Background <p>Betel quid chewing is engrained with culture and common practice among rural women in Sri Lanka. This paper describes the patterns of use of betel quid and challenges in quitting for women attending a rural hospital in Sri Lanka.</p> Materials and methods <p>This mixed method study among women chewing betel quid, attending a rural hospital in Sri Lanka, consisted of an in-depth interviews with 11 participants followed by a survey of 30 additional participants. In-depth interviews were conducted until data saturation. Data were grouped into concepts and themes and used to illustrate the quantitative results and introduce any new ideas. The cross-sectional survey consisted of an interviewer administered questionnaire to a convenient sample on their chewing habit and using Betel Quid Dependence Scale (BQDS) to assess the dependency status of betel quid. BQDS has 16 items with a dichotomous outcome (No = 0 and Yes = 1) and the score ranges from 0 to 16. Survey data were used to calculate frequency, percentage and mean (SD) values and Fisher’s exact test was used in analysing BQDS data.</p> Results <p>All in the survey chewed betel quid with areca nut, but only a third added tobacco. None used other forms of smokeless tobacco. Most did not swallow the betel quid saliva but around half kept the quid for more than one hour in the mouth. The most frequent dependency characteristic using the Betel Quid Dependency Scale, was ‘increasing the amount periodically’. BQDS had a mean (SD) of 7.7(5.1). Some initiated chewing during pregnancy believing it had a medicinal value. Even with the physician’s advice and family support, they found it hard to quit.</p> Conclusion <p>There is a need for an extensive study among women betel chewers. The interventions in quitting should be targeted at pregnancy or when they were diagnosed with a chronic medical condition, in which case encounter of the individual with the health care system is more frequent.</p>