According to data from the Australian Institute of Health and Welfare (AIHW), four in ten pregnant Aboriginal and Torres Strait Islander women smoke (40%). This has reduced from 48% in 2012.

In 2021, AIHW found that the proportion of Aboriginal and Torres Strait Islander women who quit smoking after 20 weeks of pregnancy was 12%. We know that Aboriginal and Torres Strait Islander women have strong protective feelings for their unborn babies and a desire to quit in pregnancy and data from AIHW shows a high rate of quit attempts by pregnant Aboriginal and Torres Strait Islander women. However these quit attempts are often not sustained. Some evidence suggests that continued smoking is sometimes seen as a necessary response to stressful situations in life. Educating mums-to-be about how smoking increases stress rather than reduces it, and providing alternative strategies to manage stress is important. To find out more about strategies for people who are quitting smoking to manage stress read the Key facts about smoking and stress factsheet.

Emerging evidence also suggests that Aboriginal and Torres Strait Islander women are unable to sustain their quit attempts because of a lack of culturally appropriate support. They may also be encouraged to cut down rather than quit by health professionals. There is 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.

The community-led research program Which Way? is being conducted in response to a need for Indigenous-led evidence for smoking cessation care. The study is producing new evidence to inform best practice, privileging the voices and experiences of Aboriginal and Torres Strait Islander people, including during pregnancy.

Which Way? surveyed 428 Aboriginal and Torres Strait Islander women of reproductive age. The survey included women who smoke (63%) as well as those who used to smoke (37%). The survey found that:

• 90% had tried to quit smoking at some point
• 66% reported trying to cut down smoking in the past month
• only 36% of women had ever tried medications to quit smoking (e.g. NRT)
• medications to quit smoking were more likely to be used by women over the age of 35 and those living in major cities
• reasons for not using medications included preferring to quit without help and concerns about side effects
• quitting suddenly rather than gradually was more effective for staying smoke-free.

The study provides evidence that Aboriginal and Torres Strait Islander women want smoking cessation support that is:

• provided face-to-face at an Aboriginal health service by Aboriginal Health Workers
• group-based and holistic and
• online or via phone apps.

Which Way? has previously reported that smoke-free pregnancies were 4.54 times higher among women who used Aboriginal Health Services.

A survey of Aboriginal Health Workers/Practitioners conducted by the Which Way? team found that best practice smoking cessation support was more likely to be provided by practitioners who:

• had received smoking cessation training
• felt that smoking cessation care was part of their role
• were based in Aboriginal Community Controlled Health Services.

The team have co-developed a group-based model of care for Aboriginal Community Controlled Health Services that is being rolled out across New South Wales in 2024-2026. You can find out more about the project’s approach here. You can also keep up to date with the Which Way? project progress through their Facebook page and website.

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 family
• follow a systems approach, linking pregnant women in with other support that is available either from the community, such as Aboriginal Medical Services
• increase the capacity of maternity care professionals to deliver culturally appropriate and sensitively delivered information and advice about smoking and quitting in pregnancy.

iSISTAQUIT is designed to increase health service capacity by providing best practice training for individual level cessation support to health care workers who have contact with pregnant Aboriginal and Torres Strait Islander women. You can read more about iSISTAQUIT here or find them on Facebook, Twitter and Instagram. This short promotional video describes how iSISTAQUIT training and resources provides healthcare professionals (working in a clinical setting) with the skills to support Aboriginal and Torres Strait Islander women to have a smoke-free pregnancy.

Regional Grants do not fund TIS teams to offer nicotine replacement therapy (NRT) to pregnant women who smoke. 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 babies and children. If mothers are not ready to quit, then finding ways of avoiding smoking around their children, for example by keeping a smoke free car and home are important ways of improving child health. This will also encourage other family members not to smoke around the children. Having a smoke free home and car is also associated with sustained quitting, as it provides a supportive environment for all the family to stop smoking. For more information on this topic please see the section on reducing second-hand and third-hand smoke.

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

Resources

To find relevant resources, visit the Resources to support activities page and filter resources by ‘Pregnant women and families’.

Featured icon artwork by Frances Belle Parker: The HealthInfoNet commissioned Frances Parker, a proud Yaegl woman, mother and artist, to produce a suite of illustrated icons for use in our knowledge exchange products. Frances translates biomedical and statistically based information into culturally sensitive visual representations, to provide support to the Aboriginal and Torres Strait Islander workforce and those participating in research and working with Aboriginal and Torres Strait Islander people and their communities.