There are 1.3 billion smokers among the global population of 6 billion, the majority in low- and middle-income countries (LMICs).¹ In all, 12% of the female population smokes regularly,² estimated to rise to 20% by 2025.³ Although global male smoking rates have reached their peak and are slowly waning, female rates are rising rapidly.⁴ Women from LMICs are becoming the biggest at-risk group, and tobacco companies describe women from LMICs as an “untapped market resource”.⁵ The World Health Organization’s (WHO’s) Framework Convention on Tobacco Control (FCTC) has the potential to integrate gender and diversity into all future tobacco control. In the early stages of FCTC development, Ernster et al⁶ emphasised that the gendered nature of the tobacco epidemic necessitated gender-responsive policies. The FCTC incorporates gender concerns in its preamble and, in Article 4, suggests that countries “address gender-specific risks when developing tobacco control strategies” at national, regional and international levels.

OPTIONS FOR INCLUDING GENDER IN TOBACCO CONTROL

The WHO’s gender policy recommends integrating gender concerns in all of its activities.⁷ Experience suggests that gender relations and power differences can be exploited, accommodated or transformed⁸ with different effects. For example, tobacco control efforts could exploit women’s inequality, maintain paternalism and “protect” women from tobacco use using strong proscriptions against its use by women. Simplistic messages that link increased smoking to women’s liberation feed this approach. Women’s gendered roles can be accommodated by focusing on women as nurturers. For example, tobacco control activities that focus on tobacco reduction during pregnancy or around small children rely on and reinforce women’s traditional roles and responsibilities. A strategy to actively transform gender relations would encourage tobacco control efforts that promote critical analysis and seek to reduce inequities between women …