Exploring gutka consumption: Healthcare risks on maternal and child health in Karachi, Pakistan

Abstract

‘Do you know why we eat gutka so much?’ A woman from a low-income neighborhood in Karachi asks the doctor at Aga Khan University Hospital which operates antenatal clinics (ANC) near such neighborhoods. When the doctor hesitates, she explains, ‘So we don't feel hunger’. [1].

In Karachi, a city of over 20.4 million residents, a troubling trend is emerging among its most vulnerable populations. Some pregnant women in the city's impoverished slums are consuming gutka, a form of smokeless tobacco, to cope with hunger. This desperate measure, driven by harsh economic realities, poses severe risks to both maternal and fetal health.

A cross-sectional survey conducted in Orangi Town, an urban squatter settlement in Karachi, from 1 July 2012 to 31 December 2012, found that 42.25% of women used smokeless tobacco, with 53.82% of households having at least one member using tobacco in some form [2]. Because poverty and economic conditions have worsened since the survey, it can be inferred that the prevalence of smokeless tobacco use among women living in slum areas may have also increased. High tobacco use among women is driven by cultural norms, stress, lack of health education and aggressive marketing by tobacco companies. Misconceptions about its safety, affordability and its use for morning sickness amplify its prevalence [3]. The acceptability of smokeless tobacco is worsened by poverty, leading many expecting mothers to addiction.

Correlational evidence links gutka consumption during pregnancy with higher rates of premature birth, stillbirth, low birth weight and birth defects like cleft lip [4]. A study at a tertiary care hospital found that 70% of 90 pregnant women addicted to gutka had anemia, with 55.5% experiencing moderate cases [5]. Postnatally, the Centers for Disease Control and Prevention notes that tobacco use during breastfeeding can transfer harmful chemicals to the infant and disrupt milk production because of nicotine's interference with prolactin release [6].

Government efforts to curb smokeless tobacco use in Pakistan face significant challenges because of weak legislation and enforcement. The Tobacco Vendor Act of 1958 and the Cigarette (Printing of Warning) Ordinance of 1979 are undermined by inconsistent enforcement and minimal penalties. The Cigarette (Printing of Warning) Ordinance fails to adequately address smokeless tobacco products, allowing companies to exploit gaps with misleading warnings. Additionally, the Prohibition of Smoking and Protection of Non-Smokers Health Ordinance of 2002 and related regulations are often circumvented through inconspicuous warnings and appealing packaging [7].

India has implemented higher taxes on smokeless tobacco (at a GST rate of 28%) to discourage consumption. This underscores the crucial role of government intervention in supporting expectant mothers. Ensuring access to nutritious food for them can reduce the economic pressures driving many to rely on gutka. Stricter regulations on gutka sales and increased taxes on these products are needed to deter consumption. Additionally, targeted educational campaigns funded by the government can raise awareness about the risks of gutka use during pregnancy [8].

Momina Khabir: Conceptualization (lead), writing—original draft (lead), and writing—review and editing.

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