The true scale of the damage that smoking is doing to our sexual and reproductive health became clear on Wednesday as doctors published a comprehensive report blaming cigarettes for the impotence of young men, cervical cancers, miscarriages and for many couples' fertility problems.
Both partners should stop smoking before they conceive a child, the report from the British Medical Association (BMA) says.
It recommends that pregnant women should be entitled to stay off work with full pay if their employer cannot guarantee them protection from inhaling other people's cigarette smoke, which could harm their fetus and cause the baby to be sickly and have continuing health problems. The report also attributes up to 420 UK stillbirths and 260 deaths of babies under four weeks old to smoking and underlines the known link with cot death.
"It is quite clear from the litany of appalling effects that something has to be done," said Vivienne Nathanson, the BMA's head of science and ethics. She called for UK government policy on smoking to be more ambitious: the BMA wants to see legislation to ban smoking in enclosed public places.
Pregnant women have a legal right to protection from health risks in the workplace under European law, she said. "That has to include protection from people who smoke." Nine months of pregnancy should not have to be spent in purdah, she said.
"We all have a duty to make the workplace and home and public places as safe as possible for pregnant women," she said.
The report, entitled "Smoking and Reproductive Life," says studies show that smoking may cause impotence through damage to the blood circulatory system caused by exposure to the many toxins in cigarettes, including carbon monoxide. It estimates that 120,000 men aged between 30 and 50 in the UK are impotent because of the effects of smoking.
There is a small amount of evidence suggesting that inhaling secondhand smoke might also have an effect.
Smoking was recognized as a cause of cervical cancer -- the biggest cause of cancer death in women -- by the World Health Organization in 2002.
Its main cause is infection with the human papilloma virus. Infection does not always progress to cancer, but the report says it is more likely to do so in smokers.
The report argues that the message that smoking damages fertility is still not fully getting through. "Women are generally aware that they should not smoke while pregnant but the message needs to be far stronger. Men and women who think they might want children one day should give up cigarettes," Nathanson said.
Women who smoke take longer to conceive than those who do not, and their chances of conceiving at all are reduced by between 10% and 40%. The more cigarettes she smokes, the longer it is likely to take a woman to get pregnant. She may not get pregnant at all -- women are twice as likely to be infertile if they smoke.
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