World Development Report 1984

sanguine, however, as soon as one takes into some years much less. Despite the unpromising
account specific requirements for fieldworkers: for conditions-per capita GNP between $100 and
instance, they should be village-based rather than $300, adult literacy rates as low as 20 percent, and
city-based, belong to the appropriate ethnic, lin- infant mortality rates as high as 150 per thouguistic,
or caste group, and be favorably disposed sand-spending on family planning was effective
to contraception. The Pakistani program has faced and economical.
recruitment problems of this sort. In the late 1960s Furthermore, many of the factors that hamper
only a seventh of the midwives assigned as effectiveness can be overcome as a program
fieldworkers believed in the efficacy of modern develops. Culturally acceptable solutions to
contraceptives. In the early 1970s they were administrative and personnel problems, and to
replaced by a group including many unmarried limited public interest, take time to develop, as do
women from urban areas who did not have the the quality improvements discussed above. But in
confidence of the villagers. If finding appropriate every part of the world where an effort has been
fieldworkers in each area is difficult, finding made, there has been progress.
higher-level supervisors can be even more of a Foreign funding has been largely absent in the
problem. early stages of some family planning programs, as
Program expansion also depends on the demand it continues to be in China. In other programs it
for contraceptive services. A principal task of pro- has played a catalytic role-for instance, through
grams is to generate some of this demand itself, stimulating pioneering research of demographic
but where initial interest is low or nonexistent this problems. Local finance, however, eventually
task can take time. becomes critical; most of the older, more effective
Taken together, these limits to rapid expansion programs in 1980 had 40 percent or less foreign
might seem to suggest that programs could not funding. For one thing, local finance demonstrates
make good use of more money. But such a view political commitment to family planning, the subwould
be wrong. During the 1970s India, Pakistan, ject of the next chapter. Many of the obstacles to
Bangladesh, and. Sri Lanka were spending as expansion of family planning can be overcome
much as $2.50 per married woman on family plan- with sufficient commitment, and most of them
ning programs and were still producing contracep- cannot be overcome without it.
tive users at acceptable cost-under $20 each, in
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