Mercy Chingwe (35) is a Zimbabwean woman from Harare, the capital city. She is pregnant and is expecting her first child. She is however struggling with a smoking addiction and fears continued exposure to tobacco smoke could harm her unborn child.
Despite numerous attempts by her family and friends including spiritual intervention at some point forcing her to quit, she has always found herself back on the cancer sticks. She is really worried about her failure to quit smoking.
"I have cut down on the number of cigarettes I take per day," she says. "I used to smoke 20 cigarettes per day but I have reduced to 15. I hope it works. I however find myself craving for cigarettes more than I used to. It's unusual and it's not easy for me. I hope I quit before I deliver."
It was her first time during this interview that Mercy heard of smoking alternatives or nicotine products used to assist those who wish to quit or reduce the smoking-related harm.
Zimbabwe has tight restrictions around alternative nicotine products and according to the Global State of Harm Reduction (GSHR), there is no specific law regarding e-cigarettes in Zimbabwe. However, SNUS is banned. It is also illegal to sell or market Heated Tobacco Products (HTP) in Zimbabwe and so is it illegal to sell or market nicotine for Nicotine Replacement Therapy (NRT). Advertising NRT is allowed and NRT is available in Pharmacy.
The GSHR estimates the smoking prevalence in Zimbabwe to be at 753,835 current smokers with 9.1 percent of the smokers belonging to the adult population. 18.8 percent of men in Zimbabwe are currently smokers and 0.8 percent are women. 8372 people die each year due to tobacco smoking and Zimbabwe has one of the highest tobacco-related death rates in female smokers according to the 7th edition of the Tobacco Atlas Report which puts the tobacco-related death rate at 4.3 percent annually.
Many smokers are in Mercy's predicament and they struggle to quit due to the addictive nature of nicotine. Nicotine is the addictive drug in tobacco that causes people who smoke to continue to smoke. However, science has since provided evidence that most health issues related to smoking are not caused by nicotine but by smoking combustible cigarettes. Science has proven that nicotine does not cause cancer.
According to data, 53 percent of women who smoke daily continue to smoke daily during pregnancy and despite wanting to stop smoking, they encounter barriers such as continued smoking among social networks, lack of access to quit-smoking services, emotional stress (e.g. intimate partner violence), and pregnancy-related depression.
Dr. Michael Kariuki, a consultant paediatrician, and founder member of the Harm Reduction Society of Kenya said switching pregnant women to alternative nicotine products may improve their health outcomes compared to those who continue smoking.
"Increased metabolism of nicotine during pregnancy may not allow smoking cessation to be achieved in all pregnant women who smoke. Some experts have suggested the use of e-cigarettes to reduce smoking-related harm in pregnant women. For example, the UK Stop Smoking Services do not discourage the use of e-cigarettes during pregnancy and promote them as a safer alternative to smoking tobacco. This is in line with Cochrane reviews that show that e-cigarettes may help in quitting smoking. More research is needed," said Dr. Kariuki.
He however said experts were still divided on whether or not to recommend e-cigarettes to pregnant women on the basis that they may do less harm.
"Potential THR strategies for pregnant women who smoke include supplementation with antioxidants, vitamins such as vitamin C and E are often depleted in smokers owing to reduced intake and higher levels of free radicals in the blood circulation of a smoker.
"There is some evidence from randomized clinical trials suggesting that vitamin C, vitamin E, and omega-3 supplementation in pregnant women who smoke may reduce morbidities such as impaired lung function and low birth weight in offspring, placental abruption, and preterm births. Nutritional supplementation has been shown to work through epigenetic pathways – behaviours and environment can cause changes that affect the way your genes work."
Many smokers including Mercy believe that cutting down on the number of cigarettes smoked per day may reduce the harm to their health and that of the unborn child. However, Dr. Kariuki believes such acts have little effect.
"Some may suggest smoking reduction. Cutting down the number of cigarettes smoked does not reduce most of the risks to the mother and the unborn child. Drastic reduction or complete cessation in cigarette consumption may improve some birth outcomes – risk of compensatory smoking."
Studies from the general population show that smoking reduction can be a step toward quitting for some smokers. However, for some pregnant women, smoking reduction may act as a barrier to accepting NRT for cessation, thus diminishing the chances of complete abstinence.
Data shows that smoking during pregnancy increases the risk of miscarriage, stillbirth and premature birth. The unborn child is also at risk as it results in weaker lungs, low birth weight which is associated with an increased risk of heart disease, high blood pressure, and diabetes in adulthood. There is also an increased risk of cleft palate and cleft lip and an increased risk of attention deficit hyperactivity disorder (ADHD)
In babies, tobacco smoke exposure increases asthma prevalence and severity. The effects of tobacco smoke exposure on the risk of asthma start in utero. Tobacco smoke exposure increases the severity of bronchiolitis. Tobacco smoke exposure increases the risk for and severity of other respiratory illnesses.
Passive smoking (exposure of the non-smoking mother to second-hand smoke) can also harm the fetus and there is an increased risk of ear infections, respiratory illnesses such as pneumonia and bronchitis, sudden unexpected death in infancy (SUDI) and meningococcal disease.
People who smoke inhale about 7,000 other chemicals in cigarette smoke. Many of these chemicals come from burning tobacco leaves. Some of these compounds are chemically active and trigger profound and damaging changes in the body. Tobacco smoke contains over 70 known cancer-causing chemicals. Smoking harms nearly every organ in the body, causing many diseases and reducing health in general.
