|The Value of Family Planning Programs in Developing Countries (RAND, 1998, 98 p.)|
|Chapter Three - THE RECORD OF FAMILY PLANNING|
|The Basics of Program Success|
Political support is essential to enable a program in such a sensitive area as family planning to achieve respectability and have sustained effect. Programs depend on politically allocated resources. At least as important, they also depend on a positive, widespread popular response, which is greatly aided by visible political support. Government endorsement of family planning helps legitimize what is initially innovative behavior and can helpfully be supplemented by support from the media, voluntary organizations, and even religious groups. Official support has grown over the decades and is now close to universal, but the depth of this support and the extent to which it is reflected in effective government action still vary considerably.
Government support does have to be tempered to preserve voluntary individual choice. This is important not only to protect human rights but also for pragmatic reasons. Coercive programs cannot succeed or even survive for long in countries that aspire to be democratic. India attempted to force sterilizations after emergency rule was declared in the mid-1970s; partly as a result, the government was soon voted out of office. The most coercive modern program was launched in China by a government intent on controlling every aspect of life, including childbearing. China is the only country that has "penalized people specifically and directly for violating population policy" (Li, 1995, p. 563). Yet the Chinese one-child policy has been remarkably ineffective. An analysis of fertility in Hebei and Tianjin (around the capital) concludes that "The majority of Chinese women ... ignored birth-quota regulations, refused to accept the one-child certificate, and bore the burden of heavy financial penalties" (Li, 1995, p. 582). International donors have generally turned away from such coercive programs and have been increasingly active in improving the quality and service orientation of the programs they assist.
International donors have played an important role in helping to marshal government support for voluntary family planning programs. They have done this not only through financial assistance for services but also through political dialogue, at successive world population conferences for instance (Bucharest in 1974, Mexico City in 1984, Cairo in 1994), which allowed a consensus to build in favor of family planning. Donors have also largely underwritten such activities as the World Fertility Survey and the Demographic and Health Surveys and contributed to various rounds of national censuses, which have demonstrated to governments the specific population-growth scenarios they face. Donor influence in initiating and strengthening programs has been substantial, as has been argued by such observers as Warwick (1982, p. 44), who states that, at least through the 1980s "of all the spheres of national development, population has been the most donor driven."
Some impact of donor funding on ongoing programs appears in statistical analysis, although not consistently. In comparisons across Asian countries up to the early 1980s, Ness and Ando (1984) found that the volume of outside financial aid did not affect program strength. But more recently, Tsui (1997) has shown that, across all recipient countries, population assistance from the United States (through USAID, the agency responsible for bilateral foreign-aid programs) has a small but significant impact on program effort. The inconclusive statistical evidence is understandable: donors naturally are selective in their assistance, sometimes choosing more promising settings, sometimes more impoverished ones, and often ones with which they have some special cultural or political link. This makes interpretation difficult.
Anecdotal evidence and experience suggest several ways in which donor influence has been important to ongoing programs:
· in providing the training and developing the technical and managerial resources on which programs rely
· in encouraging new approaches, from new contraceptive methods, such as implants, to new strategies, such as community-based distribution and social marketing
· in sponsoring research into ways to make programs work better, research that nascent programs seldom can spend their own time and resources on
· in encouraging service standards in such areas as the need for informed consent.
Donor involvement in a program is not a guarantee of success, but it provides resources that, coupled with national commitment and a reasonable strategy, can accelerate the progress of a program.