India's biggest tobacco problem isn't smoked

Who uses it

Khaini, tobacco mixed with slaked lime, is the most common form: 11.2% of Indian adults use it. Gutka and mawa follow at 6.8%, and betel quid with tobacco at 5.8% (GATS-2). Use is higher in villages than in towns (24.6% against 15.2% of adults), and half of all users buy it loose.

The burden falls hardest on poorer families. In rural India, 70.2% of households in the poorest 40% use tobacco, and they spend 4% of their monthly budget on pan, tobacco and intoxicants, against 2.5% on education (EAC-PM working paper, 2026).

Users already know the risk. 96% of Indian adults believe smokeless tobacco causes serious illness, and half of all users say they plan or want to quit (GATS-2). Warnings alone haven't got them there.

Banned on paper, sold everywhere

Since 2011, Regulation 2.3.4 of the Food Safety and Standards (Prohibition and Restrictions on Sales) Regulations has barred tobacco and nicotine as ingredients in any food. States used it to ban gutka. Manufacturers responded by splitting it in two: pan masala and flavoured chewing tobacco sold in separate sachets, from the same shop, to be mixed by the buyer. The Supreme Court recorded this workaround in 2016 and directed states to enforce the ban (Central Arecanut Marketing Company v. Union of India).

The ban has not worked. A 2026 working paper by members of the Economic Advisory Council to the Prime Minister found that the share of rural households consuming gutka rose more than fivefold, from 5.3% in 2011–12 to 30.5% in 2023–24. That is 5.96 crore households. In towns it rose from 3.1% to 16.8%. Gutka now takes 41% of all rural spending on tobacco (EAC-PM, reported by ThePrint).

The case for harm reduction

What kills smokeless tobacco users is the tobacco, not the nicotine. Smokeless tobacco is a Group 1 carcinogen, and IARC, the WHO's cancer agency, has never classed nicotine as one (AVI analysis). Smokeless tobacco is behind nearly 90% of India's oral cancers (Tobacco Free Kids), and India has 36% of the world's new oral cancer cases and 42% of its deaths (Yach, 2026).

Nicotine pouches deliver nicotine with no tobacco leaf, areca nut or slaked lime. The US FDA found that the pouches it authorised contain far lower levels of harmful constituents than cigarettes and most smokeless tobacco (FDA, 2025), and in June 2026 it allowed a claim that using them instead of cigarettes lowers the risk of mouth cancer (FDA, 2026).

Switching works at population scale. Sweden's move from smoking to snus gave it the lowest daily smoking rate in Europe and tobacco-attributable mortality 44% below the EU average (GSTHR). Closer to home, pouches have spread quickly in Pakistan, where naswar and gutka are widely used, driven largely by adults moving away from cigarettes and traditional oral tobacco (AVI analysis). Swedish snus is made to quality standards that Indian khaini and gutka are not.

In India that route is shut. Nicotine pouches and snus have no lawful sale pathway (the law, in full), and since September 2026 the health ministry has treated pouches as unapproved drugs (AVI analysis). So khaini and gutka stay on sale at every paan shop, while far less harmful alternatives are never assessed at all.

What AVI argues for

• Regulate by risk. Treat smokeless tobacco according to the harm each form causes, with enforceable quality standards for what is sold, rather than bans that push it into twin packs and an illicit market.
• Open a legal route for lower-risk alternatives. Give nicotine pouches and snus a regulated, evidence-based review, with age checks, instead of a blanket freeze.
• Put SLT users at the centre. Three in four Indian tobacco users don't smoke. Cessation and harm reduction policy built around cigarettes leaves them out.