Women and children exposed to tobacco are more likely than men to develop coronary heart disease over their lifetimes — as well as chronic obstructive pulmonary diseases. Additionally, exposure to tobacco through smoking or passive smoking imposes female-specific health concerns for women and children. Pregnant women and their unborn babies are also at risk of tobacco harm.

Men remain the majority of smokers: the 2016 South African Demographics Survey shows that more men smoke than women, with 8% of women older than 15 using tobacco products, while 37% of men do. Tobacco use has been strongly tied to socially constructed gender frameworks and the tobacco industry has exploited this notion by marketing tobacco use as some form of independence from restrictive and oppressive gender norms.

The use of tobacco among women can therefore be largely attributed to tobacco advertisements and promotions that exploit the notions of emancipation, appeal, independence, slimness and glamour. The tobacco industry has developed female-appealing brands such as Vogue Luxury Slim and Vogue Satin Tipped Luxury Light and pushed the likes of the “find your voice” campaign, which suggested independence could be found by using tobacco products. Descriptors on cigarettes such as “light” and “low tar” imply they are “safer” for women.

There is no emancipation in the use of or addiction to tobacco or nicotine, be it cigarettes, snuff, hookah pipes, heated tobacco or e-cigarettes and vape products, which all contain nicotine and other toxic and poisonous substances. It is also key to note that exposure to second-hand smoke is not safer or harmless, as it contains the same poisons inhaled by tobacco users.

Tobacco affects women disproportionately, with more women involuntarily exposed to second-hand smoke than men. In 2016, the World Health Organisation reported that 600,000 women globally died from exposure to second-hand smoke — double the number of men in the same period. The Drakenstein Child Health study in the Western Cape found that a third of pregnant women who participated in a study were exposed to second-hand smoke. Women need protection from second-hand smoke — in public places, residential areas and workplaces.

Tobacco affects young women, too, and has lifelong effects. The risks of developing cervical and breast cancer are increased in women exposed to tobacco smoke. Exposure also worsens period pain and increases the chance of severe and prolonged premenstrual symptoms, especially for women who start using tobacco during adolescence.

Exposure to tobacco during adolescence also affects fertility, increases the risks of spontaneous abortion, ectopic or tubal pregnancies, miscarriages and still births. The chemicals in tobacco affect hormonal production, the cervical fluid and the DNA in eggs, and 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.

A Yemeni woman passes a wall sprayed with anti-smoking graffiti in Sana’a, Yemen. The use of tobacco among women can therefore be largely attributed to tobacco advertisements and promotions that exploit the notions of emancipation, appeal, independence, slimness and glamour. EPA-EFE/YAHYA ARHAB

Women exposed to tobacco smoke have a higher chance of early menopause and intense menopause symptoms. Tobacco reduces blood supply to all organs, including the ovaries, which results in reduced function.

Research published in the Journal of the North American Menopause Society found that women who use tobacco are likely to go into menopause a year earlier than those who do not use tobacco. The age at which menopause starts is important; late menopause marks longer overall survival and greater life expectancy. Early menopause is associated with increased risk of cardiovascular disease, stroke, loss of bone density and osteoporosis. Tobacco smoking combined with other behavioural risk factors exponentially increases the risk of negative health outcomes.

Children exposed to tobacco while their mothers were pregnant may suffer health problems such as weaker lungs, increased heart rates, earaches, asthma and colds, as well as behavioural and learning deficiencies.

In South Africa, the finalisation of the Control of Tobacco and Electronic Delivery Systems Bill (the tobacco bill) will be instrumental in protecting women from tobacco and from the tobacco industry’s manipulative tactics. The bill provides for 100% smoke-free enclosed public places and this is key to reduce women’s involuntary exposure to tobacco smoke. Smoke-free public areas also create an enabling environment for people to stop smoking and erodes the societal acceptability of tobacco use. The bill indirectly empowers women who would otherwise not have a voice to protect themselves from tobacco exposure.

The bill will also introduce plain or standardised packaging of tobacco products and a comprehensive ban on all forms of advertisement and promotion of tobacco products.

This aims to counter the tobacco industry’s tactics to market its products via packaging and brands adorned with attractive colours. The shape of cigarettes and the packaging through the use of slim packs, with pink and pastel colours, have been specifically designed to target females.

It will also restrict point-of-sale advertising, which has been used to lure and target children by positioning tobacco and related products next to sweets, snacks and cool drinks in outlets close to schools.

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 consumers. Creation of e-cigarette or vape handbags have been targeted at women and girls specifically.

The tobacco bill will regulate the use and marketing of e-cigarette or vape products like any other tobacco product which is dangerous to health and requires strict regulation.

In line with research on findings that there are better family outcomes if women are educated, 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. DM

Dr Sharon Nyatsanza is project and communications manager at the National Council Against Smoking; Dr Catherine Egbe (specialist scientist) and Phindile Ngobese (intern) are with the Alcohol, Tobacco and Other Drug Research Unit at the South African Medical Research Council; and Professor Pamela Naidoo is CEO of the Heart and Stroke Foundation South Africa.