Elderly Bangladeshi woman Zahura Begum sits on a bed in The Bangladesh's National Hospital for Chest Diseases in Dhaka. (Photo courtesy: AFP)



DHAKA, April 29 (AFP) - Bangladeshi chest doctor Kazi Saifuddin Bennoor has seen many misleading cigarette advertisements, but the one that suggested smoking could make childbirth easier plumbed new depths.

Advertisements telling smokers they are smarter, more energetic and better lovers than their non-smoking counterparts are a familiar sight across Bangladesh -- something unimaginable in most other countries.

One in a rural area, Bennoor remembers, said that "if a lady smokes, her baby will be smaller and it will be easier to deliver, the labour will be less painful".

"These are very ruthless advertisements," said Saifuddin, an associate professor at Bangladesh's National Hospital for Chest Diseases.

The promotion is being linked to an alarming rise in tobacco use in the impoverished South Asian country, particularly among women and the young -- a trend repeated across many developing countries, anti-tobacco groups say.

The World Health Organization warns that tobacco companies are targeting women in developing countries as a new growth market and Dhaka-based doctors treating lung diseases report they are seeing more female patients.

Around 28 percent of adult Bangladeshi women now use tobacco, according to the latest WHO survey, and 43 percent of the adult population -- or 41 million people -- use tobacco in some form, up from 37 percent in 2004.

"(Tobacco use) has become an epidemic among rural women. It's a very serious health issue," a government advisor on health, Syed Mudasser Ali, told AFP, adding that anti-smoking laws were poorly enforced.

Tobacco advertising was banned in Bangladesh in 2005, so the advertisements are usually fly-posters that do not specify the company behind the message.

"Only a negligible number of people have been fined for breaching tobacco laws over the last few years," Ali said.
Officially 57,000 people die in Bangladesh of tobacco use annually, but that figure was likely a "huge underestimate".

The country fits a pattern emerging across the region of rising rates of female tobacco use, particularly in Southeast Asian countries such as Indonesia, the Philippines and Cambodia.

This rise is largely because more Asian women are entering the workforce, have disposable income and see smoking as "modern and liberated," said doctor Mary Assunta, director of the International Tobacco Control Project.

"I've seen tobacco companies' marketing campaigns on my university campus and in residential dormitories," said one 25-year-old Bangladeshi female smoker who used to smoke a pack a day but is trying to quit on her doctor's advice.

"They approach students with a questionnaire and ask them to fill it in to win T-shirts or lighters," she said, adding that she started smoking as her friends in class at Dhaka University all smoked.

Tobacco companies are encouraging the trend, viewing women in developing countries as their "largest unexploited market", according to the WHO -- which has chosen the theme of tobacco marketing to women for 2010 No Tobacco Day on May 31.

"We see clear marketing strategies targeting women in Asia such as lipstick-type cigarette packs in Indonesia, Malaysia and Laos," said Assunta.
The pretty, small packets of ultra-thin cigarettes are designed to be something a woman would like to carry around with her at all times, just like her favourite lipstick.

"These fit easily into women’s purses. Cigarette packs are coloured pink and there are even fruit flavoured cigarettes," Assunta said.

Tobacco companies in Bangladesh contacted by AFP all denied using illegal fly-posters or point of sales marketing, which the ministry of health hoped to stop with an amended version of the 2005 law.

The market is dominated by volume leader Dhaka Tobacco, which has a 40-percent share and monopolises low-end sales.
British American Tobacco, which makes the popular Pall Mall and John Player Gold Leaf cigarettes, dominates the 140 million dollar premium tobacco market with its Benson and Hedges brand.

"BAT Bangladesh markets cigarettes in Bangladesh in full compliance of all applicable laws, rules, and regulations," company spokesman Shamim Zahedy told AFP, adding that their marketing only targeted existing smokers.
In February, WHO chief Margaret Chan said that developing countries were the "new frontier" for tobacco marketing.
"If Big Tobacco is in retreat in some parts of the world, it is on the march in others," she said in a speech on the fifth anniversary of an international convention on tobacco control.

"In these countries as elsewhere, girls and women are a market with attractive and lucrative growth potential, and they are likewise being targeted," Chan said.
In developed countries, tobacco companies have seen their marketing restricted or banned and sales are falling as public health campaigns and tight rules on smoking in public places hit profits.

As a result, developing markets are becoming "increasingly important" for transnational companies such as BAT and Philip Morris International -- which is aggressively expanding in the Philippines and Indonesia, said Assunta.
"Tobacco companies are definitely putting effort into consolidating their positions in low income countries," she said.

Even Bangladesh, where nearly 40 percent of the population of 144 million lives on less than a dollar a day, is a lucrative tobacco market, with annual sales estimated at around one billion dollars.

In Bangladesh's remote, rural areas, the health risks of tobacco use are not always well known, Bennoor said, making poor farmers -- particularly women who are generally less well educated -- an easy target.

"It is a vicious cycle: people who are poor are more vulnerable to tobacco addiction, and then they are smoking, and it makes them poorer," he said.
For Bangladesh's rural poor, approximately 4.5 percent of household expenditure goes on tobacco, according to WHO estimates.

In some areas, there have been signs of a fightback against the advertising, however.

At Dhaka University, one fly-poster claiming "smoking makes you smarter and more manly" prompted a student-run counter-campaign.

"We are smart and we don't smoke," said handmade posters plastered over the original adverts on the university's city-center campus. (By Cat Barton/ AFP)