Cross-national female smoking prevalence versus total fertility rate and gender inequality

Melissa Joyce Garfield

The prevalence of men's tobacco use is high in both developing and developed countries (about 30%). The prevalence of women's tobacco use, however, is low in developing countries (3.1%) and higher in developed countries (17.2%). This study investigates two hypotheses for the dramatic difference in female smoking prevalence. Cross-national differences in female smoking prevalence are often tied to the variation in female's social and economic power observed around the world. Reducing gender inequality tends to improve development outcomes, such as economic productivity, education, and health. However, as gender equality has increased, tobacco use among women has also increased. This suggests that sex differences in drug use are at least in part due to gender inequalities in social, political, and/economic power, which will be referred to as the gender inequality hypothesis. Alternatively, tobacco contains a host of teratogens, including nicotine. Nicotine has been shown to activate nearly all neurophysiological toxin defense mechanisms and is associated with several conditioned aversions. It is plausible then that women in developing counties with little to no access to modern birth control methods, high fertility, and extended periods of breastfeeding avoid regular consumption of teratogenic substances to protect their developing fetuses and nursing infants. Women in developed counties with low fertility and direct means of controlling their own fertility through the use of a variety of birth control methods do not face the same reproductive risks when they consume teratogenic substances like tobacco. The prediction that women with high fertility avoid smoking tobacco will be referred to as the fetal protection hypothesis. Female smoking prevalence data from 186 countries was examined to test the fetal protection and gender inequality hypotheses of female smoking prevalence. High total fertility rate predicted low smoking prevalence even when controlling for gender inequality in social, political, and economic status. Additionally, female smoking increased in postmenopausal women in developing countries. These results suggest that fetal protection does explain some of the variation in female smoking decisions.

Cross-national female smoking prevalence versus total fertility rate and gender inequality

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