According to data from the Australian Institute of Health and Welfare, almost half of all pregnant Aboriginal and Torres Strait Islander women smoke. 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. Despite strong protective attitudes for the unborn baby, continued smoking may be thought of as a necessary response to stressful situations in life. This suggests a need for greater knowledge and understanding of the problems which smoking in pregnancy can cause. The evidence shows that tailoring health promotion social marketing for Aboriginal and Torres Strait Islander pregnant women is more likely to support changes in attitudes and intention to quit for this group.
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.
Other activities to help pregnant Aboriginal and Torres Strait Islander smokers to quit (with or without NRT) include:
The New South Wales Quit for New Life program provides an example of how these activities might be combined (see Box 1). Once again a systems approach is recommended, linking the woman 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.
Box 1: The Quit for New Life program
This program is offered across all Aboriginal Maternal and Infant Health Services (AMIHS) in NSW that provide antenatal care for women having an Aboriginal baby. It combines a number of recommendations for supporting pregnant Aboriginal and Torres Strait Islander women to quit smoking including:
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, while a study in New Zealand has shown that financial and product based rewards can promote quitting in pregnant Maori women.
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.
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