Since 2018, the Greater Manchester Smokefree Pregnancy Programme has transformed maternity care across the region, reducing smoking at delivery from 13% to 5.9% and supporting more than 7,000 additional babies to be born smokefree. Through early intervention, universal carbon monoxide screening, specialist midwifery-led stop smoking support, and a new digital platform that streamlines care, the programme has created a consistent, evidence-based model now adopted nationally. This coordinated approach demonstrates how system-wide collaboration, behavioural support and tailored interventions can deliver measurable public health impact for families and future generations.