Tobacco and alcohol use among lactating women and its association with child nutrition in India: findings from National Family Health Survey 2019-2021

Objectives: Tobacco use is one of the greatest public health problems in the world. Prevalence of alcohol and tobacco use among lactating women ranged between 35.9-83.0% and 1.4-6.1%, respectively, in various parts of the world. Both alcohol and nicotine pass quickly into breast milk. The objective of this study is to estimate the prevalence of alcohol and tobacco use in lactating women and its association with having underweight, stunted, and wasted nursing children in India. The study also draws comparisons to identify the common associated socio-economic factors for alcohol and tobacco use among lactating women and having underweight, stunted, and/or wasted children.

Study design: A cross-sectional analytical study involving secondary data from the National Family Health Survey-5.

Methods: A cross-sectional analytical study involving secondary data from the National Family Health Survey-5 conducted nationally in community settings in two phases during 2019-2021. Alcohol and tobacco use among lactating women was self-reported, and the nutritional status of children was assess anthropometrically during the survey and categorised into under-weight, stunted, and wasted as per standardised growth charts.

Results: prevalence of tobacco use among currently lactating mothers in India was 3.24%. Prevalence of alcohol use among currently lactating mothers was 0.57%. Nursing children of mothers consuming alcohol had significantly higher odds of being wasted [OR = 1.44; (95% CI = 1.07-1.92)]. Richer wealth index {compared to poor, poorer [OR = 0.74; (95% CI = 0.59-0.91)], rich [OR = 0.64; (95% CI = 0.50-0.84)], richer [OR = 0.46; (95% CI = 0.33-0.65)], richest [OR = 0.19; (95% CI = 0.11-0.33)]}, higher education status {compared to illiterate, secondary education [OR = 0.79; (95% CI = 0.63-0.97)], higher education [OR = 0.38; (95% CI = 0.24-0.62)]}, and non-tribal ethnicity [OR = 0.40; (95% CI = 0.33-0.50)] were found to be significantly associated with lower odds of alcohol and tobacco use among lactating mothers. Age, religion, residence, and occupation were also found to be significantly associated.

Conclusions: Lactating women with lower education status or belonging to lower income groups needs to be prioritised for further qualitative assessment of alcohol and tobacco use during lactation. Our study reflects the national and state-level prevalence of alcohol and tobacco use among lactating women, which often masks the local and community-level intricacies. There is a need to further explore local and community-level factors affecting alcohol use during lactation and its association with child nutrition.