Global rates of tobacco use among men have peaked and are slowly declining, while rates among women are steadily increasing, raising important questions about gender, equity and health. The focus of this epidemic will be in low and middle income countries where women are also increasingly involved in the production and manufacturing of tobacco as well as being targeted by tobacco marketing. As the tobacco epidemic evolves in the 21st Century, increasing tobacco use and production affecting girls and women threaten to undermine not only their physical and mental health, but also their economic and social progress. This article explores how tobacco use and production will affect the status of women and their progress towards gender and health equity. Several strategies for responding to this are suggested, and it is argued that the tobacco control movement has a responsibility to adopt gender and equity based principles in its goals and practices.