When it comes to smoking, women and children face unique challenges and are even more vulnerable to the hazards of tobacco use than men. Women and children exposed to tobacco and second-hand smoke are more likely than men to develop coronary heart disease over their lifetime, as well as chronic obstructive pulmonary diseases. Exposure also holds female-specific health and fertility concerns.

Passing the Tobacco and Electronic Delivery Systems Control Bill will be a vital step to protect women from tobacco, say health organisations partnering in the Protect our Next initiative. The new legislation is open for public comment until 4 September at http://bit.ly/TCBill. “The disproportionate way women in South Africa are affected by tobacco makes the protective measures in this Bill even more urgent,” says Dr Sharon Nyatsanza of the National Council Against Smoking. “It’s important that women understand the risks and can protect themselves and their families. We’re calling on women across the nation to raise their voices on this important issue and make submissions to Parliament.”

Tobacco use remains too high among women and men in SA
While men are still the majority of smokers, women also have high smoking rates, with many using smokeless tobacco. According to the 2021 Global Adult Tobacco Survey conducted in South Africa (GATS-SA), 29.4% of all adults (12.7 million) currently use tobacco, with 41.7% of men and 17.9% of women being current users. 7.2% of women use smokeless tobacco, compared to 1.1% of men. Smoking prevalence is highest among women aged 45-64, with 10.7% of female youth (~520,000), 11.5% of women aged 25–44 years (1.1 million), 12.6% of women aged 45–64 years (~686,000), and 11.0% of women over 65 years (~258,000) currently smoking.

This gender disparity is in line with the global trend, which may be due to social disapproval of women who smoke and men having more disposable income to buy cigarettes, says Dr Catherine Egbe of the South African Medical Research Council (SAMRC). “Tobacco use is closely linked to socially constructed gender frameworks, and the tobacco industry has taken advantage of this idea by promoting tobacco use as a way to break free from restrictive and oppressive gender norms.”

Marketing manipulation
The prevalence of tobacco use among women is influenced by tobacco packaging and promotions that manipulate the concepts of freedom, allure, self-reliance, slimness, and glamour. The tobacco industry has crafted brands like ‘Vogue Luxury Slim’ and ‘Vogue Satin Tipped Luxury Light’ and launched campaigns like the ‘find your voice’ campaign, suggesting that independence can be achieved through tobacco consumption. The use of descriptors such as ‘light’ and ‘low tar’ on cigarettes was also portrayed as safer for women. The e-cigarette or vape industry has been using sleek designs, attractive flavours (like cherry and bubble gum), branded items, social media and social influencers to attract young consumers.

We need to urgently counter the tobacco industry’s manipulative marketing tactics, says Dr Egbe. “There is really no freedom in addiction to tobacco or nicotine, be it cigarettes, snuff, hookah pipes, heated tobacco or e-cigarettes or vape products, which all contain nicotine and other toxic and poisonous substances.”

The Bill will require plain packaging with graphic warnings, restrict point-of-sale advertising and eliminate tobacco sales through vending machines. It will also regulate the use and marketing of electronic delivery systems including e-cigarette or vape products, which are currently unregulated.

Reducing exposure to second-hand smoke
The Bill further provides for 100% smoke-free enclosed public places and some outdoor spaces too. This is key to reduce women’s involuntary exposure to tobacco smoke and create an enabling environment for people to stop smoking, says Nyatsanza. “Exposure to second-hand smoke (SHS) is harmful, as it contains the same poisons inhaled by tobacco users. Unfortunately, more women are involuntarily exposed to SHS than men, so women are disproportionately affected. Women need protection from SHS, whether in public places, residential areas or workplaces. The Bill empowers women to protect themselves from tobacco exposure.”

Female-specific risks
So what are the health risks specific to women? “Tobacco has life-long impacts. The risks of developing cervical and breast cancer are increased in women exposed to tobacco smoke. Exposure also worsens period pain, increasing the chance of severe and prolonged premenstrual symptoms, especially for women who start using tobacco during adolescence,” Lorraine Govender of CANSA explains.

She further cites the UK-based Generations study which has linked early smoking to a significantly increased risk of breast cancer in younger, perimenopausal women. “The research found if girls start smoking at younger than 17 years, their risk of developing breast cancer in the future was 24% more likely than those who didn’t smoke,” says Govender. “The reason is that at puberty, the breast is made up of structures which are sensitive to chemical carcinogenesis – in other words, the chemicals in tobacco can trigger cancer. It’s important that teen girls are aware of this risk.”

If you’re planning on having children, Nyatsanza explains there are many reasons not to ever smoke, and to avoid second-hand smoke. “Exposure to tobacco, even during adolescence, affects fertility; it increases the risks of spontaneous abortion, ectopic or tubal pregnancies, miscarriages and stillbirths. The chemicals in tobacco affect hormonal production, cervical fluid and DNA in eggs. They can also obstruct the normal travel of the fertilised egg to the uterus. Stopping smoking before conception can reverse some of these fertility effects and improve natural fertility.”

Children exposed to maternal tobacco use during pregnancy may suffer health problems such as weaker lungs, increased heart rates, earaches, asthma and colds as well as behavioural and learning deficiencies, says Nyatsanza.

Exposure to tobacco smoke increases the likelihood of women experiencing early menopause and intense menopause symptoms. Tobacco diminishes blood supply to all organs, including the ovaries, resulting in reduced function. “The age at which menopause commences is crucial, as delayed menopause signifies extended overall survival and greater life expectancy. Conversely, early menopause is linked to an elevated risk of cardiovascular disease, stroke, decreased bone density, and osteoporosis,” says Nyatsanza.

A call for support

Empowering women and creating smoke-free environments will enhance the health of all South Africans and protect the young and vulnerable population groups in the country, Nyatsanza concludes. “We need every woman’s voice, indeed every citizen’s voice, in support of this Bill. Please make your voices heard and show Parliament South Africa supports better tobacco control.”