JOIN USAccording to Global Adult Tobacco Survey (GATS) 2009-10, two out of 10 women in India above the age of 15 years are tobacco users. This translates to approximately 78 million women, out of which 64 million women use tobacco daily. The GATS survey also revealed that about 89% of adult females believe smoking causes serious illness. This means that while there is high awareness, more public health effort is needed to ensure that smoking or use of tobacco during pregnancy is eliminated.
Another study on the consumption of tobacco in 187 countries revealed that India now has the highest number of female smokers after the United States.
On the occasion of World No Tobacco Day, let us focus on the increase in tobacco use among pregnant women and the multiple dangers this poses to their unborn babies. Besides, there is the risk of infertility which is also linked to tobacco consumption.
Smoking is, perhaps, the most dangerous method of using tobacco. Cigarette smoke contains over 4,000 chemicals including carcinogenic compounds and other toxins, exposure to which can be life-threatening to the foetus, causing birth complications such as stillbirth, premature delivery and extremely low birth weight. It can also result in foetal stunting, delayed lung development, congenital heart defects, and respiratory problems such as asthma.
Centres for Disease Control and Prevention (CDC) warns that smoking during and after pregnancy is a risk factor of Sudden Infant Death Syndrome (SIDS). Prenatal exposure to smoking is also associated with disruptive behavioural disorders in children including Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD).
India is party to the WHO Framework Convention on Tobacco Control (WHO FCTC), an international treaty developed in response to the global tobacco epidemic. It contains provisions to reduce tobacco usage by raising taxes, limiting lobbying by the tobacco industry, implementing addiction and cessation programmes and raising public awareness about the consequences of smoking.
The treaty requires all countries to regularly collect national data on the magnitude, patterns, determinants and consequences of tobacco use and exposure. India’s 2014 report does not indicate whether the country has implemented any education, communication, training and public awareness programmes targeted specifically at pregnant women.
Most of the existing anti-tobacco messaging focuses on smoking. But in India, tobacco is also consumed in smokeless forms like chewing. A 2015 study on the use of smokeless tobacco by Indian women between 18-40 years during pregnancy and reproductive years found that once women become daily tobacco users, their tobacco consumption goes up gradually and they continue to use the same amount of tobacco during pregnancy. This study also revealed that women started using tobacco during pregnancy because it was said to counter the weakening of teeth and gums that occurs during pregnancy.
We need to provide support to women who want to quit, increase taxes on all tobacco products for general discouragement and implement interventions, specifically to prevent young boys and girls from starting to use tobacco.
When it comes to raising taxes and prices, we need to target all forms of tobacco currently available in the market to prevent users from switching from one form to the other. Since the prevalence of tobacco use amongst women is higher in rural areas, community health workers such as the ASHAs and Anganwadi workers in villages need to be trained to increase knowledge on the dangers of pregnant women using tobacco.
The GATS survey indicates that 63% of adults have accessed anti-tobacco information throu-gh radio or television. However, there is not much information available on the dangers of tobacco if used during pregnancy.
Many women do not know that they should quit at least a month before they begin trying to conceive. They are unaware about the side-effects of exposure to secondhand smoke, they are unclear on the impact of smoking on the foetus and unsure whether it is safe to breastfeed if they are smokers.
We need to use all the comm-unication tools at our disposal in a compelling manner to fill the knowledge gaps, educate both women and men about the risks that their unborn babies face through exposure to tobacco.
(The writer is a neonatologist and Chairman, Cloudnine Hospital, Bengaluru)