A Novel Approach to Transforming Smoking Cessation Practice for Pregnant Aboriginal Women and Girls Living in the Pilbara

Abstract

Tobacco smoking during pregnancy contributes to a range of adverse perinatal outcomes; but is a potentially modifiable behavior. In Australia Aboriginal and Torres Strait Islander women face a range of barriers that hinder; rather than support smoking cessation. Few smoking cessation programs consider the broader social determinants of women’s lives; the gendered nature of these or the complexities which impinge on behavior change in the presence of social and economic disadvantage and substantial individual and intergenerational trauma. Drawing on the salient gender and trauma-informed literature this paper describes the rationale underpinning formative research which will inform the design of a localized, culturally meaningful smoking cessation program for Aboriginal women living in the Hedland and Western Desert communities of the remote Pilbara region of Western Australia. We contend that a women-centered, trauma-informed approach to smoking cessation has much to offer those seeking to address this critical public health issue

Improving Aboriginal Maternal Health by Strengthening Connection to Culture, Family and Community

“…As reported in an earlier paper, [ 5 ] the key aims of this project are to: (a) Explore the function of smoking in Aboriginal women’s lives, and specific contextual issues that influence their smoking such as trauma and violence, disadvantage, identity formation, social functions and stress; (b) Design and deliver a relevant, culturally meaningful smoking cessation program for women living in the Hedland and Western Desert communities in the Pilbara region of WA; (c) Address Aboriginal women’s smoking in an integrated and holistic manner, as part of the healthcare they receive before, during and after pregnancy, within a primary health care setting; and, (d) Enhance the evidence base on the effectiveness of a women-centred, trauma-informed approach to smoking cessation.…”

“…While there is recognition that Aboriginal women experience a range of adverse events including socioeconomic inequality and the ongoing traumatic effects of colonization, racism and the stolen generations [ 3 , 4 ], few studies have sought to address these factors when designing smoking cessation programs for young pregnant women and women of child bearing age. Moreover, few studies have considered the intersectionality of gender, trauma and culture in relation to Aboriginal women’s everyday lives [ 5 ]. Acknowledgement of the critical role of these complex interrelated factors in maintaining individual and family attitudes and behaviours towards smoking is what differentiates our project from others and is what makes it innovative.…”

“They Were Willing to Work with Me and Not Pressure Me”: A Qualitative Investigation into the Features of Value of a Smoking Cessation in Pregnancy Program for Aboriginal and Torres Strait Islander Women

“…Pregnant Indigenous women need to be supported in smoking cessation through intensive and multifactorial interventions that address the social and structural determinants of their health and wellbeing [1,17,20,21]. ESF is one of the few smoking cessation programs that has both applied this approach in culturally affirming ways and explored its merits through both quantitative and qualitative research [18,20,21]. Given the promising nature of the program in supporting positive smoking behavioral changes among its participants, the FOV identified in this study provide critical insights for how smoking cessation programs can support pregnant Indigenous women in safe, pragmatic and effective ways.…”

“…While social and structural barriers to Indigenous women's reduction or cessation of tobacco use during pregnancy are understood globally [4,8,12,15,17], few interventions have sought to address these in the Australian context [18]. Rather, smoking cessation initiatives have largely favored individualistic behavioral approaches [18,19].…”

“…While social and structural barriers to Indigenous women's reduction or cessation of tobacco use during pregnancy are understood globally [4,8,12,15,17], few interventions have sought to address these in the Australian context [18]. Rather, smoking cessation initiatives have largely favored individualistic behavioral approaches [18,19]. Failing to respond to the context of Aboriginal and Torres Strait Islander women's tobacco use limits program capacity to address barriers to smoking cessation, while risking further stigmatization of those who do smoke during pregnancy and compounding a deficit view of Indigenous peoples [1,2].…”