How effective is gutka (a smokeless tobacco) ban in West Bengal, India? A case study

Background Under the India's food legislation, adding tobacco or nicotine to anything that is consumed is prohibited, following this in May 2014, the Ministry of Health announced a ban on the sale of gutka, a popular packaged mixture comprising betelnut, condiment, lime and tobacco mixture. We conducted a compliance of the ban on gutka in the state of West Bengal, which has a tobacco use prevalence of 15% adults using smokeless tobacco (or more than 9 million people). Methods Three districts were selected purposively for the study. In every district, district headquarter i.e. municipality selected purposively while two Blocks were selected randomly. Based on population dispersion model, 450 consumers were divided in three clusters in each district and for every 5 consumers 1 vendor i.e. 90 vendors were interviewed. The interview schedule was pre-tested in Kolkata and after feasibility assessment of the same it was finalized. The study was conducted during September - December 2016. Results Effect of ban on gutka has been limited and disappointing. Only 17.8% of vendors knew that selling of gutka is punishable offence while 68.5% vendors replied that gutka is easily available to them. 75.3% vendor have sold gutka to the minors and only 1.1% vendors were raided. However, almost 90% vendors felt that gutka ban is helpful in quitting the deadly habit. 16.9% vendors answered that they faced a loss in their business due to gutka ban and 15.7% vendors shifted to other businesses after the ban was enforced. It is also true that sale of gutka declined after ban as 53.5% consumers reported that they have shifted to other tobacco products. Conclusions Gutkha ban has been ineffective in the absence of stricter enforcement at producer, wholesaler and vendor level. To make the ban effective immediate attention is required on enforcement across the supply chain