Patna, Bihar: On a busy street near Patna’s Rajendra Path, 11-year-old Sanjay* watches his elder brother roll up tendu leaves stuffed with tobacco flakes. Within minutes, a fresh bundle of bidis is ready to be sold for one rupee (Re 1) to eager customers that have lined up outside his paan shop. There are no warning labels or age checks; the bidis are sold loose to minors and adults alike.

India is home to over 267 million tobacco users, struggling with a public health crisis rooted in mass consumption and underregulated usage. According to the Global Adult Tobacco Survey 2 (GATS2) conducted in 2016-17, 42.4% of men and 14.2% of women in India use some form of tobacco.

Unlike in the West, where cigarettes are the primary form of tobacco, smokeless tobacco accounts the highest use in India, followed by bidis--cheap hand-rolled cigarettes that dominate the rural and informal market. The prevalence of bidi use is nearly twice that of cigarettes.

Bidi smokers face a higher risk of developing potentially-fatal chronic obstructive pulmonary disease (COPD), among other illnesses, because tobacco is packed more loosely in bidis, requiring smokers to inhale more strongly, as IndiaSpend reported in September 2015. But the bidi industry has consistently squeezed concessions from the government, we had reported.

The unfiltered killer

Bidis consist of tobacco flakes rolled in dried tendu leaves, tied with a string. The tendu leaf is a major income source, especially in central India, as IndiaSpend reported in December 2017.

“Bidis deliver higher concentrations of nicotine, tar and carbon monoxide than cigarettes making it more carcinogenic,” said Prabir Moharana, former deputy director for quality assurance at Bihar’s reproductive, maternal, newborn, child and adolescent (RMNCH-A) unit of the State Health Society.

“Bidi smokers face a 3.1 times higher risk of oral cancer compared to non-smokers, while exclusive bidi smokers have a 4.6 times higher lung cancer incidence than non-smokers,” said Ravi Mehrotra, clinician-scientist and founder of Centre for Health innovation and Policy (CHIP) Foundation, a non-profit raising awareness about cancer prevention. Mehrotra is Program Lead at the India Cancer Research Consortium, affiliated with the Indian Council of Medical Research (ICMR) and was earlier the director of ICMR-National Institute of Cancer Prevention and Research.

"This is no longer an urban versus rural problem, this is a problem of awareness across all classes,” said Ajay Kumar Bhargava, former Director of Rajiv Gandhi Cancer Institute and Research Centre in New Delhi. "People in cities are smoking as mindlessly as those in remote areas, danger lies in the normalisation of the habit."

Yet, bidis have remained highly under-regulated particularly when compared to cigarettes.

Policy gaps

Cigarettes and Other Tobacco Products Act (COTPA, 2003) is the overarching law related to tobacco, but its enforcement has been inconsistent, especially for bidis.

Section 6 of the COTPA Act bans the sale of tobacco to anyone under 18 and stops sales near schools, while Section 7 mandates packaging norms and pictorial health warnings (PHWs). Since bidis are often sold loose, they evade packaging regulations altogether. Many states are yet to operationalise a ban on the sale of loose cigarettes and bidis.

In parts of Bihar, packaged bidis with textual warnings have started to appear, marking a slow shift towards regulatory compliance. Enforcement however remains inconsistent as many bidi packs still lack the mandated warnings or are sold loose, bypassing the regulations entirely.

"Unclear implementation guidelines, resource constraints, weak monitoring and low awareness among enforcers further hinder the compliance that expose system level failures. Bidi manufacturers circumvent bans via social media platforms like Facebook, targeting low-income groups with minimal regulation,” said Mehrotra, reflecting on a digital shift in tobacco promotion that often goes overlooked. The Cable Television Network Rules of 1994 prohibit tobacco and alcohol ads on television. The Film Rules of 2011 mandate strong health warnings and anti-tobacco disclaimers in films and TV shows that depict tobacco usage.

Despite the regulation efforts by the government, deep contradictions exist. "There is no clear policy to eliminate bidis because the government directly earns from it. The burden of awareness is pushed on the individual while the system benefits," said Moharana.

Overall, Indians consume an estimated 400 billion sticks of bidis per annum, including 275 billion duty paid sticks and 125 billion duty exempt sticks, research published in December 2020 in the journal Tobacco Control found, ascribing it to the informal nature of the supply chain and tax exemptions for small producers. Other estimates are higher: up to 1.2 trillion sticks each year.

Bidi manufacturers have been sheltered from the national tax regime as a ‘cottage industry’, the study said. “Historically, bidi manufacturers that produce less than 2 million sticks per year have been exempt by the centre from duty, while the duty rates on bidis from larger manufacturers has been set relatively low,” the 2020 study said. “This exemption provides an opportunity for bidi manufacturers to circumvent their tax liability by establishing networks of smaller shell companies.”

If these exemptions were removed, total bidi consumption would decrease by 6% and the number of smokers would decrease by 2.2 million adults, the authors estimated. This would bring the rate of bidi smoking down from 7.7% to 7.5% of adults, while generating Rs 14.8 billion in tax revenues, they find.

This reporter has reached out to Bihar’s health society for comment on enforcement of tobacco laws, invisible nature of child labour in the bidi industry, and grassroot efforts. We will update this story when we receive a response.

Livelihood or liability?

Bidis cost as little as Re 1 for a bundle of five, making it the ‘poor man’s puff’. According to World Health Organization's 2021 Global Tobacco Epidemic Report, over 80% of global tobacco users live in low and middle income countries and within India, bidi consumption is disproportionately higher among the lower socio-economic groups.

"Bidis are cheaper and more accessible than cigarettes leading to a widespread usage in rural and low income communities that increases health disparities,” said Mehrotra.

In Bhubaneswar, Shanti, in her 50s, earns approximately Rs 200 a day rolling and selling bidis. She admits it is harmful for health but says, "This is our livelihood. Many children in families roll bidis after school to support their families."

Collusion between local government authorities and the bidi industry keeps bidi workers in penury, while tying their daily wage to punishing targets of about 1,000 bidis a day causes ill health, write Sunanda Sen and Byasdeb Dasgupta in their 2009 book Unfreedom and Waged Work: Labour in India’s Manufacturing Industry.

Most workers are given tobacco to roll at home, IndiaSpend reported in September 2015. Protective measures such as masks and gloves are unheard of, and soon enough, they suffer the ill effects of exposure to tobacco flakes and dust.

When asked if the government “is aware of the plight of Beedi workers due to low wages, hazardous work environment, systemic exploitation, lack of social security and limited access to various welfare scheme”, especially for women and children, the Union labour ministry told the Lok Sabha in March 2025 that labour is a subject under the concurrent list with both states and the Union government being competent to enact legislation and enforce laws. The ministry estimated that India has an estimated five million registered bidi workers (predominantly women), and went on to list a slew of schemes that are available for workers, including bidi workers. The ministry maintains that no children were employed in rolling bidis.

In July 2024, the ministry told Lok Sabha that in collaboration with the skill development ministry, about 7,300 bidi workers and their dependents were trained and about 2,750 were employed in alternative jobs between April 2017 and March 2020.

In Purnea, Bihar, 45-year-old Lalchand Kumar* is battling oral cancer after years of smoking bidi and chewing tobacco. "I thought it was just a habit, everyone around me did it, so did I," he says. "No one ever told me that it would end like this. By the time we knew, it was too late", says Kumar.

An estimated 1.3 million new cancer cases are registered annually in India, of which tobacco use is responsible for nearly a third. The human cost of this is mirrored by the economic toll. A 2018 study estimated that India loses Rs 1.77 lakh crore annually--far more than the revenue generated from taxation of tobacco--with men bearing 91% of the burden to tobacco-related illnesses and deaths.

Fragile quitting support

The government has made several efforts for individuals seeking to quit smoking. The National Tobacco Control Programme (NTCP) focuses on establishing Tobacco Cessation Centres (TCCs) in district hospitals, offering free behavioural counselling, medication, and nicotine replacement therapy. This also reflects in the data: About 32% of people who use tobacco reported trying to quit in the 12 months prior to the 2019-21 NFHS survey.

With only 600 TCCs nationwide, however, India has roughly one cessation center per two million people, with rural areas particularly underserved, as we reported in May 2025. Awareness of national quitline numbers (1800-11-2356) on tobacco packs remains low, the Tobacco Control Policy Evaluation India Report found.

The real burden of implementation falls on grassroots workers, many of whom are under-resourced and overlooked. "ASHA workers, anganwadi staff and even faith leaders are poorly trained and yet expected to fix the national policy lapses," said Moharana.

"Deep breathing especially through yoga assists in tissue regeneration and respiratory healing. More holistic approaches should be made part of mainstream treatment, not just for those who can afford private care but for everyone,” said Bhargava.

In homes across the country, tobacco usage is both a tradition and a trap modeled by parents and normalised by masses. As long as bidis remain cheap and easily available, children like Shahid will not just roll them but also smoke them. “India’s cheapest smoke will continue to come at the deadliest cost until people are made aware,” said Bhargava.

*Identity withheld at the request of the individual


Aditya Ansh

    Aditya Ansh is a freelance writer and reporter based in New Delhi, India.