BACKGROUND: Tobacco use during pregnancy significantly increases risks of preterm birth, low birth weight, and developmental issues. Despite these risks, many pregnant women continue to use tobacco due to lack of awareness or access to cessation services.
METHODS: An implementation research study was conducted by LifeFirst to integrate tobacco cessation service into a maternal and child health programme implemented by a large non-governmental organisation. A pre-implementation evaluation was followed by development of a tailored intervention protocol including training and suitable communication material. Sakhis (community based frontline workers) were trained to screen for tobacco use during antenatal home visits, provide brief advice, and conduct follow-ups during routine monthly visits; upto six months postpartum. The intervention included education on harms of tobacco use quitting strategies and monitoring of tobacco consumption.
RESULTS: Out of 820 pregnant women enrolled in the MCH program during first trimester, 104 (13%) were identified as current tobacco users. 98 of them agreed to participate in a cessation program and were monitored for 12 months. 94% were using only smokeless tobacco, while the remaining were dual users. Sakhis conducted an average of 13 follow-ups. By the end of the intervention, 55% quit tobacco, 13% reduced usage, 27% showed no change, and 4% were lost to follow-up. Participants who quit required an average of six follow-up sessions, with 47% quitting before delivery. Normal delivery rates were higher among those who quit (78%) compared to those who did not (62%). Seven women reported spontaneous abortions, of whom five had reported no change in tobacco use at their last follow-up.
CONCLUSIONS: Integrating tobacco cessation into antenatal care is feasible and beneficial. These interventions leverage regular engagement with pregnant women during a critical period for health behaviour change.Community-based frontline workers are well-positioned to deliver culturally tailored advice and provide ongoing support, improving maternal and foetal outcomes.