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World Federation policy statement. IV. Incentives and disincentives relating to voluntary surgical contraception.
[Unpublished] 1981 Nov. 3 p.The recommendations of the 1974 Symposium on Law and Population are endorsed including taking into account the value system and customs of a society to counteract family planning (FP), obstacles and urging that government-sponsored FP programs be considered basic human rights. The incentives and disincentives of the International Conference on Family Planning held in Jakarta in 1981 are also approved. These relate to ethical, social, and political issues and the availability of FP information, education, and services; evaluation of the effectiveness of incentives to enhance community improvement, peer recognition, and social rewards; and the minimalization of cash incentives because of the potential for abuse. The balancing of individual rights to collective rights is also accepted as declared by the 1977 Expert Group Meeting of the Economic and Social Commission for Asia and the Pacific. In addition, the World Federation advocates principles on contraception of Health Agencies for the Advancement of Voluntary Surgical incentives and disincentives in voluntary surgical contraception to limit family size; psychological and social incentives; fees for service; discouragement of immediate financial incentives for acceptors; and continuous institutional monitoring and education of these guidelines. Assistance of member countries of the World Federation is a primary objective in this effort.
Leiden, Netherlands, Rijks Universiteit, Leiden, Wetenschapswinkel, 1995 Feb. 67 p.After initiating public debate in the Netherlands about how and to what extent UN Population Fund (UNFPA) policies respect women's autonomy and reproductive rights, the cooperating research groups investigated the UNFPA policy dealing with incentives and disincentives to accept family planning (FP) and goals for FP providers. Interviews were held in 1994 in Bangladesh with 125 women and men in rural Bogra and in suburban Dhaka to determine 1) the extent to which incentives influence contraceptive choice, 2) decision-making roles within families, 3) the extent to which health workers are rewarded and the amount of influence they exert over contraceptive choices, and 4) the extent to which service provider disincentives affect attempts to reach service goals. This report of that study provides background information on the research and on the development of population control policies in Bangladesh, the organization of the FP program, and contraceptive methods available. Part 2 traces the incentive program from its probable introduction in India in 1956 through the Bangladeshi Financial Incentive System starting in 1976. Arguments in favor of the use of incentives are summarized. The third part of the report provides an analysis of the data gained from focus group discussions and from interviews with potential users, with women who had undergone a tubectomy more than two years earlier, with vasectomized men, with IUD users, with longterm IUD users, with Norplant users, with women who rely on menstrual regulation, and with service providers. The final section compares findings from Bogra and Dhaka and provides a discussion of the findings in light of other reports in the literature in terms of such issues as quality of care, voluntary and informed choice, and women's status. Recommendations from the study include protecting the human and reproductive rights of women by prohibiting the use of incentives in favor of improving health care, contraceptive availability, and women's status.
In: Population policy: contemporary issues, edited by Godfrey Roberts. New York, New York/London, England, Praeger, 1990. 21-37.On the basis of the orthodox assumption that population growth constitutes an obstacle to economic development, most countries have established programs aimed at reducing fertility through contraception. The methods used by family planning programs, ranging from voluntary acceptance through educational and informational campaigns to financial incentives or disincentives to outright forced sterilization, raise complex ethical issues. Specifically, there are 5 ethical principles--freedom, justice, welfare, truth-telling, and security/survival--that can be used to evaluate deliberate attempts to control human fertility. Such an approach suggests that forced abortion, compulsory sterilization, and all other forms of heavy pressure on clients to accept a given means of fertility control violate human freedom, justice, and welfare. The violations inherent in financial incentives are demonstrated by the fact that they are attractive only to the poor and disadvantaged sectors of the population. Family planning programs that offer incentives to field workers to meet acceptor quotas often lead to a disregard of client health and welfare by subtly encouraging workers to withhold information on medical side effects, outright deceive clients about methods that are not being promoted by the family planning program, and fail to take the time for adequate medical counseling and follow-up. Even programs that provide free choice to clients are illusory if the methods offered include controversial agents such as Depo-Provera and acceptors lack the capacity to make an informed choice about longterm effects. Recommended is the establishment of an international code of ethics for population programs drafted by a broad working group that does not have a vested interest in the code's terms.
Incentives, disincentives, and family planning: selective bibliography for countries in the ESCAP region: annotated.
[Unpublished] 1987 Jan. 141 p.This is a first draft of an annotated bibliography on incentives and disincentives in family planning programs in the ESCAP region. Each entry contains fields for author, title, citation, type (type of study), country, sponsor, recipient, positive or negative, form (type of incentive), structure (graduated or fixed), timing, objective (use, space or limit), and effect measures (observed endpoint). The annotation consists of an abstract or condensed conclusion in most cases. Over 100 documents are reviewed.
Laws and policies affecting fertility: a decade of change. Leis e politicas que afetam a fecundidade: uma decada de mudancas.
Population Reports. Series E: Law and Policy. 1984; (7):E105-E151.In the last decade over 50 countries have strengthened laws or policies relating to fertility. Approximately 40 developing countries have issued explicit statements on population policy emphasizing the relationship to national development. In several countries constitutional amendments have been passed reflecting a more positive attitude toward family planning. High-level units, e.g. small technical units, interministerial councils and coordinating councils have been established to formulate policies or coordinate programs. Other actions relating to fertility include: increased resources for family planning programs, both in the public and in the private sector; elimination of restrictions on family planning information, services and supplies; special benefits for family planning acceptors or couples with small families, and measures to improve the status of women, which indirectly affects childbearing patterns. The recognition that policies, laws and programs to influence fertility are an integral part of efforts to promote social and economic development was reaffirmed at the International Conference on Population in Mexico City in 1984. 147 governments expressed their support for voluntary programs to help people control their fertility. Governments cite at least 4 reasons for increased attention to policies affecting fertility and family planning. Some of these are the desire to slow population growth to achieve national development objectives, concern for maternal and child health, support for the basic human right to determine family size, and equity in the provision of health services. In addition to the strongest laws and policies to lower fertility in Asia, legal changes are occurring in Latin America, Africa, and the Middle East. Family planning programs, laws on contraceptives and voluntary sterilization, compensation, incentives and disincentives, the legal status of women and fertility and policy-making and implementation are reviewed, as well as equal employment, education, political and civil rights and equality of women within marriage and the family.
Washington, D.C., Heritage Foundation, 1984 Aug 27. 16 p. (Backgrounder No. 376)The United Nations' 2nd World Population Conference (Mexico City, 1984) called for greatly expanding funding for family planning assistance worldwide. The United Nations Fund for Population Activities (UNFPA), the conference's chief sponsor, will no doubt receive the largest portion of any assistance increase. UNFPA plays a critical role in population-related programs worldwide. The central debate on population policy should be over the extent and adequacy of the natural resources base and how countries can humanely and voluntarily change family size preferences. In countries like Singapore and South Korea, success has been achieved by combining social and economic incentives to discourage large families. Although couples in developing countries report wanting contraceptive service programs, they also want families of 4 to 6 children. So far UNFPA has been ineffective in changing the population situation. This overview of its activities reveals that UNFPA loses ultimate reponsibility for implementation of many of its own programs. UNFPA does not advocate a reduction in population growth within a single country, but rather helps couples have the number of children they desire. UNFPA's specific population and family programs are divided into functional areas: basic data collection, population change study, formulation and implementation of population policies, support for family planning/maternal child health programs and educational and communication programs. UNFPA stresses the importance of using contraceptives but not of achieving the small family norm. UNFPA's projects in some of the largest less developed nations are described, illustrating how the UN agency spends its assistance funds. From 1971 to 1982, the UNFPA spent almost US $230 million in the 10 largest less developed countries without any significant change in population growth. UNFPA program administrators are far from resolving the serious population problems facing developing countries and generally oblivious to new directions in which population policies should move. No progress will be made until UNFPA recognizes the need to approach the problem from a different perspective, working to change attitudes toward small families.
Fertility and the family: highlights of the issues in the context of the World Population Plan of Action.
In: United Nations. Department of International Economic and Social Affairs. Population Division. Fertility and family. New York, New York, United Nations, 1984. 45-73. (International Conference on Popualtion, 1984; Statements)This paper uses as its organizing principle 5 major themes which run through the sections of the 1974 World Population Plan of Action (WPPA) devoted to fertility and the family. The purpose of this paper it to assure that their discussion is comprehensive and that it reviews all the major research and policy concerns with respect to fertility and the family that have played an important role in the general debate about these issues since 1974. Summerized here are the contributions included in this volumen, as each deals with at least 1 of these issues. The 1st major theme focuses on fertility response to modernization as a facet of the interrelationship between population and development. Discussed are aspects of modernization leading to fertility increases, in particular the reduced incidence and shorter duration of breastfeeding, and those leading to fertility decline, namely the decline in the value of children as a source of labor and old-age support. Freedom of choice, information and education are the principal approaches within which childbearing decision making is discussed. Women's reproductive and economic activity during their life cycle, and the relationship of family types and functions to fertility levels and change are equally addressed. Finally, demographic goals and policy alternatives with respect to fertility change are discussed in terms of a number of policy options: family planning programs, economic incentives and disincentives and more global socioeconomic measures. Although primary attention is given to the problems and policies of developing countries, the special problems of certrain developed countries which view their fertility as too low are also considered. The issues raised in this paper are put forward as an aid to assist in the identification of emderging areas of policy concern and of fruitful new research directions.
The human right to family planning. Report of the Working Group on the Promotion of Family Planning as a Basic Human Right to the Members' Assembly and the Central Council of the International Planned Parenthood Federation, November 1983.
London, International Planned Parenthood Federation, 1984. 52 p.This report examines the problems involved in the exercise of the right to family planning; reviews the approaches taken towards overcoming these problems and promoting the right to family planning at local, national, and international levels, including the experience of the International Planned Parenthood Federation (IPPF); and makes recommendations to the 1983 meetings of the Central Council and the Members' Assembly on the action that should be taken by the IPPF and its members to enhance the commitment to family planning as a basic human right during 1982-84 Plan and beyond. The report's 5 sections discuss the following: the concept of the right to family planning (historical background and a conceptual elaboration); links between the right to family planning and other human rights (basic human rights and needs, advocacy for social development, and women's rights); access to fertility regulation information and services (full and voluntary choice of methods, rights of young people, financial accessibility of fertility regulation services, and the right to have children); incentives and disincentives to individuals and couples, incentives to providers of fertility regulation information and services, and research needs; and strategies for promoting family planning as a basic human right (ensuring that the individual has the knowledge of the right to fertility regulation and understands the options, generating societal support for family planning, ensuring ready access to the means ror fertility regulation, legal support for the right to family planning, and increasing political commitment to the right to family planning). The application of the term "the right to family planning" to many different elements of personal and social behavior as well as to policy making and program development has led to some confusion and potential conflict between rights and responsibilities. It is recommended that a clear distinction be made in the definition of the right to family planning to reflect 2 important components, namely, the right of everyone to have ready access to information, education, and services for fertility regulation; and the right of everyone to make decisions about reproductive behavior. Family planning organizations canachieve institutional credibility as caring organizations and assure program effectiveness by encouraging the recognition of the links between the right to family planning and the right to other social and economic improvements that are the essence of development.
New York, Population Council, 1979 Oct. 68 p. (Center for Policy Studies Working Papers No. 48)After outlining various problems posed by the growth or decline of population and the class of feasible means available to governments for dealing with them, the authors pose the question of whether important ethical issues are raised by interventionist policies actually in use today. These policy options are surveyed in detail and shown to fall into 3 categories of government intervention: 1) Limitations imposed on access to modern methods of fertility control. 2) Incentives and disincentives of various kinds. 3) Politically organized peer pressure. With regard to ethical issues raised by these policies, the authors invert the traditional procedure in the ethical literature of first providing an overarching ethical theory and then deducing consequences pertaining to particular issues -- in this case population controversies. Instead, they adopt a contextual and piecemeal approach to the ethical concerns which views ethics as a species of decision making, resting on agreed-upon premises and proceeding to substantive conclusions as to what sort of action should be taken in particular situations. Proceeding to examine the 3 sets of policies from this perspective, they find limitations on access and incentive programs ethically permissible provided certain safeguards and intuitive conditions are satisfied. The 2nd category -- politically organized peer pressure -- is found unethical except under stringent conditions and where other approaches have been tried first. In the final section of the paper, the authors clarify aspects of the ethical framework underlying their judgments on the policy and raise and discuss a number of subsidiary problems. (Author's)
Social Biology. 25(2):145-163, Summer 1978.This paper reviews and compares the methodologies of some 70 investigations of the effect of family planning programs on fertility levels. Differences among the studies include variations in questions asked, research methods used, program type investigated, and made of program action assumed. Programs can affect fertility by providing means of fertility control, education, legitimation, incentives/disincentives or any combination of these but the actual effect of these modes is unclear. Comparison is usually made between the effects on fertility of a program as a whole and a hypothetical estimate of what fertility rates would have been without the program. This hypothetical estimate is in fact not subject to empirical measurement, and a variety of methods have been developed largely to attack this methodological problem. The article compares the characteristics of several methods and provides a matrix comparing their strength, limitations and applications. The methods discussed include: 1) decomposition of change which identifies several factors affecting changes in crude birth rate; 2) correspondence between program activity and fertility trends over time to across areas or groups, which often takes close statistical association as evidence of causality; 3) matching studies, which try to remove the influence of nonprogram factors by controlling the characteristics of the subject; 4) experimental and control areas, comparing presumably similar groups with and without family planning programs; 5) multiple regression across areal units which provides some information on areal trends but requires extensive data for many statistical areas; 6) calculation of national effects of births averted among acceptors; and 7) simulation, which compares data to mathematical projection models, such as the TABRAP/CONVERSE and POPSIM models. No one method is best but certain methods are best to answer certain questions. All of the methods have difficulty establishing actual causality between the program studied and fertility trends and ruling out alternative explanations. Recent studies encouraged by the U.N. Population Division are seeking cross-method and cross-program evaluation.
Options for new laws and policies in the promotion of fertility management in the ESEAO (East and South East Asia and Oceania) region.
In: International Planned Parenthood Federation (IPPF). East and South East Asia and Oceania region. Joint consultation of regional medical committee and regional information, education and communication committee, March 2-3, 1976, Hong Kong. Kuala Lumpur, Malaysia, IPPF, (1976). p. 40-49Most countries in the East and South East Asia and Oceania (ESEAO) region have adopted policies and programs to reduce population growth and, consequently, have become more and more interested in innovative laws and policies which may have an impact on population. In this connection it is important to devote some attention to the following relatively new aspects in the field of family planning and population planning -- law and planned parenthood/population beyond family planning, the status of women and family planning, and recent developments in laws and policies affecting fertility. Only in the last few years has the role of law, as it affects population, been given proper consideration. Since 1971 Law and Population Projects have been initiated in 25 countries including several of the ESEAO region. Their objective is to study the impact of various laws on population and to propose legal reforms in support of family planning. At the November 1975 Governing Body meeting of the IPPF, it was concluded that family planning associations can and should be encouraged to play a pioneering role in promoting legal change. New approaches to promote fertility reduction include the so-called beyond family planning measures -- efforts to lower birthrates indirectly by instituting social or economic measures that would themselves influence people toward diminished fertility -- which are actually included in the field of law and planned parenthood/population. The relationship between the status of women and family planning, 1st endorsed by the U.N. Commission on the Status of Women in 1965, has been emphasized repeatedly since then, but much still needs to be done in this region to improve the status of women. Many countries in the ESEAO region have reassessed existing laws affecting fertility, and the following data, compiled from various sources, will give some idea of the present state of innovative laws and policies in Singapore, Malaysia, the Philippines, and Indonesia.
Pasadena, California, Population Communication, . 9 p. (A Population Communication Report)This report provides short summaries of the discussions of the Population Communication sponsored meeting on the subject of fertility incentives and disincentives. The meeting's purpose was to review the current status of incentives and disincentives and to determine what donors and governments could do in designing and implementing programs. The following were among the topics covered by various participants: the urgent need for incentives; the UN Fund for Population Activities (UNFPA) analytical study of incentives; the World Bank and incentives; the US Agency for International Development Policies (AID); the Population Crisis Committee (PCC) guidelines for community incentives; research guidelines for incentives; the 1 child family goal of the People's Republic of China; the Indian experience with incentives; the Indonesian incentive program; the approach of the Philippines to incentives; the Bangladesh experiment with incentives; the Singapore Incentive Program; the Thailand Community Incentive Program; and the status of incentive programs in fertility control. Ambassador Marshall Green spoke on the need for increased focus on incentives and disincentives in population policies and programs, stressing that there are a great number of possibilities for action. The World Bank in its Indonesia III Population Project provides financing for community incentive schemes. AID has confined its incentive payments to providers of services and to some degree, the cost to acceptors, e.g., transportation. PCC has recently funded the Thailand community incentive program and will consider support for trials of the community incentive approach in other settings in Asia, Africa, and Latin America. According to Henry P. David, Director of the Transnational Family Research Institute, incentive programs should be voluntary and noncoercive, with full consideration given to local cultural conditions and the expressed needs of the community for quality of life improvements. Since the inception of the family planning program in 1951, incentives have been a part of Indian policy. Incentives and disincentives have not attracted much interest in the Philippines. There have been a few small pilot studies, but little has been done to determine how these could be implemented on a wider scale. Lenni W. Kangas reports that the lack of measurement tools no longer needs to be a major impediment to mounting community incentive efforts.