Academic journal article Bulletin of the World Health Organization

Women and Tobacco: Moving from Policy to Action

Academic journal article Bulletin of the World Health Organization

Women and Tobacco: Moving from Policy to Action

Article excerpt

Voir page 898 le resume en francais. En la pagina 898 figura un resumen en espanol.


The focus of the WHO International Conference on Tobacco and Health, which was held in Kobe, Japan, on 14-18 November 1999, was "making a difference to tobacco and health: avoiding the tobacco epidemic in women and youth" (1). At this conference, scientists, representatives from governments and nongovernmental organizations (NGOs), as well as tobacco control activists called for a global effort to prevent a rising epidemic of tobacco use among women and youth. The Kobe Declaration stated: "There are already over 200 million women smokers, and tobacco companies have launched aggressive campaigns to recruit women and girls worldwide. By the year 2025, the number of women smokers is expected to almost triple ... It is urgent that we find comprehensive solutions to the danger of tobacco use and address the epidemic among women and girls. Tobacco has been identified as a contributing factor to gender inequity and undermines the principle of women and children's right to health as a basic human right" (1).

The importance of a gender perspective and the empowerment of women were the main messages of the conference, which was marked by an increasing awareness among policy-makers of the need to bring gender into the mainstream of tobacco control policies. This article addresses issues concerning gender and tobacco control and suggests actions for policy-making and implementation. The underlying assumption is that gender relations -- defined as roles and responsibilities that are socially determined between men and women -- affect the prevalence, determinants, treatment and eventual outcome of tobacco-related diseases among women (2). Gender is institutionally structured and is a complex array of values and norms that permeate social structures and organizational systems, including legal, political, economic, health and religious systems. A gender perspective in tobacco control policies will contribute to a more accurate epidemiological understanding of tobacco use as well as to making programmes more successful.

Tobacco use by women

Rising prevalence and impact of smoking on women's health

Projections by WHO for the 1990s gave global estimates of the proportions of smokers as 47% among men and 12% among women (3). However, the prevalence of smoking among women is much higher ([is greater than] 20%) in the Americas and Europe, and as much as 30% in Brazil, Denmark, and Norway (4). Even if the rates may be declining in some countries, there are signs that -- owing to aggressive marketing -- the rates among women are rising, particularly in developing countries.

Surveys in many industrialized countries have shown that rates of smoking among young women aged 14-19 years are comparable to or higher than those among young men (5). Rates are also rising in many countries in the South-East Asia and Western Pacific Regions, where smoking is a symbol of women's liberation and freedom from traditional gender roles. Moreover, there is a popular belief among some young women that smoking keeps them slim. There is even greater cause for alarm because the statistics on cigarette consumption do not reflect the widespread use of smokeless tobacco among rural women. In India, for example, 22% of rural women in Kerala chew tobacco in pan (betel leaf). Women also smoke bidis (small indigenous cigarettes) and hookahs, as in Bihar and parts of Punjab and Hariyana, and rural women in Goa are known to rub and plug the inside of their mouths with burnt powdered tobacco (6).

Table 1 summarizes the health risks for women who smoke. Compared with non-smoking women, smokers are more likely to experience primary and secondary infertility (7, 8) and delays in becoming pregnant (9-12). With respect to pregnancy outcomes, women who smoke are at increased risk of premature rupture of membranes, abruptio placentae (premature separation of the implanted placenta from the uterine wall), placenta previa (partial or total obstruction by the placenta of the cervical os), and preterm delivery (13-30). …

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