Compared with the rest of the country, New Hampshire ranks better than most states when it comes to many pregnancy and birth statistics. The teen pregnancy rate is often the lowest of any state, and the percentage of women who get prenatal care is among t

But the percentage of women who smoke while pregnant is consistently higher than the national average, according to a report released yesterday by the department of Health and Human Services. Using babies born in 1999 and 2000, health officials collected information from parents and hospitals that enabled them to publish the first comprehensive report on the state's birth trends. Though many of the state's pregnancy and birth rates compare favorably with the rest of the country, New Hampshire does worse when it comes to smoking. Nationwide, 12.2 percent of pregnant women reported using tobacco in 2000; in New Hampshire, it was 16 percent. "We don't know why, but it's obviously not due to women not getting care while pregnant," said Lisa Bujno, bureau chief for the bureau of Maternal and Child Health in the Office of Community and Public Health. "My impression is that in general, for people of all ages in this state, we have a higher smoking population than the national average. So I don't think this points out a shortfall in New Hampshire's prenatal care. I think what it points out is that there may be a shortfall in addressing the tobacco problem here." New Hampshire, Maine and Vermont have traditionally had the lowest rates of teen pregnancy in the country, but New Hampshire also has a low cigarette tax and a historically high rate of tobacco use. According to the Center for Disease Control Web site, in 2001 New Hampshire had the ninth highest rate of adult smoking. The health department's report reaffirms what officials and doctors have known for years: Though the state's schools, health providers and clinics do a fairly good job of making services available to women, especially young women, more smoking means more of every kind of smoker. "When we look at the high rate of tobacco use in the state among young people, that translates into smoking moms," said Debbie Carluccio, executive director of the Smoke-Free New Hampshire Alliance. "Young women keep thinking that they're going to quit, but they underestimate how addictive nicotine is." The good news is that New Hampshire's rate of teenage pregnancy has remained steady over the years and in 1999 and 2000 was by far the lowest in the country. In 2000, the rate was 23.3 births per 1,000 women between the ages of 15 and 19. Nationally, that rate was 48.5. Northern New England - New Hampshire in particular - has a record of having programs in place that provide a variety of confidential services to young people, according to Jennifer Frizzell, public affairs director of Planned Parenthood of Northern New England. The state has tended to respect a teenager's right to make decisions, Frizzell said, helping keep the pregnancy rate low. "New Hampshire has laws that allow medical providers to provide a wide range of services to minors without parental permission, such as STD testing and contraceptives," she said. "For a lot of young people, getting those tools goes a long way toward preparing them for how to handle sex with maturity." Also, she said, despite New Hampshire's conservative leanings, the strong anti-sex attitude toward health and sex education that you see in some areas of the country does not exist here. "You see many programs here take a strong role in educating about sexuality in a realistic way and not just teaching abstinence," said Frizzell. "Consistent with the slant that government is not better than educators or parents at addressing these topics, some schools in New Hampshire take a very strong approach in helping teens develop skills to help them negotiate these issues." For the years studied, New Hampshire was among the top five states with the highest percentage of women who got early prenatal care. In 2000, more than 90 percent of births in New Hampshire were to mothers who had prenatal care early on in their term, compared with 83.2 percent at the national level. The fact that so many of the state's pregnant women are seen by doctors makes the state's rate of pregnant smokers all the more frustrating to officials and doctors. "It's awful," said Doug Black, a longtime Concord obstetrician. "The new smokers are young teenage girls who start early and get addicted before they're pregnant. And pregnancy is a great motivation to give up smoking, but even so some of them can't do it. Most of them cut down. They do the best they can, but there's only so much you can do." In considering what more doctors may be able to do in the future, Smoke-Free New Hampshire has looked at developing guidelines that doctors could use to help pregnant women quit. Though every doctor will encourage a pregnant patient to quit, not all doctors may know which methods have been proven most effective, said Carluccio. "When mothers are accessing prenatal care frequently, there's an opportunity for intervention," said Carluccio. "Often the most effective way to help someone quit is for a doctor to really help connect them with some of the things that can help them quit. And moms who are smokers are by and large really motivated to quit. Many of them just need to have access to the resources and support to help them do it."

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