02 Dec 2017
5 min read
As Preeti* lights her cigarette in the restaurant’s smoking area, she notices several people sneaking glances at her, their eyebrows raised. But most people at the restaurant barely throw a glance her way. After all, the sight of a young woman smoking in Kathmandu is no longer an oddity. In fact, it has almost become a trend. While smoking in general has decreased over the years in Nepal, there seems to have been a rise in the rate of young urban women smoking. According to the Nepal National Demographic Health Survey 2016, (published by New ERA and the Ministry of Health) Preeti is among the 5.1 per cent of female smokers living in urban areas in Nepal. Although this figure isn’t too large when compared to the percentage of male smokers, that number has been predicted to rise in the years to come.
Many decades ago, female smokers in Nepal could easily be grouped into two distinct categories: the lower-class rural women and the upper-class wives of aristocrats, for whom smoking was a status symbol. But in recent decades, this trend of smoking has also pervaded the middle-class demographic of women. Today, it’s become relatively common to see young women of any age, class or ethnic group puffing away on a cigarette. “During the Panchayat era, smoking among women was limited to a certain class of people. These days, there is no classification as such,” says Shanta Lall Mulmi, a development activist who was awarded by the WHO for his work in tobacco-control programmes. “All women have the liberty to smoke and that’s probably why there’s a discernible, and more importantly, alarming increase in the rate of young women smoking.”
It is difficult to attribute one particular reason as the cause for this rise in smoking because depending on the age group, there may be several different factors at play. But there’s one factor that’s common among all age groups: the habit starts early on. Whether it is the excitement of trying out something new, or the desire to fit in with a certain crowd and be perceived as ‘cool’ or ‘modern’, this habit often manifests at a young age, usually during a user’s teenage years or early 20s. “I started smoking at 16. There were many opportunities for me to try it earlier, but I decided to try it out for the first time during a trip away from home,” says Preeti, 19. Alarmingly, many young women start smoking because they operate on the false assumption that smoking helps them lose weight. Dr Abha Shrestha, who specialises in Community Medicine and Tropical Disease, at Dhulikhel Hospital, debunks this ‘theory’. She says this notion is completely false and that various studies done on the subject conclude that smoking actually yields no such effects.
Another alarming trend currently on the rise amongst Nepali teenagers is the use of hookahs, or shishas, which can lead to cigarette addiction. Teenagers opt for hookahs because they view them as a less harmful alternative to cigarettes; but hookahs actually contain the same amount of nicotine as cigarettes. In fact, says Dr Biraj Karmacharya, Chief of Department of Community Programs, Dhulikhel Hospital, smoking hookahs is worse than smoking cigarettes. “Hookahs can be very harmful. They can not only lead to cigarette addiction, but they also contain 30 times more carcinogenic tar and 15 times more carbon monoxide than cigarettes.”
While teenage girls usually opt for cigarettes to appear more fashionable and trendy, working women have been found to use cigarettes as a coping mechanism. Smoking helps to alleviate stress, they say. But Karmacharya begs to differ. “Multiple studies have shown that smoking does not alleviate stress in any way. It’s a false belief,” he says. In most cases, women use cigarettes solely out of habit, one that they developed because of their addiction to smoking at a young age. “My job tends to get unbearably stressful, as I have to juggle multiple things at once. So I often reach for a cigarette or two to help take the edge off,” says Mahima*, 29, another smoker. “It happens subconsciously, and I can tell that I do it merely out of habit.”
Influence through media and the West
Because Western influence is ubiquitous in Nepal, the media definitely has had a huge hand in promoting smoking amongst women. Owing to exposure to the West through movies, TV shows and the internet, women are starting to shed the image of their being meek and submissive. They no longer believe in the notion that they shouldn’t smoke because it’s ‘unladylike’, or that women who smoke are ‘characterless’.
Despite Nepal still being a male-dominated society, notions of feminism and gender equality have very much seeped into the minds of the female populace. As women have become more progressive, they’ve started questioning why they should be held to different standards than men. The thinking goes thus: Why should they have to stick to gender norms that society has created for them? If men are allowed to smoke, then why shouldn’t women? “Whenever a male friend and I smoke, people often stare at just me. I can just see it on their faces, that they are judging me simply because I am a woman who smokes. It bothers me a little,” says Preeti.
Moreover, seeing other urban women overcome the stigma against female smokers gives more women the confidence to smoke openly. Through a perverse twist of logic, many of them have come to believe that they’ve evolved from the obedient and presentable people they were told to become to independent individuals who believe in having the same equality and freedom that men have.
Smoking, the leading cause of preventable deaths worldwide, possesses serious health risks for everyone: many diseases like cancers, bronchitis, and hypertension, which could lead to cardiovascular diseases, stem from smoking. However, smoking is more detrimental to women, as the health risks for them are even greater. Smoking doesn’t just decrease chances of fertility, miscarriage and hasten the onset of menopause; it also causes women to be more susceptible to depression, decreased bone density, cataracts and skin diseases. In fact, Dr Shrestha talks about how there are often more women than men who end up getting admitted to the emergency because of conditions induced by smoking. And it is only after repeated probing that they admit they smoke regularly.
Annually, in Nepal, about Rs 16 billion is spent on the treatment of tobacco-induced diseases. So, why is it that women insist on smoking despite knowing of its harmful effects and consequences? “It’s because although most urban women are educated, they aren’t necessarily health educated,” says Dr Shrestha. Mahima’s rationale, for example, bears this claim out. “I continue smoking because I know I will quit eventually, either when I’m married or the day I find out I’m pregnant. I also resort to wishful thinking: I feel that I can mitigate the harmful effects by controlling my smoking intake, and I can, of course, quit for good in a few years.”
These women believe, that unlike alcohol and drugs, cigarettes don’t have any immediate effects, that they are in control of their health, that this addiction is only temporary and that they can quit when they see fit without any grave repercussions. What they don’t realise is that the damage is already done. According to the Centers for Disease Control and Prevention, USA, there is no such thing as a safe level of exposure to tobacco smoke. Even people who smoke occasionally at social gatherings are at high risk because cigarettes cause not just decreased lung capacity, elevated heart rate, chronic cough and reduced stamina, but also abnormal cell division, and thus possibly, cancer.
In Nepal, smoking-related problems are being tackled in various ways. Tobacco- control and -regulation laws restrict people from smoking in public places, or even in open spaces like parks, schools, gyms and bus stops. Two years ago, Nepal introduced a law that said that 90 per cent of a cigarette pack should be covered with pictures depicting the harmful effects of smoking. Previously, it was 75 per cent. Nepal was the first country to increase this percentage to 90. Advertisements and promotions of cigarettes are not allowed, and shops aren’t even allowed to sell cigarettes openly.
While these measures have had effects on the overall smoking population, there’s still a lot that needs to be done when it comes to dealing with the increase in urban female smokers. Mulmi believes that we need to target the root cause of the problem: preventing teenagers from developing the addiction in the first place. “We need to work on preventive measures, rather than the curative measures,” says Mulmi. Our goal should be to educate everyone about the harmful effects that smoking has on not only smokers, but also on the people around them, as passive smoking is equally harmful. Health education should be a major priority.”
Dr Shrestha and Dr Karmacharya, too, agree. “Awareness campaigns and advertisements depicting the consequences of smoking are a must. People have to be aware of just how much damage this habit can wreak. Everyone knows the general facts, but we need to go deeper and make people understand why smoking is so harmful.”
*Names have been changed