Exploring the adequacy of smoking cessation support for pregnant and postpartum women

Abstract

BackgroundSmoking in pregnancy exemplifies the relationship between tobacco use and health inequalities. While difficulty reaching and engaging this population in cessation support is often highlighted in the literature, there is limited research that explores the factors that shape the provision and use of support by this subpopulation. Using Ontario, Canada, as a case study, this study examines how the use of cessation support by women is encouraged or discouraged by cessation policy, programming and practice; how geographical and sociocultural factors influence provision and uptake of support; and how barriers and challenges can be addressed through a comprehensive approach.MethodsSemi-structured, in-depth interviews with key informants (31) and pregnant or postpartum women (29) were conducted to examine the cessation needs of this subpopulation, barriers to the provision and uptake of cessation support and directions for policy, service provision and programming.ResultsKey barriers included: the absence of a provincial cessation strategy and funding, capacity and engagement/accessibility issues. Geographical features presented additional challenges to provision/uptake, as did the absence of resources tailored to Aboriginal women and adolescents. Key informants recommended a comprehensive cessation strategy to facilitate coordination of cessation resources provincially and locally and elucidated the need for capacity building within tobacco control and within reproductive, child and maternal health. Participants also highlighted the need to further develop tobacco control policies and target the social determinants of health through poverty reduction, housing and education support. The provision of incentives, transportation, childcare and meals/snacks; adoption of woman-centred, harm-reduction and stigma reduction approaches; and promotion of programs through a variety of local venues were recommended by participants to address engagement and accessibility issues.ConclusionsThe current cessation system in Ontario is not equipped to adequately reduce smoking among pregnant and postpartum women. A comprehensive, multi-sector strategy designed to provide tailored and sustainable support through different system entry points is needed. A cultural shift in practice is also necessary to eliminate mixed messaging, strengthen practice and encourage open channels of communication about smoking between women and their providers. The study highlights the need to address smoking among women in a more holistic manner and for capacity building strategies that focus on strengthening providers’ competency and confidence in practice. Future research should explore: capacity building strategies, especially among rural and remote communities; the smoking and cessation experiences of different subpopulations of pregnant and postpartum women; the effectiveness of tailored strategies; and interventions that address smoking among partners and other family members.

Canadian Indigenous Womens Perspectives of Maternal Health and Health Care Services: A Systematic Review

“…Pregnant and postpartum women who were current or former smokers had received inconsistent information; they were unsure whether smoking cessation during pregnancy was safe or stressful to the fetus and whether pregnant women were eligible for nicotine replacement therapy 64 . HCPs and women being investigated by CPS reported inconsistent policies and limited supportive services available to assist a mother in retaining custody of her child; several women had their children apprehended by CPS despite completing parenting programmes at the request of CPS 59,65 .…”

“…"I think it is very limited…sort of a patchwork of strategies that are loosely weaved together." Key informant discussing the uncoordinated nature of smoking cessation resource 64 .…”

“…;seven articles on experiences of birthing and maternal healthcare [57][58][59][60][61][62][63] ; and eight articles that presented data relevant to both categories [64][65][66][67][68] (Table 1). These articles were further classified by the primary area of research described in the study: eight articles on maternal healthcare and/or medical evacuation [65][66][67][68] ; three articles on the impact of policies on maternal health [59][60][61][62][63] ; three articles on gestational diabetes mellitus (GDM) 61,62 ; and two articles on maternal weight changes and/or breastfeeding [66][67][68] .…”

Barriers and facilitators to smoking cessation in pregnancy and in the post‐partum period: The health care professionals’ perspective

“…For example, previous research has suggested that the type of team a midwife works in (community/integrated vs. hospital/clinic) is far more important in determining smoking cessation referral behaviour than the cessation training received or length of time they have worked as a midwife (Beenstock et al ., 2012). A further perceived barrier to addressing prenatal smoking is lacking a cohesive and coordinated interorganizational strategy and the funding to implement it (Borland, Babayan, Irfan, & Schwartz, 2013). A lack of service protocols to implement cessation interventions has also been highlighted as an inhibiter of support access (Colomar et al ., 2015).…”

Identification of Behavioral Risk Factors During Pregnancy

“…Alcohol consumption in pregnancy, besides the fact that threatens maternal health, affects the embryo growth and development [5], with possible damage on organogenesis. Brain and central nervous system damage, the occurrence of congenital malformations in the fetus, can also be consequences of exposure to the toxic action of alcohol during intrauterine life.…”