World Development Report 1984

* Where the burden of follow-up rests on cli- ment schemes of the Federal Land Development
ents, programs can experiment with various ways Authority in Malaysia and through women's rural
of encouraging clients to seek appointments. For credit cooperatives and vocational training in
example, financial incentives might be offered to Bangladesh. Profamilia, the private family planclients
who return for a follow-up visit within a ning organization in Colombia, extended its servspecified
period of time, just as South Asian pro- ices to the countryside through the National Fedegrams
offer compensation to acceptors of steriliza- ration of Coffee Growers. In China, India, and the
tion for the costs of transport, food, and work time Philippines family planning services are organized
lost. The media can also be used to reassure accep- in factories. Both the Indonesian and Chinese protors
about side effects and to encourage them to grams have used strong political organizations,
return for checkups. which extend into rural areas, to provide many
* The quality of follow-up can be monitored by economic and social services, including family
periodic sample surveys of acceptors. planning.
Private family planning associations are well
Ensuring social acceptability suited to implement these approaches: they are
small, decentralized, well staffed, highly moti-
To be successful, family planning programs must vated; have greater control over service quality;
have the support of the clients and communities and are less confined by the bureaucratic conthey
serve. But in communities in which modern straints of government. But many of these
family planning has never been provided, there approaches have also been tried on a larger scale.
may be little evident demand because potential cli- For example, the Planned Parenthood Federation
ents are not aware of the benefits of the service, of of Korea pioneered the highly successful mothers'
smaller families, or of longer child spacing inter- club program. At first these clubs served as
vals. Services introduced by an "outside" agency sources of contraceptives, of reassurance for accepwith
few local links and little appreciation of local tors, and of information on the benefits of family
customs and needs may not be readily accepted. planning. They now have merged with the
The absence of links to the local community can be Saemaul Women's Association and are also
a weakness for family planning in particular, involved in agricultural cooperatives and commubecause
it is a personal matter and may conflict nity construction projects. Mothers' clubs have
with social norms that favor high fertility. also been used by programs in Indonesia and
Private family planning associations and NGOs Bangladesh. The national program in Indonesia
have led in experimenting with new ways to has successfully involved village headmen, reliinvolve
clients and communities. Their strategies gious leaders, and local volunteers on the islands
have included consultation with local leaders, of Java and Bali, where more than two-thirds of
training local people as paid or volunteer workers, Indonesia's population lives. In the Philippines
consulting and training traditional midwives and some outlets for contraceptives are organized and
healers, establishing local management or review run by local volunteers.
committees, encouraging local contributions of Where communities and clients are involved,
money and labor, and organizing groups of family they are less likely to see family planning as being
- planning acceptors to reinforce effective use and to imposed by outsiders. Use of traditional midwives
engage in other community development projects. and volunteers, and local contributions in cash or
In communities where there is no apparent in kind also reduce the cost of services. But these
demand for family planning, it can be introduced strategies require certain managerial qualities not
jointly with services in greater demand. The Hon- always found in larger public programs: decentralduras
Family Planning Association includes a ized decisionmaking; technical and organizational
planned parenthood theme in its community- expertise to support local organizations, volunbased
adult literacy program. In Awutu, Ghana, teers, and clients; skilled managers and fieldfamily
planning is promoted for child spacing as workers who can identify local leaders, stimulate
part of a maternal and child health project. Family community activities, supervise volunteers, and
planning is provided with agricultural extension to reconcile local needs with program capabilities;
a population of 100,000 in Allahabad (in the state and, sometimes, workers who are technically comof
Uttar Pradesh, India) and as part of the nation- petent in more than one field. Finally, social accepwide
Integrated Rural Development Project in tance of family planning takes time and is a contin-
Pakistan. It has been offered through the resettle- uous process. There is no benchmark for
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