New WHO report reveals urgency of confronting tobacco use among women

A new report by WHO/Europe about women and the tobacco epidemic has been launched. The report, “Through a gender lens: women and tobacco in the WHO European Region”, has revealed that, although tobacco use among women is decreasing overall, the rate is going down at a much slower pace than in men, and in some countries it is increasing.

The global noncommunicable diseases action plan includes a target to reduce global prevalence of tobacco use by 30% by 2025 relative to 2010. However, estimates project the Region will miss this target entirely and will be the only WHO region in the world expected to fall short, by as much as 3.8%, of the 30% relative reduction target among women.

In light of these figures, it is important to refocus tobacco control efforts across the Region to actively confront tobacco industry attempts to hook women and girls on tobacco products and to promote gender-transformative policies as a high priority.

The tobacco industry is finding innovative ways to promote its deadly products to women, such as via social media influencers and the funding of women’s groups. Old tactics of gendered product design and packaging remain a challenge for tobacco control. Substantive action on this element of tobacco marketing is critical to tackle the high smoking rates among women and girls.

There is a pressing need for interventions that prevent the uptake of smoking among girls. The tobacco industry is actively aiming at young women and girls in a number of ways to encourage addiction to tobacco products, so early prevention is crucial. The situation is challenging: WHO estimates that 12% of girls aged 13–15 are current tobacco users in the Region – 1.5 times the global average of 8%.

Women advocates have been at the frontline of the struggle against tobacco for generations, pushing to prioritize the empowerment of women and girls in the face of the public health crisis. Margaretha Haglund has been working tirelessly for action on women and tobacco throughout her career. She was President of the International Network of Women Against Tobacco (INWAT) from 1997–2006 and has worked as an expert for thinktanks and governments, implementing women-tailored policies for tobacco prevention and cessation.

“This publication can be an important tool to inspire countries to implement gender-sensitive strategies in tobacco control,” she says. “So far, not enough countries have taken action, so inspiration is hugely important. Sharing examples of the tobacco industry’s marketing towards women and girls and information on novel products are particularly welcome.”

Significant obstacles – the tobacco industry and lack of political will

Mrs Haglund identifies 2 significant obstacles for women-focused tobacco control that she has encountered in her career: the tobacco industry itself and lack of political support for tobacco control action. “The tobacco industry uses the lack of political will to stop, delay and weaken tobacco control legislation,” she says, “The industry is gradually becoming aware that the conventional cigarette will no longer be accepted by society due to its dramatic effects on health, environment and economy. Therefore, we’re also seeing an increase in ‘pure’ nicotine products, flavoured to entice new generations into nicotine addiction.”

Mrs Haglund emphasizes a central strategy for fighting against the tobacco industry: the importance of countries ratifying and observing the WHO Framework Convention on Tobacco Control (FCTC), a treaty adopted by the World Health Assembly in 2003, in full. “There is no magic bullet to reduce smoking prevalence in women,” she says. “But all countries need the same thing: the implementation of the FCTC at its highest level.”

The WHO FCTC is a strong policy framework that covers every angle of tobacco control. One of the most significant elements of the treaty is Article 13, which advocates a comprehensive ban on tobacco advertising, promotion and sponsorship (TAPS). This is an important policy plank for countries to consider, which would close the loopholes that allow the continued promotion of tobacco products to women and girls. Nonetheless, as of 2019, only 7 countries in the Region had a comprehensive ban on all forms of direct and indirect tobacco advertising.

Protecting women from the harms of tobacco is enshrined in the WHO FCTC as a guiding principle which declares “the need to take measures to address gender-specific risks when developing tobacco control strategies” (Article 4.2.d). To support this, countries should ensure tobacco control data is gender-disaggregated, and that questions of gender are mainstreamed throughout all policy, planning and decision-making.

“Through a gender lens: women and tobacco in the WHO European Region” also highlights the need to tailor interventions to different groups of women. This means using an intersectional lens that understands that “women” is not one homogeneous group, but that women’s experiences overlap with a great number of social determinants of health and identities. Successful strategies to reduce women’s smoking prevalence are sensitive to these contexts. They are also gender-transformative and challenge – rather than reproduce – harmful gender stereotyping in their campaigns and messages.

The health situation for women and tobacco in the Region is deeply concerning: many countries are behind the curve in challenging the deadly strategies of the tobacco industry. But examples of best practice in tobacco control are readily available, and concrete steps forward can be taken to turn the tide on tobacco. With strong political will, it is possible to ensure the health and well-being of women and girls across the Region.