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Economics and Ethics of Results-Based Financing for Family Planning: Evidence and Policy Implications


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  • Chowdury, Sadia
  • Vergeer, Petra
  • Schmidt, Harald
  • Barroy, Helene
  • Bishai, David
  • Halpern, Scott
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    This paper was developed for World Bank task team leaders (TTLs) and teams designing results-based financing (RBF) programs in family planning (FP). It explores the rationale for introducing such incentives based on insights from classical and behavioral economics, to respond to supply- and demand-side barriers to using FP services. To help the reader understand why incentivizing FP requires specific attention in RBF, the evolution of incentives in vertical FP programs introduced from the 1950s to the early 1990s and the ethical concerns raised in these programs are described. RBF programs after the 1990s were also studied to understand the ways FP is currently incentivized. The paper also touches on the effects of the incentive programs for FP as described in the literature. Finally, it examines ethical concerns related to FP incentives that should be considered during the design, implementation, and evaluation of programs and provides a conceptual framework that can be of use for task teams in the decision making process for FP in RBF programs. It should be noted that the paper is concerned exclusively with developing a framework that can help design ethical programs to address the unmet need for FP.

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    Bibliographic Info

    Paper provided by The World Bank in its series Health, Nutrition and Population (HNP) Discussion Paper Series with number 84663.

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    Length: pages 92 pages
    Date of creation: 01 Dec 2013
    Date of revision:
    Handle: RePEc:wbk:hnpdps:84663

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    Keywords: abortion; abstinence; access to health services; adolescents; aggressive; approach to women; babies; behavior change; birth rate; birth rates; capitation; changes in ... See More + ertility; child health; child mortality; child survival; childbirth; children per woman; cities; classical economics; coercion; Commission on Population; community health; complications; comprehensive reproductive health; condoms; consumers; contraceptive acceptors; contraceptive choices; contraceptive methods; contraceptive prevalence; contraceptive use; counseling; DECISION MAKING; demand curve; demographers; demographic goals; Department of Population; developing countries; drugs; earthquake; economic performance; employment; Equal access; essential health services; ETHICAL CONSIDERATIONS; expenditures; extended families; families; FAMILY PLANNING; Family Planning Programs; Family Planning Services; family size; Family Welfare; fatigue; female sterilization; fertility; fertility decline; Fertility declines; fertility rate; fertility rates; food supplies; forced abortion; free choice; gender equity; health care; health care coverage; health care policy; health care providers; health care services; health care workers; health centers; Health Economics; health education; health effects; health facilities; health indicators; health investments; health outcomes; Health Policy; health professionals; health providers; Health Results; health risks; health sector; health service; health services; Health Specialist; health system; health workers; high fertility; HIV; HIV/AIDS; hospital; hospitals; household income; human capital; Human Development; human resources; human rights; illness; immunizations; impact evaluations; impact on health; infants; information services; informed choice; informed choices; informed decisions; injectable contraceptives; insurance; integration; INTERNATIONAL ACTION; International Conference on Population; International Family Planning; IUD; IUDs; lack of information; lack of knowledge; large families; live births; low-income countries; lower fertility; married women; maternal deaths; maternal health; maternal health care; maternal mortality ratio; maternity leave; MEDICAL CARE; Medical Ethics; medical records; medical specialists; medical treatment; method of choice; methods of family planning; Ministry of Health; modern contraception; modern contraceptive methods; modern family; modern family planning; modern family planning methods; mortality; national government; National Population; natural resources; newborns; number of couples; number of people; number of women; Nutrition; oral contraceptives; outpatient care; pace of population growth; pamphlet; pandemic; Parenthood Federation; patient; patient satisfaction; patients; pensions; Policy Implications; policy makers; Population and Development; population control; population growth; Population Policies; Population Research; Population Research Centre; posters; pregnancies; pregnancy; pregnant women; prenatal care; Price subsidies; production costs; provision of services; Public Health; quality assurance; quality care; quality of care; quality of services; quality services; reducing maternal mortality; religious reasons; Reproductive Health; reproductive health program; reproductive rights; respect; rural women; safe motherhood; screening; service delivery; service providers; sex; sexually active; side effects; small families; smaller families; smoking; social compensation; social consequences; Social marketing; social reasons; socioeconomic development; socioeconomic factors; Spouse; spouses; state governments; sterilization; substance abuse; supply curve; supply curves; training health workers; transportation; unintended pregnancies; unsafe abortions; urban areas; vasectomy; workers;

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    1. Hector Lamadrid-Figueroa & Gustavo Angeles & Thomas Mroz & Jose Urquieta-Salomon & Bernardo Hernandez-Prado & Aurelio Cruz-Valdez & Martha Tellez-Rojo, 2010. "Heterogeneous impact of the social programme Oportunidades on use of contraceptive methods by young adult women living in rural areas," Journal of Development Effectiveness, Taylor & Francis Journals, vol. 2(1), pages 74-86.
    2. Luis Angeles, 2010. "Demographic transitions: analyzing the effects of mortality on fertility," Journal of Population Economics, Springer, vol. 23(1), pages 99-120, January.
    3. Lewis, Maureen & Kenney, Genevieve, 1988. "The private sector and family planning in developing countries," Policy Research Working Paper Series 96, The World Bank.
    4. Laibson, David, 1997. "Golden Eggs and Hyperbolic Discounting," The Quarterly Journal of Economics, MIT Press, vol. 112(2), pages 443-77, May.
    5. Shane Frederick & George Loewenstein & Ted O'Donoghue, 2002. "Time Discounting and Time Preference: A Critical Review," Journal of Economic Literature, American Economic Association, vol. 40(2), pages 351-401, June.
    6. Warren C. Robinson & John A. Ross, 2007. "The Global Family Planning Revolution : Three Decades of Population Policies and Programs," World Bank Publications, The World Bank, number 6788.
    7. Jejeebhoy, Shireen J., 1995. "Women's Education, Autonomy, and Reproductive Behaviour: Experience from Developing Countries," OUP Catalogue, Oxford University Press, number 9780198290339, September.
    8. Jessica Todd & Paul Winters & Guy Stecklov, 2012. "Evaluating the impact of conditional cash transfer programs on fertility: the case of the Red de Protección Social in Nicaragua," Journal of Population Economics, Springer, vol. 25(1), pages 267-290, January.
    9. Cryder, Cynthia E. & John London, Alex & Volpp, Kevin G. & Loewenstein, George, 2010. "Informative inducement: Study payment as a signal of risk," Social Science & Medicine, Elsevier, vol. 70(3), pages 455-464, February.
    10. Guy Stecklov & Paul Winters & Jessica Todd & Ferdinando Regalia, 2006. "Demographic Externalities from Poverty Programs in Developing Countries: Experimental Evidence from Latin America," Working Papers 2006-01, American University, Department of Economics.
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