Implementing a Tobacco Cessation Program for Pregnant Women in an Antenatal Care Setting: A Mixed Methods Study

Abstract

Background: Tobacco use during pregnancy has deleterious effects on the woman and child. Many pregnant women make quit attempts but few are successful. Antenatal Care (ANC) services create an opportunity to identify tobacco users and provide cessation services. The aim of the study was to assess the feasibility of implementing LifeFirst tobacco cessation services for pregnant women attending ANC clinic. Methods: We used mixed methods study design. All pregnant women attending ANC services during one year were screened verbally for tobacco use. Current tobacco users (last 30 days) registered voluntarily for LifeFirst and a detailed first session was conducted. Telephonic follow-up sessions were conducted over six months. An in-depth interview was conducted with the counselor to identify the influencing factors. Results: Of the 1431 pregnant women screened, 41 were current tobacco users (40 used smokeless) and all enrolled for the service. 56% of them were highly dependent (Fagerstrom score) and 35(85%) had never made a quit attempt. At the end of the intervention, 48% were lost to follow-up mostly due to change in contact phone numbers. All the remaining women self-reported that they had stopped using tobacco. ANC clinic setting and a female counsellor were considered as facilitators. Loss to follow-up, non-implementation of guidelines to screen and offer brief advice and the resultant late tobacco use screening acted as barriers. Social myths added to these complications. Conclusion: Integration of tobacco cessation with ANC services is feasible. Creating awareness about ill-effects of tobacco during pregnancy and providing cessation support is required. Integration through trainings will provide additional benefit.

Tobacco exposure among antenatal women in India: Challenges in tobacco screening & cessation counselling

“…Some women initiate tobacco use during their pregnancy due to craving, to relieve stress and anxiety related to pregnancy or to suppress vomiting during pregnancy 6 . Others believe that it relieves ‘labour pain’ and body pain and strengthens teeth during pregnancy 5 7 14 . One study reported that women use tobacco because they believe that it relieves gastric problems and body pain, suppresses hunger, eases stress, relieves tooth ache and is customary to use in special family functions such as weddings and after eating non-vegetarian meals.…”

“…In a study based in an antenatal care setting, an interview with a tobacco cessation counsellor revealed that the women who attended counselling sessions provided either the wrong contact number or that of their spouses’, which made it difficult to establish effective contacts for further follow ups and telephonic counselling. Some even hid their tobacco habits from other family members and did not want to be contacted at home, thereby leading to high attrition rates from counselling sessions 7 .…”

“…Although pregnant tobacco users were ‘highly interested in receiving cessation services’, these could not be provided because the clinics lacked a system to provide cessation services, thus leading to a ‘missed opportunity’ 10 . Another study reported ‘insufficient human resources’ as one of the main challenges in screening and identification of pregnant tobacco users at antenatal clinics 7 .…”

“…In the foetus, it can cause neurologic and neurodevelopmental defects and increase the chances of pre-term birth, congenital anomalies, low birth weight, and stillbirth. Tobacco is also known to be associated with sudden infant death syndrome and respiratory diseases in newborns and has long-term effects throughout the life such as type 2 diabetes, cognitive disorders, behavioural disorders, obesity and hypertension in offspring 1 2 7–9 .…”

“…The essential antenatal care package consists of tetanus toxoid injections, iron–folic acid (IFA) supplementations, at least four antenatal visits throughout pregnancy, regular blood, urine tests, ultrasonographies, recording blood pressure and weight at every visit beginning from the first trimester onwards 11 . These frequent antenatal visits provide a unique opportunity to be screened and advised for tobacco cessation 7 , apart from addressing anaemia and other nutritional problems.…”