The number of women choosing to smoke is on the rise in some developing countries, the World Health Organization warned on Monday -- the organization's World No Tobacco Day -- calling for initiatives to help slow the trend.
Tobacco-related deaths among women will likely "rise from 1.5 million in 2004 to 2.5 million by 2030," WHO chief Margaret Chan wrote in a new report. "Almost 75 percent of these projected deaths will occur in low- and middle-income countries."
Tobacco consumption has risen in many developing countries because of population growth as well as tobacco marketing, the WHO says. In remarks in February, Chan called developing countries the "new frontier" for the tobacco industry.
"In these countries, as elsewhere, girls and women are a market with attractive and lucrative growth potential," Chan said.
Smoking rates among women have traditionally been far lower than among men -- about 40 percent of men smoked worldwide in 2006 compared with 9 percent of women. Those figures are even more pronounced in some developing countries -- in both Indonesia and China about 60 percent of men smoke, while only 4 percent of women do.
"Women smoking has been quite low in many, especially Asian and South East Asian, countries because cultural norms have held sway," said Frances Stillman, co-director of the Institute for Global Tobacco Control at the Johns Hopkins Bloomberg School of Public Health.
But according to Stillman and David Adelman, a managing director and tobacco industry analyst at Morgan Stanley, this starts to change when a country becomes more developed and women begin to make their own money.
"As women become more empowered, educated and independent, it becomes more socially acceptable for women to smoke, so what you see as a general phenomena is that prevalence of smoking among women goes up as economies develop," Adelman said.
Tobacco companies have also been very successful in linking smoking with alluring images of independence and adventure in appealing to women through the last century, said Judith Mackay, senior policy advisor to the WHO on tobacco issues.
While the WHO Framework Convention on Tobacco Control, signed by 168 countries and put into action in 2005, requires countries to implement a comprehensive advertising ban within five years, not all countries have signed or implemented their plans yet, said Mackay.
"Advertising and promotion to women is still occurring around the world where it is allowed," Mackay said. "Historically, it's linked smoking with emancipation, 'you're your own woman now'…and with glamor, sport and attraction."
Darryl Jayson, vice president of the non-profit trade group the Tobacco Merchants Association, which represents tobacco manufacturers and suppliers, said the Framework Convention is having an impact and advertising is already highly limited in many countries.
"A lot of the countries are implementing this, so the market conditions are going to be very different [for tobacco companies] than they might have been in the past," Jayson said.
Jayson and Adelman said multinational tobacco companies are trying to promote their brands in every market available to them, but are not zeroing in on developing countries.
"There is a misperception that all the growth [for tobacco] is in emerging markets," Adelman said. "It’s a unique industry and profits are growing almost everywhere" -- even where consumption is dropping, like the United States, Canada, Western Europe and Australia.
However, said Adelman, emerging markets are seeing more growth in the volume of cigarettes sold, and the lower prices on tobacco products mean there is more room for gradual price increases in the future.
WHO is hoping to curb that volume growth with enforcement of the Framework Convention and is calling for member countries to ban all tobacco advertising, promotion and sponsorship and to pay more attention to educating women about the health risks of tobacco.
Mackay says the good news is that rates of women smoking in the developing world are still low for the moment.
"If you have one opportunity at true preventive health," Mackay said, "it's this."