S31 1 integrating tobacco control and maternal and child health to achieve the united nations millennium development goals- edouard tursan d'espaignet

MDGs, Tobacco and MCH | April 26, 2012 1 |

Integrating tobacco control and

maternal and child health to

achieve the UN Millennium

Development Goals


Presentation Outline

Connection of tobacco and MDGs

Impact of tobacco use on maternal health – Fecundity and fertility, impact of co-morbidities related to tobacco

Impact of tobacco use on child health – Preterm, LBW, IUGR, congenital malformations, SIDS, URI, Asthma

Tobacco use among adults and youth (prevalence) – Smoking and smokeless

– SHS exposure and gender disparities

Interventions based around Life cycle approach

WHO guidelines for management of tobacco use and SHS during pregnancy


UN Millennium Development Goals

Eradicate extreme poverty

and hunger

Achieve universal primary

education

Promote gender equality

and empower women

Reduce child

mortality

Improve maternal

health

Combat HIV/AIDS,

malaria and other diseases

Ensure environ- mental

sustain-ability


Reduce child mortality

Improve maternal

health


Maternal health: To reduce by three quarters the

maternal mortality ratio between 1990 and 2015

Child mortality: To reduce by two thirds the infant

and under-five mortality between 1990 and 2015

NCD HLM proposed global tobacco target: 40%

relative reduction in current tobacco smoking by

2025

MCH and Tobacco targets


Impact of Tobacco on Maternal and Child

health

Neonatal & Infant outcomes Maternal Outcomes

Preterm birth

Low birth weight

Congenital malformations

Sudden Infant Death

Syndrome

Infertility

Spontaneous abortion

Ectopic pregnancy

Placenta previa

Placental abruption

Premature rupture of

membranes

Smoking in the

preconception period and

during pregnancy

Stillbirth

Preterm birth

Low birth weight

Pre-eclampsia Using smokeless tobacco in

the preconception and

during pregnancy

Stillbirth

Lower birth weight

Respiratory problems Exposure to second hand

smoke during the

preconception period and

pregnancy


Advertising and Promoting targeting

women and girls

Tobacco industry spends billions of dollars worldwide

each year on advertising, promotion and sponsorship.

In the last 2 years, the industry has launched its most

aggressive marketing campaigns aimed at women and

girls in over a decade

October 2008: Purse packs -- small, rectangular cigarette

packs that come in mauve or teal and contain superslim

cigarettes.

Designed to look like popular clutch-style purses with pop-up

purse packs inside and coupons for over $5 off.

Targeting women of different cultures

Targeting young women


Prevalence of current cigarette smoking

among 13-15 year olds

Source: Global Youth Tobacco Survey, 2000- 2007


Prevalence of current use of smokeless and

other tobacco products among 13-15 year olds



Prevalence of adult tobacco smoking

Source: Global Adult Tobacco Survey, 2008–2010


Proportion of non-smoking adults exposed to

secondhand smoke, by WHO region - 2010


Prevalence of SHS exposure at home and

public places - 13-15 year olds


WHO Framework Convention

on Tobacco Control

Proposed action by WHO:

Development of guidelines for management

of tobacco use and second hand smoke

during pregnancy


Effective interventions and their delivery mechanisms

Existing delivery

mechanisms

Health interventions Tobacco use

Primary Health Care (PHC) facilities

and existing health care systems

Screening of women and girls for tobacco

use (smoking and smokeless tobacco) at all

clinical visits

Brief tobacco cessation advice

Referral to intensive behavioural counseling

services

Pharmacotherapy including Nicotine

Replacement Therapy (NRT) if available

Tobacco use (smoking

and smokeless) by

women


Effective interventions and their delivery mechanisms

Existing delivery

mechanisms

Health interventions Exposure to SHS

Primary Health Care (PHC) facilities

and existing health care systems

Screening for tobacco use (smoking tobacco)

at all clinical visits, both men and women

Provide information of dangers of second

hand smoking and its harmful effects on the

pregnant woman, unborn child and other

family members

Brief tobacco cessation advice for the

partners/husbands and others who smoke

Referral to intensive behavioral counseling

services

Pharmacotherapy including Nicotine

Replacement Therapy (NRT) if available for

the partners/husbands who smoke

Exposure to second hand

smoke


Antenatal Care Coverage – WHO regions


Antenatal Care Coverage

Antenatal care coverage - at least four visits (%). Source: WHOSIS, 29 Sep 2009

0

20

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80

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Antenatal care coverage - at least four visits (%). Data extracted from WHOSIS, 29 Sep 2009


SHS Exposure among Pregnant Women by Country

0

25

50

75

100

Dom

inican

Rep

ublic

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Niger

ia

Eth

iopia

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ya

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aine

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va

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ia

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one

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car

Aze

rbaijan

Nep

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Philip

ines

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glad

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India

Arm

enia

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or-L

este

Country

Percent

Women whose husband/partner attended at least one antenatal care visit


WHO Guidelines

TARGET: health care providers and health systems

stakeholders

AIM: Make evidence-based recommendations for:

– management of tobacco use during pregnancy

– prevention of second hand smoke exposure during pregnancy

TIMEFRAME:

Planned to be completed by end of 2012


WHO Guidelines

Invitation to a side meeting:

Date: 24 March 2012

Time: 14:00 – 16:00 hours (followed by coffee/tea)

Venue: Pan-Pacific Hotel, Singapore

2nd Floor, Meeting room Ocean 6.

7 Raffles Boulevard, Marina Square, Singapore


Thank you

Health & Medicine

S31 1 integrating tobacco control and maternal and child health to achieve the united nations millennium development goals- edouard tursan d'espaignet