Tobacco Use Among 1 310 716 Women of Reproductive age (15–49 Years) in 42 Low- and Middle-Income Countries: Secondary Data Analysis From the 2010-2016 Demographic and Health Surveys

Abstract

Introduction Tobacco use among women, especially during pregnancy is a public health concern. There is a need to understand the diverse nature of their tobacco consumption across the globe. Methods We used Demographic and Health Surveys (DHS) data collected between 2010 and 2016 from 42 low- and middle-income countries (LMICs) to estimate the prevalence of smoking, smokeless tobacco, and dual use among pregnant and non-pregnant women of reproductive age (15–49 y). We compared tobacco use between both groups adjusted for age, type of residence, education and combined wealth index, and a subgroup analysis for the South-East Asia Region (SEAR) as the tobacco use in SEAR among women is far more diverse than in other regions primarily due to the popularity of smokeless tobacco use in this region. Results Based on the data of 1 310 716 women in 42 LMICs, the prevalence of smoking was 0.69%(95%CI: 0.51–0.90) among pregnant women and 1.09%(95%CI: 0.81–1.42) among non-pregnant women. The prevalence of smokeless tobacco use was 0.56%(95%CI: 0.33–0.84) among pregnant women and 0.78%(95%CI: 0.35–1.37) among non-pregnant women. The relative risk ratios(RRR) for smoking (0.85; 95%CI: 0.67–1.09) and smokeless tobacco use (0.81; 95%CI:0.67–1.00) were not-significantly lower among pregnant women than non-pregnant women and education and wealth index had an inverse relationship with both forms of tobacco. In SEAR, among pregnant women, the prevalence of smoking and smokeless tobacco use was 1.81% and 0.45%, respectively. However, pregnant women were 7%(RRR 1.07; 95%CI:1.02–1.12) more likely to use smokeless tobacco than non-pregnant women. Conclusion Despite the added risk of foetal harm during pregnancy, there is no evidence that the tobacco consumption between pregnant and non-pregnant women differ in 42 LMICs. A significantly higher use of smokeless tobacco among pregnant women in SEAR is of particular concern and warrants further investigation. Implications Tobacco use among women in low- and middle-income countries (LMICs) is lower than high-income countries (HICs), but this may be because LMICs are earlier in the epidemiological transition of tobacco use. If ignored as a public health issue and the tobacco industry continues to market its products to women, the level of tobacco use may rise as it did in HICs. Also, despite low prevalence rates and with no evidence that these differ among pregnant and non-pregnant women, is concerning as tobacco consumption in any form during pregnancy is associated with poor birth outcomes. This suggests a need for raising awareness about the harms of tobacco use among women in LMICs, especially during pregnancy. There is a need to develop preventive and cessation interventions to decrease tobacco use (smoking and smokeless) among women who are from low socio-economic status and less educated, as they bear the greatest burden of tobacco use.

Prevalence of smoking and smokeless tobacco use during breastfeeding: A cross-sectional secondary data analysis based on 0.32 million sample women in 78 low-income and middle-income countries

“…It suggests that tobacco use among women during postpartum is higher than during pregnancy in LMICs. 3 , 5 Much higher prevalence estimates of tobacco during pregnancy have been reported from population-based studies in high-income countries, including the USA (6.7%) 18 and the UK (10.6%). 19 The highest prevalence of tobacco use among breastfeeding women was in the Southeast Asia region, while the lowest was in the European region.…”

“…In another study using DHS data for 42 LMICs for 2010-2016, the prevalence of smoking and smokeless tobacco use among non-pregnant women was estimated at 1.1% (95% CI 0.8–1.4) and 0.8% (0.4–1.4), respectively. 5 Studies report that many women quit tobacco during pregnancy, but a large proportion resume during the postpartum period, often to the level of their preconception tobacco use, 6 however stoppage of tobacco use during pregnancy in LMICs is not universal.…”

Sex and macroeconomic differences and trends in early attempts at cigarette smoking among adolescents: findings from 147 countries

“…This suggests a need to raise awareness about early attempts at cigarette smoking and the need for developing intervention programs to reduce the early initiation of tobacco use in girls from a low level of national economic development. Unfortunately, the prevalence of cigarette smoking has increased along with increasing country income among girls aged 13–15 years [ 22 ] and women aged 15–49 years [ 42 ]. This indicates major issues in reducing the high prevalence of cigarette smoking in high-income countries and highlights how to prevent the early initiation of cigarette smoking in low-income countries.…”

Toxic effects of smokeless tobacco on female reproductive health: A review

“…A recent secondary data analysis by Shukla et al (2021) on tobacco use by women showed concerning numbers regarding the prevalence of ST during pregnancy, especially in South-east Asia Region. Since the period from conception up to two years of age in children, i.e., the first 1000 days of life provide a critical stage of development and linear growth, external factors can influence the health conditions of both mother and developing fetus ( Quelhas et al, 2018 ).…”