Like their male counterparts who smoke, women smokers are at increased risk of cancer, notably of the lung and mouth, but including for women cervical cancer, cardiovascular disease and pulmonary disease. But in many ways women are even more susceptible than men to health risks from tobacco. Smoking also produces several other harmful effects that particularly affect women. Women who smoke have greater rates of infertility and other problems in conception, and if they smoke during pregnancy they face an increased risk of numerous complications for themselves and their babies. The combination of taking oral contraceptives and smoking substantially increases the risk of heart attack and stroke. After menopause, women who smoke have less bone density and an increased risk of hip fractures than those who do not. Although smoking has not been associated with an increased risk of breast cancer, it has been linked to an increased risk of cervical cancer. Smoking also may delay conception and may have an increased risk for ectopic pregnancy, which is when the baby develops outside the uterus, usually in the fallopian tube, and spontaneous abortion.
The reasons women smoke may be different from men. Some women smoke to keep their weight down. Those who are disadvantaged are more likely to smoke. Smoking prevalence in 1998 among US women with 9 to 11 years of education was almost three times higher than women who had 16 years of schooling. Such women smoke more cigarettes per day, are less likely to stop smoking and have less social support to stop.
According to a report of the US Surgeon General (2001), the problem of women and smoking is significant: an estimated 27,000 more women died of lung cancer than breast cancer in 2000; 3 million women died prematurely because of smoking in the twenty years since 1980, and on average they died 14 years prematurely; 22 percent of women smoked cigarettes in 1998, despite awareness of health consequences; and 30 percent of high school senior girls reported smoking in the past month. Smoking prevalence was almost three times higher among women with nine to 11 years of education (32.9 percent) than among those with 16 years or more (11.2 percent).
A study of more than 66,000 nurses between the ages of 30 and 55 indicated that smoking lowers the age of the natural menopause. Furthermore, there is strong evidence of an association between smoking and cancer of the cervix. Smoking also has more immediately bad effects on pregnant women, their foetuses, and nursing mothers. It increases the likelihood of miscarriage and stillbirth, and may result in low birth-weight and backward babies. Both the quality and quantity of breast milk may be reduced if the mother smokes.
The results of a Canadian survey showed that the relative risk of disability was 1.25 times higher in women who were current or former smokers compared with non-smokers. Almost 12% of the days taken off work because of sickness in Canada are attributable to smoking: smoking accounts for 19.4 million 'disability' days every year, or 2.65 days per year for each woman aged between 15 and 64. Similarly, in the USA, it was estimated that cigarette smoking accounted for 18% of all newly diagnosed cancers in women and for a quarter of all cancer deaths in 1980.
Statistics about women and smoking in the developing world are strikingly similar to those seen in surveys of Western women 20 years ago. In poor countries it is literate women, possibly of the middle, professional classes, who smoke and who see the habit as a symbol of being modern and moving with the times. Industrialization and more money to spend also affect the smoking habits of women. In Nigeria, for example, there have been few women smokers up to now because there are many socio-cultural influences that inhibit the habit among women, but as women's literacy and their access to cash increases, the influence of Western culture grows, and the latest surveys in Nigeria show a considerably higher incidence of smoking among women than before.