National smoke-free pregnancy incentive scheme
Smoking during pregnancy increases the risk of complications, stillbirths and neonatal death. It also impacts the wider family, with children of smoking parents up to 3 times more likely to take up smoking. Supporting more women to have a smoke free pregnancy and to stay smoke free after the birth reduces the risk of many smoking related complications and illnesses, for both the mother and the baby.
Because of tailored NHS support offers and other existing support offers via maternity and stop smoking services, the number of women smoking at time of delivery has fallen to an all time low of 5.6% in England in 2024/25. However, smoking rates for pregnant women still remain high in some disadvantaged areas, driving inequalities in health outcomes.
The National Smoke Free Pregnancy Incentives Scheme (NSPIS) supports pregnant women who smoke, to quit, by offering financial incentives, alongside behavioural support. Evidence shows incentives to be highly effective in helping pregnant women stay engaged with stop smoking support, throughout their pregnancy and following delivery, a time when relapse rates are high.
The NSPIS was launched in September 2024. Today over 80% of maternity trusts offer the scheme, with thousands of pregnant mothers supported to quit and deliver their babies smoke free.
The scheme was expanded in January 2026 to include the option of a ‘significant other’, a friend or family member who will quit smoking with the expectant mother, supporting her to remain smoke free, providing additional support and creating more smoke free homes.
The scheme is currently funded until 31 March 2029.
Elizabeth’s story: “For the first time, I felt like there was real help”
Elizabeth successfully quit smoking during her pregnancy with specialist support from her local maternity stop smoking service and the National Smoke Free Pregnancy Incentives Scheme.
Elizabeth had been smoking for 11 years before she became pregnant aged 24.
“I always knew smoking wasn’t good for my health, but I’d never had the determination or reason to quit before. When I found out I was pregnant, it stopped being about just me and I knew I had to do it.”
At her first midwife appointment, Elizabeth was asked whether she smoked and was told about the incentives scheme.
“My midwife explained how the scheme worked and that I could receive shopping vouchers for staying smoke free, alongside getting support to quit. For the first time, I felt like there was real help there, not someone just telling me what to do”.
Elizabeth received regular support throughout her pregnancy and says the encouragement from advisors made a real difference.
“The support was amazing. I looked forward to my appointments. The advisors were brilliant and I could talk to them about anything”.
“I used the vouchers for baby bits, essentials, I even treated myself sometimes. It felt like someone was saying: you’re doing well and we recognise that”.
“Knowing my baby was born smoke free makes me so happy. He was a healthy weight and he’s growing well and he’ll never be around smoke. I feel so proud of what I achieved”.
What the incentives scheme involves
The Saving babies’ lives care bundle specifies that all pregnant women should have their carbon monoxide (CO) levels tested as part of identifying smoking status, and receive very brief advice (VBA) on smoking at their first antenatal appointment with a midwife. Their identification as a smoker or recent quitter should trigger an opt-out referral to a local stop smoking support/tobacco dependence treatment service. The national incentive scheme works with local referral pathways.
Pregnant women enrolled on the scheme via a participating maternity service are able to access incentives (in the form of Love2shop vouchers) over the course of their pregnancy and following delivery of their baby, providing they continue to attend regular stop smoking appointments and are verified as smoke free (a carbon monoxide [CO] reading of 3 parts per million [3ppm] or less [as per NICE guidance]).
Vouchers are paid weekly over the first 4 weeks of the quit attempt and then monthly through to birth. There are 2 further incentives at month 1 and month 3 following delivery. The maximum value of vouchers for those staying smoke free throughout pregnancy and following the birth is £400.
DHSC funds the vouchers with the training and support coming from Accenture. A data collection system triggers the incentives.
Participating maternity services are expected to provide stop smoking behavioural support in line with the 10 Year Health Plan for England, which commits to providing opt-out smoking cessation interventions as part of all routine care within hospitals, and the Saving Babies Lives Care Bundle.
NSPIS has also expanded to include the option of inviting new participating pregnant smokers to nominate a friend or family member to quit smoking with them and support them to remain smoke free. These ‘significant others’ can be offered support by the maternity tobacco dependency advisor or referred to local stop smoking services. They must be verified by the participating maternity service as remaining smoke free at or around the 36th week of pregnancy and 3 months following the birth with a CO reading of 9ppm or less (as per NICE guidance).
The scheme’s expansion is evidence based and recommended by NICE guidance. The total maximum value of vouchers which can be received by ‘significant others’ who quit and remain smoke free is £100.
King’s College London and University of Stirling are evaluating the scheme looking at both quantitative and qualitative outcomes. The report is expected towards the latter part of 2026.
For those organisations still wanting to join, please email nhsgm.nspis@nhs.net.
Supporting earlier engagement and improved outcomes in maternity services
Maternity stop smoking services across England are seeing increased engagement from pregnant women following the introduction of the National Smoke Free Pregnancy Incentives Scheme.
By offering regular incentives linked to carbon monoxide verified smoke free milestones, the scheme encourages women to engage earlier in pregnancy and maintain consistent contact with maternity stop smoking teams. This creates more opportunities for services to provide tailored support and increases the likelihood of women successfully quitting smoking during pregnancy.
Carla Anderson, Public Health Matron at Northumbria Healthcare NHS Foundation Trust, said: “The national incentive scheme has been really well received by the team. Women are engaging with the pathway earlier in pregnancy due to the regular incentives and requirement for regular contacts to facilitate this. We have found the system easy to use and it has reduced our admin time significantly”.
Services have also highlighted the wider benefits the scheme brings to families and frontline teams.
Kaylee Hopwood, Tobacco Dependency Treatment support delivery manager at Northern Lincolnshire and Goole NHS Foundation Trust, said: “We were delighted to be able to offer the National Smoke Free Pregnancy Incentives Scheme to our pregnant smokers. We feel it is going from strength to strength as an added benefit to what the service delivers at the trust. The team is not only engaging but is also supporting local families in some of the most useful ways possible now.”