Passing the “Torches of Freedom”: Smoking Behaviors of Women in Nepal

ABSTRACT

Globally, men constitute a larger percentage of smokers than women, but the rate of women smokers is growing. Smoking is a feminist issue: there are unique consequences for women's health, well-being, and agency. Recently passed anti-smoking legislation in Nepal, which has the highest rate of women smokers in South Asia, omits gender-conscious recommendations, potentially diminishing the impact of the legislation on women's lives. Relying on the 2001, 2006, and 2011 waves of the Nepal Demographic and Health Survey, this paper expands the dialogue around women's smoking and places it at the forefront of research on women's health issues. The results indicate that for women in Nepal, formal education and visiting a health facility mitigate smoking behaviors, whereas being employed and living in certain regions promotes smoking behaviors. The aim is for this and the ensuing inquiries to change government anti-smoking legislation in order to improve women's health.

KEYWORDS:

• Women
• Nepal
• smoking
• culture
• education
• zero-inflated negative binomial (ZINB)

JEL Codes:

• I18

ACKNOWLEDGMENTS

The authors thank Brady Horn, Ebru Kongar, and Sarah Stith for their comments and guidance on earlier drafts of this manuscript. We are also grateful to the Associate Editor and three anonymous reviewers for their insightful feedback. All errors or omissions are our own.

Notes

1 The South Asian region contains Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka.

2 This is calculated using the WHO age-standardized estimated prevalence of smoking among those ages 15 or older.

3 As of February 2017, 100 Nepalese Rupees was equivalent to US$0.93 or €0.86.

4 See Frank J. Chaloupka and Kenneth E. Warner (2000) for a comprehensive overview.

5 In 2001, only ever-married women were eligible for interviews.

6 In 2001, this question read: “Do you smoke cigarettes or bidis or tobacco?”

7 In 2001, this question read: “In the last 24 hours, how many cigarettes/bidis did you smoke?”

8 Married includes currently married, widowed, divorced, living together, and not living together. Never married is the reference category.

9 We initially stated that 19 percent of women in Nepal smoked, but here we find that 10 percent of women smoked in 2011. This difference comes from how the WHO calculated their age-standardized smoking prevalence. According to the Technical Notes II from the WHO Report on the Global Tobacco Epidemic 2013:

When presenting age-standardized prevalence rates, this report uses the WHO Standard Population, a fictitious population whose age distribution is largely reflective of the population age structure of low- and middle-income countries. The resulting age-standardized rates refer to the number of smokers per 100 WHO Standard Population. As a result, the rates generated using this process are only hypothetical numbers with no inherent meaning. They are only meaningful when comparing rates obtained from one country with those obtained in another country. (WHO 2013: 99)

When the WHO reports the percent of women in Nepal currently smoking, which comes from the 2011 NDHS, they obtain 8.7 percent, a number much closer to our result.

10 The remaining results for the logit and count regressions remained consistent with results found in Tables 3, 3A, and 3B (Tables 3A and 3B are available upon request). The only noteworthy difference is in the ZINB model where distance, considered to be an issue in obtaining healthcare, was no longer statistically significant.

Additional information

Notes on contributors

Kristina N. Piorkowski

Kristina N. Piorkowski is a PhD Candidate in Economics at the University of New Mexico and Doctoral Fellow with the Robert Wood Johnson Foundation Center for Health Policy at the University of New Mexico. Her area of study is health economics. Her research focuses on the intersection of women, health, and behavior. Specifically, she is interested in why women engage in risky health behaviors in both high- and low-income countries.

Alok K. Bohara

Alok K. Bohara is Professor of Economics at the University of New Mexico and Director of Nepal Study Center. He holds a PhD from the University of Colorado, Boulder. His current research interests include work on climate change and resiliency, environmental economics and nonmarket valuation, health and environment, inequality, social capital, gender empowerment, field interventions, coupled socio-ecological systems, and spatial econometrics. His work has appeared in such journals as American Economic Review, Journal of Environmental Economics and Management, Land Economics, American Journal of Agriculture Economics, Ecological Economics, Journal of Southern Economics, and American Journal of Political Science.