children in the period between conception and age two. One of the biggest, most powerful and most effective public health messages that we can give is that effecting a strong attachment with one’s child, right from the earliest days, will have lifelong benefits for that child. That includes the time that the child is in the womb. A mother who is happy, settled and in a good place is much more likely to pass on those positive messages to a child than a mother who is stressed and suffering from perinatal mental illness or various other pressures.

At least one in six women in this country will suffer some form of perinatal illness. We know from the science, which is producing considerable data, that a child who is not securely attached—preferably to both parents but certainly to the mother, to start with—is much less likely to thrive at school and to be settled and sociable, and more likely to fall into drink and drug problems and to have difficulties with housing and employment. The first 1,001 days are absolutely critical, and we should be doing more. It is a false economy not to do so, and not to invest money early on.

The Government have quite rightly flagged up the importance of mental health. The Prime Minister absolutely gets the importance of mental health, and particularly of perinatal mental health. The additional money allocated is good, but it is still not enough. The problem, as we all know, is that that money is not making it through to the sharp end, so opportunities are still being missed to identify women who have some form of mental health problem—typically depression around the time of pregnancy—signpost them to the appropriate services and deliver quality and appropriate services in a timely fashion. That is why the charity I chair, PIP UK, has seven PIPs around the country, operating out of children’s centres, to which women can be referred, often with their partners, to get the support and confidence they need to effect the strong bond and attachment with their child.

The Maternal Mental Health Alliance has costed the problem of not forming such bonds at £8.1 billion each and every year. I repeat that, each year, the cost of getting it wrong is over £8 billion. The cost of getting it right is substantially less, yet too many clinical commissioning groups around the country still do not even have a plan for delivering perinatal mental health for women where and when they actually need it. On top of that, in our report “Building Great Britons”, the all-party group calculated that the cost of child neglect is over £15 billion a year in this country. By not getting it right for really young children and for babies, we are therefore wasting £23 billion financially, but far more importantly we are not giving those children the very best start in life socially, which we could do with a bit more, smarter and better targeted up-front investment.

I reiterate to the Minister and his colleague, the Under-Secretary of State for Health, my hon. Friend the Member for Oxford West and Abingdon (Nicola Blackwood)—she very kindly saw a delegation from the all-party group on the 1,001 critical days recently, and I know she takes this subject very seriously and has convened a roundtable—that we absolutely must come up with such public health messages and talk in this place about the importance of getting it right early on, but what matters at the end of the day is actually delivering the service to those women where it is needed, at the appropriate time and place.

Finally, may I take the liberty of mentioning to the Minister, as I think I did in a previous Adjournment debate, the question of the registration of stillbirths? It is a subject on which I have campaigned for some years in this place, and on which I have had a private Member’s Bill. This falls within the remit of baby loss, which is in the title of this Adjournment debate; I know you are scrupulous, Mr Speaker, about our not straying beyond the remit of a debate.

Following some very helpful responses from predecessor Ministers and officials at the Department of Health and having convened various roundtables—with the Royal College of Midwives, the Royal College of Obstetricians and Gynaecologists and other key players, as well as various stillborn charities—I thought we had got to a place where the law could be changed to emulate what has been done in New South Wales in Australia. However, we still have a iniquitous and highly distressing situation: somebody who has gone through the trauma of carrying a child as far as 23 weeks and six days will find, if the child is, tragically, born prematurely and stillborn, that the child is not recognised in the eyes of the state, although a child born just after the 24-week threshold will be recognised as a stillborn child. I have previously raised the example of a woman who had twins either side of that threshold: sadly, they both died, but one was never recognised, while the other was recognised as a stillborn child, with a certificate being issued by the hospital.

For a woman who has given birth to a stillborn child, such a situation is one of the most sensitive and vulnerable of times. My hon. Friend the Member for Colchester knows this so well, and other hon. Members have given their own very emotional accounts of going through such traumas. The fact is that the state has still, so far, failed to take the straightforward and fairly cost-free step of coming up with a simple registration scheme for those for whom such a scheme would help to provide some form of closure.

For a stillborn child born at under 24 weeks—what I am talking about is different from miscarriage, although I am in no way trying to underplay the trauma caused by having a miscarriage—to be recognised as a human being, rather than as a child who, sadly, was born before an artificial threshold, seems to me to be a sensible but humane thing to do to help the too many women who still give birth to stillborn babies. We need to bring that figure down, and we are doing so. In the meantime, we can at least give some succour and comfort to parents who have to go through this situation by saying that we appreciate and recognise what has happened, and sympathise and empathise with what they have gone through.

May I ask the Minister again whether there is any way that we can get this campaign going again? The issue has featured in one of our national soaps: an actress who went through it in real life re-enacted it in “Coronation Street”. There has also been a lot about it in the press. I ask the Minister to ask his Department to look at this issue again to see whether something can be done, because I think there could be a solution.

Mr Speaker, I have more than abused my privilege in this three hour and 50 minute debate, but these are issues on which there is a good deal of sympathy and empathy in the House. Yet again, we are greatly indebted to my hon. Friend the Member for Colchester for bringing them back to the House, where we have the power to make a difference to our future constituents’ lives.

I congratulate my hon. Friend the Member for Colchester (Will Quince) on securing this debate on public health guidance and baby loss. I also congratulate you, Mr Speaker, on scheduling it on a day when the other business, inexplicably, was so curtailed, thereby enabling some very distinguished Members on both sides of the House who chair directly relevant all- party groups to make unusually—I would not say unprecedentedly, Mr Speaker, because you would be better placed than I to say whether it was unprecedented—long contributions in an Adjournment debate, and very welcome they were too.

We know from families who have experienced baby loss that the silence that often surrounds the loss can make the experience much harder. For that reason, I join the tributes from the right hon. Member for Rother Valley (Sir Kevin Barron) and my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) to my hon. Friend the Member for Colchester for the work that he does in leading the all-party parliamentary group on baby loss and for bringing the experiences that he has suffered to bear on this issue a number of times.

Before I address the specific points made by my hon. Friend the Member for Colchester—I counted six challenges that he laid down in his speech, and I will try to address each of them—as I have the luxury of a little time, I will set the scene on the work the Government are undertaking to reduce adverse outcomes during pregnancy and the neonatal period.

My hon. Friend referred to the maternity transformation programme in England, which began a year ago. It provides an opportunity to shape services for the future. Improving women’s health requires a collaborative approach across the entire health system, including commissioners, primary care, maternity services, public health and local authorities, to meet the needs of women and their partners. The result of all that work is that England is a very safe country in which to have a baby. Sadly, a small number of babies are stillborn or die soon after birth but, according to the latest figures, stillbirths and neonatal deaths occur in 0.5% and 0.3% of births respectively.

We are absolutely committed to improving maternity care and recognise that every loss is a personal tragedy for the family concerned. As a result, it is our national ambition to halve the rate of stillbirths, neonatal deaths, maternal deaths and brain injuries that occur during or soon after birth by 50% by 2030. We are making considerable progress. The other day, I had the privilege of attending the Royal College of Midwives awards ceremony—one of the more enjoyable parts of my role in the Department of Health—where I was able to confirm that since 2010, the proportion of stillbirths is down by 10%, the proportion of neonatal deaths by 14% and the proportion of maternal deaths by 20%. Our plan is having some effect, which is very pleasing, but there is always more that we can do.

To support the NHS in achieving this ambition, we have a national package of measures with funding attached, including: an £8 million maternity safety training fund to support maternity services in developing and maintaining high standards of leadership, teamwork, communication, clinical skills and a culture of safety; a media campaign, “Our Chance”, comprising 25 animations and videos targeted towards pregnant women and their families to raise awareness of the symptoms that can lead to stillbirth; and a £250,000 maternity safety innovation fund to support local maternity services to create and pilot new ideas.

The fund was allocated in the past couple of weeks. One project that secured funding will develop a one-stop multidisciplinary care clinic for women with diabetes, hypertension, morbid obesity and epilepsy. Another project aims to develop a pathway whereby all women with high carbon monoxide breath test results—this was referred to by my hon. Friend—are referred for serial ultrasound measurements to provide them with more information about the potential impact of smoking on the child they are carrying. We are also investing £500,000 to develop a new tool to enable maternity and neonatal services to systematically review and learn from every stillbirth and neonatal death in a standardised way.

The Government are seeking to put in place infrastructure to improve maternal health, but clearly young mothers, partners and families have a role to play too. The evidence shows that the national maternity ambition cannot be achieved through improvements to NHS maternity services alone and the public health contribution will be crucial. It is vital that women and their families are made aware of and understand the lifestyle risk factors that can impact on the outcomes for them and their babies, and the changes they can make to increase their likelihood of positive outcomes. Hon. Members referred to a number of them.

As soon as a lady knows she is pregnant, she should be encouraged to contact her maternity service for a full assessment of health, risk factors and choices, so that a personalised plan of care can be prepared. Women with complex social factors, in particular teenagers and those from disadvantaged groups, do not always access maternity services early or attend regularly for antenatal care, and poorer outcomes are reported for both mother and baby. Maternity services need to be proactive in engaging all women.

Early in pregnancy, a midwife will provide a woman with information to support a healthy pregnancy. This will include information about nutrition and diet, including supplements such as folic acid and vitamin D as well as lifestyle advice, central to which is smoking cessation—on which my hon. Friend focused his remarks—the risks of recreational drug misuse and alcohol consumption, which my hon. Friend the Member for East Worthing and Shoreham focused on in his remarks.

When starting pregnancy, not all women will have the same risk of something going wrong, and women’s health before and during pregnancy are some of the factors that most influence rates of stillbirth, neonatal death and maternal death. We know that a body mass index of over 40 doubles the risk of stillbirth. A quarter of stillbirths are associated with smoking, and alcohol consumption is associated with an estimated 40% increase to stillbirth risk. In addition, the MBRRACE-UK perinatal mortality surveillance report, published in June last year, showed that women living in poverty have a 57% higher risk of having a stillbirth. Women from black and minority ethnic groups have a 50% higher risk, and teenage mothers and mothers over 40 have a 39% higher risk of having a stillbirth.

Those striking facts are why the Department of Health will continue to work closely with Public Health England and voluntary organisations to help women to have a healthy pregnancy and families to have the best start in life. Last year, NHS England published new guidance that aims to reduce the number of stillbirths in England. Building on existing clinical guidance and best practice, the guidance was developed by NHS England working with organisations including the Royal College of Midwives, Royal College of Obstetricians and Gynaecologists, British Maternal and Fetal Medicine Society and Sands, the stillbirth and neonatal death charity. The Saving Babies’ Lives Care Bundle includes key elements intended to significantly impact on stillbirth rates through reducing smoking in pregnancy, detecting foetal growth restriction, raising awareness of reduced foetal movement and improving effective foetal monitoring during labour.

I now come specifically to the challenges posed by smoking in pregnancy. My hon. Friend the Member for Colchester stole most of my thunder by declaring many of the statistics on the impact of smoking, but I am particularly pleased that he focused on the fact that the plan, as set out in the tobacco control plan for England in 2011, which set a target to reduce the number of women smoking in pregnancy to 11% or fewer, has now been achieved at the national level, with a rate of 10.6% for England as a whole. As my hon. Friend also pointed out, this masks wide geographical variations across the country, ranging from 4.9% across London to 16.9% in Cumbria and the north-east. There was an even greater difference at the level of clinical commissioning groups, from which I believe my hon. Friend collected his statistics. These range from 1.5% at the low end to over 26% at the higher end, which is clearly a totally unacceptable variation.

Although we have made progress in recent years, about 70,000 babies continue to be born each year to mothers who smoke—and more if we include exposure to second-hand smoke. My hon. Friend made an interesting observation about the impact of partners continuing to smoke while their partners are pregnant. My hon. Friend mentioned the figure of 25%, so for one in four pregnant women their partners continue to smoke. That is an area on which we need to focus our attention and seek to raise the awareness of the impact of passive smoking. I am grateful to my hon. Friend for raising that issue.

Smoking during pregnancy is the main modifiable risk factor for a range of poor pregnancy outcomes. It is known to cause up to 2,200 premature births, as my hon. Friend said, 5,000 miscarriages and 300 perinatal deaths every year across the UK. It also increases the risk of developing a number of respiratory conditions, attention and hyperactivity difficulties, learning difficulties, problems with the ear, nose and throat, obesity and diabetes. Pregnant women under 20 are six times more likely to smoke than those aged 35 or over. Specialist stop smoking support, while available to pregnant women, clearly needs to be targeted on those higher-risk groups. That provides much of the challenge that my hon. Friend set for us in his remarks.

We are looking to take considerable action to advance the cause of reducing smoking. My hon. Friend asked in particular when we intend to publish the next iteration of the tobacco control plan. He asked me to define a well-used parliamentary term—“shortly”. I regret to say that it is way beyond my pay grade to provide closer definitions of that term. There are others, including someone who recently arrived in the Chamber, who might have some influence on the speed with which plans emerge from the Government. I very much hope that we will be able to progress with the next iteration of the tobacco control plan in the next few months.

My hon. Friend referred to the babyClear programme, which is about informing pregnant women about the risks they run from continuing to smoke. It is an important programme that has been evaluated by Newcastle University, which published some findings last month. We think that this is closely aligned with the NICE guidance, which is appropriate. It builds on the point made by my hon. Friend and by the hon. Member for Belfast East (Gavin Robinson) about the sensitivity involved in giving advice to pregnant women. My hon. Friend the Member for East Worthing and Shoreham referred to the mental health challenges that pregnancy can cause for some women. I think there is a sensitivity involved in the delivery of hard-hitting messages to women who find it impossible to shake their addiction to smoking. We must be aware, in conveying the message that persisting in smoking during pregnancy may lead to long-lasting damage to the baby, that there may be mental health implications to which we need to be alert.

My hon. Friend the Member for Colchester mentioned the possibility of introducing an opt-out, rather than an opt-in, for carbon monoxide testing of women who present as pregnant to their maternity services. That is an interesting idea, and I am certainly willing to discuss it with NHS England and the Department. If it is possible for such a test to identify pregnant women who are smoking, it would be foolish of us not to introduce it.

My hon. Friend referred to the maternity transformation plan. I will write to him giving a specific response to his ideas and explaining how they might be used to embed smoking cessation in the nine elements of that plan. I cannot give him a similar reassurance about the training programmes for midwives, because they are determined independently by the Nursing & Midwifery Council and it is not for me to prescribe what should be involved in such training, but the debate will doubtless be heard by the midwife trainers.

My hon. Friend’s final request was for a warning on cigarette packets that would specifically alert people to the risks of smoking during pregnancy. Again, I am afraid that that is not in my gift, but it is a very interesting idea. As was pointed out by the right hon. Member for Rother Valley, there are already some stark and shocking images on cigarette packaging. We have just engaged in a major consultation that has led to the introduction of plain packaging. I suggest that my hon. Friend send his proposals to those who are responsible for monitoring the impact of plain packaging across Government.

I hope that I have addressed my hon. Friend’s points. Let me now respond to the requests from the right hon. Member for Rother Valley, who is the vice-chair of the all-party parliamentary group on smoking and health, in relation to e-cigarettes. He suggested that, as a research priority, we should ask Public Health England to consider whether they are helpful or unhelpful in encouraging pregnant women to stop smoking, and also whether the nicotine contained in them could lead to foetal damage in the future. I think that that is potentially an interesting subject for research, and I should be happy to pose the question to Public Health England.

I am pleased that my hon. Friend the Member for East Worthing and Shoreham was able to contribute to the debate, because he is very knowledgeable about these issues. He welcomed the progress that is being made in reducing smoking, and I am glad he recognised that. However, he focused many of his remarks on another aspect of public health guidance, in his capacity as chair of the all-party parliamentary group for foetal alcohol spectrum disorder.

I stand corrected.

Significant health messages are being sent about the consequences of continuing to drink while pregnant, and, again, progress is being made. I do not have the figures in front of me relating to the level of alcohol that pregnant women continue to consume, but the Government share my hon. Friend’s ambition. We must continue to bear down on alcohol consumption, because it has the potential to cause lifelong harm to babies.

My hon. Friend finished with a request that we consider once more the registration date for stillbirths, and his example of the twins falling either side of the 24-week definition puts the points very concisely and starkly. Again, I am not in a position to give him comfort on that issue here and now, but I will write to him, having consulted colleagues in the Department of Health on where we stand on it.

On that basis, I am very grateful to my hon. Friend the Member for Colchester for securing this debate and giving us the opportunity to spend almost an hour, I think, discussing this subject, which is unusual and welcome.

Question put and agreed to.

House adjourned.