Does MPOWER really empower women?

Shobha Shukla, CNS (Citizen News Service)
Well, the answer seems to be NO, as was made out in the deliberations at the 46th Union World Conference on Lung Health held in Cape Town recently. WHO had introduced the MPOWER measures in 2008 to assist in the country-level implementation of effective interventions for tobacco control as contained in the global tobacco treaty (formally called the WHO Framework Convention on Tobacco Control (FCTC).

These 6 measures are:-
  • Monitor tobacco use and prevention policies
  • Protect people from tobacco smoke
  • Offer help to quit tobacco use
  • Warn about the dangers of tobacco
  • Enforce bans on tobacco advertising, promotion and sponsorship
  • Raise taxes on tobacco

However, as gender equality is improving, smoking rates in women are also going up. Smoking is a fake emancipation for women. They seem to subscribe to the dictum—what men can do, women can do better, including tobacco use. According to the Tobacco Atlas—one of the largest public health opportunities available to governments in the 21st century is to prevent an increase in smoking among women in low and middle income countries (LMIC).

Dr Ehsan Latif, Director Tobacco Control at the International Union Against Tuberculosis and Lung Disease (The Union), spoke with CNS (Citizen News Service) about the challenges in counteracting the increasing use of tobacco products by women. In his opinion, women suffer twice as much as the males from the impact of tobacco. Even if they do not consume tobacco directly they suffer from effects of passive smoking or second hand smoke (SHS). In traditional patriarchal societies, they cannot control their male counterparts’ behaviour of smoking. So it becomes doubly important to look after the health of women who suffer from active as well as passive smoking.

Dr Latif also feels that female smokers are always under reported, especially in countries like India, as females are traditionally shy to admit to smoking due to social taboos. So perhaps prevalence of smoking in women is much higher than what is actually reported.

Dr Jamhoih (Jamie) Tonsing, Regional Director, The Union South-East Asia Office, shares some chilling facts. Out of 1 billion tobacco users worldwide, 250 million women are daily smokers—22% in developed countries and 9% in developing countries. Every year 1.5 million women die from tobacco use (this figure is projected to increase to 2.5 million by 2030) and 75% of them are from low and middle income countries. Women also constitute 64% (670,000) of all adult deaths from second hand smoke. Cigarette smoking accounts for 50% of lung cancer cases in women world wide.

In nearly 50 countries, 20% of the women smoke, including 17 countries where this figure is between 30% to 50%. In Sweden, Norway and New Zealand women smoke as much as men. While smoking rates are declining in in developed countries like Australia, Canada, Japan, UK and USA, they are increasing in developing countries.

It is also worrisome to see that the gap between boys and girls smokers is narrowing. Worldwide, smoking rates among boys and girls follow a growing trend—in 24 countries girls smoke more than boys while in over 50 countries as much as boys.

Dr Dilek Aslan, Professor of Public Health at Hacettepe University Ankara attributes the growing use of smokeless tobacco (SLT) in women to greater cultural acceptability of use of SLT in comparison to cigarette smoking in women. This is more true of Asian countries where SLT use is much more socially acceptable in various forms--naswar, gutkha, zarda and moist snuff (with different compositions of tobacco, lime, mint and other ingredients).

Another alarming trend is increase in women smoking waterpipes/ hookah. In Iranian women, hookah smoking is the most common form of tobacco use. Sheesha/ hookah is becoming increasingly popular among young girls, who view it as a sign of modernity. Hookah use has been found to result in cancer of the lung, bladder, stomach, esophagus and tobacco juices from hookah increase the risk of oral cancer, warns Aslan.

Joel Gitali, Chairperson of Kenya Tobacco Control Alliance (KETCA), Kenya lamented the rising incidence of smoking in African women, even as rates are going down in men. What is more alarming, is that smoking prevalence rates in girls are much higher (10.5%) as compared to 1.5% in adult women (as per 2012 data). 

83% of Kenyans use smokeless tobacco. He said that more advocacy is needed in Africa, than anywhere else. There is a special need to focus more on poor women, especially those working on tobacco farms. Tobacco farmers and their families, who are poor, are targetted by the tobacco industry.

Dr Elif Dagli of Turkey mentioned tobacco companies’ interventions targetted to bring more women in their fold by bringing in new products in the market that are erroneously touted to be less risky than cigarettes, eliminate burning and at the same time sustain the habits of taste, sensory experience, and nicotine delivery. She mentioned 4 new products on the block-- aerosol with nicotine and aroma; carbon heated tobacco; aerosol of nicotine salt with organic acids; improved e-cigarettes and the e-shisha pen.

Dr Latif too warns about e-cigarettes. “The industry is offering electronic nicotine delivery systems (ENDS) as cessation devices, but then why are they flavouring it? For an adult smoker who wants to quit, a bubble gum flavour or a candy floss flavour should not matter. By flavouring ENDS the industry is trying to market them to children as well.”

“If ENDS is actually a cessation product, it should be regulated as a cessation product/medicine, or else banned. When I go to a pharmacy I cannot buy more than two packets of paracetamol, but I can buy an unlimited supply of e-cigarettes from the same pharmacy. Why?

Instead of turning a blind eye towards this emerging problem, governments need to act quickly to tackle the menace of e-cigarettes. We need to come to an unanimous resolution that e-cigarettes are bad for us and should be regulated as soon as possible and there should be no ifs and buts about it”.

Sandra Mullin of World Lung Foundation called for synergies between tobacco control and other public health programmes. She mentioned that many women remain unaware of the health risks of tobacco use and cite many wrong reasons for tobacco use. They  believe that it relieves hunger and tension, makes them slim, acts as a breath freshner, and rids pregnant women of morning sickness.

As tobacco industry marketing is aimed at women/girls, counter marketing should also target them. Women will have to be reached through strategic health communication campaigns. Effective campaigns can (i) change risk perception, (ii) influence attitudes and intentions, (iii) influence policy, (iv) cause behaviour change, and (v) change social norms.

There are continuous and aggressive efforts by the tobacco industry to link smoking to women’s rights, gender equality, glamour, success and slimness; and to make women targetted tobacco products (flavour and aroma) and product design (packs that look more appealing to women).

No wonder then that in India smoking among women has doubled from 1.4% to 2.9% during 2005-2010.

Dr Mira Aghi, a noted tobacco control activist, makes a fervent plea that women deserve equal focus for tobacco control as, like men, they too get severely addicted and suffer illnesses due to tobacco. She finds it ironic that while the tobacco industry has aggressive and well researched strategies to get women to initiate and continue using tobacco products, the tobacco control policies appear quiet on this. While India has good tobacco control policies, their implementation is weak. Moreover these policies do not pay attention to the unique needs and psyche of women tobacco users in order to help them.

Dr Tonsing too agrees that tobacco control has largely remained gender blind.

Tobacco control strategies need to focus on women/girls’ specific issues like countering industry measures targetting adolescent girls; providing prevention and cessation programmes that are integrated with women and child specific services and using literary material that are understood by women.

Margaretha Haglund, founder of International Network of Women Against Tobacco (INWAT), listed out steps to counteract the tactics of tobacco industry:
(i) Use the power of statistics to raise awareness about women and tobacco
(ii) Get to know the enemy—the tobacco industry and its allies—and then expose it by raising public awareness on its seductive strategies, and  neutralizing its interference with tobacco control
(iii) Establish gender specific indicators to measure effects of tobacco control programmes and policies for both men and women
(iv) Use the power of FCTC Article 4.2.d that requires Parties to use a gender lens when implementing tobacco control
(v) Strengthen women’s leadership
We need to empower women to say NO to any tobacco product.
Shobha Shukla, CNS (Citizen News Service) 
16 December 2015 
(Shobha Shukla is providing thematic coverage from the 46th Union World Conference on Lung Health in Cape Town, South Africa, with kind support from TB Alliance. Follow her on Twitter @Shobha1Shukla)

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