# How do family members influence smokeless tobacco consumption during pregnancy in India? Perspectives of pregnant women

## TL;DR

The study explores how family members and community health workers influence pregnant women's smokeless tobacco use in India, finding that social norms are shifting toward discouraging its use.

## Contribution

The study provides new insights into the evolving sociocultural dynamics and the role of community health workers in reducing smokeless tobacco use during pregnancy in India.

## Key findings

- Family members increasingly encourage pregnant women to stop using smokeless tobacco.
- Community health workers play a significant role in advising against smokeless tobacco use during pregnancy.
- Social norms around smokeless tobacco use during pregnancy are shifting toward discouragement.

## Abstract

Smokeless tobacco (ST) use in South Asia is culturally ingrained and socially accepted. A better understanding of these sociocultural influences could inform behavioural approaches to prevent ST use. We sought to understand how family members influence pregnant women’s behaviour, attitudes, and perceptions towards ST use. Moreover, we captured the influence of community health workers in this context. A qualitative study using a framework analysis was conducted in selected Indian populations. Eight in-depth interviews among pregnant and postpartum women were conducted in Gujarati, the local language, investigating ST use during pregnancy and the influence of family and peers. All transcripts were transcribed verbatim and translated into English and analyzed in NVivo. The social norms and expectations around ST during pregnancy appeared to have shifted away from promoting towards discouraging its use in the past few years. Women described how their spouses and other family members encouraged them to stop using ST during pregnancy, with some women must hide their ST use from their family members. They also received advice on the harms of ST use from community health workers (Accredited Social Health Activist–ASHA workers). Influenced by the advice received from such workers, several women tried to reduce their ST use during pregnancy. Our findings suggest that the acceptability of ST use in pregnancy may be in decline among families in India. Hence, efforts to promote ST prevention during pregnancy are likely to be “pushing against an open door”. Furthermore, community health workers appeared to play an influential role in supporting women to abstain from ST use during pregnancy.