rOPULAT10~~ !,::'J r,:'JT~'"TiJ:J FROJ£CTi . ~ , . - "T .~;::)..o l.1 ~: j~\: I i ~" :~ .. 't.?l '. " , . " / . : == . ,:J) /' f / ,~. ~ h· q ! . ~: ... - 1'. ., , -, ~. I l I " 1\ ". " ," , INCENTIVE APPROACHES IN POPllllATION PLANNING PROGRAMS I I I: 1'1111 I READINGS AND ANNOTATIONS I . == -- 1 INCENTIVE APPROACHES IN POPULATION PLANNING PROGRAMS: Readings and Annotations Edited by Oliver D. Finnigan, III Table of Contents i Editor's Foreword ii Introduction iii Annotation I. The Problem F,Fertility Levels and Fertility Trends in the Philippines, 1 Wilhelm Flieger 2. Small Family Norm for Filipinos 2 Y. Lando Jocano 3. Desired Family Size and Efficacy of Current Family Planning 3 Programs Ronald C. Ridker II. Suggested Solutions 1. Beyond Family Planning 4 Bernard Berel'on -2. Incentives in Family Planning Programs: Time.for a New Look 5 J. Timothy Sprehe 3. Integrated Incentives for F'ertility Control 6 Leni W. Kangas 4. What May be Offered.as Incentives 7 Edward Pohlman II. Incentive Programs To Date (April 1972) A. Incentives for contraceptive acceptance 1. Population.and Family Planning Programs: A Factbook 8 Dorothy Nortman 2. Incentive Payments, IPPF working paper No. 4 9 3. Incentives in the Diffusion of Family Planning Innovations 10 Everett M. Rogers 4. A Field Study of Family Planning Incentives and Field Staff 11 in Indonesia Everett M. Rogers ,5. Useof the Agent System in Seoul 12 E. Hyock Kwon 6. Motivational and Incentive Components of the Korean 13 Family Planning Program Taek II Kim, Walter B. Watson 7. Field Structures in Family Planning 14 Wajihuddin Ahmad 8. The-Maximum Acceptance Study, Taiwan Committee for 15 Family Planning 9. Non-Monetary Commodity Incentives in Family Planning 16 Programs: A Preliminary Trial Gordon W. Perkin 10. The Ernakulam Vasectomy Campaigns 17 Everett M. Rogers B. Incentives for-birth prevention -1. Savings Accounts for Family Planning, An Illustration-from 18 the Tea Estates of India Ronald C. Ridker -2, Planning, Starting, and Operating an Educational Incentives 19 Project 0. D. Finnigan, T. H. Sun 3. Law and Family Planning 20 Luke T. Lee IV. Ideas and Recommendations 1. Doing Research on Incentives 21 Edward Pohlman 2. Testing Incentive Plans for Moving Beyond Family Planning 22 0. D. Finnigan V. Postscript Litterbags-and Dimes for Litterbugs 23 Xenneth Goodall ii Editor's Foreword For those who wish to get a capsule view of the contents of this volume the editor has prepared introductions to sections and summaries of articles. These annotations are inserted as dividers between articles and are printed on colored paper. They are intended to provide the busy reader with the higlights of each article and with some conti­ nuity through editorial comments. As with all editing efforts, my own biases may enter into the picture and I therefore apologize in advance to authors and readers alike for these snapshots. I urge those who have the time to read the articles as well as the annotaticns. All but seven of the twenty-four articles included in this volume have been produced in the past twelve months. Because of the rapidity with which new ideas are being produced, new disciplines are entering this field and new experiments are being begun, we urge readers to use this volume only as a starting point. Hopefully one year from now tli s compendium will seem primitive and outdated. Since only 400 copies of this volume have been produced, only limited stocks are available. For further information, contact: Office of Health & Public Services USAID/Philippines c/o American Embassy Manila, Philippines Oliver D. Finnigan, III June 1972 Manila POPULATION A0D NUT!TION PROIEPIS / / ~A/ 17 t. INCENTIVE APPROACHES .9 IN POPULATION PLANNING 43, U PROGRAMS it ' I- C t S READINGS AND ANNOTATIONS iii Introduction For.the past decade, family planning programs have been extending inf or­ mation and contraceptive services throughout the less developed world. As family planning programs have expanded they have been constrained somewhat by limited funds. It has therefore become necessary to use management tools of proven value to cut down on overhead expenses and to maximize the value of financial inputs in terms of performance out­ puts. In those countries with the most effective family planning pro­ grams, this has meant-a heavy reliance on "fees for services rendered," awards, prizes, bonuses, and other reinforcements, collectively classi­ fied as incentives. These incentives have generally been direct or in­ direct payments in cash or in kind given to individuals or groups to en­ courage contraceptive acceptance or continuation. A number of social scientists have.been predicting that even if these pro­ grams depress fertility, they will only drop birth rates to the point where .most unwanted births are-prevented. They will have little or no effect on-the number -ofwanted children, unless other measures are taken to -change attitudes and values. These social scientists point out that the ,average couple in the developing world wants four or more children. They assert that because large numbers of children provide labor, income and old, age security to families, one of the best means of reducing family size ideals would be to provide compensation to parents for having fewer .children than is dictated by family economics. This volume is an attempt to call together-some of the key literature on incentives and compensations within and outside of family-planning pro­ grams. The editor presents with anoverview of the problem, a glimpse of some of the incentive plans which have been attempted to date and some suggestions for-future testing or implementation. It seems that all parties engaged in the dispute over how to best solve the population problem recognize that any person' s notion about ideal family size is not innate; it is somehow acquired through learning. Learned behavior is, by definition, the product of environmental influence interacting-with the learner. Any program that would control fertility must concern it­ self with those.aspects of the environment that have an influence.on the number of children born to a family. This:range of influences is certainly much greater than informational programs and contraceptive delivery ser­ vices. The problem, then, is to identify the full range of contingencies in the environment of a given population that influence family size, and to alter these elements in order to increase acceptance of contraception, and to decrease average family size. It is now fairly well accepted by sociologists, demographers, and program administrators that unless family size ideals are reduced by some means supplemental to present family planning efforts, birth rates will not fall or will fal only moderately in most countries. Annotation 1 PART I THE PROBLEM This compendium discusses two complementary problems which are faced by population planners and by family planning program administrators. First, is the problem of maximizing the value of financial inputs in terms of performance outputs. As family planning programs have expanded, th(r have been constrained somewhat by limited funds. It has therefore become necessary to use management tools of proven value to minimize overhead expenditures and to insure that a given financial input will yield a specified performance output in terms of acceptance or continuation on contraception methods. In those countries with the most effective family planning programs, a good deal of experimentation has taken place with regard to variaas means of client recruitment and contraceptive delivery. In Korea, field experiments in a half dozen rural counties and one large urban district have helped to re­ fine program approaches. Similar field experimentation has taken place in Taiwan (the Taichung experiment), Iran (Isfahan District), Pakistan (Sialkot), and in most states in India. A second problem discussed in this volume is the inability of present family planning programs to significantly reduce the number of children that families wish to have. These programs are for the most part recruiting couples who now, or will eventually have, four or more children. There is, as yet, no built-in mechanism to insure that the fertility decline will not plateau as soon as fertility levels have dropped to the point where couples are havirg the number of children they wish to have (four or more). In other words, the problems we face are (1) to help insure that efforts within family planning are effective in recruiting and holding couples and (2) to help provide a mechanism whereby couples can afford to decide to have fewer childrea than they had previously felt to be desirable. In most respects the population growth picture in the Philippines is similar to that found in other less developed countries. In some few ways Philippine problems are unique or are shared with only a few other countries. Generali­ zations taken from Philippine population data may, therefore, be of benefit both within and outside of the Philippines. Because this compendium is prepared for Philippine colleagues, we will first take a look at the problems with which we are faced in the Philippines and will then look at other countries. Annotation la "Fertility Levels and Fertility Trends in the Philippines" (summary only), Wilhelm Flieger, mimeographed, March 1972 This summary of findings from the National Demographic Survey can be further condensed as follows: 1. In the Philippines fertility remains high, although mortality has fallen drastically. 2. Women-are marrying a bit later now; but-once married they tend in have more children and to have them sooner. For marriedwomen under 35, fertility is still rising; and for older women, no change at all is evident. 3. Fertility levels today are higher even than pre-World War II "traditional" levels, and there is no indication of a nationwide break­ down of this pattern, except in-industrialized metropolitan VIManila, .where some fertility decline has begun to become measurable.