Improving the quality of tobacco and alcohol cessation services for pregnant women
Alcohol and tobacco use during pregnancy poses serious risks to the health and welfare of mothers and unborn babies. Preterm birth, developmental disabilities such as fetal alcohol syndrome, mental and growth retardation, low birth weight, and asthma and sudden infant death are some of the effects that drinking and smoking while pregnant have on babies. Through the USAID ASSIST Project, we’re working in Ukraine jointly with the Ministry of Health to improve reproductive health services at the primary health care level by working specifically to decrease alcohol and tobacco use by pregnant women, to improve health outcomes for mothers and babies.
A new guide recently released by the Centers for Disease Control and Prevention, Planning and Implementing Screening and Brief Intervention for Risky Alcohol Use: A Step-by-Step Guide for Primary Care Practices, provides new resources and a 10-step guide to help primary care staff implement alcohol screening and brief intervention (SBI). The resource is intended to be relevant for a large audience of alcohol users, and it includes a focus on the risks for women who are or might become pregnant, and the early detection mechanisms that providers can use to identify such risks.
While mild alcohol consumption is not harmful for healthy and non-dependent adults, any alcohol consumption by a woman who is pregnant or may become pregnant puts herself and her child at risk for many harmful fetal alcohol spectrum disorders (FASDs), which are completely preventable. In Ukraine, recent estimates in two regions of the country put the proportion of pregnant adolescent girls and women who reported consuming alcohol while pregnant at 46.3%. Additionally, research shows that 2.4 million girls and women (15+ years) are estimated to smoke cigarettes in Ukraine, yet less than half of smokers who had visited a health care provider were asked if they smoked. Additionally, public surveys suggest that counseling on reduction of alcohol use and smoking cessation during pregnancy is insufficient.
One of the ways we’re working to improve the quality of tobacco and alcohol cessation services in Ukraine is by supporting providers to incorporate brief physician interventions (BPIs) into routine practices and by developing evidence-based guidelines for nationwide implementation of BPI. BPIs are short, physician-led counseling sessions aimed at relaying the risks associated with alcohol and tobacco use and are based on the 5 A’s: Ask about alcohol and tobacco use, advise patient to quit, assess willingness to quit, assist in quitting, and arrange follow-up.
In early July, we conducted a training of trainers on an evidence-based BPI for tobacco and alcohol cessation in Poltava, Ukraine. We were excited to welcome two US experts to participate in the training: Prof. Richard Windsor, who specializes in BPI related to tobacco and Ass. Prof. Tatiana Balachova, who specializes in BPI related to alcohol. Twelve trainers, all gynecologist and obstetricians from national and local health care facilities participated in theoretical and practical training sessions which focused on how to prevent and halt alcohol and tobacco consumption among pregnant women and women and girls of reproductive age in Ukraine. The training was a huge success. Participants engaged in role playing and I observed an improvement in the knowledge and attitudes of the participants. In August, trained doctors will train members of improvement teams in pilot policlinics in BPI methodology before implementation begins. The overall number of planned doctors to be trained for BPI is 90 primary health care providers.