Like in many other countries in Asia, many more men than women in Viet Nam smoke: the current smoking rate among men is a staggering 42.3%, and the rate for women is only 1.7%. However, in reality – tobacco is already causing significant damage to the health and lives of Vietnamese women due to both active and passive smoking.
So, we – the World Health Organization (WHO) and the Viet Nam Women’s Union – are joining forces to bring to light the hidden threat to the health of Vietnamese women caused by tobacco use and the need to strengthen tobacco control policies to protect their health.
Tobacco harms women
Tobacco is the only legal product that, when used according to the manufacturer's instructions, leads to death for at least a half of the people who use it. All tobacco use is harmful – including cigarettes, electronic cigarettes (e-cigarettes) or vapes, heated tobacco products (HTPs) and shisha. In Viet Nam, a 2006 study estimated that each year at least 40,000 people die prematurely from tobacco use, and the study predicted this figure to be on the rise, therefore, the current figure is likely to be much higher.
The impact of tobacco on women in Viet Nam often goes unnoticed because so few women light up. Yet the smoking rate of 1.7% already represents more than 400,000 Vietnamese women who are at a heightened risk of cardiovascular diseases, cancer, including cancers of the mouth, throat and digestive system, bladder, pancreas, kidney, breast and cervix. This is an alarming issue and needs timely actions.
Second-hand tobacco smoke also harms women
Even though fewer women in Viet Nam smoke, 48% are regularly exposed to toxic second-hand smoke at home, while 25% of women are exposed to second-hand smoke at work.
In the short term, this passive smoking can produce harmful inflammatory and respiratory effects within just 60 minutes of exposure that last for at least three hours afterwards. Long term, it can cause coronary heart disease, stroke, lung cancer, breast cancers among women, other diseases and premature death.
Second-hand smoke is especially deadly for women. It is estimated that more than 19,000 people in Viet Nam died due to “passive” or “involuntary” smoking in 2019, with the majority – 60% – of these deaths in women.
Smoking and second-hand smoke causes serious harms to pregnant women, babies and children
More and more studies show that there is a significant decrease in the ovulation and fertilization response in women smokers of reproductive age. Smoking (including passive smoking) can cause infertility in women. Smoking during pregnancy raises the risks of miscarriage, stillbirth and premature birth, and giving birth to weak, low-weight babies. It doubles the risk of sudden infant death and birth defects.
Women’s exposure to second-hand smoke during pregnancy is similarly harmful: it is linked to a 23% increased risk of babies being stillborn and a 13% increased risk of birth defects.
Children living with smokers are at greater risk of respiratory infections, asthma and middle-ear disease, and of dying before their fifth birthday. They also more often experience behavioural problems and do less well in school. Children with caregivers who smoke are almost 70% more likely to try smoking by the age of 15.
The multinational tobacco industry is targeting girls and women
Recognizing that girls and women in Viet Nam are untapped customers, the tobacco industry relentlessly targets women with marketing and advertising that associates smoking with fashion, glamour, independence and empowerment.
In recent years, the same tactic has been used in Viet Nam to market harmful e-cigarettes and heated tobacco products online and through online trading and social media.
This is already causing harm. About 1.5% of girls aged 13 to 17 have started using e-cigarettes. Rates are more than double (3.6%) for those who live in Ha Noi and Ho Chi Minh City. Despite the fact that these products are not allowed in Viet Nam in theory, they are becoming more popular, particularly among young people.
E-cigarette harm children, teenagers and adults
E-cigarettes usually contain nicotine and other toxic chemicals that can harm cardiovascular and respiratory health.
Nicotine poses particular health risks to children, adolescents and pregnant women. Exposure to nicotine while in utero causes increased risk of sudden infant death syndrome, decreased hearing and obesity later in life. For children and adolescents, nicotine negatively affect memory, learning ability and mood control. Nicotine addiction also increases the risk of addiction to other harmful substances such as alcohol and narcotic drugs.
E-cigarettes expose users to emission that contains many toxic substances, including cancer-causing chemicals. In short-term, e-cigarette use can cause EVALI syndrome (e-cigarette or vaping use-associated lung injury) which in the US led to more than 2800 cases of hospitalization and 68 deaths in late 2019 and early 2020. In addition, e-cigarette use is also associated with increased drug use.
Recently, there has been an alarming increase in Viet Nam in poisoning from people – often young women – using e-cigarettes or swallowing the liquid in e-cigarettes. The Ministry of Health raised the alarm on the health risks of e-cigarettes after their use has led people to need emergency medical care.
Girls and women face risks from tobacco farming
Although tobacco growing is only a small part of the agricultural sector in Viet Nam, girls and women face particular harms from growing tobacco. As primary tobacco laborers, women and children are especially vulnerable to nicotine poisoning from handling green tobacco leaves, and being exposed to harmful chemicals and tobacco smoke during the curing process. Pregnant women and their unborn babies face higher risks including that of miscarriage.
More needs to be done to protect women
In recent years, Viet Nam has made significant strides in combating the tobacco epidemic. With the technical support of WHO, the Viet Nam Women’s Union and other partners in Viet Nam have been actively participating in communication and advocacy for women, children and the community about the harmful effects of tobacco use and passive smoking. However, there are many challenges remaining and more needs to be done.
A major priority is strengthening the enforcement of the smoke-free law, which is vital for protecting women and the general public from second-hand smoke. The competent authorities need to strictly implement the ban on smoking in public places and workplaces and apply strict penalty for violations.
In addition, we must have measures to prevent the tobacco industry from targeting women in order to replace their diminishing consumer base as the male smoking rate declines.
To achieve this, it is critically important to increase tobacco taxes and prices – to encourage existing smokers to quit, and make it less attractive for current non-smokers, including young women, to start.
At the same time, the authorities in Viet Nam need to strengthen the enforcement of the ban on the advertising and promotion of tobacco and nicotine products, including e-cigarettes. Accelerating efforts to ban the sale of new tobacco and nicotine products (as these products are currently smuggled) is crucial.
In addition, the whole political system needs to strengthen communications, advocacy and monitoring of tobacco harm prevention to help young people, especially girls, limit their exposure to and appeal of electronic cigarettes or other similar products.
If we can stop someone from starting to use tobacco while they are young, it is like a vaccine that protects them for life, because people are less likely to start using it when they are older.
By taking these measures, Viet Nam can further protect women – especially young women and girls – from the dangers of tobacco and nicotine.
Let us join hands to build a new era of Vietnamese women with health and knowledge, contributing to a healthier Viet Nam!
WHO has a long history of working closely with the Government of Viet Nam to reduce harm from tobacco, as part of WHO’s vision for all people to attain the highest possible level of health. Learn more at www.who.int/vietnam
For many years, the Women’s Union has worked in collaboration with the Ministry of Health to support health communication and other programmes to increase people’s knowledge of health harms, including from tobacco, and their access to health care, so they can live healthy lives. Learn more at http://vwu.vn/
Note: This opinion piece was first published in Phunu Vietnam.