BACKGROUND: Community health workers (CHWs) play a critical role in strengthening maternal and child health (MCH) programmes at the grassroots level within India’s three-tier health system. According to the Global Adult Tobacco Survey 2 (India), 7.5% of pregnant women use tobacco. Limited knowledge and lack of access to cessation support perpetuates tobacco use during pregnancy.
METHODS: From May 2022 to April 2024, LifeFirst, an evidence-based tobacco cessation service, was integrated into a rural community-based MCH program across three Indian states. CHWs were trained to screen, offer brief advice, and provide tailored cessation support to pregnant women. A qualitative post-implementation evaluation was conducted in August 2024 to assess the feasibility, acceptability, and sustainability of the intervention. In-depth interviews were conducted with CHWs (n=23) till data saturation was attained. Thematic data analysis was conducted using the framework method.
RESULTS: CHWs initially normalized tobacco use among pregnant women. Training on cessation enabled them to understand the harms of tobacco use, particularly in the context of pregnancy and childbirth. Baseline screening and documentation helped CHWs establish rapport with pregnant women and provide personalized cessation guidance. CHWs confirmed the cessation service integrating seamlessly into their work routine within the MCH workflow. Monthly home visits to pregnant women proved critical for reduced tobacco use and abstinence. Since pregnant women reported abstinence post 3-6 months of receiving the intervention, CHWs expressed the need to extend the service to adolescent girls and newly married women for early prevention. While CHWs were highly motivated, financial incentives were highlighted as needed of cessation service delivery.
CONCLUSIONS: Integrating task-shifting strategies to empower CHWs to deliver culturally appropriate cessation support within the antenatal care setting can enhance access and outcomes, particularly in remote rural areas. Scaling up this model can strengthen maternal and child health outcomes while addressing the broader public health challenge of tobacco use.