Stunting in children is characterized by height falling significantly below the median for their age and sex as set out by the World Health Organization (WHO) Child Growth Standards. Stunting is associated with higher mortality and morbidity, and has negative effects on cognitive development, academic performance and in adulthood, economic productivity. The WHO has recently released a brief report on and warned against the impact of smoking on child stunting.
In the brief report, the WHO concludes that tobacco smoke exposure in pregnant women is associated with stunting and other adverse growth outcomes in children, with a dose-response relationship. Maternal smoking during pregnancy is significantly associated with fetal growth restriction, smallness for gestational age, preterm birth, low birth weight in infants, and stunting in children. Some studies showed that higher risks of child stunting for pregnant women who smoked more than 10 cigarettes a day. Underlying mechanisms of smoking during pregnancy affecting child growth outcomes include increased oxidative stress (which causes cellular and tissue damage) and epigenetic modifications (which alter gene expression). Even tobacco smoke from cigarettes with no additives, low tar or low nicotine content can affect bone formation and inhibit growth in children. Some studies also found the link between use of smokeless tobacco and alternative tobacco smoking products in pregnant women and poor birth or growth outcomes in children. Similar to active smoking, secondhand smoke (SHS) exposure during pregnancy increases risks of fetal growth restriction, preterm birth, low birth weight and child stunting.
Both smoking and SHS exposure are detrimental to child growth. Comprehensive tobacco control policies are essential to mitigate the harms of smoking. The WHO advocates for full implementation of the WHO Framework Convention on Tobacco Control and MPOWER measures (i.e. monitoring tobacco use, protecting people from tobacco smoke, offering help to quit, warning against dangers of smoking, enforcing bans on tobacco advertising, and raising tobacco taxes) to reduce smoking and protect lives. Urgent actions should be taken to protect pregnant women and children from SHS exposure and encourage smoking cessation in pregnant women.
The Tobacco Control Legislation (Amendment) Bill 2025 has been passed and gazette on 19 September 2025 to implement a series of tobacco control measures in phases. Measures will be taken to strengthen protection against SHS exposure in vulnerable groups, including pregnant women and children. Since 1 January 2026, smoking will be banned within three meters of entrances and exits of schools, hospitals, designated clinics and health centres, child care centres, and residential care homes. Smoking in queues to entre hospitals, and specified clinics and health centres will also be banned.
Source: World Health Organization