The latest Indian National Family Health Survey (NFHS-5) has noted a disturbing trend of increasing tobacco consumption among women, particularly those living in rural areas.
AF Development Care (AFDC), a New Delhi-based research agency, in cooperation with IIT (Indian Institute of Technology) Bhubaneswar in Odisha state, decoded the NFHS-5 data on consumption patterns as part of an ongoing research collaboration on tobacco control.
One striking fact derived from this analysis (reflected in the figure below) is that tobacco consumption among women in rural India has gone up, from 13.67% in NFHS-4 to 17.83% in NFHS-5.
The NFHS-5 data further indicate that tobacco use by women in rural areas has increased all states except Manipur, Meghalaya and Nagaland.
Overall, 12.8% of women use smokeless tobacco (SLT), with a few Indian states reporting above-average prevalence of SLT use among women, as high as 56.5%.
The oral-cancer trend among Indian women has surpassed the global rates for both men and women.
An earlier study suggested that tobacco consumption is can be poverty-driven, as the poor use tobacco to suppress hunger. A number of previous reports suggested that close to 76% of rural Indians could not afford a nutritious diet. India ranked 94th out of 107 countries in the Global Hunger Index 2020.
Most of the earlier policy measures were based on the assumption that tobacco consumption is more of a male than a female habit, but that may no longer be valid in India. This means the government must review its existing tobacco-control policies and shift its focus more toward rural areas and women, and all interventions need to be district-based rather than national.
Moreover, women living in poverty in rural areas have limited access to affordable health care and are vulnerable to disastrous out-of-pocket medical expenses. The government in its new approach needs to understand that the impact of tobacco use on male and female health may be similar but is certainly not identical, as women, particularly in rural India, face a great diversity of health problems.
AFDC, in a research report on “Women Beedi Rollers and Alternative Livelihood Options” published last year, singled out a critical policy issue on how women employed to roll beedis, a type of thin cigarette popular in India containing unprocessed tobacco flakes, are mostly impoverished, and face serious occupational health hazards, ranging from respiratory ailments to all sorts of other health issues.
AFDC has advised the government to provide alternative employment opportunities to the millions of female beedi rollers, who have no choice but to continue with this home-based work. The report further says that India’s unorganized beedi industry employs more than 6.4 million workers. Of this, 5 million women work in this hazardous occupation despite earning very low wages.
Apart from changes required at the national level in India, there is a need for the World Health Organization to re-strategize its plan under the WHO Framework Convention on Tobacco Control (FCTC). In its present form, the FCTC does not have proper guidelines for gender-related measures on tobacco control.
All countries, including India, must work to change their strategies on tobacco control, as female tobacco use may significantly shift in the future. In the absence of proper action from governments, these women will succumb more to lung cancer and other tobacco-related diseases.
Worldwide lung-cancer rates among women are already started to surpass breast-cancer rates, predominantly where women’s tobacco consumption rates have increased or are likely to rise.
The Conference of the Parties to the WHO FCTC must come up with a new call to action in its upcoming COP9 meeting to include gender across all facets of tobacco control. India, as the current chair of the WHO executive board, can influence much of what this world body needs to change its strategy, instead of being influenced itself all the time.