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The revised fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) of the American Psychiatric Association (APA, 2000) classifies tobacco dependence as an addiction

They range from mild ones to powerful urges

In women, this spans hormone secretion, metabolism, direct toxicity to eggs, ovulation, placental growth and health, fertility (including, specifically, risk of an ectopic pregnancy), rate of miscarriage, decreased fetal oxygen levels with the accumulation of carboxyhemoglobin, and fetal endocrine imbalances, she elaborated

This is despite Sri Lanka being the first South Asian country and the fourth in the world to ratify the World Health Organisations (WHO) Framework Convention on Tobacco Control (FCTC) 15 years ago