Two projects, a condom distribution scheme and family planning franchise, demonstrated that low-income men and women will take advantage of private sector services if the prices are low.

Pakistan has a fertility rate of about 6 births per woman and a modern contraceptive prevalence of 17%. In 1986, Population Services International (PSI) began a condom social marketing (CSM) programme to increase contraceptive use in urban areas. In January 1987, the CSM project began selling a lowpriced brand of condoms through retail outlets; contraceptive advertising in the mass media is restricted by government. In 1991, to recover the costs of condoms, the price doubled. This was followed by a decline in sales. Research showed that the largest drop in consumer demand came from lowincome residents of small cities. Therefore, gradual price increases or crosssubsidization might be better routes towards cost recovery for projects targeting lowincome people.

In 1995, PSI and Social Marketing Pakistan (SMP) began a clinic franchising project called Green Star. The aim of Green Star was to raise the quality of private sector family planning clinics serving lowincome women and to increase the availability and use of femalecontrolled methods of contraception. The five components of the project included training female private practitioners in family planning counseling and IUD insertion, creating demand for quality family planning services and products, increasing the supply of contraceptives, providing technical support to the clinics, and evaluating the project performance. An initial evaluation showed that Green Star clinics were providing quality family planning services and that the number of family planning clients at newly franchised clinics doubled within a year. The evaluation recommended that prices of contraceptives and services be kept low in order to reach lowincome women. The franchising project has expanded nationally and nearly 1500 clinics in urban Pakistan are currently part of the Green Star network.

By 1996 the CSM project was selling more than 80 million condoms annually. Retail audits showed that these condoms accounted for about 60% of all condom sales in Pakistan.