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Australian Indigenous HealthBulletin Alcohol and other drugs knowledge centre Yarning Places

spacing1Key Facts

Preventing Aboriginal Maternal Smoking banner

Tobacco smoking in pregnancy

Smoking while pregnant is dangerous because the poisons in tobacco can be passed on to the baby [1]. Women who smoke when they are pregnant may have more problems during pregnancy and labour, and are at higher risk of:

Smoking in pregnancy also means the baby may:

Being born too early and too small can cause serious health, growth and development issues throughout the baby’s life, even into adulthood [13]. 

Smoking is one of the most important preventable risk factors for these complications in pregnancy and poor health outcomes for babies [4]. It is best if mothers can stop smoking before getting pregnant, but the earlier they stop during pregnancy the better. It is also better for pregnant women to try to avoid being around smokers altogether [1].

Passive smoking

Second hand smoke (or passive smoke) is also associated with a range of harmful health effects both for pregnant women (and their unborn babies) and for infants and children who are exposed to second hand smoke in their environments [5]. Emerging research is also pointing to the serious health risk of third hand smoke which includes pollutants from tobacco smoke that remain on surfaces and in dust, commonly in homes and cars, after active smoking has ceased [6]. Infants and children may be particularly vulnerable to the harmful effects of third hand smoke given their early developmental stage [6].

Of women who do quit smoking during pregnancy, approximately 80% relapse within one year [4]. One study exploring smoking knowledge and attitudes among Aboriginal women found they were unlikely to identify the health importance of a woman remaining a non-smoker after the birth of a child, and that cutting down only for the duration of a pregnancy was common [7]. Given the identified health risks of second and third hand smoke, addressing relapse and promoting smoke-free environments for infants and children is also a key priority area in addition to targeting smoking during pregnancy [5, 68]. 

When women are pregnant, it is a good time for intervention as they may be more likely to consider making changes such as quitting or reducing smoking, to ensure the healthy development of their baby [9]. As well as having positive health outcomes for the child, this can also have a longer-term preventative effect as children who live with non-smokers are less likely to commence smoking themselves [10].

Given that one of the most commonly identified factors contributing to smoking behaviours among pregnant Aboriginal women, new mothers, and the broader Aboriginal population, is stress [7, 11-13], addressing social factors that contribute to stress and high tobacco use among pregnant women and new mothers, and developing healthier strategies to deal with stress among women, their partners and family, may be effective targets for successful smoking prevention interventions within this population [13]. Strategies that offer alternative stress reduction and coping methods, including activities to keep smokers mentally and physically occupied have been highlighted as particularly important among Aboriginal people who smoke [7].

Smoking in the Aboriginal population

Studies have highlighted the ‘normalisation’ of smoking in Aboriginal populations and the complex issues that influence the health and wellbeing of Aboriginal people, as significant contributing factors to high rates of smoking [7]. Smoking among partners, family and friends, and the social obligations to exchange and share tobacco, pose significant barriers to cessation and prevention efforts, particularly when cessation may lead to isolation from social activities and exclusion from a group [7, 11, 14, 15].

Low levels of knowledge among Aboriginal women about the specific risks to the fetus as a result of smoking during pregnancy, and the high rates of relapse, may also contribute to persistent high rates of smoking among pregnant women [4, 7].

Therefore, tobacco prevention activities must include approaches that acknowledge and incorporate the socioeconomic determinants in people’s lives and the unique social and cultural contexts within which Aboriginal people live [15, 16].

Smoking in pregnancy statistics

Tobacco use among pregnant Aboriginal women in Western Australia (WA) is disproportionately high. In 2012, 48% of Aboriginal women in WA smoked during pregnancy; this was more than four times the rate of smoking in non-Aboriginal women during pregnancy (10%) [17]. In 2012, a higher proportion of Aboriginal women (40%) had one or more complications during pregnancy compared with non-Aboriginal women.

The proportions are similar at a national level with 48% of Aboriginal women smoking during pregnancy, and 11% of non-Aboriginal women smoking during pregnancy, in 2012 in Australia [18].

For a comprehensive overview of tobacco use among Aboriginal peoples and Torres Strait Islanders read Tobacco in Australia [2] (Chp 8).

For more information on tobacco and how it affects the body, access the tobacco chapter in the Handbook for Aboriginal alcohol and drug work [1].

Smoking prevention and cessation support

Pregnancy is an opportunistic intervention point as it is a time women may be more likely to make changes such as quitting or reducing smoking, to ensure the healthy development of their baby [9]. In general, guidelines recommend assessment of smoking status, with advice and support for smoking cessation, as a routine and integral part of antenatal care [19].

However, there is minimal evidence for effective approaches to supporting pregnant Aboriginal women to quit smoking [20]. Consequently, the current antenatal smoking cessation guidelines are not specific to Aboriginal women and therefore do not incorporate the socioeconomic and cultural determinants of smoking, and barriers to quitting, among this group [19].

This section provides information and links to resources that offer guides for supporting smoking prevention and cessation in pregnancy; however it is acknowledged that some of these guidelines are mainstream resources.

Refer to: Management of smoking in pregnant women in the Australian Family Physician, which reviews the evidence for best practice intervention by general practitioners. It includes information on guidelines for the use of Nicotine Replacement Therapy in pregnancy [21].

Refer to: Chapter 3.2 Tobacco, in the National Clinical Guidelines for the Management of Drug Use During Pregnancy, Birth and Early Development Years of the Newborn [22].

View article: A Pragmatic Guide for Smoking Cessation Counselling and the Initiation of Nicotine Replacement Therapy for Pregnant Aboriginal and Torres Strait Islander Smokers [23].

Refer to: pages 113 - 117 in the Handbook for Aboriginal Alcohol and Drug Work that describes how to help a client tackle their smoking [1]. 

Further key points on best practice strategies for smoking prevention and cessation interventions with pregnant Aboriginal women, new mothers and their families are outlined below.

This portal specifically focuses on tobacco smoking in pregnancy and does not included dedicated information on cannabis. Information on cannabis is available from the Australian Indigenous HealthInfoNet AOD Knowledge Centre.


Further reading

Pregnancy and maternal health:

Includes spontaneous abortion, ectopic pregnancy, complications of pregnancy, and preterm delivery.

Refer to: Tobacco in Australia. Chapter 3.7: Pregnancy and smoking [2].

Fetal development and infant health:

Includes birthweight, respiratory health, stillbirth, sudden infant death syndrome (SIDS), birth defects, health issues in infancy, long-term development, and breastfeeding and smoking.

Refer to: Tobacco in Australia. Chapter 3.8: Child health and maternal smoking before and after birth [2].

Second hand smoke: pregnancy and infants

Includes fertility, low birthweight and preterm delivery, lung development in the unborn child, spontaneous abortion (miscarriage) and stillbirth, birth defects, and cardiovascular effects.

Refer to: Tobacco in Australia. Chapter 4.11: Second hand smoke and pregnancy [2].

Health effects of second hand smoke for infants and children

Refer to: Tobacco in Australia. Chapter 4.9: Health effects of second hand smoke for infants and children [2].

For non-clinical health workers who may be exploring smoking prevention projects and strategies, there are also a range of general guides on best practice for health programs in Aboriginal communities which are available through the health promotion resources list for this topic.

Health planning/promotion tools

Refer to: A best practice model for health promotion programs in Aboriginal communities [25].

Making two worlds work: using a health promotion framework with an ‘Aboriginal lens' [26].

Appropriate health promotion for Australian Aboriginal and Torres Strait Islander communities: crucial for closing the gap [27].

Integrated health promotion: A better way to health [28].



1.            Lee K, Freeburn B, Ella S, Miller W, Perry J, Conigrave K (2012) Handbook for Aboriginal alcohol and drug work. Sydney: University of Sydney

2.            Scollo MM, Winstanley MH (2012) Tobacco in Australia: facts and issues (4th ed.). Retrieved 2012 from

3.            Lumley J, Chamberlain C, Dowswell T, Oliver S, Oakley L, Watson L (2009) Interventions for promoting smoking cessation during pregnancy. Cochrane Database of Systematic Reviews.

4.            Passey ME, Sanson-Fisher RW, Stirling JM (2014) Supporting pregnant Aboriginal and Torres Strait Islander women to quit smoking: views of antenatal care providers and pregnant Indigenous women. Maternal and Child Health Journal;18(10):2293-2299

5.            Cancer Council Western Australia (2015) Make Smoking History: smoking around others. Retrieved 2015 from

6.            Hang B, Sarker AH, Havel C, Saha S, Hazra TK, Schick S, Jacob P, Rehan VK, Chenna A, Sharan D, Sleiman M, Destaillats H, Gundel LA (2013) Thirdhand smoke causes DNA damage in human cells. Mutagenesis;28(4):381-391

7.            Wood L, France K, Hunt K, Eades S, Slack-Smith L (2008) Indigenous women and smoking during pregnancy: knowledge, cultural contexts and barriers to cessation. Social Science & Medicine;66(11):2378-2389

8.            Von Kohorn I, Nguyen SN, Schulman-Green D, Colson ER (2012) A qualitative study of postpartum mothers' intention to smoke. Birth;39(1):65-69

9.            Bull L, Whitehead E (2006) Smoking cessation intervention with pregnant women and new parents: a survey of health visitors, midwives and practice nurses. Journal of Neonatal Nursing;12(6):209-215

10.          Australian Government (2014) Pregnancy and quitting. Retrieved 24 December 2014 from

11.          Gilligan C, Sanson-Fisher RW, D’Este C, Eades S, Wenitong M (2009) Knowledge and attitudes regarding smoking during pregnancy among Aboriginal and Torres Strait Islander women. Medical Journal of Australia;190(10):557-561

12.          DiGiacomo M, Davidson PM, Davison J, Moore L, Abbott P (2007) Stressful life events, resources, and access: key considerations in quitting smoking at an Aboriginal Medical Service. Australian and New Zealand Journal of Public Health;31(2):174-176

13.          Hauck Y, Ronchi F, Lourey B, Lewis L (2013) Challenges and enablers to smoking cessation for young pregnant Australian women: a qualitative study. Birth;40(3):202-208

14.          Briggs D, Lindorff K, Ivers R (2003) Aboriginal and Torres Strait Islander Australians and tobacco. Tobacco Control;12(supplement):ii5-ii8

15.          Cancer Council NSW (2008) Clearing the smoke: best practice smoking cessation strategies for people with multiple disadvantages. Sydney: Cancer Council NSW

16.          Burns J, Burrow S, Drew N, Elwell M, Gray C, Harford-Mills M, Hoareau J, Lynch R, MacRae A, O’Hara T, Potter C, Ride K, Trzesinski A (2015) Overview of Australian Indigenous health status, 2014. Perth, WA: Australian Indigenous HealthInfoNet

17.          Hutchinson M (2015) Western Australia's mothers and babies, 2012: 30th annual report of the Western Australian Midwifes' Notification System. (Statistical series number 100) Perth: Department of Health, Western Australia

18.          Hilder L, Zhichao Z, Parker M, Jahan S, Chambers GM (2014) Australia’s mothers and babies 2012. (AIHW Catalogue no PER 69, perinatal statistics series no 30) Canberra: Australian Institute of Health and Welfare

19.          Passey M, Sanson-Fisher RW (2015) Provision of antenatal smoking cessation support: a survey with pregnant Aboriginal and Torres Strait Islander women. Nicotine & Tobacco Research;Advance Access(

20.          Passey ME, Bryant J, Hall AE, Sanson-Fisher RW (2013) How will we close the gap in smoking rates for pregnant Indigenous women? Medical Journal of Australia;199(1):39-41

21.          Mendelsohn C, Gould GS, Oncken C (2014) Management of smoking in pregnant women. Australian Family Physician;43(1):46-51

22.          New South Wales Department of Health (2006) National clinical guidelines for the management of drug use during pregnancy, birth and the early development years of the newborn. Sydney: New South Wales Department of Health

23.          Gould GS, Bittoun R, Clarke MJ (2014) A pragmatic guide for smoking cessation counselling and the initiation of nicotine replacement therapy for pregnant Aboriginal and Torres Strait Islander smokers. Journal of Smoking Cessation;first view(

24.          Goldade K, Nichter M, Nichter M, Adrian S, Tesler L, Muramoto M (2008) Breastfeeding and smoking among low-income women: results of a longitudinal qualitative study. Birth;35(3):230-240

25.          Office of Aboriginal Health (2000) A best practice model for health promotion programs in Aboriginal communities: based on the Formative Evaluation of the Kuwinyuwardu Aboriginal Resource Unit Gascoyne Healthy Lifestyle Program written by Royden James Howie [brochure]. Office of Aboriginal Health, Department of Health

26.          Mungabareena Aboriginal Corporation, Women's Health Goulburn North East (2008) Making two worlds work: building the capacity of the health and community sector to work effectively and respectfully with our Aboriginal community. Wodonga, Vic.: Mungabareena Aboriginal Corporation and Women's Health Goulburn North East

27.          Demaio A, Drysdale M, de Courten M (2012) Appropriate health promotion for Australian Aboriginal and Torres Strait Islander communities: crucial for closing the gap. Global Health Promotion;19(2):58-62

28.          Victorian Government Department of Health (2005) Integrated health promotion: a better way to better health. Melbourne: Victorian Government Department of Health


Last updated: 25 March 2017
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