Mothers and babies

According to data from the Australian Institute of Health and Welfare (AIHW), almost half of all pregnant Aboriginal and Torres Strait Islander women smoke (44%). Smoking in pregnancy can be supported/encouraged by people’s expectations about what is considered ‘normal’ behaviour, as well as family influences.

Quitting is seen as a difficult thing to do. In 2017, AIHW found that the proportion of Aboriginal and Torres Strait Islander women who quit smoking after 20 weeks of pregnancy was 12%. Despite strong protective feelings for the unborn baby and a desire to quit in pregnancy, continued smoking is sometimes seen as a necessary response to stressful situations in life. There is also evidence that women’s interest in quitting is hindered by:

  • the attitudes of maternity care professionals
  • poorly communicated information about quitting in pregnancy
  • a lack of culturally sensitive support.

Overall, pregnancy can be a missed opportunity for smoking behaviour change. The evidence shows that effective population health promotion should:

  • tailor health promotion materials such as social marketing for Aboriginal and Torres Strait Islander pregnant women
  • use strong positive female role models from within the community
  • encourage a smoke-free home and car environment that is healthier for the baby
  • follow a systems approach, linking pregnant women in with other support that is available either from the community, Aboriginal Medical Services, or even social media such as the Quit for you – quit for two mobile device app
  • increase the capacity of maternity care professionals to deliver culturally appropriate and sensitively delivered information and advice about smoking and quitting in pregnancy.

One of the TIS Program elements iSISTAQUIT is designed to increase health service capacity by providing best practice training to health care workers who have contact with pregnant Aboriginal and Torres Strait Islander women. You can read more about iSISTAQUIT here.

Regional Grants do not fund TIS teams to offer nicotine replacement therapy (NRT) to smokers. However, it is important that TIS workers have up-to-date knowledge of the individual level cessation supports available to pregnant women, as these can inform population health promotion activities (e.g. community knowledge building). While NRT does not always result in smoking cessation by pregnant women, using NRT rather than smoking while pregnant is better for the baby because it removes the other dangerous toxins contained in tobacco smoke. Antenatal smoking guidelines, Management of smoking in pregnant women recommend that pregnant women should first try to quit using counselling and support. If this does not work, then the woman should be offered oral short-acting forms of NRT (lozenge or mouth spray). If this is not effective, smoking cessation treatment may progress to nicotine patches, or if necessary combined therapy (i.e. patches plus oral forms). NRT must only be used in pregnancy under the supervision of a suitably qualified health professional. Other stop smoking medicines (varenicline and bupropion) are not safe to use in pregnancy.

During pregnancy, vaping (using e-cigarettes) that contain nicotine should be discouraged. The emerging evidence suggests this is at least as harmful for the baby as smoking conventional cigarettes.

A recent study in Australia has also demonstrated the acceptability of rewards or incentives to encourage pregnant Aboriginal and Torres Strait Islander women to quit or reduce their smoking.

Smoke-free homes and cars

Second-hand and third-hand smoke are health risk factors, particularly for children. If mothers are not ready to quit, then finding ways of avoiding smoking around their children, such as in the car or at home are important ways of improving child health. For more information on this topic please see the section on reducing second-hand and third-hand smoke.

You can find further information in the video and factsheet produced by NBPU TIS which can be downloaded here.

Further reading