Perceived Effects of Second-hand Smoke on a Pregnant Woman: A Phenomenological Study

INTRODUCTION:

Different forms of tobacco such as cigarettes, water pipe, chewing paan, gutka and naswar are used in Pakistan. According to Global Adult Tobacco Survey (2014), overall prevalence of tobacco use in Pakistan is 19.1% (23.9 million adults). 7 out of 10 adults and 5 out of 10 children are exposed to second hand smoke in indoor workplace and at home. Second hand smoke (SHS) is strongly associated with exposure of non-smoking pregnant women to various toxicants which can harm the fetus and post partum harm infants and children. Effects of second-hand smoking during pregnancy include low birth weight, sudden infant death, acute and chronic respiratory symptoms, asthma and ear infection . In South and Southeast Asia, women have a higher rate of exposure to SHS than men whereby they are exposed in different places disproportionality, such as public transportation (62%), restaurants (56%) and at workplace (37%). In LMICs, smoking inside the home is unrestricted and pregnant women are adversely affected by exposure to SHS which increases the risk of stillbirth and congenital malformation. It is, therefore, important to avert negative consequences of pregnancies that are exposed to second-hand smoke.

BACKGROUND:

Previously researchers have tried to explore societal and cultural aspects of indoor smoking and exposure to SHS and attributed gender inequality and gendered power dynamics to women's failure to negotiate smoke-free homes. Additionally, several interventions have been found to be effective in changing smoking-related behavior, however, most do not provide think description of interventions to ascertain their theoretical basis. Therefore, examining the phenomenon of second-hand smoke with an in-depth understanding of social and cultural factors may help in describing smoking- and anti-smoking related behavior through qualitative exploration. Findings of this pioneering qualitative work can be utilized for designing an effective reduction strategy for tobacco use which can act as a conceptual framework for behavior change to reduce or eliminate the effects of second-hand smoke on pregnant women.

More than 40% of all pregnant women in Pakistan are exposed to second-hand smoke - causing approximately 17,000 still births in a year. In Pakistan only 1% of still births are attributed to women actively smoking during pregnancy, but for second-hand smoke the figure is 7%, largely due to the high numbers of pregnant women exposed to tobacco smoke in the home. Negative effects of Second-hand smoking (SHS) on maternal and fetal health are well established. In LMICs smoking inside the house is largely unrestricted adversely affecting pregnant women by exposure to SHS. SHS exposure in non-smoking pregnant women has increased the risk of stillbirth and congenital malformation along with behavioral and cognitive issues in children. Partner's support during pregnancy is important for developing a better maternal health. Therefore, a phenomenological research approach is appropriate for describing the essence of experience in terms of affective and emotional aspects. Phenomenology is an approach of creating phenomenological knowledge in a situation by describing implicit meaning of experience. The investigators therefore propose an epistemological approach of phenomenology.