Global tobacco control is deeply political, divisive, and reflects the prevailing gendered and other social hierarchies that influence policy and research agendas. This critique is not unique to tobacco control; it is seen across global health, which suffers from a lack of women’s participation and leadership—and gender-responsive policy, programs, research and resource allocation.
Of 8 million annual smoking-related deaths worldwide, 1.5 million are women. Yet current strategies specifically to help women who smoke are woefully inadequate. More countries have achieved significant decreases in smoking among men than among women, and most are seeing only a minimal decrease—or even an increase—in women’s smoking.
The World Health Organization’s Framework Convention on Tobacco Control (FCTC), adopted by the World Health Assembly in 2003, is self-described as an “evidence-based treaty that reaffirms the right of all people to the highest standard of health” and “a milestone for the promotion of public health and provides new legal dimensions for international health cooperation.”
The ninth Conference of the Parties of the FCTC is currently in session. The 180 member countries meet every two years, although last year’s conference was postponed due to the pandemic. Held online, the current conference is closed to the public and most media. Advocacy organizations for people who vape are banned, and yet policies decided at the COP impact more than a billion nicotine users. This lack of transparency and silencing of groups doesn’t bode well for women.
The FCTC articles—which enshrine the Convention’s objectives, guiding principles and obligations—contain a single item that refers to gender.
Despite efforts by women’s health and gender-equality advocates and practitioners globally, the FCTC—which sets the tone and priorities for coordinated global action—is largely genderblind. It fails to recognize and take seriously the concrete recommendations of the Kobe Declaration—the result of the youth- and women-focused 1999 WHO International Conference on Tobacco and Health—which drew upon the 1995 Beijing Declaration and Platform for Action and called for the architects of the FCTC to meaningfully enshrine the importance of more and better gender-disaggregated data on both health and economics, resource allocation for gender-specific research and advocacy, affordable and gender-responsive programs, and investments in the education of women and girls.
The preamble of the FCTC communicates “alarm” at increases in tobacco use by women and girls, and succinctly acknowledges the need for women’s participation in tobacco control—including a reference to the Convention on the Elimination of All forms of Discrimination against Women—and gender-specific strategies. Though this preamble ostensibly sets the tone for valuing and recognizing the unique needs and contributions of women, the FCTC articles—which enshrine the Convention’s objectives, guiding principles and obligations—contain a single item, Article 4.2(d), that refers to gender:
“Alarmed by the increase in smoking and other forms of tobacco consumption by women and young girls worldwide and keeping in mind the need for full participation of women at all levels of policy-making and implementation and the need for gender-specific tobacco control strategies…”
“Emphasizing the special contribution of nongovernmental organizations and other members of civil society not affiliated with the tobacco industry, including health professional bodies, women’s, youth, environmental and consumer groups, and academic and health care institutions, to tobacco control efforts nationally and internationally and the vital importance of their participation in national and international tobacco control efforts…”
“Recalling that the Convention on the Elimination of All Forms of Discrimination against Women, adopted by the United Nations General Assembly on 18 December 1979, provides that States Parties to that Convention shall take appropriate measures to eliminate discrimination against women in the field of health care…”
“Strong political commitment is necessary to develop and support, at the national, regional and international levels, comprehensive multi-sectoral measures and coordinated responses, taking into consideration … the need to take measures to address gender-specific risks when developing tobacco control strategies.’’
Traditional tobacco control policies and programs emphasize cessation and portray addiction through the lens of personal choice and failure, the stigmatizing effects of which can have harmful consequences and perpetuate health and socioeconomic inequities. For example, research has shown that such strategies can lead to increases in smoking and/or substance use, negative impacts on mental health, discrimination by health care professionals, and delays in seeking health care among low-income mothers. These experiences of stigma are heightened for women who already face marginalization and discrimination based on their race or ethnicity.
Harm reduction approaches center the lived experiences of people – which are shaped by their gender, race, socioeconomic status and cultural context. The focus is on reducing the harms of the method of nicotine consumption when cessation is not desired, rather than demanding abstinence.
This structural sexism is why a group of women are forming the coalition Women in Tobacco Harm Reduction.
Harm reduction strategies have great potential among pregnant women, low-income women, drug users, people with mental health diagnoses, and indigenous and LGBTQ communities. Safer nicotine products like e-cigarettes and snus need to be accessible and affordable, otherwise these marginalized groups won’t be able to make the switch.
The field of tobacco harm reduction (THR) is relatively new to the global stage, and it is increasingly clear that—as with the status quo of traditional global tobacco control—the voices, needs, and work of men dominate. That has to change.
This structural sexism is why a group of women who work in THR as practitioners, researchers, writers and advocates are forming the coalition Women in Tobacco Harm Reduction. We urge greater prioritization and distribution of resources toward research on women and tobacco harm reduction, and elevating the needs and voices of women, especially in low-and middle-income countries. We support gender equality in THR-related policy, advocacy, journalism and research. We will not be silent.
Photograph by Helen Redmond.