tampabay.com

Bangladesh: Land of water

By REENA SHAH STAMETS
Published October 13, 2006


(Part two of a series published by the Times Oct. 27, 1993)

"One Billion Sold," the King of Spades rug announces in Robert Ciszewski's office. The burly American plays this card in an unlikely sales success in this illiterate, conservative Islamic country.

Raja (or king) is the best-known brand name, recognized in the remotest hamlet. It is also the best-selling condom in Bangladesh. Born as a generic rubber in a Tennessee factory and reincarnated and packaged in Bangladesh, Raja has become a synonym for "condom" in a country where 20 years ago most people didn't even know what a condom was.

You can see the King of Spades everywhere. On billboards and T-shirts, in cigarette kiosks and corner stores, on the backs of rickshaws, and until genteel viewers recently objected, you could even see Raja advertised on TV.

The campaign has worked, even though seven out of 10 Bangladeshis would not be able to read the word Raja.

"People may be illiterate, but everyone plays cards, whether they're in the city or a village," says Ciszewski, a U.S. aid-sponsored consultant. "The poorest person plays cards and knows what this symbol is when he sees it."

When Ciszewski came to Bangladesh in 1974, only 8 percent of couples used birth control. Now, 40 percent do.

There is a long way to go, but Ciszewski is elated. One evening, after the prayers at the local mosque concluded, 5,000 villagers sat down on a school field and did something that would be improbable in America. Men, women, teenagers and young children together watched a series of short films that repeated one message again and again: People with small families, people who use condoms and pills, are healthier and happier.

"This is the only country in the world that's done this without being a Taiwan or Korea," he says. "It flies in the face of all the things we had heard about ignorant, backward and superstitious people. Bangladesh is so far ahead of the United States. People take family planning seriously. They talk about it openly. You don't find the hypocrisy that you do in America."

To appreciate how far Bangladesh has come, consider that population experts have always maintained that people limit family sizes only after first attaining a modest standard of living. We think of large families as more mouths to feed. Poor people think of many children as more hands to work. If people expect disease and hunger to wipe out most of their family, they better their odds by having more children.

Bangladesh skipped this step. Here, public awareness has come before prosperity. The population growth rate has been halved to 2 percent. People still have an average of four children compared to six a few years ago, but change has begun.

The agent of this change is "social marketing." You sell a socially beneficial idea or product just as you would a brand of toothpaste, but at a price poor people can afford.

In Bangladesh, U.S. aid helped found the Social Marketing Company, a Bangladeshi company with Ciszewski as one of its advisers. It unleashed an education and publicity blitz that saturates people with information about the benefits of pills, condoms and oral rehydration salts (which help prevent infant deaths from diarrhea). An extensive marketing network makes sure that these products are available in far-off villages and are affordable even for people whose monthly income is $10.

People are likely to value something more if they buy it instead of getting it free. So instead of giving out contraceptives, the company sells them at the highly subsidized rate of 1 taka (2.5 cents) for three condoms or a cycle of pills.

As contraceptives and information about them have become available, villagers are eager to use them. Pills and condoms are available cheaply at the remotest village kiosk, but there is a strange contradiction about this: If villagers need aspirin for a simple headache or medicine for a child's illness, there is none to be had, even for money. There are no pharmacies for miles.

Other than a few overcrowded hospitals miles away to treat serious illnesses, rural Bangladeshis have no regular health care. The suspicion and resentment villagers sometimes harbor toward birth control is understandable. The government sends family planning workers to go from door to door in villages, persuading people to use birth control. But it has nothing to offer them when they are ill. Shouldn't basic health care precede birth control? "Undoubtedly," Ciszewski agrees.

But that is the Bangladeshi government's responsibility, as is family planning, and the government doesn't have the political will or the wallet to provide either. Family planning is a small enough slice for foreign aid agencies to bite into - and it is a popular cause, financed by nearly every country's foreign aid program.

As in many Third World countries, Bangladesh's government is corrupt and bankrupt. It maintains just enough law and order to stay in power, and it has turned over virtually every aspect of the country's development to foreign aid agencies.

Ciszewski, a former pharmaceuticals salesman, came to Bangladesh with a hankering to do something more meaningful than being another aid worker continually handing out food to poor people. Most foreign aid workers in Dhaka sneer at social marketing as American commercialism run amok, but they cannot deny that it has reached out to more people, and its commonsense approach has changed lives more effectively than their grandiose plans that have never taken off.

Bangladesh was not an easy market to crack. How does one sell contraceptives in a country whose people are too shy and fearful to try these foreign devices, whose clergy threatens to expel users from mosques, and whose government is too inefficient and too edgy about political fallout to support such a sensitive issue?

Most Bangladeshis live in cramped quarters that afford virtually no privacy. Attached bathrooms are for the affluent only. Sex is quick and furtive, and contraceptives would seem to be an added encumbrance. In rural areas, even married couples shy away from going to see the occasional movie together. They are afraid the rest of the village will titter at them.

The Social Marketing Company recruited top sales managers from private corporations and wedded sociological research with a savvy sales pitch. The result was Raja, the condom brand, and Maya (meaning love, but also a popular female name) birth control pills.

Why choose the King of Spades instead of the King of Hearts as the symbol for Raja? "The King of Spades has a mustache," says A. A. M. Anwar, the company's sales director. "He's the most powerful of all the kings."

Raja may be a macho man, but the selling of birth control in Bangladesh has nothing to do with sexual freedom or enjoyment as it does in America. This is a country where people would get arrested if they held hands in public. The way contraceptives are distributed conforms to the strict moral tone of Bangladeshi society. Every condom pack carries a warning: "For use by married couples only."

When family planning workers go from door to door with pills, they give them only to married women, and that too with the consent of husbands.

"We emphasize the health aspect, not sex," says Anwar, who formerly sold Philips light bulbs. "If people have less children, their standard of living is better. The closeness between the husband and the wife is better. The health of the woman is better than if she was in childbirth every year." This is also a reason there is no squeamishness about the very public discussion of birth control in Bangladesh, Anwar says. "If a child asks his parents, `What is Raja?' they don't feel embarrassed. They simply explain that it is some medicine grown-ups use for their health."

Although Raja and Maya's effect on a couple's relationship are only broadly hinted at, they have transformed lives, especially women's lives.

"When you no longer have to be terrified that you'll get pregnant every time you are with your husband - that makes life different," Ciszewski says. Couples can plan their lives. Bangladesh's booming garment factories have for the first time recruited women into industry, and birth control has helped them hold on to these well-paying jobs.

Once created, Raja and Maya relentlessly filled every corner of the country with their likenesses. "We wanted to make them so familiar that people didn't feel embarrassed to talk about them and use them," explains Ciszewski.

They appeared next to cigarette packs in village shops. Boat sails carrying the logos drifted by villages, so that men catching fish or women fetching water could see them. Roving folk singers warbled their virtues.

During the intermission in village dramas, magicians would entertain crowds by producing reams of Raja condoms from nowhere. Airplanes showered villages with leaflets advocating birth control.

"But we had to stop that," Anwar says. "Some of them fell inside the mosque, and the priests got very angry."

The support of the clergy was gradually won over by generous travel grants to Islamic universities in Egypt. There, they learned that family planning didn't go against the teachings of the Koran. At first, clerics had railed against people who used artificial means to block the wishes of Allah. But they came around.

A song celebrating the importance of "maya" in a family became a national hit. "It's more popular than the national anthem," Anwar boasts. Once, a group of primary school girls demurely sang the Maya theme song at a school ceremony, to the horror of their parents.

A radio soap opera about the life of a family planning worker - who were once hated as callous government workers - was also a smash. It was a warm portrayal of a caring worker, showing her dealing with love triangles and scheming landlords, and it melted away the hostility of villagers.

Films screened with outdoor projectors in villages show life stories people can identify with. The skits are unsophisticated and their messages obvious. A boatman struggling with his overcrowded ferry loudly wonders that a large family is a similarly heavy burden on the man who supports it. A bride is told by her friend not to make the same mistake she did in having several children. "All this sounds corny to you and me," Ciszewski says, "but when a crowd of villagers is sitting there watching these films, you can see they're completely into it. There's complete silence because they're watching their own lives." Such persuasion wouldn't work as well in America, where people are saturated with information. In Bangladesh, people are starved for it. Most of the people in the country haven't seen television. Only four out of 100 people own radios.

The company's efforts to sell Raja and Maya have been so successful that its 84 salespeople have cornered three-fourths of the market. They outsell the government's 25,000 family planning workers who hand out contraceptives free. Last year, they sold 117-million condoms and 10-million cycles of pills. Although Bangladesh's government says family planning is a priority, it spends little of its money and attention on it. The market in this country of 114-million people is huge, but neither the government nor any private company manufactures contraceptives. The government continually pleads poverty, and businesses won't cater to a market unless they can turn a profit. Most rural Bangladeshis earn less than $150 a year and would be unable to afford contraceptives if they weren't subsidized by aid.

Even the one taka (2.5 cents) a villager spends on contraceptives is a powerful indicator of progress in a poor, hungry country, Ciszewski says. "That's really quite a statement that instead of buying some more rice, you use that one taka to buy a packet of Raja."