Incentives and disincentives to promote the Small Family Norm

 INCENTIVES
 

An incentive may be defined as payments or their equivalent, made directly to contracepting couples and/or to couples not bearing children for specified periods. In other words, an incentive may be viewed as those objects of financial value that are given by an organization to an individual, couple or group in order to encourage reproductive behavioural change.

2. Incentives are classified into positive and negative. Payment for the initiation or the effective practice of contraception, periods of non-pregnancy or non-births, bonus for child spacing or non-pregnancy etc. are positive incentives. Withdrawal of maternity benefits after ‘n’th child and limitation of governmentally provided medical treatment, housing, scholarships, loans and subsidies, etc. to families with more than ‘n’ children may fall under negative incentives.

3. Incentives in India are officially referred to as “compensation for loss of earnings due to adoption of the I.U.D. or sterilization”. Such incentives seemed justifiable on ground of their cost-benefit ratio relative to alternative investments or public expenditures. Some argue that since these payments go to the poor, there is no reason to dispense with them. The first large-scale family planning incentive scheme was begun in 1956 by the government of Madras state (now Tamil Nadu). Two types of incentives were recognized even at that early stage, namely, adopter incentives paid to the adopter to motivate adoption and diffuser incentives paid to the canvasser (motivator/promoter/field worker) to spread the rate of adoption of family planning methods. The Tamil Nadu incentive programme moved ahead of other Indian state programmes in rates of adoption. Later, some southern states were forced to start paying incentives because otherwise some of their residents travelled to a neighbouring state to adopt a family planning method and to obtain accompanying incentives. Latter, the Central Government began to reimburse states for partial costs of incentives and by 1969-70 agreed to provide the entire cost of adopter incentives for I.U.D., vasectomy and tubectomy plus diffuser incentives.

4. The First National Conference of the Indian Association of Parliamentarians for problems of population and development held in May, 1981 at New Delhi also, recommended that “there should be differential structuring of incentives for male and female sterilization with considerably higher incentives for men, in order to encourage more responsible sharing of contraception between the sexes. Incentives should also be given in the form of accelerated development to localities/communities for collective effort and achievement in the sphere of family planning”.
 
 DISINCENTIVES
 

5. During the past few years Haryana and Rajasthan have passed laws that prospectively debar persons who do not adopt the two-child norm from contesting elections for Panchayats, Zilla Parishads and Nagarpalikas. The Population Policy of Madhya Pradesh states that “ persons having more than two children after January 26, 2001 would not be eligible for contesting elections for panchayats, local bodies, mandis or cooperatives in the state. In case they get elected, and in the meantime they have the third child, they would be disqualified for that post”. The policy of Rajasthan proposes “ legal registration of marriage”, compulsory observance of minimum age at marriage for availing of “government facilities and services” and “stiffer penal provisions for violation of the legal age at marriage”. Madhya Pradesh also lays down that “from January 26, 2001, persons marrying before legal age at marriage will not be eligible to seek government employment in Madhya Pradesh”. The legal age at marriage is made a criterion for those seeking jobs especially public jobs, getting admission in educational institutions, applying for loans, etc. in some States. The case of raising the age of marriage is certainly undeniable. The linking of family size to the right to contest elections is presumed to demonstrate a degree of political commitment that is considered essential. The argument that it would adversely affect the interests of women or the disadvantaged sections of society does not seem convincing, particularly in a setting when people themselves have realized the need to regulate family size. There is also a demand that such disqualifications should be extended to the Members of Legislative Assemblies and Parliament also.
   
 ISSUES RELATING TO INCENTIVES AND DISINCENTIVES
 
6. Incentive and disincentive programmes raise important ethical, administrative and political questions. Ethically, some consider incentives coercive reducing the freedom of choice which is important in family planning. Others argue in reply that incentives that reduce any extra costs of family planning can actually increase people’s choice, particularly the choices available to poorer people. Also, in some countries it is argued that the societal need to control population growth may have to take precedence over individual preferences. Administratively, incentive programmes present some pitfalls. Unless implemented without corruption or abuse, they may discredit rather than strengthen a family planning programme. Incentives or disincentives for government officials or salaried workers based on their fertility behaviour or contraceptive use are more easily administered than payments to rural residents or others outside the organized sector of the economy. Politically, incentives and disincentives have been most acceptable and most successful where public opinion supports the policy goals. In Singapore, for instance, where strong incentives and disincentives reinforce already low fertility, many people say that they would have small families any way.
7. Several reviews of recent experience have concluded that in the short run, payments to acceptors and providers increase the number of sterilizations. In part this may be because a small one-time payment stimulates people who are already thinking about sterilization to make a definite decision. Similarly an immediate monetary incentive to a full-time family planning field worker may produce demonstrably better results in contraceptive acceptance in a short period than does no incentive or a low incentive. However, for success of the family planning programme, an efficient extension work is essential and incentives are effective tools in the hands of extension workers. A change agent armed with heavy cash incentive scheme was more effective in his motivational effort and was able to motivate workers to adopt sterilization relatively at early age and at lower parity than those without incentives. Incentives can work effectively only when they are carried on the vehicle of a well-designed extension work. Studies conducted in Indonesia have also shown that the incentive programmes have increased the number of family planning acceptors and have improved acceptors’ economic circumstance.
8. In a three-district survey study in Andhra Pradesh during 2002 conducted by the Population Research Centre, Vishakhapatnam and sponsored by the National Commission on Population, 683 acceptors of sterilization were asked whether they would have accepted sterilization in the absence of incentives, almost 75% stated that they would have accepted the methods even without incentives. However, one-fourth of the acceptors would not have adopted the methods without incentives. The validity of responses to a hypothetical question can always be doubted. Yet, the lesson clearly seems to be that incentives probably influence about 25% of the acceptors or users of contraception. About 83% of the acceptors reported that higher incentives should be given to couples who adopt the methods with only one or two daughters. Whether the adoption is because of fear of losing the benefits being given by the government to the acceptors of sterilization, 10% of the respondents replied that they adopted the methods because of fear of losing the benefits.
9. While drafting laws and regulations and policies and programmes relating to incentives and disincentives, above discussed implications of incentives/ disincentives should be taken into consideration so as to make an appropriate balance between rights of people and national goals for achieving population stabilization. More importantly are the need for public understanding of the rationale behind any new benefits or penalties and the administrative capacity of government units to implement these programmes fairly and efficiently.
 
 INCENTIVES AND DISINCENTIVES AS RECOMMENDED BY THE NATIONAL DEVELOPMENT COUNCIL (NDC)  COMMITTEE ON POPULATION (1992)
 
The 3rd Para of the preface of the NDC Report reads :--
 
The necessary approach to the type of disincentives that need to be considered for population control was demonstrated by the state of Rajasthan through the amendment to Section 11 of Rajasthan Panchayats Act by an Ordinance issued by the Governor of Rajasthan on June 17, 1992. This has subsequently been enacted by the State Legislative Assembly which in addition has also passed the Rajasthan Municipalities (Second Amendment) Bill, 1992, introducing identical legislative measures dealing with the disqualification of a person who is elected to hold office, provided that he has more than two children and after one year of election, another child is born to such an elected representative. Similarly, several innovative schemes have been introduced in Rajasthan and Andaman & Nicobar Islands which provide special incentives and aim to project the image of the girl child as an asset to the family rather than a liability.
The Committee recommended to appropriately modify the incentives/ disincentives applicable to employees of Central/State/UT Governments, Autonomous Bodies, and Public Sector Undertakings etc. for adopting small family norm as follows:
 
  • Leave Travel Concessions, free or concessional rail / bus or air journeys wherever applicable, CGHS facilities / reimbursement of medical expenses, Maternity Leave benefit (excluding those directly affecting the health of the pregnant mother and foetus/new born), etc. are made available up to two children only.
  • Special increments for undergoing sterilization, incentive of lower rate of interest for house holding advances, interest bearing advances viz. vehicle loans should be available to the employees with two or less children only.
  • Priority in allotment of Government accommodation is given to employees who have adopted 2-child norm.
  • Any public servant violating the Child Marriage Restraint Act or who has more than 2 children should be debarred from promotion for a period of five years and birth of child beyond three should result in dismissal from service.
  • Persons violating the child Marriage Restraint Act or having more than 2 children may be debarred from recruitment in the Government/Autonomous Bodies/Public Sector Undertakings.
Legal and administrative implications of the above recommendations should be examined before implementation once the Government accepts these in principle.
 
  • Regarding incentives available under the compensation of loss of wages to the accepters of sterilization the States/UTs may be given flexibility of operation.
  • Special incentives and support to such programmes as involvement and continuation of schooling of female children, delaying the age of marriage, old age pensions as already adopted by several States should be introduced in other States also.
  • Benefit of loans, advances, allotment of land/house sites, facilities of PDS should be withdrawn from families violating the 2-child norm but may be restored after the couple has undergone sterilization operations.
  • Amendment to Panchayati Raj Act brought by the Rajasthan Government is recommended to be emulated. The Central/State Governments should consider bringing similar legislation for disqualifying the peoples’ representatives at different levels if they violate small family norm after getting elected. Such a step should have useful demonstration effect on the people at large.
 PROMOTIONAL AND MOTIVATIONAL MEASURES FOR THE ADOPTION OF SMALL FAMILY NORM- AS ENVISAGED IN  NPP- 2000
 
  • Panchayats and Zilla Parishads will be rewarded and honoured for exemplary performance in universalizing the small family norm, achieving reductions in infant mortality and birth rates, and promoting literacy with completion of primary schooling.
  • The Balika Samridhi Yojana run by the Department of Women and Child Development, to promote survival and care of the girl child will continue. A cash incentive of Rs. 500/- is awarded at the birth of the girl child of birth order 1 or 2.
  • Maternity Benefit Scheme run by the Department of Rural development will continue. A cash incentive of Rs. 500/- is awarded to mothers who have their first child after 19 years of age, for the birth of the first or second child only. Disbursement of the cash award will in future be linked to compliance with antenatal check up, institutional delivery by trained birth attendant, registration of birth and BCG immunization.
  • A family welfare linked – Health Insurance Plan will be established. Couples below the poverty line, who undergo sterilization with not more than two living children, would become eligible (along with children) for health insurance (for hospitalization) not exceeding Rs. 5000/-, and a personal accident insurance cover for the spouse undergoing sterilization.
  • Couples below poverty line, who marry after the legal age of marriage, register the marriage, have their first child after the mother reaches the age of 21, accept the small family norm, and adopt a terminal method after the birth of the second child, will be rewarded.
  • A revolving fund will be set up for income – generating activities by village-level self help groups, who provide community – level health care services.
  • Crèches and childcare centres will be opened in rural areas and urban slums. This will facilitate and promote participation of women in paid employment.
  • A wider, affordable choice of contraceptives will be made accessible at diverse delivery points, with counceling services to enable acceptors to exercise voluntary and informed consent.
  • Facilities for safe abortion will be strengthened and expanded.
  • Products and services will be made affordable through innovative social marketing schemes.
  • Local entrepreneurs at village levels will be provided soft loans and encouraged to run ambulance services to supplement the existing arrangements for referral transportation.
  • Increased vocational training schemes for girls, leading to self-employment will be encouraged.
  • Strict enforcement of Child Marriage Restraint Act, 1976.
  • Strict enforcement of the pre-Natal Diagnostic Techniques Act, 1994.
  • Soft loans to ensure mobility of the ANMs will be increased.
  • The 42nd Constitutional Amendment has frozen the number of representatives in the Lok Sabha on the basis of population at 1971 Census levels. The freeze is currently valid until 2001, and has served as an incentive for State Governments to fearlessly pursue the agenda for population stabilization. This freeze needs to be extended until 2026.
 INCENTIVES / DISINCENTIVES – GIVEN BY THE STATES/ UTs
 
 ANDAMAN & NICOBAR ISLANDS
 
Under the “Planned Families Scheme by 2000 AD” Rs. 5000/- is given to acceptors of Permanent method of Family Planning with 2 or less children to only the registered women under the scheme.
 
 ANDHRA PRADESH
 
As Per Population Policy:  
 
Unit/Criteria
Nature of Incentives/disincentives
District/Gram Panchayat/Village Level for:
(i) Exceeding protection of couples under family welfare programme beyond a fixed percentage, say 60%


(ii) 100% ante-natal coverage of women members... and on the percentage of eligible couple – members who are protected under FWP


(iii) ...Best performing district…best performing primary health centre and.. best performing gram panchayat
(i) Such incentives will be provided in the shape of additional works, school buildings, etc. and by setting apart a portion from the overall funds available under schemes such as JRY, EAS, RWS, etc.

(ii) Every village which achieves the performance level... will also be selected for full coverage under schemes such as TRYSEM, low cost sanitation scheme and weaker section housing scheme

(iii) Preference in funding of DWCRA groups

(iv) Rolling shield at every level
Individual Level for:
(i) 3 couples per district with two girl children adopting permanent method of family planning or with one child adopting permanent method or with two or less children adopting vasectomy

(ii) Acceptors of permanent methods at district and mandal level

(iv) Acceptors of sterilization with (in priority):

* two girl children, one child adopting vasectomy, acceptor with one child, acceptor with two children adopting vasectomy, acceptor with two children
(i) An award of Rs 10,000 each to three couples per district... by lucky dip



(ii) Similar prizes with local contribution


(iv) Preference will be given... in schemes such as assignment of land, allotment of surplus agricultural land, assignment of house sites and houses, IRDP, SC Action Plan, BC Action Plan, TRYSEM, PMRY, CMYEP, etc.
‘Best’ Service Providers for
(i) District health officer, medical officer, mass media functionary, female health supervisor, male health worker, NGO for innovative strategies

(ii) At district and mandal level

(iii) Team of service providers who have achieved a performance level which is above a prescribed minimum standard
(i) Chief Minister’s Gold Medal

• Awards presented on World Population Day
• Cash awards
Government employees to serve as role models as that they may give lead in adopting two child norm
Government to examine the desirability of limiting incentives such as LTC and educational concession for the first two children only. Government will also examine the desirability of restricting family planning incentives to all acceptors of sterilization ...to an equal one time benefit. Government will explore the possibility of modifying the service rules and promotion policies such that adoption of two child norm is encouraged
 
 HARYANA
 
INCENTIVES:
1.
A sum of Rs.300/- (each case) is being spent on the acceptors of sterilization which includes cash compensation, cost of medicines and transport cost with a view to promote small family norm. Similarly a sum of Rs.16/- (each case) is also being spent on medicines for I.U.D. cases.
2.
Cash incentive to acceptors and motivators.
3.
Special leave to acceptors or spouse of sterilization for six days.
   
DISINCENTIVES:
1.
Maternity leave shall not be admissible to a female Govt. employee after two children.
2.
A person having more than two living children on the expiry of one year of the pronouncement of the said act shall be disqualified for contesting the election of Panchayati Raj Institutions.
 
 HIMACHAL PRADESH
 
Himachal Pradesh has a scheme of incentives and disincentives for promoting the mall family norm as per details given below:
 
INCENTIVES:
1.
One increment to Government Servant who undergoes sterilization after two children.
2.
Ten days special casual leave to males and 20 days to females who undergo tubectomy/ vasectomy to all government staff.
3.
Individuals other than the Government servants who motivate not less than 20 cases shall earn a cash prize of Rs. 1000/- each. – one for each of the 12-districts.
4.
Best motivator from the NGOs shall get Rs. 10,000/- provided he/she motivates 100 cases.
5.
Individuals who motivate 80 and 100 cases shall get Rs. 50/- and Rs. 100/- per case respectively with a certificate of commendation.
6.
One Panchayat in each Assembly Constituency (barring Shimla Urban Constituency) achieving highest immunization, lowest IMR and lowest birth rate in a calendar year shall get Rs. 1.00 lakh.
   
DISINCENTIVES:
1.
Maternity and Paternity leave restricted up to two surviving children only.
2.
Persons with more than two children debarred from contesting Panchayat Elections.
 
 KARNATAKA
 
Incentives under family welfare services
Family Planning method Total Incentive to the Beneficiaries
Vasectomy Rs. 145/-
Sterilization (female) Rs. 115/-
   
Operating Surgeons
Government Doctors Rs. 7/- per case
Private Doctors Rs. 50/- per case
 
An additional increment for the Government servants for limiting the number of children to 2 or less.
 
 MADHYA PRADESH
 
Unit/Criteria
Nature of Incentives/disincentives
Empowering women:
To increase the age at marriage for women, the government will enact a Compulsory Marriage Registration Act and will conduct special campaigns with the help of government departments, NGOs, and panchayati raj institutions to inform the public. In addition, the legal age at marriage will be made a criterion for those seeking jobs, especially public jobs... admission in educational institutions applying for loans, etc.
Mobilizing community support:

• From 26 January 2001, persons marrying before legal age at marriage will not be eligible to seek government employment in MP
• Persons having more than 2 children after 26 January 2001 would not be eligible for contesting elections for panchayats, local bodies, mandis or cooperatives in the state. In case they get elected and in the mean time they have the third child, they would be disqualified for that post
• The girl-child scheme like Rajlakshmi to ensure retention of girls in schools and to prevent child marriages will be launched in the state with the help of financial institutions.
• Awards will be given in the field of community support for population stabilization at all levels for the best performing health institutions, individuals and panchayat raj institutions every year
• Rural development schemes, particularly those dealing with infrastructure, will be linked with family planning and reproductive health performance
 
 MAHARASHTRA
 
Unit/Criteria
Nature of Incentives/disincentives
Money Awards to BPL groups:
An incentive of Rs. 10,000/- in the form of fixed deposit for 18 years to below poverty line couples accepting terminal method after one or two daughters (with no male child). This daughter(s) will be given an additional incentive of Rs. 5000/- each as fixed deposit for five years when she completes her schooling up to 10th standard and does not get married before 20 years of age.
Employment Benefits:

The condition of small family norm will be included in service rule amongst Government and semi Government employees. Those having not more than two children will be given House Building Advance, Vehicle Advance and Medical Reimbursement.
Electoral Disincentives:

Acceptance of small family norm as a condition for qualifying for elections to various bodies such as Zilla Parishad, Panchyat Samiti and Cooperative Societies etc.
 
 ORISSA
 
INCENTIVES:
 
Either the husband or the wife undergoing vasectomy or tubectomy after one or two children, is eligible to hold a green card with the following benefits:
 
1.
Preference in allotment of houses constructed by Government / Housing Board in urban or rural areas
2.
Preference in providing LIGH and MIGH (low/Middle Income Group Household) loans.
3.
Reservation of 5% in Engineering, Medical, Polytechnic and ITI institutions will be made for admission of children of green card holders.
4.
Green card holding State Government servants will get an incentive allowance of two increments if he or she undergoes sterilization with one child and one increment after two children.
5.
A lottery with cash prizes used to be drawn by the State Government for the green card holders.
   
DISINCENTIVES:
   
1.
Persons with more than 2 children would not be able to contest elections to the PRIs.
2.
Maternity leave up to 90 days to female government employees has been restricted to a maximum of 2 children only.
 
 RAJASTHAN
 
Unit/Criteria
Nature of Incentives/disincentives
All over the state to promote small family norm
Age at Marriage:

Observance of the minimum age of marriage to be made compulsory for availing of government facilities and services

Stiffer penal provisions for violation of the legal age at marriage

Ensuring strict enforcement of Sarda Act, Pre Natal Diagnostic Technique Act, etc.
Symbolic awards for good performance

In case of panchayati raj institutions/municipalities where the candidates having two or more children are ineligible to contest elections.

The same provisions can also be considered for other elected bodies like cooperative institutions and as a service condition to state government employees

The legal provisions barring people with more than two children from elections to panchayats and municipal bodies is a testimony of the firm political will and commitment towards population control
Government employees to encourage two child norm

Provision of certificate of excellence at district level to various classes of government employees, and voluntary and social organizations for outstanding achievements
Service Providers

Linking part of the sanction of various development works/ schemes with the level of achievement of the population policy

A policy decision has been taken to discontinue the incentive scheme... (even to service providers and sterilization acceptors)

It will be useful to give symbolic awards for good performance and initiate efforts to minimize laxity and negligence
 
 TAMIL NADU
 
1.
Deposit in the name of the child, Rs.3000/- per sterilization after first girl child and Rs.1500/- after the second girl child.
2.
Special Casual Leave to 1Government servants for sterilization and vasectomy.
3.
Payment of additional compensation to acceptors who undergo sterilization operation for a second time due to failure of earlier operation.
4.
Monetary assistance of Rs.500/- to women to compensate for the loss of wages to them during the last 8 to 12 weeks of delivery.
 
 UTTAR PRADESH
 
Unit/Criteria
Nature of Incentives/disincentives
Role of panchayats in programme implementation
  • Panchayats would be responsible for recording marriages in addition to births and deaths. This data would be shared with the grassroots level workers to help them provide RCH services, including family planning
  • Of the total financial resources allocated to PRIs, 10% will be earmarked for performance based disbursement; particularly for performance in the areas of reproductive and child health services and female education
  • Those panchayats whose performance best meets clients RCH needs will be honoured by the Chief Minister and given special development grants for community assets
 
 WEST BENGAL
 
  1. Incentives to the tune of Rs. 500/- awarded to girls who marry after 18 years of age and for the birth of the girl child of birth order one or two.
  2. Compensation in respect of tubectomy (Rs. 300/-), vasectomy (Rs. 200/-) and IUD insertion (Rs. 20/-).