5. Know when to refer

It is important to recognize that for many women smoking is a secondary issue—to poverty, trauma, violence, lone motherhood, and other factors. Most pregnant smokers in Canada, especially those who do not spontaneously quit, are often experiencing multiple social and economic pressures. In these cases, tobacco cessation is not only a low priority, but smoking serves multiple purposes or “benefits” the woman in mediating her existence.

For many pregnant women in “high priority” or “hard-to-reach” groups, these issues tend to blur or bury the importance of tobacco cessation and other health-seeking behaviours while pregnant. It is important to recognize that smoking cessation does not occur in a vacuum. For example, studies show that between 2 and 20% of women experience domestic violence during pregnancy.

While these issues should not be considered a barrier to engaging with women regarding their smoking, they should inform practice. In these situations, you may need to make a referral to other services and supports.


Local resources vary across the country and are constantly changing. However, the following websites are a good starting place to get a sense of the range of programs that exist and to which you might refer your patients.

BC Association of Pregnancy Outreach Programs

Information about programs that provide prenatal and early parenting support to women who experience health or lifestyle challenges during pregnancy, birth, and the transition to parenting.

Visit website

BC Mental Health and Addiction Services

Programs include Adult Tertiary Psychiatry, Geriatric Psychiatry, Forensic Psychiatric Services, Child and Adolescent Mental Health, Women’s Reproductive Mental Health, and the Provincial Specialized Eating Disorders Program.

Visit website

Canadian Centre on Substance Abuse-Information about Canadian addictions treatment services and programs

Database on substance-use-treatment programs by province. Information on programs specializing in tobacco and addiction support, both in outpatient and residential treatment settings. 

Visit website

Canadian Centre on Substance Abuse

Helplines and contact numbers for addictions treatment by province or territory

Visit website

Centre for Addictions and Mental Health

Treatment Programs

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Connex Ontario Health Services

Information about alcohol and drug treatment, problem gambling helpline, and mental health services and supports across Ontario.

Visit website

Further Reading

Greaves, L., Poole, N., Okoli, C. T. C., Hemsing, N., Qu, A., Bialystok, L., & O’Leary, R. (2011). Expecting to Quit : A Best Practices Review of Smoking Cessation Interventions for Pregnant and Postpartum Girls and Women, 2nd edition

Greaves, L., Johnson, J., et al. (2004). Reducing harm: A better practices review of tobacco policy and vulnerable populations. Vancouver, BC: BC Centre of Excellence for Women’s Health. Full-text »

Nevala, J., Sears, K., and Steibelt, E. (2010). Women and tobacco info pack. Program Training and Consultation Centre (PTCC), a resource centre of the Smoke-Free Ontario Strategy (Download PDF from www.ptcc-cfc.on.ca)

Back to 5 ways to Change Your Practice


  • Resources for Health Care Providers
  • Screen all women and girls of childbearing age for tobacco use

    Smoking cessation is an issue that precedes and extends far beyond the perinatal period.


Quitting smoking and finding reasons to quit smoking are easier with the support of others. Visit our Facebook page to connect with other mothers and mothers-to-be who are finding ways to stop, reduce, or quit smoking.