Prevalence of smoking and smokeless tobacco use during breastfeeding: A cross-sectional secondary data analysis based on 0.32 million sample women in 78 low-income and middle-income countries

Abstract

Background: Smoking and smokeless tobacco use during the postpartum period is well studied in high-income countries, whereas low-income and middle-income countries (LMICs) lack evidence.

Methods: In this cross-sectional study we used data from the Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) conducted in 78 LMICs between January 2010 and December 2019 to study tobacco use among 0.32 million sample lactating women. Age-standardized prevalence of smoking and smokeless tobacco use was estimated and presented with a 95% Confidence Interval (CI) for 78 LMICs. Pooled estimates overall and by WHO regions were obtained using random-effects meta-analyses. Country-level and community-level variance to understand contextual factors was also quantified using multilevel modelling.

Findings: Pooled prevalence of any tobacco use among breastfeeding women in LMICs was 3.61% (95% CI 3.53-3.70); with the lowest prevalence in regions of the Americas (1.44%, 1.26-1.63) and the highest in the Southeast Asia region (6.13%, 6.0-6.27). The pooled prevalence of tobacco smoking was reported to be 1.16% (1.11-1.21), with the highest prevalence in the Eastern Mediterranean region (4.27%, 3.88-4.67) and the lowest in the African region (0.81%, 0.76-0.86). The pooled prevalence of smokeless tobacco use was reported to be 2.56% (2.49-2.63), with the highest prevalence in the Southeast Asia region (4.92%, 4.80-5.04). Illiterate and poor women in LMICs bore the enormous burden of tobacco use.

Interpretation: The prevalence of smoking and smokeless tobacco use among lactating women in LMICs varied considerably across different WHO regions. Considering the cross-sectional design of the study, caution is required while interpreting the results. To improve mothers' and children's health and nutrition outcomes and reduce health inequalities in LMICs, reducing tobacco use through evidence-based interventions is critical.

Funding: None.

Keywords: Breastfeeding; Lactating women; Low-income and middle-income countries; Smokeless tobacco; Smoking; WHO FCTC.

Figure 1

Flowchart of samples included in this study. LMIC = Low-income and middle-income countries; DHS = Demographic and Health Survey; MICS = Multiple Indicator Cluster Survey; SLT = smokeless tobacco.

Figure 2

Prevalence (%) of tobacco use among breastfeeding women in 78 countries. Circles are the prevalence estimates and the horizontal bars show 95% CIs. The prevalence of smoking is shown in blue colour, the prevalence of smokeless tobacco use is shown in orange colour and the prevalence of any form of tobacco is shown in brown colour. SM = smoking; SLT = smokeless tobacco use; AT = any tobacco use; CAR = Central African Republic; CDR = Congo Democratic Republic; SA = South Africa; STP = São Tomé and Príncipe.