This post originally appeared on VICE Australia.
Tasmania is the pregnant smoker capital of Australia, according to a study by the country's National Health Authority carried out between 2009 and 2012. The study found 22 percent of pregnant Tasmanian women were smokers. For context, the national average is around 12 percent.
Looking at pregnant smokers under 20 years old, that figure jumps to 35.7 percent. And while women are three to four times better at quitting when they're pregnant than on average, the relapse rate of lighting up once the baby is born sits at 80 percent.
But the state's figures are more complicated than women being shitty towards their unborn kids. They're tied in with the state's ongoing battle with comparatively high rates of unemployment and lower education opportunities. They also make it the best place to trial a progressive anti-smoking program.
Dr. Mai Frandsen from the University of Tasmania has been given a three-year scholarship to try and reduce the rates of expectant moms smoking cigarettes. And she's pretty confident she can do it—by paying them to quit.
Starting in northern Tasmania, but extending statewide in the next couple of months, she'll invite any woman in her first trimester who has smoked in the past seven days to join the study. They'll be monitored over 12 months, having check-ins through their first and second trimester, and then three months after the birth. She'll also follow up 12 months after that, to see if her system was effective long-term.
Over those 24 months, traditional support services like counseling and patches will be available. But every month she'll invite them into her lab to have their carbon monoxide levels measured. Dr. Frandsen explains if their reading comes back negative, "I give them a 50 dollar gift card to a shop where they can buy nice things for their baby or themselves. They can't use it on groceries."
The decision to not allow the cards to cover groceries was to ensure that the women were participating in the program purely by choice, with the pay off being a luxury as opposed to it being an avenue to buy essentials which could serve as a means to support themselves.
Paul Grogan, Director of Advocacy, Cancer Council Australia points out that although Dr. Frandsen's approach is an Australian first, money has always been a primary instigator in encouraging people to quit. "The most effective policy levers have been tobacco tax, which uses price as a motivator," he explained to VICE. "There is some evidence that shows incentives to avoid the harms of smoking can work particularly well for pregnant women compared with other population groups."
But the Cancer Council support hasn't prevented the program from drawing skepticism. People have asked if a $50 gift card is going to be enough of an incentive, when years of medical advice and scare tactics didn't convince these women to quit. But Dr. Frandsen argues the program will be successful because it's based less on money and more on validation. "The incentive is a token of positive reward. It's a little way of boosting your confidence that people are in your corner," she explains.
When asked if we should be rewarding women for stopping a behavior they know is dangerous to their child, Dr. Frandsen isn't bogged down in the ethics of it. "As a researcher I'd like to reward every mom, but I'm in the business of trying to get people to quit smoking, that's why I've focused on women who need our help most."
She pressed that ultimately the program is about shifting the automatic shame we place on anyone we see smoking with a swollen belly. Because as uncomfortable as it is to pay someone to stop a dangerous behavior, Tasmania's dreary smoking statistics show the fear approach simply isn't working.
Paul Grogan notes that smoking is still "The number one preventable cause of cancer and other diseases in Australia," and Tasmania's rates in particular are as high as they've ever been. Despite issues some have with offering incentives, he concluded that "any study that showed potential to reduce the harms of smoking should be investigated."
As for Dr. Frandsen, she is more cheery about her experiment. "I'm very much trying the carrot approach," she says. "And rather than them being told how to do it, I'm saying you can do this whatever way you want and I will support and reward you."
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