Background:
A formative study was conducted at governmental antenatal clinics serving low-income women in Mumbai, India to measure the association of tobacco use with iron deficiency anemia, consumption of iron-rich foods and household food insecurity; and to identify opportunities to integrate tobacco cessation services with existing antenatal care for iron deficiency and anemia control.

Methods:
We administered a structured questionnaire to a sample of 100 pregnant patients at 5 governmental antenatal care clinics that serve low-income communities. Blood tests were done for serum cotinine, hemoglobin and ferritin. We also conducted 10 key informant interviews with physicians and auxiliary nurse midwives, and 5 focus group discussions with community health workers to better understand the services offered during antenatal clinic and home visits.

Results:
Blood test revealed that 16%, 72% and 41% of women used tobacco, were anemic and had iron deficiency anemia (IDA), respectively. Tobacco use was independently associated with IDA (OR=14.3; 95%CI=2.6, 77.9). Tobacco use and IDA were not associated with household food insecurity. Clinics had a system for screening and follow-up care for anemia and iron-deficiency, but not for tobacco use. Antenatal care providers were interested in including services to screen for tobacco use and provide cessation guidance. Patients wanted help to quit.

Conclusions:
It may be worthwhile to assess the feasibility of integrating tobacco use screening and cessation services with antenatal services for anemia and iron deficiency at governmental clinics serving low-income populations in India.