Feeny E, Dain K, Varghese C, Atiim G A, Rekve D, Gouda H N et al. Protecting women and girls from tobacco and alcohol promotion BMJ 2021; 374 :n1516 doi:10.1136/bmj.n1516

Gender transformative measures could curb the industries’ expansion into low and middle income countries, contain the burden of chronic disease, and promote gender equity, argue Emma Feeny and colleagues

Women have traditionally consumed less tobacco and alcohol than men because social and cultural norms have stigmatised their use of these products, particularly in low and middle income countries. The combination of changing gender norms, aggressive industry marketing, and continuing population growth in low and middle income countries, however, means that without urgent action, the number of women and girls consuming tobacco and alcohol is likely to rise substantially in the coming years.

This change has important implications for the burden of chronic or non-communicable diseases and injuries, for public health, service delivery, and—given the strong, reciprocal links between non-communicable diseases and poverty1—sustainable development. Consumption of tobacco and alcohol has repercussions throughout life, particularly when it begins at a young age, making it harder to stop or reduce consumption later in life. Such consumption increases women’s risk of developing cardiovascular diseases, cancers, and a range of other conditions (table 1). Risks can also be transmitted to the next generation: tobacco and alcohol use during pregnancy can have lasting effects on the health of children, who are also more likely to use tobacco and alcohol themselves if exposed to parental consumption.4, 5

Non-communicable diseases already account for over 70% of all deaths worldwide, but this huge and growing burden among women is often overlooked by global health stakeholders, who continue to view women’s health from a reproductive viewpoint. The biggest killers of women globally are cardiovascular diseases, cancers, and chronic respiratory diseases.6 People living with non-communicable diseases are also at risk of severe covid-19 should they become infected.7

Because tobacco and alcohol use are now steady or falling in many high income countries, producers have identified women and girls in low and middle income countries as a growing market.8,9 The global prevalence rates of smoking among women are decreasing, but trends among girls are concerning; in 123 countries, the prevalence of girls using tobacco is higher than the prevalence of adult women, and in some countries, such as Mozambique and Argentina, it is also higher than the prevalence of adolescent boys using tobacco.10 The proportion of men who drink is much higher than the proportion of women who do so, but the global gap between male and female drinkers is shrinking.11

These threats are well recognised, but calls for action to reduce the exposure of women and girls in low and middle income countries to the well honed tactics of the tobacco and alcohol industries have so far gone unheeded.9,12 If this continues, we can expect to pay a high price, with an increase in non-communicable diseases and undermining of hard won development gains. Developments in sex and gender research and practice provide opportunities to not only prevent a rise in smoking and drinking among girls and women, but to break down pervasive gender inequities while doing so.13

Sex specific impacts of tobacco and alcohol, and interaction with gender

To understand the association between women, tobacco, and alcohol, and better protect women and girls from tobacco and alcohol promotion, it is important to distinguish between sex—the biological attributes that distinguish male, female, and intersex; and gender—the social and cultural norms, identities, and relations that structure societies and shape our attitudes and behaviour.14

Click here to read to full open access analysis.

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