An Overview of the Policy and Market Landscape of Tobacco Production and Control in Mozambique

Regional differences in the daily consumption of smoked and smokeless tobacco among adults (25-64 years) in Mozambique: 2005 versus 2014/2015

Within-country differences in the prevalence of tobacco consumption may be expected in Mozambique, as determinants of tobacco use vary considerably countrywide. We compared the daily use of smoked and smokeless tobacco in 2005 and 2014/2015 across Mozambican regions. Two surveys were conducted in Mozambique, in 2005 and 2014/2015, with representative samples of the adult population, following the World Health Organization's STEPwise Approach to NCD Risk Factor Surveillance. Prevalence estimates were computed for daily use of different types of tobacco, stratified by regions. Data from the 2014/2015 survey were compared to those from the 2005 survey, after direct age-standardization. During the 10-year period, a significant reduction was observed in the prevalence of daily tobacco smoking among women in the Northern and men in the Southern provinces, due to the decrease in the consumption of hand-rolled cigarettes among Northern women (from 9.6% to 2.3%), and manufactured cigarettes among Southern men (from 23.7% to 11.8%). In Center and Northern regions, nonsignificant increases were observed in the consumption of manufactured cigarettes among men. The consumption of smokeless tobacco among Southern women decreased (from 3.1% to 1%). There was a decrease in the daily consumption of hand-rolled cigarettes among women in the North and of manufactured cigarettes among men in the South, as well as a potential trend towards residual smokeless tobacco consumption. However, the results suggest increases in the daily consumption of manufactured cigarettes among men in the Center and Northern regions.

Foregrounding women and household dynamics to inform Article 17: a qualitative description analysis of tobacco farming households in Mozambique

PURPOSE

This paper examines the intrahousehold dynamics between women and men present in tobacco farming households in Mozambique. Attention to the experiences and realities of the smallholder farmers is crucial for understanding approaches to alternative livelihoods. Intrahousehold dynamics can provide important insights into how these households and their members view tobacco production and engage with the political economy of tobacco farming, how they make decisions, and the rationale and values behind these decisions.

METHODS

Data were collected through single-gender focus group discussions (n=8) with 108 participants (men=57, women=51). Analysis was informed by a qualitative description methodology. This research presents a gender-based analysis examining the perspectives, roles, decision-making processes and desires of female and male tobacco farmers in four key tobacco-growing districts in Mozambique.

FINDINGS

Throughout this paper, women are found to hold leverage and influence in tobacco farming households, and this leverage is in part gained via the necessity of women's unpaid labour in achieving profitability in tobacco farming. Both women and men are also found to strongly desire and pursue the well-being of the household.

CONCLUSION

Women hold agency within tobacco-growing households and participate in decision-making processes regarding tobacco agriculture. Women should be included in future tobacco control policies and programmes pertaining to Article 17.

Tobacco policy (in)coherence in Mozambique: an examination of national and subnational stakeholder perspectives

Mozambique ranks fifth on the list of tobacco producing countries in Africa, while also being a Party to the WHO Framework Convention on Tobacco Control (FCTC). Tobacco farming is regarded by some governments as a strategic economic commodity for export and remains deeply entrenched within Mozambique's political and economic landscape. This study uses a qualitative description methodology to identify tensions, conflicts and alignment or misalignment in policy on tobacco across government sectors and levels in Mozambique. We conducted semi-structured qualitative interviews with 33 key informants from sectors across national and subnational levels including health, agriculture, economic and commercial sectors, as well as non-state actors from civil society organizations, the tobacco industry, farmers unions and associations and individual farmers. Incoherence was present across sectoral mandates, perspectives on industry's presence in the country and regions and between FCTC provisions and informant perceptions of tobacco production as a development strategy. Despite tobacco being viewed as an important economic commodity by many informants, there was also widespread dissatisfaction with tobacco from both farmers and some government officials. There were indications of an openness to shifting to a policy that emphasizes alternatives to tobacco growing. The findings also illustrate where points of convergence exist across sectors and where opportunities for aligning tobacco policy with the provisions of the FCTC can occur.

Tobacco consumption in Mozambique in 2005 and 2015

INTRODUCTION

The burden related to smoking exposure is growing in many low-income settings. We aimed to quantify the use of smoked and smokeless tobacco in Mozambique in 2014/2015, and to compare the estimates with those obtained in 2005.

METHODS

A cross sectional study was conducted in 2014/2015 on a representative sample of the Mozambican population aged 15 to 64 years, following the World Health Organization Stepwise Approach to Chronic Disease Risk Factor Surveillance (STEPS). Prevalence estimates with 95% confidence intervals were computed for different categories of tobacco consumption. The age-standardised prevalence in the age-group 25-64 years was compared with results from a STEPS survey conducted in 2005.

RESULTS

Between 2005 and 2014/2015, the prevalence of daily smoking decreased from 9.1% to 3.4% (p < 0.05) in women and from 33.6% to 27.3% (p < 0.05) in men. There was a significant decrease in the daily consumption of hand-rolled cigarettes among women (from 3.1% to 1.4%, p < 0.05). Among men, there was a decrease in the prevalence of daily consumption of smokeless tobacco (from 3.5% to 1.0%, p < 0.05). In 2014/2015, both manufactured and hand-rolled cigarette consumption were more prevalent among men, while the use of smokeless tobacco was more common among women; the consumption of both hand-rolled cigarettes and smokeless tobacco were more prevalent in rural settings.

DISCUSSION AND CONCLUSIONS

In Mozambique, there was a decrease in the prevalence of daily smokers in both genders and of daily consumption of smokeless tobacco among men between 2005 and 2014/2015. Efforts are needed to maintain the positive trends.

Tobacco industry presence and practices in Mozambique: a 'chaotic' but worthy market

BACKGROUND

Mozambique has experienced a series of tobacco industry consolidations both in tobacco leaf buying and processing, and in cigarette manufacturing and marketing. The growth of the tobacco industry presence in Mozambique was followed by an increase in tobacco industry's Corporate Social Responsibility (CSR) activities. This is the first paper to describe the history of tobacco industry activities in Mozambique, a party to the WHO Framework Convention on Tobacco Control (FCTC).

METHODS

We reviewed industry documents and associated web-based information. Industry documents (1990-2021) were identified through University of California San Francisco's Truth Tobacco Industry Documents Library. We followed with a search of web-based sources pertaining to the tobacco industry in Mozambique. We complemented our analysis with select media sources to identify statements by government officials in relation to the tobacco industry. We mapped major tobacco industry players, industry partnerships and corresponding CSR activities.

RESULTS

Tobacco production increased substantially in Mozambique in the 1990s when tobacco companies began targeting African countries. The increased attention to tobacco production, trade and sales in Mozambique was coupled with greater industry involvement in CSR activities. We identified 10 tobacco industry CSR programmes in Mozambique. Most of the CSR programmes focus on health including HIV/AIDS, social issues and environmental issues.

CONCLUSIONS

Similar to other tobacco-growing countries, the industry facilitated an increase in tobacco production and continues efforts to increase the tobacco consumption market while engaging in CSR activities focused on social and environmental issues. As in other countries, CSR initiatives in Mozambique enhance industry's reputation. Importantly, these CSR programmes and partnerships breach national laws and the provisions of the FCTC. The continuation of these programmes suggests limited attention within government to protect public policy from industry interference in compliance with Article 5.3 of the FCTC.

CoViD-19 effects on social-emotional development: Putative underlying mechanisms

Early childhood is the timely and critical period in the growth of the human being when the trajectory of children's holistic development is traced, and the foundation for their future as well-established and productive adults is set. The CoViD-19 pandemic produced profound changes in everyday life almost everywhere in the world. The personal, social and societal restrictions imposed during the CoViD-19 pandemic unquestionably blunted early childhood development by depriving young children from normal and healthy attachments through secure relationships with parents, teachers and peers. Furthermore, the public health measures enacted to counter the spread of the pandemic (e.g., mandatory masking, lockdown) contributed to a lack of social interactions essential for childhood development, and provoked perceptions of psycho-emotional stress (e.g., objective fear of the masked interlocutor, perceived fear of abandonment) in the children, which may have hampered critical periods of development. Based on theoretical foundation and our observations in the field, we propose that early intervention support may have a significant impact on the development of children victims of the effect of the CoViD-19 pandemic.

Oncology in Mozambique: Overview of the Diagnostic, Treatment, and Research Capacity

Mozambique is one of the poorest countries worldwide, with nearly two thirds of the population living below the poverty line. Similarly to other less developed countries, there is a weak provision of health care for non-communicable diseases due to competing priorities with infectious diseases. Although the leading causes of death in Mozambique in 2019 were Acquired Immune Deficiency Syndrome/Human Immunodeficiency Virus and other sexually transmitted diseases and respiratory infections and tuberculosis, with increasing urbanization and westernization of lifestyles, deaths attributed to cancer are also on the rise. This review summarizes cancer burden, cancer prevention and screening, cancer care resources, and trends in cancer training and research in Mozambique, providing a background for the development of cancer care policies in the country.

Tobacco farming: overcoming an understated impediment to comprehensive tobacco control

Tobacco farming has emerged as an important concern for tobacco control advocates. Tobacco-growing countries face unique and important challenges to comprehensive, intersectoral tobacco control. These challenges stem from narratives that position tobacco as an important driver of economic growth and development, perpetuated by tobacco interests with close ties to government decision-making. While the global tobacco control movement has enshrined a commitment to alternatives to tobacco growing, there remain numerous obstacles. Tobacco growing is often situated in contexts with limited markets for other agricultural products, limited knowledge and economic resources to pursue alternatives, and/or a structure that favours industry control over the supply chain, all constraining the decision space of farmers. An evidence-informed approach is necessary to address tobacco supply, including growing, processing, manufacturing and trade, in this complex context. This paper reviews the economic, environmental and policy context of tobacco growing with an emphasis on the past decade of empirical work on the political economy of tobacco supply and introduces strategies to pursue alternatives. This analysis debunks many of the arguments used to perpetuate the narrative of tobacco's prosperity and provides critical insights into the institutional constraints faced by government sectors in pursuing a policy of alternatives.