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Women and tobacco - cause for concern

Tobacco harms young and old, men and women. Women and children, however, face unique challenges and may be more vulnerable to the hazards of tobacco use than men. Women and children exposed to tobacco are more likely than men to develop coronary heart disease over their lifetime, 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 to tobacco harms. 

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, whilst 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 amongst 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 brands that appeal to females, such as ‘Vogue Luxury Slim’ and ‘Vogue Satin Tipped Luxury Light’ and heralded campaigns such as the ‘find your voice’ campaign which suggested that independence could be found by using tobacco products. Descriptors on cigarettes such as ‘light’ and ‘low tar’ were also depicted as ‘safer’ for women. 


There is no emancipation in use or 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. It is also key to note that any exposure to second-hand smoke (SHS) is not safe or harmless, as it contains the same poisons inhaled by tobacco users. 


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


Tobacco affects young women too and it 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.


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


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, as 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 risk behavioural risk factors exponentially increases the risk of negative health outcomes. 

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. 


In South Africa, the finalisation of the Control of Tobacco and Electronic Delivery Systems Bill (The 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 erode the societal acceptability of tobacco use. The Bill indirectly empowers those 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 will counter tobacco industry’s tactics to market their products via packaging and brands with attractive colours. The shape of cigarettes and the packaging through the use of slim packs, featuring 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 cooldrinks, 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 again been targeted at women and girls. The Tobacco Bill will regulate the use and marketing of e-cigarette and vape products like any other tobacco product which is dangerous to health and requires strict regulation. 


Akin to research on the 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. 





Sharon Nyatsanza, PhD – National Council Against Smoking

Professor Pamela Naidoo – Heart and Stroke Foundation South Africa

Catherine Egbe, PhD – Alcohol, Tobacco and Other Drug Research Unit - South African Medical Research Council

Phindile Ngobese - Alcohol, Tobacco and Other Drug Research Unit - South African Medical Research Council



Call the National Council Against Smoking - Quitline at 011 720 3145 for tips to help you stop smoking, or visit: www.againstsmoking.co.za or WhatsApp on 0638282909

CANSA runs an online programme which also provides support and information for smokers who would like to stop smoking on http://www.ekickbutt.org.za/.

The Heart and Stroke Foundation South Africa has professional staff that can provide educational support during the challenging time you may face during trying to quit tobacco smoking. During the period of the lockdown, you may call 084 2507374 for assistance.





Available for interview:

Dr. Sharon Nyatsanza, Project & Communications Manager, NCAS

Dr Catherine Egbe, Specialist Scientist: Alcohol, Tobacco and other Drug Research Unit, South African Medical Research Council

Professor Pamela Naidoo, CEO, The Heart and Stroke Foundation of South Africa

Phindile Ngobese - Alcohol, Tobacco and Other Drug Research Unit - South African Medical Research Council


Media contact:

Tamaryn Brown

Connect Media for CART agency

tamaryn@cart.agency / tamaryn@connectmedia.co.za

+ 27 (0) 84 3510560


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Smoking is the single most preventable cause of death in the world. The World Health Organisation (WHO) says that in South Africa (SA) alone, smoking results in more than half of lung cancer deaths, 37% of chronic obstructive pulmonary disease deaths, and over 20% of cardiovascular deaths and tuberculosis (TB) deaths. Smoking-related TB deaths are especially prevalent in South Africa, due to a higher vulnerability of HIV-positive individuals to TB.  Because it attacks the lungs, the novel coronavirus (COVID-19) could be an especially serious threat to those who smoke or vape.

The new Control of Tobacco and Electronic Delivery Systems Bill will make it easier for South Africans to choose smoke-free lives, regulate the danger of e-cigarettes and decrease the impact of second-hand smoke on the majority of the population, who are non-smokers. Why is taking time to implement? Tobacco industry profits are at the expense of addicted smokers, their families, and public health.  Together, the National Council Against Smoking (NCAS), the Cancer Association of South Africa (CANSA) and the Heart and Stroke Foundation of South Africa are steadfast in campaigning for the new Bill to be passed. It’s time for our people and our government to show leadership in implementing global best practice to curb the onslaught of big tobacco. 

Zanele Mthembu, Public Health Development and Policy Consultant

Savera Kalideen, Executive Director of the National Council Against Smoking 

Sharon Nyatsanza, Project and Communications Manager, National Council Against Smoking 

Lorraine Govender, National Advocacy Co-Ordinator, Cancer Association of South Africa (CANSA)

Professor Pamela Naidoo, CEO, The Heart and Stroke Foundation of South Africa

Dr Catherine Egbe, Specialist Scientist: Alcohol, Tobacco and other Drug Research Unit, South African Medical Research Council

Tamaryn Brown
Connect Media for Cart Agency
+27 (0) 84 3510560

Nirvana Kishoon 
Cart Agency
+27 (0) 82 823 3167


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