Determinants of initiation, continuation and cessation of smokeless tobacco among pregnant and lactating women: A qualitative study from low-income communities in urban India.

Smokeless tobacco (SLT) consumption increases risk of cardiovascular diseases, different cancers and leads to adverse reproductive health outcomes among women and new-borns. This study examines the factors associated with initiation, continuation and cessation of SLT use among women in the reproductive age so as to formulate and include prevention and cessation interventions from its inception. The study was conducted in the urban low-income communities in India. Using snowball and purposive sampling techniques, in-depth interviews were conducted with 20 pregnant and 22 lactating women who currently used SLT products. Data was analysed using thematic analysis with the help of QSR NVivo software. Findings revealed that factors such as people influencing usage, change with different life stages including pre-marital and post-marital periods. Perceived health benefits, altered taste preferences during pregnancy and social influences were also studied. Women were found to be more aware of the harmful effects of tobacco during pregnancy than during breastfeeding. Social stigma around women consuming tobacco acted as a major driving factor for cessation. Most of the participants were willing to quit, but were not aware of any technique or program for cessation. The findings of the study highlight the need to develop behavioural change intervention tools which are culturally and locally appropriate and have a gender sensitive approach. Different socio-cultural factors associated with initiation/cessation at different life stages should also be taken into consideration while developing these tools.