(WOMENSENEWS)–Using cash to incentivize behavioral modification is riding a big wave in development policy circles. In India, we’ve just seen how far wrong that can go.
Thirteen women in a rural part of the country recently died after undergoing substandard government sterilizations and several more are terribly ill as a result.
The procedures were part of a population control campaign in which poor women were paid $10 to undergo the invasive surgery. Paid sterilization, one of many ways poor women are incentivized to do something in the name of development, is not new.
In Peru, in the 1990s, an estimated 300,000 indigenous women were victims of a similar population control campaign in which many reported being threatened or bribed. Backed by international aid organizations, at the time, the campaign was framed both as a woman’s right to birth control and a tool to help families lift themselves out of poverty.
We see this same transactional approach in richer societies as well. Some examples are more morally dubious than others.
In his 2012 book "What Money Can’t Buy: The Moral Limits of Markets," author Michael Sandel points to a dramatic increase in giving people cash to do the ‘right’ thing. Examples include cash for weight loss, paying drug-addicted women in the United States to undergo sterilization and school districts rewarding high school students with money for good grades. Sandel argues that when behavior is driven by financial reward, communal ideas about what is intrinsically good or right are put at risk.
Furthermore, he questions the ethicality of paying people to do things that may not be in their own best interest.
Paying poor women to do what should be their own voluntary choice is the crux of what is arguably the fastest growing health and development policy.
Called ‘the world’s favorite new anti-poverty device’ by The Economist, "conditional cash transfers," called CCTs, are programs used by governments and international development organizations to break the inter-generational cycle of poverty. In these programs, low income people are incentivized with small sums of money to meet certain behavioral requirements. These conditions usually relate to the health and education of their children or using maternal care services. Most of the programs give the cash to women, because they are considered more responsible than their male partners, and more likely to invest the cash earned in the household. If they fail to meet the conditions, they may be suspended from the program.
For example, the Peruvian program "Juntos" (Together) requires poor rural women to take their children to school and for regular growth and nutrition check-ups; and, if the women are pregnant, they must go for prenatal care. If they meet these conditions, they are paid about $70 every other month. Started in 2006, Juntos is now Peru’s largest social program, reaching approximately 1.5 million people.
Roots in Mexico in Mid-1990s
Conditional cash transfers in their current form originated in the mid-1990s in Mexico and Brazil. Eighteen of the 21 Latin American countries now have some form of them in place.
Experts from the region have shared their insights in development policy forums and have fostered global implementation. CCTs can now be found in Africa, South and Southeast Asia, the United Kingdom and the USA.
Cash payments for prioritizing health and education might seem reasonable and a far cry from a government’s blatantly exploitative attempt to limit population among its impoverished people.
However, these seemingly well-intentioned policies often have big blind spots that may impact negatively on women’s own wellbeing. Some programs, for instance, lack cultural sensitivity. A requirement of a CCT program may be that women have hospital births, instead of at home. This may mean that she will be expected to give birth without her partner present, and lying down instead of standing. Or, she may be attended by someone that doesn’t speak her native language.
Questions about quality of service also surround many CCTs when they are implemented amid overall budgetary constraints and shortages of staff and supplies. Women and children may arrive at a school with no teachers or a clinic that is closed. Some programs have even been implicated in coercive political practices, where women, to receive promised benefits, are required to demonstrate support for political parties by joining parades and rallies.
An ethical alternative to paying women to change undesirable behavior or alter their reproductive practices is to empower them with education and access to quality health services, including voluntary methods of contraception and to inculcate opportunities for leadership. Studies have shown that, apart from being more ethically sound, this approach actually works.
Trends in post-disaster relief aid also provide some guiding light.
In cases where women were once given handouts of food, it is now increasingly common practice to give them small sums of cash. These are often referred to as unconditional cash transfers–or simply ‘cash transfers.’
Food handouts were traditionally delivered as enormous dumps of often poor quality grain and dairy products from wealthy western countries which, in the end, disrupted the local agricultural economy.
With these form of cash transfer, women are able to use their discretion and purchase the items they like–or need–from local producers.
The non-profit organization GiveDirectly transfers unconditional cash payments to poor families in Kenya and Uganda through their mobile phones. They’ve found that applying conditions to the payments isn’t necessary. Independently, families decide to spend the cash on food, education, medical expenses and household improvements.
This arrangement allows women to act in the best interest of their children, and themselves.
Coercively paying women off–even to do the right thing–is neither fair nor a real development strategy.
To be sure, CCTs, used in particular ways, can produce positive results that realize their missions.
In Peru, the Juntos program, for instance, has a 91 percent compliance rate, and has decreased the gender gap between boys’ and girls’ education.
Nonetheless, given the intrinsic moral questions of cash that comes with conditions, it’s wise to tread carefully. Instead of paying women to make what should be a private choice, we should invest in their access to healthcare, education and income. As we saw in India, the ends do not necessarily justify the means.