Madhya Pradesh stands out as the best model of implementing gutka ban. This is the result of administrative will coupled with political and public action

The implementation of the Food Safety and Standards Authority of India (FSSAI) notification 2011 that effectively prohibits the production, sale, and consumption of gutka products containing tobacco and nicotine is one of the landmark public health interventions in Madhya Pradesh in recent years. In a country where 90% oral cancers are directly related to use of smokeless tobacco, the State-level intervention that Madhya Pradesh has initiated is of high importance for two apparent reasons. First, this has undone the previous history (also the myth, of an impractical ban!) of 2001 that failed to sustain the ban due to various pressures including that of judiciary and industrial lobbies. Secondly, the current move has provided momentum to the action against gutka and pan masala all over the country. , After Madhya Pradesh imposed gutka ban, Kerala, Bihar, Maharashtra, Rajasthan, Jharkhand, Chhattisgarh, and Haryana followed suit.

The health challenges of the gutka products have long been a concern for public health activists and people. In India, the consumption of gutka is widespread and this outnumbers any other form of tobacco use. As per the Global Adult Tobacco Survey India 2010, 75% of the current 275 million tobacco users consume gutka. Because of easy availability, low prices and the attractive marketing, gutka products have gained popularity among schoolgoing children and adolescents over the years. As per the Global Youth Tobacco Survey India Report, 2006 the use of gutka is 10% among the boys and 5.5% among girls of schoolgoing age. The National Institute of Health & Family Welfare in its fact-finding report mentions of 3,028 chemical ingredients in gutka products. Of these, 28 chemical ingredients are proven carcinogens! As per the study of Indian Council of Medical Research, 70,261 people were detected with cancer of the mouth, tongue and hypo pharynx in 2010 because of “smokeless tobacco products.” The numbers of those affected have been steadily rising from 2008.

Madhya Pradesh stands out as the best model of implementing gutka ban and this is importantly, the result of administrative will coupled with political and public action. The need for enforcement primarily originated from the high levels of gutka consumption in the State. The State developed an initial plan of action under the leadership of the then Food Commissioner, and implemented the plan rigorously by ensuring the support of district administrations, the general public and the media. As of July 2012, approximately 50 raids were conducted and four million pouches confiscated.

The implementation has evidently succeeded to curtail both the supply and the demand for gutka in the State. The enforcement of ban is widely discussed and appreciated en masse. Now, rampant use is reduced. Access is considerably reduced for casual users, children and women. Retailers had a loss of 50% turnover in the last four months after the ban and most importantly all the 16 registered factories were sealed to close. Certainly, blackmarketing exists through cross-border smuggling but the wide reach of the supply chain is shattered by the ban and subsequent administrative actions.

However, one of the major drawbacks is the lack of adequate cessation facilities in the State. In the absence of such facilities, gutka users may switch to other products that are cheap but equally harmful.

However, what is important now is to sustain the fight through continuous monitoring of implementation systems with coordinated inter-State/district activities. Further to this, the experience of Madhya Pradesh and other States should inform the National Tobacco Control Programme of India in order to extend the best practices across the country. This would surely provide a great leap forward to the tobacco control initiatives.

(Liju Ramachandran (alohiram@gmail.com) is a Public Health Researcher with Voluntary Health Association of India,

New Delhi.)

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