Nearly 200 million adult women worldwide smoke cigarettes. As observed among high-income countries in the 20th century, the first stage of the tobacco epidemic occurred as the rate of smoking among men increased and surpassed 50%. During the next stage, smoking rates decreased among men and increased among women. This is currently taking place in many low- and middle-income countries. In 2010, half of the world’s female smokers were in high-income countries and the remaining half in low- and middle-income countries.

Tobacco companies market directly to women and create an association between smoking and gender equality. This is happening today in many low- and middle-income countries where there are potential new smokers and sparse marketing restrictions, but this practice is not new for tobacco companies. Almost a century ago, the American Tobacco Company purposefully linked smoking with women’s right to vote, with cigarettes called “torches of freedom.” This type of forced association between smoking and gender equality can be expected worldwide.

Women are the target of marketing campaigns, specifically ones promoting “light” or “low-tar” cigarettes. Women often choose these cigarettes because of a false assumption that the products are less harmful than full-flavor cigarettes. In reality, all cigarettes contain approximately the same amount of tar and nicotine, but smokers of “light” and “low-tar” cigarettes compensate (e.g., covering ventilation holes, sucking harder, etc.) to more efficiently extract nicotine from the cigarettes. This has resulted in no net benefit for women who continue to smoke and use these “lighter” products.

Smoking decreases fertility in women, combines with oral contraceptives to increase the risk of heart attacks and stroke, and results in poor health outcomes for fetuses and newborns. If women begin smoking at rates equivalent to men, the world will face a public health disaster of enormous proportions.