Tobacco Use and Child Stunting: A Hidden Public Health Crisis

 

Tobacco Use and Child Stunting: A Hidden Public Health Crisis

Stunting—impaired growth and development caused by chronic undernutrition, repeated infections, and poor maternal health—remains one of the world’s most urgent health challenges. According to the World Health Organization (WHO), 148 million children were stunted in 2022, with Asia accounting for 52% of cases and Africa 43%.

Beyond limiting height, stunting reduces cognitive development, school performance, and economic productivity in adulthood. For girls, stunting also increases risks in future pregnancies, perpetuating a cycle of poor maternal and child health.

While poverty, poor sanitation, and malnutrition are widely known causes, a less-discussed but equally critical factor is tobacco use and exposure to tobacco smoke.

The WHO 2025 Report: Tobacco and Stunting

In June 2025, WHO released a landmark report, Tobacco and Stunting – Tobacco Knowledge Summaries. It compiles global evidence showing how maternal smoking, second-hand smoke, and even emerging nicotine products contribute to impaired fetal growth, low birth weight, and stunting in early childhood.

The report highlights that cessation or reduction of tobacco use during pregnancy significantly improves child growth outcomes—making tobacco control not just a cancer-prevention strategy but also a nutrition and child development policy.

 

How Tobacco Harms Child Growth

Scientific studies confirm multiple pathways through which tobacco exposure harms children:

• Maternal smoking during pregnancy leads to fetal growth restriction (FGR), preterm birth, and reduced birth weight—strong predictors of stunting (Pereira et al., 2017).
• A dose-response relationship exists: heavy smoking (10+ cigarettes/day) increases stunting risk (Butler & Goldstein, 1973).
• Second-hand smoke exposure during pregnancy or infancy is linked to stunting, particularly when exposure exceeds three hours daily (Astuti et al., 2020).
• Smokeless tobacco use, prevalent in South Asia, is linked to low birth weight and preterm delivery due to placental damage (Gupta & Subramoney, 2004).
• E-cigarettes and heated tobacco products also show associations with low birth weight and fetal growth restriction (Hosokawa et al., 2022; Ammar et al., 2023).

The Indian Context

India faces a double burden of high tobacco consumption and child undernutrition:

• Nearly 267 million people use tobacco in India, including 29 million women (Global Adult Tobacco Survey, 2016–17).
• Smokeless tobacco use during pregnancy is particularly widespread, especially in rural areas, exposing unborn children to harmful chemicals.
• India also has one of the world’s largest populations of stunted children—over 35% of children under five are stunted (NFHS-5, 2019–21).

This overlap makes it urgent for India to address tobacco exposure as part of its nutrition and maternal-child health strategies.

 

Breaking the Cycle: Tobacco Control as Nutrition Policy

The evidence is clear: reducing tobacco exposure during pregnancy improves fetal growth and reduces the risk of stunting. WHO recommends scaling up its MPOWER measures:

• Monitor tobacco use and prevention policies
• Protect people from second-hand smoke
• Offer help to quit tobacco use
• Warn about the dangers of tobacco
• Enforce bans on tobacco advertising and promotion
• Raise tobacco taxes to cut affordability

By integrating these measures into maternal and child health programs, governments can reduce stunting rates while also preventing millions of deaths from tobacco-related diseases.

 

The Way Forward

Tobacco use is not just a cancer or heart disease issue—it is also a child nutrition and development crisis. Every cigarette smoked during pregnancy, every bidi lit at home, every packet of gutka consumed—directly or indirectly—steals children’s potential to grow, learn, and thrive.

👉 Investing in tobacco control is investing in healthy childhoods, stronger education outcomes, and sustainable economic growth.

It’s time policymakers, health professionals, and communities treat tobacco control as an urgent priority for child nutrition.

 

📚 References & Further Reading

• World Health Organization. Tobacco and Stunting – WHO Tobacco Knowledge Summaries (2025). Full Report
• Pereira PP et al. Maternal active smoking during pregnancy and low birth weight. Nicotine Tob Res. 2017. DOI
• Butler NR, Goldstein H. Smoking in pregnancy and subsequent child development. BMJ. 1973. DOI
• Astuti DD et al. Cigarette smoke exposure and stunting among children. Clin Epidemiol Glob Health. 2020. Link
• Gupta PC, Subramoney S. Smokeless tobacco use and low birth weight in India. BMJ. 2004. DOI
• Hosokawa Y et al. Heated tobacco product use and fetal growth in Japan. IJERPH. 2022. DOI
• Ammar L et al. E-cigarette use during pregnancy and adverse birth outcomes. PLoS One. 2023. DOI

#TobaccoControl #Stunting #ChildHealth #PublicHealth #EndTobacco #ProtectChildren #GlobalHealth #MaternalHealth #SmokeFreeFuture