Family Planning Targets and Quality of Services: Workers' Perspectives and Dilemmas

Abstract

This paper uses data from in-depth group interviews with family planning workers in Bangladesh to demonstrate both the dysfunctional influence of family planning targets on quality of care as well as the strong connection between targets and the manage ment system. The findings show that the presence of targets influenced the advice and information workers provided, pushing them towards long-term methods such as steril isation and the IUD rather than helping clients select methods most suited to their needs. The paper then shows the connection between the target system and the struc ture of official and unofficial incentives, the pattern of supervision, the system of accountability and a hierarchically organised and gender-biased organisational cul ture. The authors argue that unless these underlying managerial determinants of qual ity of care are addressed, the hope for reaching the goals of the International Conference on Population and Development (ICPD) will remain illusory.