Call to put tobacco control under gender lens

Shobha Shukla, Citizen News Service - CNS
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Tobacco kills 6 million of its one of the best users every year. So the tobacco industry needs to attract new customers to replace those who die or quit in order to keep their sales and profits up. And who could be a better target than the vulnerable group of women and children. Several symposia held during the recent 16th World Conference on Tobacco or Health (WCTOH 2015) in Abu Dhabi, focussed on the gender aspect of tobacco control. Speaker after speaker cited that the tobacco industry has been wooing women all around the world by implementing specific marketing campaigns targetted at women, especially in developing countries, with a view to feminize tobacco use. The magnitude of their impact is clearly visible.

The historical gender gap in tobacco use is narrowing. Overall smoking prevalence has decreased but there is a shift in smoking to disadvantaged groups of women/ girls in high-income countries and emergence of tobacco use among women/girls in low and mid income countries.

In two countries in the world - Vanuatu (in the South Pacific Ocean) and Sweden - there are more women smokers than men. There are 24 countries where more girls than boys smoke.

With 19% of women smokers, Europe has the biggest market growth in female smoking. In most European countries, the younger the women are, the less are differences between women/girls and men/boys smoking rates and in 15 countries of EU more girls than boys smoke.

In the East Mediterranean Region, the gender gap is narrowing down fast among boys and girls, especially when it comes to shisha/waterpipe smoking. The prevalence of shisha among young girls in some countries of the region is more than that in adult females.

In Turkey, flavoured hookah/waterpipe smoking is gaining popularity among women by leaps and bounds, especially in the youth.

In Latin America there is an increasing tobacco use among women. The most vulnerable groups are women with low income and low education and also those working as labor in tobacco leaf growing and processing.

20% of the Indian women use tobacco in some form or the other. Although smokeless tobacco is more popular with them but shisha smoking in young girls is the latest fad in urban areas.

So where have we failed down the line?

As Dr Mira Aghi of India lamented, “Policy makers have failed to acknowledge social and biological influences and their interplay with gender while making policies on tobacco control. On the other hand, the tobacco industry has carefully assessed the needs, lifestyle and preferences of women and developed gender-based strategies to hook more girls/women into lifelong tobacco addiction.”

It is true that advertisements by tobacco companies like: ‘Feel the moment: what’s stopping you?’ (in Mexico); Virginia Slim website saying ‘Your hair, your hands and your clothes with less cigarette smell’ (in Argentina) aggressively target women in order to increase profits.

Tobacco control may be gender blind, but tobacco industry is not!

But at the same time, as Dr Lorraine Greaves of Canada summed up so succinctly, “Tobacco control has typically been sex and gender blind in research, policy and programming. Gender accommodating tobacco control messages ignore women’s health and have often over emphasized on women’s stereotype qualities about attractiveness or nurturing. An American Cancer Society campaign poster saying,—‘Quit, because it makes you look ugly’-- reinforced attractiveness, not health. Another NHS ‘Ugly Smoking’ campaign of 2005 relied on objectifying beauty norms (Smoking is Ugly). A shame and blame game approach of PSA, Cancer Society of Finland said—‘A mother can be her baby’s worst enemy’. Thus Most tobacco control lacks recognition of gendered social context, power relations, and access to resources”.

Global tobacco treaty calls for gender mainstreaming

All this is despite clear directions from the WHO Framework Convention on Tobacco Control (WHO FCTC) Preamble requiring gender mainstreaming. Article 4.2 d of the FCTC indicates that Parties to the FCTC ‘need to take measures to address gender-specific risks when developing tobacco control strategies’ and incorporate gender-specific tobacco control measures’. It stresses upon women’s leadership and gender sensitivity in all aspects of tobacco control.

Dr Greaves called for gender transformative tobacco control initiatives that are aimed at advancing equality of women/girls while preventing/reducing tobacco use in them. “Gender transformative initiatives ‘actively strive to examine, question and change rigid gender norms and imbalances of power as a means of reaching health as well as gender equity objectives”, she said.

Dr Mariela Alderete of Argentina felt that it is important to understand the social, economic and cultural situations in a country in order to reduce tobacco use in women by fully incorporating gender issues in the tobacco control agenda and even more so in women’s health organizations.

Dr Margaretha Haglund of Sweden said that a full and comprehensive ban on tobacco company advertising is key to success. “Get to know your enemy to win this war. Raise public awareness on tobacco industry’s seductive strategies. There is a great imbalance between tobacco industry promotion and response from tobacco control society. It is important to collect and analyse sex/gender specific data on tobacco use, and tobacco production and use this statistics to raise awareness about women and tobacco”, she advised.

Gender sensitive tobacco control is not only about helping women tobacco users but also women who do not consume tobacco in any form and yet bear the brunt of its ill effects. These are women who are involved in tobacco farming or are wives of farmers doing tobacco cultivation.

Dr Silvana Rubano Turci referred to a study done in Brazil (the 2nd largest producer and the biggest exporter of tobacco leaves) that found that “women involved with tobacco farming suffered many health problems as there were no treatment protocols for green tobacco sickness and other diseases related to tobacco exposure; there were human rights violations due to unfair working conditions and the hegemonic presence of the tobacco industry showed clear imbalance of power”.

Dr Mira Aghi shared the plight of women bidi rollers of India, who suffer debilitating health problems, and yet are paid a pittance. They remain in a crouched position the whole day and so suffer from backache and knee problems. They develop chronic bronchitis and asthma due to tobacco fumes.

Then again the effect of second hand smoke at home on female family members and on women working in smoking bars/cafes or other closed public spaces makes them suffer heavy health consequences for no fault of theirs.

In an interview given to Citizen News Service (CNS), Dr Jeffrey Drope, Managing Director of Economic and Health Policy Research Programme of American Cancer Society warned that, “The tobacco industry is well aware of cultural taboos of smoking in girls and so are tailoring their marketing to attract them - targetting very young girls by promoting glamour and beauty (slimness) through messages that are sometimes even explicitly sent out. We have to redouble our efforts to not only prohibit the obvious advertising on billboards and magazines, but the less obvious advertising by tobacco industry through their corporate social responsibility (CSR) programmes—planting trees, sponsoring schools, etc. It may be difficult to resist a grant for education in poor set ups. Tobacco Industry takes advantage of these structural weaknesses. This is just not just a public health issue, but a human rights issue too and requires the political will to be nimble enough to solve these new emerging problems in tobacco control.”

Shobha Shukla, Citizen News Service (CNS)
Follow Shobha on Twitter: @shobha1shukla
24 March 2015