Culturally safe smoking cessation for Indigenous pregnant women

Pregnancy is a time when many women reconsider tobacco, yet stopping can be difficult when nicotine dependence is strong and daily life is stressful. Smoking during pregnancy raises the risk of miscarriage, stillbirth, preterm birth, low birth weight and sudden infant death. Australian maternity services therefore have a clear role in offering timely, non-judgmental cessation support, including to women who have tried to quit before.

A culturally safe smoking cessation program for Indigenous pregnant women should treat quitting as a health priority while respecting autonomy, culture and lived experience. It should recognise that nicotine dependence develops amid stress, housing insecurity, financial pressure, family smoking and previous encounters with institutional care. Aboriginal and Torres Strait Islander women are not a single group; local community knowledge must guide how support is offered, who delivers it and what a good outcome looks like.

Address dependence without stigma

National Australian data continue to show higher rates of smoking during pregnancy among Aboriginal and Torres Strait Islander women than among non-Indigenous women. Smoking is also more common in some disadvantaged areas, where access to treatment, suitable housing and paid employment may be limited. Responding to these differences requires practical support rather than blame, shame or a belief that motivation alone can overcome dependence.

Cultural safety goes beyond treating everyone identically. It requires examining power, racism, communication and the effects of clinical decisions on a woman and her family. Aboriginal and Torres Strait Islander cultural authorities also warn against conflating commercial tobacco use with ceremonial practices. Tobacco-free policies affecting shared spaces should therefore be developed with local representatives rather than imposed through a one-size-fits-all rule.

Care should be voluntary, trauma-informed and flexible. Clinicians can explore the woman’s goals, previous quit attempts and preferred sources of support without demanding immediate abstinence. Relapse is a common part of nicotine dependence and should prompt renewed assistance, not disciplinary action or withdrawal of care.

Build the program with community authority

A credible program begins with Aboriginal community-controlled health services, local Aboriginal health workers and women with lived experience. Community representatives should have a genuine role in governance, service design, staff selection and evaluation. Yarning circles, individual conversations and other locally preferred formats can create space to discuss smoking without making it the only topic on the agenda.

Queensland initiatives can use Brisbane Diamantina Health Partners to connect universities, research institutes and health services around this work. Such partnerships can provide epidemiological expertise, clinical pathways and evaluation capacity while leaving cultural authority with communities. They should avoid reproducing research relationships in which universities define the priorities and communities are consulted only after decisions have been made.

Access differs across Brisbane, regional centres and remote Queensland communities. A program relying on digital appointments or travel to specialist clinics will exclude some women. Outreach, community-based clinics, telephone follow-up and partnerships with regional primary care and telehealth services are more equitable. Travel, childcare, interpreter needs and the time required for several appointments must be considered when support is planned.

Deliver support through connected care

The pathway should begin in accessible antenatal care, where midwives and Aboriginal health workers can ask about tobacco use sensitively and offer support at every visit. Medicare-funded primary and public maternity services can provide continuity when the same team follows a woman through pregnancy, birth and postnatal care. A warm referral to a familiar local provider is likely to be more effective than a generic referral to a distant cessation service.

Brief advice alone may be insufficient for moderate or severe nicotine dependence. Clinicians can offer behavioural counseling, motivational interviewing, a quit plan and relapse-management strategies. The national 13 QUIT service provides telephone and web support, while pharmacists can supply nicotine replacement therapy. During pregnancy, medication decisions should be discussed with the treating clinician and supported by close follow-up. Vaping exposes the developing fetus to nicotine and should not be presented as a harmless alternative.

Workforce development should include cultural safety, nicotine dependence, trauma-informed care and the effects of racism on clinical engagement. Ongoing supervision and reflective practice are essential because a one-off workshop cannot prepare staff for complex situations. Workforce learning can combine local cultural supervision with professional education resources, while service data and consumer feedback identify the gaps that require further training.

Include families, markets and measures

Family members can influence quit attempts, so services should offer voluntary support for partners and relatives who smoke. A smoke-free home plan may include practical measures such as nicotine replacement, agreed household strategies and support for families living in crowded housing. It should also consider stress, mental health and financial concerns rather than assuming that a woman controls every exposure in her environment.

Long-term engagement should be reciprocal and community-led. The account of five returns to Nepal illustrates how repeated participation can build trust and sustain relationships. The lesson for smoking cessation is that communities should shape the work and retain a voice in how results are used.

Tobacco is sold through convenience stores and service stations in Brisbane and across Australia, while online sales create another channel for people aged eighteen and over. Nicotine replacement products offer a different market through pharmacies. Programs can address this environment by combining product access with counseling, smoke-free support and attention to affordability. Evaluation should track quit attempts, abstinence and relapse alongside trust, service accessibility, cultural safety and the quality of relationships.

Fund a shared commitment

Universities can support co-design and evaluation; health services can embed cessation into antenatal and postnatal care; and funders can finance Aboriginal workforce positions, community governance, transport and flexible delivery. Clear agreements should define ownership of data, the reporting of outcomes and how communities will be involved in decisions about publication and service change.

Commit now to one maternity catchment with Aboriginal clinical and community leadership. Fund the partnership, establish a culturally safe referral pathway and publish the first six-month findings with community approval. Make that commitment through Brisbane Diamantina Health Partners and build a smoking cessation service that women can trust and use on their own terms.