SMOKING IN PREGNANCY

Smoking in Pregnancy



Smoking in Pregnancy

Introduction

Smoking is a major public health problem. All smokers face an increased risk of lung cancer, other lung diseases, and cardiovascular and other disorders. Smoking during pregnancy can harm the health of both a woman and her unborn baby. Currently, at least 10 percent of women in the United States smoke during pregnancy.

In the United States and in other industrialized countries, 18 percent of women smoke. This proportion is somewhat smaller in developing countries where only 8 percent of women smoke. Statistics from the United States are compelling. According to the U.S. Public Health Service, if all pregnant women in this country stopped smoking, there would be an estimated:

* 11 percent reduction in stillbirths

* 5 percent reduction in newborn deaths

Cigarette smoke contains more than 2,500 chemicals. It is not known for certain which of these chemicals are harmful to the developing baby, but both nicotine and carbon monoxide play a role in causing adverse pregnancy outcomes.

Bradshaw's Taxonomy of Need

Bradshaw (1972) has illustrated how different perspectives on need can be expressed. Each perspective contributes valuable information to the care planner or policy maker which adds to the depth and breadth of understanding of need, but no perception of need is sufficient on its own and thus the framework can be a useful tool for planning appropriate services.

Felt need describes what people say they need and is important because it is about hearing the views of people themselves. However, basing care or funding decisions on felt needs alone is risky because people may be making recommendations from a limited knowledge base or when they have a narrow perspective on health. People may express needs in terms of possible solutions; they may believe the possible solutions are limited to the services that are currently available (Doyal & Gough 1991).

Expressed need is the need expressed by peoples' use of services, such as waiting times for available services. Expressed needs only take account of existing services, and do not allow people to express the need for possible new service or policy changes.

Normative need is the 'need determined by "experts" on the basis of research and professional opinion' (Talbot & Verrinder 2005).The limitations of only using normative need as a basis for planning is the paternalistic view that experts are always correct, and they know what is best for the community of interest. This perspective fails to take account of the different needs of some client groups, the personal values of the so-called experts, and the evolving nature of health care services.

Comparative need is the need assessed by comparing the available services between different locations. Comparative need can be useful to mount an argument for additional resources; however the assumption is that the service needs between areas are the same.

Historically, women's needs in pregnancy have been normative needs, defined by health professionals, within the context of a biomedical model. The first antenatal clinic in Australia opened in Adelaide, Australia in 1910, (Oakley 1986) and such clinics have remained ...