Pregnant women and families

According to data from the Australian Institute of Health and Welfare (AIHW), less than half of all pregnant Aboriginal and Torres Strait Islander women smoke (44%). This has reduced from 52% in 2009.

In 2018, AIHW found that the proportion of Aboriginal and Torres Strait Islander women who quit smoking after 20 weeks of pregnancy was 10%. 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.

Evidence that is emerging from the community-led Which Way? Smoking Cessation Study shows that:

  • Only 36% of women had ever tried medications to quit smoking
  • 64% of women who want to quit smoking want the support of an Aboriginal Health Worker
  • 66% of Aboriginal and Torres Strait Islander women reported trying to cut down smoking in the past month.

This study is a response to Aboriginal and Torres Strait Islander women’s stated need for non-pharmaceutical quit support when pregnant. Which Way? is co-developing an Indigenous-led evidence base for a smoking cessation intervention to support Aboriginal and Torres Strait Islander mothers to be smoke-free during pregnancy and beyond by exploring:

  • Aboriginal and Torres Strait Islander women’s preferences for cessation support
  • what non-pharmacological approaches are already being used in communities
  • healthcare provider attitudes and beliefs about non-pharmaceutical approaches to quit support.

The team will then co-develop and pilot a cessation intervention based on this evidence. 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.

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.

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 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 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’.

In February 2020, the Indigenous Smoking and Pregnancy Roundtable was held in Canberra, ACT and was chaired by National Coordinator, Professor Tom Calma AO. The meeting brought together an invited group of 35 academic researchers and service providers to consider current needs and future directions for addressing smoking in pregnancy for Aboriginal and Torres Strait Islander mothers. Participants included representatives from a number of Regional Tobacco Control Grant recipient organisations. You can view the presentations and summary report on the Pregnancy Roundtable 2020 page.

Further reading

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.