The incentive trap. A study of coercion reproductive rights and womens autonomy in Bangladesh.

After initiating public debate in the Netherlands about how and to what extent UN Population Fund (UNFPA) policies respect womens autonomy and reproductive rights the cooperating research groups investigated the UNFPA policy dealing with incentives and disincentives to accept family planning (FP) and goals for FP providers. Interviews were held in 1994 in Bangladesh with 125 women and men in rural Bogra and in suburban Dhaka to determine 1) the extent to which incentives influence contraceptive choice 2) decision-making roles within families 3) the extent to which health workers are rewarded and the amount of influence they exert over contraceptive choices and 4) the extent to which service provider disincentives affect attempts to reach service goals. This report of that study provides background information on the research and on the development of population control policies in Bangladesh the organization of the FP program and contraceptive methods available. Part 2 traces the incentive program from its probable introduction in India in 1956 through the Bangladeshi Financial Incentive System starting in 1976. Arguments in favor of the use of incentives are summarized. The third part of the report provides an analysis of the data gained from focus group discussions and from interviews with potential users with women who had undergone a tubectomy more than two years earlier with vasectomized men with IUD users with longterm IUD users with Norplant users with women who rely on menstrual regulation and with service providers. The final section compares findings from Bogra and Dhaka and provides a discussion of the findings in light of other reports in the literature in terms of such issues as quality of care voluntary and informed choice and womens status. Recommendations from the study include protecting the human and reproductive rights of women by prohibiting the use of incentives in favor of improving health care contraceptive availability and womens status.