Half of pregnant, lactating women in Bhubaneswar slums use smokeless tobacco on waking

Despite smokeless tobacco (SLT) consumption posing several adverse impacts on pregnancy and child health, 45% of pregnant women and 55% of lactating women in slums of Bhubaneswar reported consuming SLT immediately after waking up, says the Regional Medical Research Centre (RMRC) study.

The RMRC, an Indian Council of Medical Research (ICMR), found the alarming habit of SLT in a study that was recently released.

Researchers warn SLT use during pregnancy heightens the risks, like preterm births, stillbirth, babies with low birth weight, and small for gestational age.

The study conducted by senior RMRC scientists Subhendu Kumar Acharya and Anna Salomi Kerketta covered pregnant and lactating women aged 18–49 years in the slums.

They found key factors influencing SLT use were peer and family influence, stress relief, pregnancy-induced craving, curiosity, individual attitude and beliefs, to remaining engaged in work.

“The study finding shows long-term effects of SLT use among pregnant and lactating women. About 52.5% of participants started SLT use during their adolescence, and 57.5% had no formal education. For the enrolled pregnant women and lactating mothers, the mean age of SLT initiation was 14.95 years and 12.58 years, respectively, indicating a significantly longer history of tobacco consumption,” the study says.

“The SLT use continues to pose one of the most pressing but under-recognised threats to women’s health in India, particularly among vulnerable groups such as pregnant and lactating women. Unlike cigarette smoking, which carries visible stigma in many Indian communities, SLT consumption often remains hidden in plain sight. Paan, khaini and gutkha are part of everyday life, deeply woven into cultural practices, household routines, and even perceived health remedies,” researchers said.

The RMRC scientists had chosen SLT consumption among women as tobacco-related illnesses account for millions of preventable deaths each year.

“In India, where tobacco use is widespread and culturally embedded, women disproportionately use SLT rather than smoking products. Over 80% of female tobacco users in India consume smokeless tobacco,” it says.

The study, as reported by women in slums, says morning sickness, nausea, and gastric discomfort were often cited as triggers, with women believing SLT helped relieve symptoms. Besides, women perceived SLT as giving them energy or motivation to complete household chores and physical labour.

“Women view SLT as a remedy for toothache, gastric problems, headaches, and even pregnancy-related nausea. Homemade products are often considered natural and safer than packaged ones, despite similar risks,” the RMRC study says.

The study emphasised routine screening and counselling of women for awareness. According to the Bhubaneswar study, initiation often begins in adolescence, reinforced by social norms, stress, and misconceptions, and continues into critical phases of life such as pregnancy and lactation.

“The result is a vicious cycle of addiction and intergenerational harm, with severe consequences for maternal and child health. Breaking this cycle will require not only stricter policy enforcement but also community-centred, culturally sensitive approaches that challenge myths, empower women, and provide real alternatives,” it observes.