To fight childhood stunting, let’s double down against smoking
MANILA, Philippines — My mother always tells me that I struggled to grow as a baby, and that my first days of life had been touch and go. As a child, I was skinnier and sicklier than my friends, and I eventually ended up a little stunted or short for my age.
My parents said that they did everything “right”: at least by thestandards of the late 1980s. My mom got prenatal care early, had a balanced diet, took her vitamins, kept an active lifestyle — and quit smoking as well.
Although she quit cold turkey, she could not quit for the rest of the family, friends, or colleagues who continued to smoke around her — at home, at work, and other social spaces. The air they breathed was different then. It was still acceptable to smoke at work or even near schools.
Moreover, cigarette smoking was normalized in TV shows and movies. It was even a symbol of freedom as in that advertisement inviting people to “Marlboro country” on horseback.
In that context, the diagnosis was clear: Exposure to tobacco smoke, even unintentionally, had contributed to that negative turn in my health.
Contrary to what many people think, stunting — or a child being unexpectedly short for their age — is not only the result of poor childhood nutrition, but also can be attributed to repeated childhood illnesses, poor maternal health, and other factors impacted by tobacco use.
As early as 1964, the Surgeon General of the USA had published an extensive report on the harms of cigarette smoking, including evidence of its impact on newborns’ birth weight and other poor outcomes in early life.
Newer evidence further supports the urgency to protect mothers and their children from tobacco exposure. Families with active smokers at home were more likely to have children under the age of five who were stunted or short for their ages.
Unborn children exposed to nicotine through either maternal smoking, or other household members’ smoking, are at risk for low birth weight, premature birth, and other poor health outcomes that may hinder their early childhood growth.
The Philippine Obstetrical and Gynecological Society estimates that up to 69.8% of expectant mothers are exposed to second-hand cigarette smoke in the home and community, especially through partners’ smoking.
Clearly, a majority of our young Filipino children are at risk of serious harm from smoking — with illness and stunting as long-term consequences. Even if the mothers of these children receive free prenatal care, or faithfully adhere to vaccinations and dietary advice, the risk for stunting and other illnesses will remain for as long as there is second-hand smoke exposure.
Exploring intersections of tobacco control
Although the most recent Expanded National Nutrition Survey shows that stunting among Filipino children under the age of five has dropped from 26.7% in 2021 to 23.6% in 2023, this progress has been slower than hoped.
In the fight against stunting, much attention is usually given to nutrition-specific interventions, such as feeding programs, micronutrient supplementation, and cooking healthy meals for their children.
For these important programs to succeed, they should be complemented by other measures to support children’s health, including protecting them from the harms of exposure to tobacco.
Since our strategic plans in combating chronic malnutrition — such as the “First 1000 Days” or F1KD program — also emphasize maternal health, attention should be given to preventing maternal exposure to smoking.
Tobacco control should also be emphasized in other strategies, such as the Philippine Multisectoral Nutrition Project.
Although this project seeks to improve key behaviors against stunting, tobacco control should not be ignored as an immediate way to improve both maternal and child health.
Combating stunting via tobacco control might seem daunting, but one can always start small. Since most second-hand exposure to tobacco happens at home, parents and other family members who smoke should be directed to tobacco use cessation services.
They should be given ample social support in their journeys to quit smoking. Having more people break the habit — for the sake of our children — should be considered a low-hanging fruit in the battle against stunting.
What more can we do? Since a whole-of-society approach is pushed to promote childhood nutrition, the same should be done to protect our children from tobacco harms as part of the battle against stunting.
Smoking bans in all public places should be enforced comprehensively, as part of reducing or eliminating exposure to second-hand smoking, especially since 41.7% of Filipino youth between the ages of 13 to 15 years old are exposed to second-hand smoke in public indoor spaces.
Eventually, we will ask ourselves how to make these changes really stick. To sustain efforts, tobacco use should be further denormalized through revitalized media campaigns alongside stringent bans and restrictions on tobacco product advertising, promotions, and sponsorships.
Public officials should be on guard against spin tactics and ploys of the tobacco industry to keep Filipinos hooked on their products, and take an active role to expose and counteract tobacco industry interference in our health policies.
Tobacco-free environment for all
Ultimately, the fight to reduce tobacco use is so important because it is not only Filipino children who stand to benefit, but also the elderly, persons living with chronic illnesses, and many others whose lives and wellness are endangered by other persons’ tobacco use.
The Philippine Statistics Authority’s 2024 data on mortality shows that chronic respiratory diseases, which are impacted by many factors including tobacco smoke exposure, continue to be the seventh leading cause of death in the country.
This figure highlights the reality that many of our fellow Filipinos are still at risk for these life-threatening and life-limiting conditions, and the risk can be greatly reduced through strengthening our tobacco control programs.
Now, as a public health physician and a mother, I see the same hopes, fears, and aspirations of other families that their children will also be happy and healthy. After all, most parents would do their best, as mine did, to take care of their kids.
The best way to support parents’ good decisions is to make an environment that is pro-health, including one that is free from cigarette smoke, vape, and other forms of tobacco.
It may be a bit late for many of us who have been impacted by tobacco harms to reverse our health conditions, but it is not so for the next generations. The heights — and health — of the younger members of Gen Alpha, and those of succeeding generations, lie in the decision to smoke or not.
May we learn from the past, and choose wisely for tomorrow.
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Katrina Gomez Chua is a public health physician and a policy associate for ImagineLaw’s tobacco control project. The views on this article are her own.
