Introductory small cash incentives to promote child spacing in India.

The Ammanpettai Family Welfare Program began in 1985 as a pilot program to determine whether offering small monthly cash incentives for a limited period would be a cost-effective way to increase the use of modern temporary methods of contraception among rural Indian women who do not want to become pregnant but are not ready to adopt sterilization. The program has demonstrated that a modest cash incentive for 3-5 months attracts very large numbers of women to a clinic where they learn about and are provided with the pill, condoms, or the IUD. In catchment areas where official government reports showed temporary-methods prevalence rates of 3-5 percent at best, the Ammanpettai incentive program has attracted up to 70 percent of eligible women to join the program and try the method of their choice. By requiring that participants bring their youngest child to the clinic, the program provides for mother and child health surveillance, including immunizations. The great majority of rural women who join the program work as field laborers, have little or no schooling, and have little knowledge of or experience with modern contraceptive methods. Continuation rates are 25-50 percent at one year if follow-up is maintained by village resident women distributors. The program has been extended to several rural primary health centers in Thanjavur District, to 14 government health posts in the city of Madras, and to a semiurban area and several rural areas in Bihar. The cost-effectiveness of this program compares favorably with that of the current government family welfare program.