Implementing a Tobacco Cessation Program for Pregnant Women in an Antenatal Care Setting: A Mixed Methods Study

Abstract

Background: Tobacco use during pregnancy has deleterious effects on the woman and child. Many pregnant women make quit attempts but few are successful. Antenatal Care (ANC) services create an opportunity to identify tobacco users and provide cessation services. The aim of the study was to assess the feasibility of implementing LifeFirst tobacco cessation services for pregnant women attending ANC clinic. Methods: We used mixed methods study design. All pregnant women attending ANC services during one year were screened verbally for tobacco use. Current tobacco users (last 30 days) registered voluntarily for LifeFirst and a detailed first session was conducted. Telephonic follow-up sessions were conducted over six months. An in-depth interview was conducted with the counselor to identify the influencing factors. Results: Of the 1431 pregnant women screened, 41 were current tobacco users (40 used smokeless) and all enrolled for the service. 56% of them were highly dependent (Fagerstrom score) and 35(85%) had never made a quit attempt. At the end of the intervention, 48% were lost to follow-up mostly due to change in contact phone numbers. All the remaining women self-reported that they had stopped using tobacco. ANC clinic setting and a female counsellor were considered as facilitators. Loss to follow-up, non-implementation of guidelines to screen and offer brief advice and the resultant late tobacco use screening acted as barriers. Social myths added to these complications. Conclusion: Integration of tobacco cessation with ANC services is feasible. Creating awareness about ill-effects of tobacco during pregnancy and providing cessation support is required. Integration through trainings will provide additional benefit.