23-4
The quota system—and the problems it creates
To meet their goals for ‘number of couples controlled’ by a family planning
campaign, many health ministries have introduced a quota system. Every month,
each medical officer or health worker is required to recruit a certain number of new
birth control ‘accepters’.
Such quotas frequently lead to abuses. People are seen as numbers. Couples
are often pressured into planning their families against their will. In Latin America,
mothers have been refused medical care for their sick babies until they agree to use
contraceptives. In Asia, young women and teenage boys have been sterilized by
force so that authorities could meet their quotas!
Trying to force, bribe, or shame people into ‘planning’ breeds anger and distrust.
Many women who do not want another child end up getting pregnant because they
do not trust family planning programs. In Mexico, Project Piaxtla had a voluntary
birth control program long before the government approved family planning. Many
couples were interested and became involved. But since the government started
its family planning campaign, the number of couples planning their families in the
Piaxtla area has dropped to less than half. People have grown distrustful.
An attempt has been made to ‘clean up’ the image of population programs, to
make their objectives seem less political, more personal, and more health oriented.
But the big questions remain: To what extent are family planning efforts an
attempt to control the poor? To what extent are they an attempt to strengthen
the social position of the poor? These are questions that health workers in
community-based programs urgently need to consider and discuss.
•
So far in this chapter, we have discussed the abuses and problems connected
with certain approaches to family planning. The distrust that has resulted can only
be overcome by uncovering the truth. Health workers need to be well informed
to effectively help people with family planning.