Isolation, marginalisation and disempowerment – understanding how interactions with health providers can influence smoking cessation in pregnancy

Abstract

Background Maternal smoking during pregnancy can lead to serious adverse health outcomes for both women and their infants. While smoking in pregnancy has declined over time, it remains consistently higher in women with lower socioeconomic circumstances. Furthermore, fewer women in this group will successfully quit during pregnancy. Aim This study explores the barriers to smoking cessation experienced by socially disadvantaged pregnant women and investigates how interactions with health providers can influence their smoking cessation journey. Methods Women (either pregnant or birthed in the previous 10 years, who smoked or quit smoking in pregnancy) were recruited from a metropolitan public hospital antenatal clinic in South Australia and community organisations in surrounding suburbs. Seventeen women participated in qualitative semi-structured small focus groups or interviews. The focus groups and interviews were recorded, transcribed and thematically analysed. Findings Four interconnected themes were identified: 1) smoking embedded in women’s challenging lives and pregnancies, 2) cyclic isolation and marginalisation, 3) feeling disempowered, and 4) autonomy and self-determination. Themes 3 and 4 are characterised as being two sides of a single coin in that they coexist simultaneously and are inseparable. A key finding is a strong unanimous desire for smoking cessation in pregnancy but women felt they did not have the necessary support from health providers or confidence and self-efficacy to be successful. Conclusion Women would like improvements to antenatal care that increase health practitioners’ understanding of the social and contextual healthcare barriers faced by women who smoke in pregnancy. They seek improved interventions from health providers to make informed choices about smoking cessation and would like women-centred care. Women feel that with greater support, more options for cessation strategies and consistency and encouragement from health providers they could be more successful at antenatal smoking cessation. If such changes were made, then South Australian practice could align more with best practice international guidelines for addressing smoking cessation in pregnancy, and potentially improve outcomes for women and their children.

Prenatal tobacco smoke exposure and risk for cognitive delays in infants born very premature

“…Several studies indicate that concern about the effects of smoking on their baby’s health and the desire to quit smoking to protect their unborn child may serve as facilitators to help pregnant women quit smoking 43 , 44 . However, some pregnant mothers report being unclear about whether smoking is truly harmful to their babies 45 , 46 . Although there is little research related to prenatal TSE and long-term neurodevelopmental outcomes in children who were born preterm, one study of preterm infants born at < 32 weeks GA found poor motor and cognitive outcomes at 2 years corrected age in those who were exposed to prenatal TSE compared to those with no prenatal TSE 47 .…”

Provision of E-Cigarettes for Smoking Cessation in Pregnancy: Perceptions and Experiences of Pregnant Women from Two UK Sites

“…NRT are recommended and endorsed as part of standard practice in the UK. However, pregnant women have identified the need for greater options and support for smoking cessation strategies [11]. Rates of smoking in pregnancy are also higher among people with more socioeconomic disadvantage [12], yet evidence suggests that women from lower socioeconomic backgrounds might benefit less from interventions currently available [13].…”