'Local government, standardised packaging, and licensing are key': a stakeholder-based qualitative study on strengthening smokeless tobacco regulation in Bangladesh.

Introduction: Smokeless tobacco (ST) use is widespread and poses a considerable health burden for Bangladesh. However, the tobacco control law enforcement for ST is significantly weaker than for smoking tobacco, leading to a near-total non-compliance of ST products. We explored tobacco control stakeholders' perspectives on high ST non-compliance, in order to improve regulation in Bangladesh.

Methods: We conducted a qualitative study involving in-depth semistructured interviews (n=20) with five stakeholder groups (policymakers, non-governmental organisations, researchers, international agencies and advocacy networks) between July and September 2024. Participants were asked about their perspectives on regulatory non-compliance of ST, policies and enforcement mechanisms, and supply chain control and international collaboration to address ST non-compliance in Bangladesh. We used the framework approach to analyse the data, which involved iteratively coding, charting and interpreting the interview transcripts.

Findings: Stakeholders perceived weak monitoring and enforcement of ST, leading to substantial non-compliance of ST regulation in Bangladesh. Factors such as market's informality, cultural embedment and lack of registration and licensing of ST businesses contributed to this. A disjointed regulatory framework and perceived low tax return made ST non-compliance a low priority for regulators. Furthermore, diversity in packaging and targeting of consumers' social and cultural beliefs by the manufacturers made ST compliance more challenging than cigarettes. Widespread tax evasion arises from a flawed self-declarations system and a lack of explicit tax markers due to regulatory weaknesses and manufacturers' influence. Bangladesh's current legal framework fails to address ST product diversity. Participants suggested introducing standardised packaging and licensing with local government involvement to strengthen regulations and address ST non-compliance.

Conclusion: ST control has long been neglected by policymakers in Bangladesh. Besides government commitment, strengthening regulation to address high ST non-compliance would require implementing evidence-based approaches.