Women smoke at lower rates than men worldwide, but still suffer over 2 million annual smoking-related deaths. And women who do smoke are disproportionately impacted by health consequences. Beyond the general risks of cancer, heart disease, and respiratory illness, women face specific threats such as reproductive health complications, cervical and breast cancers, and higher susceptibility to smoking-related heart disease and COPD.

Women’s smoking behaviors are particularly often influenced by stress, societal expectations, and the intersection of gender and socioeconomic status. While men may smoke openly, women’s smoking is frequently hidden in many cultures, making it harder to reach them with public health interventions.

Societal norms often portray smoking as a male habit, further alienating women who need support.

Although the prevalence of smoking among women in Africa, for example, is relatively low, the harms they face are substantial. According to the World Health Organization, approximately 22,000 women die annually from tobacco-related diseases in the region. Additionally, about 64 percent of adult deaths due to second-hand smoke there are among women—a reminder of the indirect toll that is often forgotten. 

In many communities, smoking among women is especially stigmatized, limiting their access to cessation and harm reduction resources. Societal norms often portray smoking as a male habit, further alienating women who need support.

These realities underline the need for targeted harm reduction strategies, with tailored messaging and programs that resonate with women’s experiences and circumstances.

A compelling example of the transformative potential of community-driven initiatives is the Lady Health Workers Smoking Cessation Initiative in rural Pakistan. This initiative trained over 170 Lady Health Workers, as they’re known under a major pre-existing health-access program, to deliver education on smoking to people’s homes.

In 24 weeks, those women delivered outreach to 25,760 households in the country’s Gujranwala district, raising awareness about the risks of smoking and introducing harm reduction strategies.

Both men and women in these households showed interest in tobacco harm reduction options, and the initiative benefited people regardless of gender. But by deploying women as health workers, and by going straight to people’s homes—as opposed to public spaces where women may be underrepresented—its architects ensured that its success in shifting perceptions and encouraging healthier practices included women. Such work reifies the value of integrating harm reduction into existing community health care frameworks, particularly for vulnerable populations.

By framing THR as a tool for empowerment, we can begin to dismantle the stigma that keeps many women from seeking help.

Incorporating a gender perspective into THR means recognizing differences in experience and proactively designing solutions. Educational campaigns, for instance, should consider the specific ways women are introduced to smoking—women are more likely to start through social interactions and peer influence—and the extra barriers they face in seeking help. Access to harm reduction products, such as vapes, pouches or nicotine replacement therapies, must also be equitable, with an emphasis on affordability and availability in underserved areas.

THR can be life-changing for women. Safer alternatives to combustible cigarettes can significantly reduce their risks of disease and early death, including risks to mothers and babies during and after pregnancy.

Better health and knowledge are forms of empowerment, and THR enables women to take control of their health without the added burden of societal judgement. THR can represent economic empowerment, too, when safer products often cost less than cigarettes, leaving women with more money to put towards other needs. By framing THR as a tool for empowerment, we can begin to dismantle the stigma that keeps many women from seeking help.

THR for women can have a powerful ripple effect. Women often serve as caregivers and decision-makers within families, meaning that their health and knowledge directly influence the well-being of others. Children with parents who don’t smoke, for example, are less likely to go on to smoke themselves. When women adopt harm reduction strategies, they set an example for their families and communities that can spark wider change.

Tobacco harm reduction’s potential remains untapped without a concerted effort to address the gendered dimensions of smoking.

If the potential of THR is to be fully realized, women must be actively involved in THR advocacy, policy-making and implementation. This starts with creating spaces for women’s voices in the global conversation. Women bring distinct perspectives to the table, informed by their lived experiences and the societal, economic and health challenges they face.

Increasing awareness about THR among women is a critical step. Social media campaigns, community outreach programs and educational workshops should use language, imagery and methods that resonate with women, emphasizing empowerment and choice.

Collaboration with health care providers is equally important. Training programs should equip doctors, nurses, and community health workers to address the specific needs of women who smoke, and to foster supportive and nonjudgmental environments in which to do so.

Policy advocacy is another key area. Governments and public health organizations must prioritize gender-sensitive approaches to THR, ensuring that policies address the barriers women face. This includes subsidizing THR products, funding gender-specific research, and integrating THR into broader public campaigns around women’s health.

Empowered women become advocates for change. By amplifying their voices in public health discussions, we can challenge the stigma surrounding smoking and harm reduction, paving the way for more inclusive and effective strategies. Women’s leadership in THR advocacy will help ensure that future initiatives are better rooted in an understanding of the diverse realities of tobacco use.

Tobacco harm reduction offers a lifesaving opportunity for millions of women, yet its potential remains untapped without a concerted effort to address the gendered dimensions of smoking. Together, we can transform THR into a tool for empowerment, equity and lasting change for women everywhere.

Photograph of a woman in Myanmar by Vyacheslav Argenberg via Wikimedia Commons/Creative Commons 4.0

The author is the recipient of a scholarship from Knowledge-Action-Change. The Influence Foundation, which operates Filter, has separately received grants from KAC. Filter‘s Editorial Independence Policy applies.

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