THE traditional use of chewing tobacco as a morning sickness remedy may damage the health of thousands of Cambodian newborns every year, a new World Health Organisation (WHO) study warns.

“Tobacco use among adults in Cambodia: Evidence for a tobacco epidemic among women,” published in the December 2009 bulletin of the WHO, examined tobacco use habits among 7,858 Cambodian women, mostly from rural areas, making it the largest survey of its kind undertaken in the country. The report estimated that more than 560,000 Cambodian women chew tobacco, with the percentage of users increasing with age.

“About one out of five rural women who used chewing tobacco started their habit for relief from morning sickness. The highest prevalence of chewing tobacco among women was seen among midwives (67.9 percent) and among traditional healers (47.2 percent),” it read.

Tobacco is mostly chewed with betel nut, a substance used across Asia for its stimulant, analgesic and deworming properties. This age-old combination’s social and medicinal uses, however, do not extend to pregnancy. Among populations with little formal education, the high incidence of tobacco and betel use among midwives and traditional healers can often obscure this fact.

The report states that, “In addition to the wide-ranging effects of fetal tobacco syndrome, emerging data suggests that the use of areca [betel] nut among pregnant mothers results in increased infant mortality.”

Dr Niklas Danielsson, specialist in child and adolescent health at the WHO in Cambodia, said “the babies of smoking mothers are born smaller” than those of nonsmokers, exposing them to further risks. Chewing tobacco poses the same danger to fetal health. When tobacco is chewed as opposed to smoked, Danielsson said, blood nicotine levels are higher.

The report also questions that Cambodia’s current anti-tobacco initiatives are equipped to confront this problem.

Dr Susan Mercado, WHO’s tobacco control adviser for the Western-Pacific region, was quoted by The Associated Press as calling for programmes to target specific kinds of tobacco use, and pointing out that second-hand smoke is not the only tobacco-related threat faced by women.

The report follows an October request by the Ministry of Health to significantly scale back its Millenium Development Goal target for reducing the number of women who die during childbirth, from 140 deaths per 100,000 live births to 250 deaths per 100,000 live births. The Kingdom’s current maternal mortality rate stands at 461.