World Development Report 1984
World Development Report 1984
World Development Report 1984
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* Where the burden of follow-up rests on cli- ment schemes of the Federal Land <strong>Development</strong><br />
ents, programs can experiment with various ways Authority in Malaysia and through women's rural<br />
of encouraging clients to seek appointments. For credit cooperatives and vocational training in<br />
example, financial incentives might be offered to Bangladesh. Profamilia, the private family planclients<br />
who return for a follow-up visit within a ning organization in Colombia, extended its servspecified<br />
period of time, just as South Asian pro- ices to the countryside through the National Fedegrams<br />
offer compensation to acceptors of steriliza- ration of Coffee Growers. In China, India, and the<br />
tion for the costs of transport, food, and work time Philippines family planning services are organized<br />
lost. The media can also be used to reassure accep- in factories. Both the Indonesian and Chinese protors<br />
about side effects and to encourage them to grams have used strong political organizations,<br />
return for checkups. which extend into rural areas, to provide many<br />
* The quality of follow-up can be monitored by economic and social services, including family<br />
periodic sample surveys of acceptors. planning.<br />
Private family planning associations are well<br />
Ensuring social acceptability suited to implement these approaches: they are<br />
small, decentralized, well staffed, highly moti-<br />
To be successful, family planning programs must vated; have greater control over service quality;<br />
have the support of the clients and communities and are less confined by the bureaucratic conthey<br />
serve. But in communities in which modern straints of government. But many of these<br />
family planning has never been provided, there approaches have also been tried on a larger scale.<br />
may be little evident demand because potential cli- For example, the Planned Parenthood Federation<br />
ents are not aware of the benefits of the service, of of Korea pioneered the highly successful mothers'<br />
smaller families, or of longer child spacing inter- club program. At first these clubs served as<br />
vals. Services introduced by an "outside" agency sources of contraceptives, of reassurance for accepwith<br />
few local links and little appreciation of local tors, and of information on the benefits of family<br />
customs and needs may not be readily accepted. planning. They now have merged with the<br />
The absence of links to the local community can be Saemaul Women's Association and are also<br />
a weakness for family planning in particular, involved in agricultural cooperatives and commubecause<br />
it is a personal matter and may conflict nity construction projects. Mothers' clubs have<br />
with social norms that favor high fertility. also been used by programs in Indonesia and<br />
Private family planning associations and NGOs Bangladesh. The national program in Indonesia<br />
have led in experimenting with new ways to has successfully involved village headmen, reliinvolve<br />
clients and communities. Their strategies gious leaders, and local volunteers on the islands<br />
have included consultation with local leaders, of Java and Bali, where more than two-thirds of<br />
training local people as paid or volunteer workers, Indonesia's population lives. In the Philippines<br />
consulting and training traditional midwives and some outlets for contraceptives are organized and<br />
healers, establishing local management or review run by local volunteers.<br />
committees, encouraging local contributions of Where communities and clients are involved,<br />
money and labor, and organizing groups of family they are less likely to see family planning as being<br />
- planning acceptors to reinforce effective use and to imposed by outsiders. Use of traditional midwives<br />
engage in other community development projects. and volunteers, and local contributions in cash or<br />
In communities where there is no apparent in kind also reduce the cost of services. But these<br />
demand for family planning, it can be introduced strategies require certain managerial qualities not<br />
jointly with services in greater demand. The Hon- always found in larger public programs: decentralduras<br />
Family Planning Association includes a ized decisionmaking; technical and organizational<br />
planned parenthood theme in its community- expertise to support local organizations, volunbased<br />
adult literacy program. In Awutu, Ghana, teers, and clients; skilled managers and fieldfamily<br />
planning is promoted for child spacing as workers who can identify local leaders, stimulate<br />
part of a maternal and child health project. Family community activities, supervise volunteers, and<br />
planning is provided with agricultural extension to reconcile local needs with program capabilities;<br />
a population of 100,000 in Allahabad (in the state and, sometimes, workers who are technically comof<br />
Uttar Pradesh, India) and as part of the nation- petent in more than one field. Finally, social accepwide<br />
Integrated Rural <strong>Development</strong> Project in tance of family planning takes time and is a contin-<br />
Pakistan. It has been offered through the resettle- uous process. There is no benchmark for<br />
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