Smoke Free Sweden: Pakistan’s Stance on Nicotine Pouches Deprives Women of a Safer Way to Quit Tobacco

ISLAMABAD--(BUSINESS WIRE)--On International Women’s Day (March 8), Pakistan’s policymakers are being warned that reluctance to embrace oral nicotine pouches is denying women access to an innovation linked to one of the world’s most dramatic declines in female smoking.

The warning accompanies the release of Empowerment in a Pouch, a report documenting how access to tobacco-free nicotine pouches has accelerated Sweden’s progress towards becoming smoke-free, particularly among women.

“Sweden’s experience shows what happens when people are offered safer, realistic alternatives to the most dangerous forms of tobacco use,” said Professor Marewa Glover, behavioural scientist and co-author. “When lower-risk options are accessible and socially acceptable, users move away from the most harmful products. When they are absent, toxic traditions persist.”

In Pakistan, lawmakers have yet to clearly regulate or permit oral nicotine pouches, despite growing international evidence that smoke-free nicotine products carry substantially lower risks than combustible tobacco.

As a result, most nicotine users continue to rely on highly toxic traditional products such as naswar - a mixture of tobacco, ash and slaked lime - and paan, a betel quid containing areca nut and tobacco. These are strongly associated with oral cancers, cardiovascular disease and other serious health harms, particularly among women.

The report shows that since nicotine pouches became available in Sweden in 2016:

• Women’s smoking rates have fallen by nearly 50%, now among the lowest globally.
• Women’s quit-smoking rates increased around threefold, putting Sweden on track to become the first smoke-free country (adult daily smoking below 5%).
• Female smoking is declining six times faster in Sweden than elsewhere in Europe, according to WHO statistics.

Nicotine pouches contain no tobacco and involve no combustion. Used under the lip, they deliver pharmaceutical-grade nicotine without smoke, ash or carcinogenic additives. Survey data and focus groups show women value their discretion, convenience and reduced stigma compared with traditional tobacco use.

Participants rated nicotine pouches as the most effective quitting aid, outperforming vapes and traditional nicotine replacement therapies.

“As Pakistan considers how to regulate oral nicotine pouches, it has a clear opportunity,” said Dr Delon Human, co-author and former secretary-general of the World Medical Association. “A risk-based framework could make safer alternatives accessible and affordable, accelerating progress against some of the country’s most devastating tobacco-related diseases.”