Paan and the People :: History, Meanings and Roles in India

Paan maker at work

Paan is a breath freshener, made of betel leaf (from the Piper betel vine), areca nut (from the Areca catechu tree), and slaked lime (predominantly calcium hydroxide), to which tobacco is often added (Merchant et al., 2000). Other ingredients and flavouring agents vary according to local practices and often include spices like cardamom, fennel, rose petals, aniseed or coconut. The fillings are folded inside the paan leaf to make a tight, triangular shaped packet, which is either chewed and swallowed or spit out. It is usually purchased from street sellers, known as "paan-wallahs". Paan is claimed to be chewed as a palate cleanser and for digestive purposes, and has a sweet, spicy flavour. The types of paan available across South East Asia are hugely varied, with ingredients particular to local taste and preference (Sivaramakrishnan, 2001). The tobacco and areca nut both are pharmacologically addicting stimulants, and chewers experience a relaxing and euphoric effect on consumption. The combination of ingredients turns saliva red, and paan users are often recognised by their bright red mouths and stained teeth. It is now well established by academics and health professionals that chewing areca nut and tobacco is carcinogenic, as paan users suffer significantly higher rates of mouth, tongue and throat cancers (Gandhi, Kaur & Sharma, 2005).

Paan chewing is an ancient Indian tradition, with the first literary references in India dating at least 2,000 years ago. The practice is thought to originate in South East Asia, and scholars believe it may have been introduced to Indian society via marine trading. Tobacco, however, was introduced around the sixteenth century by the Portugese (Chiba, 2001). Paan was once only available to royalty during the Mughal dynasty (Sivaramakrishnan, 2001). The practice of sharing paan became an erotic ritual shared between lovers because of its euphoric, relaxing properties; women would chew it to paint their mouths bright red. Paan later became hugely popular amongst the rich classes as a symbol of hospitality and wealth, with elaborate rituals used to store, create and serve paan. Today, it is traditionally consumed at weddings and special occasions as a sign of hospitality, welcome and honour (Merchant et al., 2000). The individual paan leaf and betel nut are significant cultural symbols too, commonly used during religious festivals and ceremonies that involve exchange of money, as well as proposals for business and marriage. Paan has also gained popularity through its use in Indian cinema and media, and one famous scene from the 1978 film 'DON' featuring Amitabh Bachchan (arguably the most popular Bollywood actor for over 40 years) features him singing about paan and the paan wallah.

Youtube - Khaiyke Paan Benaras Wallah

Bachchan singing "Paan Benaras Wallah"
Bachchan singing "Paan Benaras Wallah"

Paan and the Population :: Class, Caste and Modern Consumption

As stated above, paan was once considered a royal delicacy, associated with erotic and indulgent pleasures (Sivaramakrishnan, 2001). It evolved to later become a socially significant symbol of wealth for families belonging to higher caste of the Indian class system. Taylor-Sen (2004) states that paan consumption then became a habit adopted by British during their rule of India, and Indian families often served it to the British Raj as a symbol of peace and co-operation.

This pattern of consumption has since significantly changed, with the most prevalent users of paan today occupying lower socioeconomic status. This complex change can be attributed to the social and cultural meanings associated with paan chewing, a habit attractive because of the wealth and class it once represented. The symbolism and beliefs about paan are deep rooted within Indian psyche and culture and can be traced back over generations (Sivaramakrishnan, 2001). Furthermore, it is an accessible addictive agent, being readily available and cheap, and many consumers falsely believe it has medicinal properties (Gandhi, Kaur & Sharma, 2005). The act of chewing paan is today a predominantly social activity amongst urban ‘blue collar’ workers (such as taxi drivers and labourers), and the shared daily ritual has been said to give a sense of collegiality and pleasure to their days of long hours and menial work (Croucher & Islam, 2002). In addition, chewing paan staves off hunger, making it attractive to these workers as well as urban-slum dwellers (Sivaramakrishnan, 2001).

Paan is therefore hugely popular amongst those who live in this relative poverty, but has lost favour with educated urban populations who are now aware of its carcinogenic properties (Merchant et al., 2000). This part of the population considers the bright red mouth and saliva to be cheap and undignified, and paan chewing is therefore frowned upon as a pleasure of the poor (Taylor-Sen, 2004). Interestingly, many educated and wealthy members of the urban population enjoy it on rare occasions (for instance, at functions such as weddings) but choose sweet varieties flavoured with coconut and fruit instead of tobacco and areca nut. Traditional paan is therefore a cheap pleasure, indulged to excess primarily by the least advantaged members of society. Thus the greatest burden of adverse health outcomes are experienced by the already disadvantaged (Merchant et al., 2000).

Red mouth and saliva of paan eater

It is estimated that 10% of the world population are regular consumers of paan (Croucher & Islam, 2002). Patterns of usage vary greatly between the states of India, and consumption is more prevalent within urban areas. With urbanisation, better transport and the growing relative affluence of rural areas, paan usage is now increasing amongst rural populations too. A study estimates that in Mumbai (a cosmopolitan city with a population of approximately 22 million), 57% of the adult population consumes some form of paan at least twice a week, almost always with tobacco (Gupta, 1996). The survey was conducted among 99,598 residents 35 years and older (belonging to middle and lower socioeconomic groups). A range of population based rural, urban and urban-slum studies conducted all over India over 25 years estimate that between 20% and 40% of the population 15 years and above are betel quid chewers (Gupta, 1996). Even more worrying is evidence that amongst rural communities, areca nut usage is high amongst youth aged 5 to 20, with 27.4 % of boys and 1.6% of girls chewing betel quid regularly (Shah, Merchant, Luby & Chotani, 2002). The prevalence of paan usage is also high amongst South Asian immigrant communities across the world, with traditional as well as commercially packaged ready-made products widely available.

Prevention and cessation intervention programmes have had limited success thus far (Gupta, 1996). One study in particular has demonstrated success in a particular rural community through the use of cinema slides, pictorial booklets, films posters, folk dramas, radio programs and newspaper articles, designed for the target population. At the 5 year follow up, the percentage of chewing tobacco users who had stopped was higher in the intervention cohort compared to the control cohort: 10.2% of men and 14.9% of women chewers in the intervention cohort had stopped. However, significant measures have yet to be implemented, which will require strong and consistent governmental support and legisative input (Gupta & Ray, 2003).

Paan spit on the city walls

Paan and its Impact :: Diet, Cancer and Interventions

The link between use of paan and cancer has been well established, and heavy users have a significantly increased mortality and morbidity rates (Gandhi, Kaur & Sharma, 2005). Paan with tobacco causes oral cancer, cancer of the pharynx, and cancer of the oesophagus in humans. Further evaluation of paan without tobacco was made possible by recent epidemiologic studies from parts of the world where tobacco generally is not added, confirming that tobacco is not the only component of paan that is carcinogenic (Boucher, 2001). Areca nut has cytotoxic and genotoxic properties, and has been observed to cause oral submucous fibrosis (a pre-cancerous condition that can progress to malignant oral cancer), leading to the determination that areca nut itself is carcinogenic to humans. Current male chewers of paan with tobacco in case-control studies in India had relative risks of oral cancer varying between 1.8–5.8 and relative risks for oesophageal cancer of 2.1–3.2. Of the 390,000 oral and oro-pharyngeal cancers estimated to occur annually in the world, 228,000 (58%) occur in South and South-East Asia (Gupta & Ray, 2003). Dental decay is also a significant consequence of paan chewing (Boucher, 2001).

As earlier stated, literate and educated members of the Indian population are decreasing their consumption of paan with areca nut and tobacco. However, consumption patterns have been difficult to change for those belonging to lower socioeconomic groups, and this is unlikely to change until government legislation supports this population in gaining access to appropriate education and intervention programmes (Gupta & Ray, 2003). While the Indian government has various strategies in place around tobacco control, there has been limited focus on freshly made paan. A positive move was made in early 2011 when the Food Safety and Standards Authority of India (FSSAI) banned tobacco use in ready-made paan masala packets, and this had reasonable success as the Smokeless Tobacco Federation of India noted a 40 percent drop in business (Indo-Asian News Service, 2011).


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Preven., 2: 264-269 (2001).Gandhi, G., Kaur, R., and Sharma, S. (2005). Chewing Pan Masala and betel quid – fashionable attributes or cancer menaces? Journal of Human Ecology, 17 (3), 161 – 166.

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Merchant, A., Husain, S. S. M., Hosain, M., Fikree, F. F., Pitiphat, W., Siddiqui, A. R., Hayder, S. J., Haider, S. M., Ikram, M., Chuang, S.-K. and Saeed, S. A. (2000). Paan without tobacco: An independent risk factor for oral cancer. International Journal of Cancer, 86, 128–131. doi: 10.1002/(SICI)1097-0215(20000401)86:1<128::AID-IJC20>3.0.CO;2-M

Shah, S.M., Merchant, A.T., Luby, S.P., Chotani, R.A. (2002). Addicted schoolchildren: prevalence and characteristics of areca nut chewers among primary school children in Karachi, Pakistan. Journal of Paediatric Child Health, 38 (5), 507 – 510.

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