Incentives and disincentives in the Indian family welfare program

Abstract

The Indian family welfare program has offered financial incentives since the early 1960s to both family planning motivators and acceptors of sterilization and the IUD. This article reviews the available evidence regarding the impact of incentives on the quality and quantity of family planning services in India. Administrative concerns related to the implementation of incentive programs are discussed, and the current debate on disincentives, as well as the brief period when disincentives were used, is summarized. The studies reviewed, though few in number and varying in quality and methodology, indicate that incentives to acceptors help to increase the level of contraceptive acceptance, especially when they are part of a well designed strategy of service delivery and client motivation. Incentives do not appear to have an adverse effect on quality of services and acceptors, and they do not seem to influence method choice. Disincentives, if they are used, should not impinge on fundamental individual rights of either the parents or the child.

PIP: This article examines evidence on the impact of incentives on family planning services in India. The government of India currently spends 10% of its total expenditure for Family Welfare Programs to provide compensation for lost wages and expenditures such as drugs and transportation to acceptors of sterilization and the IUD. Several incentive and disincentive programs used since the 1960's are reviewed. Incentives offered most often have been individual, positive, monetary, immediate, non-graduated incentive for acceptance of contraception. Currently, sterilization acceptors receive Rs. 100 (US$9.00) and IUD acceptors, Rs. 9 (US$1.00). Many states have also offered non-monetary incentives to acceptors as well as motivators. Acceptor incentives are effective in raising acceptance levels and do not seem to have any direct adverse effect on quality of services or quality of acceptors; also, differences in size of incentives offered do not seem to influence preferences for various methods, a more important factor being the priority attached to a method by the program. Limited experience with a disincentive program (1976-1977) indicates that their punitive effect on public servants tends to result in coercive behavior toward potential acceptors, and eventually led to rioting and political backlash. Most effective incentives are those that have a direct positive impact on quality of life of acceptors.