10% of pregnant women are still smoking at the time of delivery - not because they 'choose' to smoke through pregnancy, or make a 'decision' to, or because they don't want to quit for the sake of their child. They have just, for whatever reason, been unable to quit. Almost without exception they will have tried.
For many women, pregnancy gives their willpower enough of a boost to manage it, but that's not the same for everybody. There are loads of factors which affect how easy or difficult quitting will be for any individual, just as there are loads of factors which influence how likely they are to have started smoking in the first place.
Smoking is the biggest cause of health inequalities in the UK. Smoking is far more prevalent among poor people and is particularly prevalent among people with MH issues, unemployed people, homeless people, prisoners and former prisoners, people who have been in care, lone parents, people with no qualifications, gay men and lesbians.
The more disadvantaged someone is, the more likely they are to smoke and to suffer from smoking-related disease and premature death.
Disadvantaged smokers are also less likely to be able to successfully quit. Again, on the whole, this is not because they don't want to quit. It's because on average, they will have started smoking younger, will smoke more per day and will be more heavily addicted than more advantaged smokers. They're also far more likely to be surrounded by other smokers.
The highest rates of smoking are consistently found among those who are most disadvantaged. People whose control over their daily lives is highly constrained and who do not have the resources and opportunities to thrive are most likely to be smokers and least likely to take the necessary steps to quit. (ASH)
So when you judge these women, you're most probably punching down.
Not only that, it doesn't work. It does nothing to lower that 10% statistic. Pretty much everybody who could possibly be shamed into quitting smoking has already quit. The ones who are left, who are ever more concentrated in the disadvantaged groups outlined above, are not impervious to shame. They feel ashamed just as much as wealthier smokers with more stable lives, it just doesn't help them quit.
Not only does it not work, it makes quitting even harder. Because they now have two problems - they can't quit smoking and they are living with a deep sense of shame. It makes it harder to ask for help if you fear being yet again judged. It makes it harder to care about your health or wellbeing at all if you are repeatedly told you are a smelly, selfish, stupid arsehole, yet feel powerless to change. Sometimes it leads to a kind of brazen 'fuck you' bravado - the 'defiant' smoker.
And when it comes to pregnant smokers, all those problems caused by shaming and stigma are made so much worse. We need a different approach if we are going to increase the number of women who successfully quit in pregnancy and thus make inroads into that 10% figure.