Document Type



Obstetrics and Gynaecology (East Africa)


Objectives: The objectives of our study were (1) to explore knowledge, beliefs and practice among mid-wives and gynecologists concerning a smoking cessation policy for pregnant women and their partners and (2) to examine if midwives and gynecologists do have a role in smoking cessation in pregnant women.

Method: We performed a qualitative study using semi-structured interviews with nine midwives and eight gynecologists. Data were analyzed using deductive content analysis, based on the 5 A’s frame-work (Ask–Advise–Assess–Assist–Arrange).

Results: The national smoking cessation policy seemed to be insufficiently known. “Ask” and “Advise" were part of a standard prenatal consultation, the next three steps were rarely implemented. Participants had a negative image of “the smoking pregnant woman”: a low educated woman with a smoking partner and “bad examples” in their history. Reported barriers were fear of provoking resistance and lack of time and communication skills regarding smoking cessation.

Conclusions: These findings suggest that training in communication skills and dealing with resistance should be offered, i.e. by using motivational interviewing. It could be considered that a trained midwife or tobaccologist is part of an obstetrical team or that the AAR-method (Ask–Advise–Refer) is used instead of the 5 A’s framework.


This work was published before the author joined Aga Khan University.

Publication (Name of Journal)

Sexual & Reproductive Healthcare