CHECK, CHUCK OR CHOKE: Choice is Yours…

A couple of weeks back when I was strolling in the busy streets of New Delhi a group of young, energetic and happening professionals attracted my attention. It was a group of some 8-10 IT/MBA professionals,probably waiting for the DTDC bus. It was like any other group of young indians busy discussing on various national and international issues. Must say that our generation of young Indians is definitely a very intellectual GENERATION in terms of being informed- thanks to social media. But then suddenly I could see circles of white smoke ascending into the already polluted air of Delhi from within the group. Speaking in the colloquial style “laundey hain to dhuyan to hoga hi” which refers to a sad reality about the boys here in Delhi or for that any big metro/city/town.In today’s date if we just take a random survey we will come across this astonishing fact that out of every 10men visiting a tea stall there will be atleast 7such people who will be asking for a “butt”. This butt itself is a big environmental hazard in our country, reports suggest that the a city like Bengaluru alone suffers from a burden of around 31 lakh littered cigarette butts every day!!… Bengaluru is the IT-capital of India and without any biasousness towards any profession I would like to say a major chunk of this litter comes from this population. The sad part is that a majority of doctors are also into this,despite being the most informed lot about the pros and cons of smoking.

Let’s now comeback to the group of these young professionals I was talking of.Usually on seeing such circles of smoke I tend to ignore it out of utter dejection that“nothing will happen” in this country. So many ads are being made about the ill effects of smoking, year long people are campaigning against it but still the result is a dismay. But there was something very striking about this group- out of the 8-10people in this group some 5-6 were girls and the rest were boys and to my surprise the “smokes of freedom” as some may call it were coming from the mouths of those girls. Now it’s not that I am watching this event from a sexist/racsit point of view, unlike many pseudo-feminist who would like to spoil the essence of this whole post, I am looking at it from the point of view of a concerned feminist and a worried doctor.

For so many years in our anti-smoking campaigns we have some how forgotten this concept that our generation has now evolved over time,it’s not the same old era of conservatives where the women were not allowed to come out of their houses, rather it’s the era of liberal democracy where men and women together build and carry the wheel of progress. Today while it’s a pride that women is equalling and in many places bettering than the men but then we can’t be blind of this fact that with growing modernisation our lifestyle habits are also changing, so are our addictions changing and their effects. Today while we continue our strong campaign against “smoking and tobacco” we need to change some of our advertisements, so to quote the WHO report which say “ ABOUT 200million of the world’s one billion smokers are women. The tobacco industry aggressively targets women in order to increase its consumer base and to replace those consumers who quit or who die prematurely from cancer,heart attack,stroke,emphysema or other tobacco-related disease.”

The report further says that girls and boys start using tobacco for different reasons, and tobacco use harms women and men differently. Approximately 1.5million women die every year from tobacco use. Understanding and controlling the tobacco epidemic among women is an important part of any tobacco control strategy.

Now when an organisation as big as the WHO and an report as important as the WHO’s “Gender equality is good for health” raises some serious concerns about the growing epidemic danger of smoking and tobacco towards our mothers,sisters and daughters, it won’t be wrong if we talk specifically about the female smoking. Some people who would like to read it in the very narrow minded ambit of “gender biasness” I would like to request them that for a moment keep your ‘pseudo feminist feminism’ aside and think about the larger positive impact

Globally around 40% men smoke as against only 9% of women, but that doesn’t mean we have to wait to take action and ask women to quit smoking until their ratio comes up to near 40%. Isn’t it easier to control 9% more quickly than 40%?? Most of the figures or reports that’s available till date are of countries like UK and USA but that doesn’t mean India should also wait till we see similar figures in our country. To control this fast growing addiction we first need to analyse the reasons that is leading to this:[as per WHO independent survey]

  1. Many more girls than boys smoke in the false belief that it is good way to control weight.
  2. Overcoming Low Self esteem: for years women were given less respect in our men dominated social customs and laws and from these years of suppression the aggression to overcome this low self esteem,many girls took smoking/tobacco as an easy to go substance.

Tobacco control strategies must recognise that boys’ and girls’decision to start tobacco are influenced by different cultural,psychological and socialeconomic factors. For example let me share with you a small incidence from my personal life:

There was a female helper in our house who was chronic alcoholic/ tobacco addict. She was working in our house for nearly two decades but suddenly for last 6-7years she began having behavorial changes and her situation grew so grim that we finally had to admit her to a rehab to save her life. Even then her treatment was damn difficult as she was having severe withdrawal symptoms.The reason behind her this indulgence to alcohol/tobacco was a very common familial problem in the lower economic slums of India. Her husband was cheating on her and later he married the other lady and banished this maid from her own house, in depression she first started taking alcohol and later on this depression became her reason for aggression to look more dominant than her husband. Sadly this is the reality in India!

3. The next big reason why WHO is specifically worried about the effects of smoking on the health of women is because they are the soft targets of the tobacco industries: A report suggests that the tobacco industry gears richly funded marketing campaigns towards women through advertisements that draw gender stereotypes and falsely link tobacco use to concept of beauty,prestige and freedom. Marketing startegies lure consumers with misleading categories, such as ‘light’ or ‘low tar’. More women than men smoke “light” cigarette(63% vs 46%) often in the mistaken belief that “light” means “safer”. In fact with increased usage light smokers often engage in compensatory smoking, inhaling more deeply and more frequently to absorb the desired amount of nicotine.

  • Second-Hand smoking

This is a bigger and immediate threat of smoking/tobacco towards the health of women. WHO states that about 64% of deaths due to second hand smoke or what we call passive smoking are that of women. This means that no matter how much we work in controlling the growing habit of smoking in women, our efforts will be half hearted until we try to control the men who are smoking. In some countries,second hand smoke is a greater threat to women than the possibility that women might start using tobacco. People who smoke should avoid exposing the people with whom they live and work to second hand smoke. Women and children often lack power to negotiate smoke free spaces, including in their homes,in their workplaces and in other public spaces. Everyone regardless of age or sex,should be protected from second hand smoke.


Reports suggest that full hazards of prolonged smoking are considerably larger for women than for men.

  1. A recent meta analysis involving millions of individuals, showed that,although smoking considerably increased the risk of coronary heart disease in both sexes, women who smoke have a 25%greater excess relative risk for CHD.
  2. Smoking during pregnancy increases risks of premature delivery,still birth and newborn deaths and numerous genetic anomalies.
  3. Reduction of breast milk in mothers who smoke is not just a curse for the mother but a life long of nutritional and immunological deficiency and malnourishment gifted to the child.
  4. Women who smoke are more likely than those who do not to experience infertility and delays in conceiving.
  5. The probability and aggression with which a women develops lung cancer is higher in women smoking than the men. Moreover for a country like India already overburdened with the miseries of TB this is an alarming situation
  6. There is an increased risk of cervical cancer.

Here I would like to state that when a mother or would be mother, who is very much literate and self independent, aware of all these facts still decides not to quit smoking just because of the pseudo fear that “log kya kahenge” is a very sad irony of today’s time. A habit that started as a recreational trial, will not only make a criminal prosecution on their health but also the health of their future generations. To this many of my pseudo feminist friends may say that I want to hold women solely responsible for the upbringing of a child, but my dear intellectuals don’t forget that the first word you uttered in your entire life is “Maa” and your first teacher is always your mother. For years we have been awaring our fathers to “Quit Smoking” but now time has come that we have to talk to our mother,sisters,daughters also.

Lastly as a doctor what worries me most is the after effect. The hazards of smoking is not only restricted to pregnant women but the entire womanhood in general. Though we doctors always propagate the idea of “prevention is better than cure” but our practical experience says, its still the “cure” that’s bossing the medical science and the health sector. When a survey report suggests that “ women may find it much harder to stop smoking than men do” this is alarming. The US CENTERS FOR DISEASE CONTROL AND PREVENTION found that while 29% of male smokers have been able to quit, only 19% of female smokers have permanently broken the habit. Women are three times more likely than men to relapse while trying to quit smoking without any help. Researchers are of the opinion that this disparity is because women tend to suffer withdrawal more intensely than men,especially during the last two weeks of their menstrual cycles. Women who are generally the stronger gender psychologically tend to some how succumb to the urge of nicotine in post rehab periods. When facts like nicotine patches and nicotine gum being less effective on women come to the forefront, when cases of premature maternal as well as fetal deaths due to ill effect of smoking come to our knowledge, the heart of a doctor is bound to strive to bring some kind of change.

People may try to run away from these every practical facts but it’s high time we analyse from whom and for what are we shying away from this. Parents can never ask their children to abstain or refrain such ‘pseudo-eliteclass’ habits if they themselves practice similar activities. While a father sets the example in the family and can try to bring strict discipline in the family but a mother’s loving and caring words will be more effective. It is good that today women are excelling in every damn field and showing the world their real power but at the same time women should also take additional care both for themselves as well as for the generations to come. In Odisha there is a saying “denga munda re thenga” which simply means the higher we grow in our stature the bigger is our responsibility. Our boys have dissapointed us for so many years yet there are signs of improvement nowadays, but incase of the girls it is a problem in a very primary stage, which if controlled now will solve problems both for today and tomorrow.

Lastly I would like to state as Kurt Vonnegut once said -“ Cigarettes are a classy way to commit suicide”. Irrespective of caste,creed,sex,religion the time has come for us to CHECK– new smokers, CHUCK– from the old smokers or else we all will be heading towards a CHOCKED future. In the words of Lord Buddha-

What you are is what you have been, and what you will be is what you do now”.