Those of us who easily become discouraged by population issues will do well to focus on the extraordinary gains of Thailand’s family planning program. With 54 million people living in an area slightly larger than California, Thailand once faced a population growth rate as daunting as that of other developing countries. But as a result of a far-reaching family planning effort – officially launched in 1971 with the adoption of a national population policy – Thailand has gained impressive control over its growth rate. Use of contraceptives among married couples has increased from 15 to 70 percent, and in 15 years Thailand’s population growth rate has been cut in half, from 3.2 percent to 1.6 percent.
Thailand has lowered its birth rate quickly – and substantially – thanks to the creativity of family planning approaches, the openness of the Thai people to new ideas, and the willingness of the gov- ernment to work with the Population and Community Development Association (PDA), a private non-profit organization and the largest nongovernmental agency in Thailand.
Primary to the effort is the character of the Thai people and their culture. Relationships between men and women in Thailand are more egalitarian than in most of the developing world. Thai spouses share equally in decisions regarding children, family life, and contraception. And the prevalence of Buddhism (95 percent of Thais are Buddhist) has also supported the family planning effort in Thailand. Buddhist scripture preaches that "many children make you poor."
A second reason for Thailand’s success is the charisma and creativity of its family planning leadership. Mechai Viravaidya, a former government economist and public relations genius, launched the PDA with great fanfare. His imagination fueled the family planning effort in its early stages, raising it from a progressive program to an inspired celebration of contraceptive information. Mechai established a high profile public education campaign, staging such events as a condom balloon-blowing contest featuring village headmen competing for condom-inflating glory. Mechai and other PDA workers could be found handing out condoms at movie theaters and traffic jams – anywhere where there was a crowd. Even the traffic police were given boxes of condoms to distribute on New Year’s Eve in a program known affectionately as "cops and rubbers."
Although condoms – now commonly called "mechais" in Thailand – became the natural trademark of his publicity campaign, Mechai used a variety of other family planning tools as well. Under his direction, birth-control carts sporting pills, IUDs, spermicidal foam, and condoms sprouted up at bus stations and public events.
The Thai government has supported Mechai’s efforts by making a wide range of new contraceptive technologies available to the public. Thailand was among the first countries to allow the use of the intravenous, injectable contraceptive DMPA, and remains one of its largest users. Thai physicians have also developed simplified methods of female sterilization, and now operating room nurses are trained to perform the procedures. Non-scalpel vasectomies are available at festivals and other public events, and in a characteristically celebratory manner, PDA offers free vasectomies on the King’s birthday. Sterilization has now become the most widely used form of contraception in the country.
While creative publicity techniques drew public attention to family planning issues, many attribute the Thai people’s commitment to participate to the fusion of economic development with family planning education. PDA offers loans that are linked to people’s use of contraception. American Sara Newhall, who works with Mechai at PDA in Bangkok, described in a recent interview with IN CONTEXT how Mechai arrived at his economic program of family planning incentives:
"Mechai was an economist, coming at it from a resource management angle. He’s not a doctor or a social worker. PDA’s message is that family planning is not enough; it does not put food on the table. So if you’re going to convince an agrarian society to change its attitude from ‘we need more field hands’ to one of family planning, you have to introduce alternatives for income generation.
"PDA moved from contraceptive distribution to the issue of water, introducing a revolving loan scheme to build, with German funding, thousands of water jars, squat toilets, and rain water cachement jars for drinking water. Then they moved to agriculture-oriented income generation. Pig banks, rice banks, buffalo – at the beginning of the season, people would [borrow] three pigs. No money, but monetary value – a loan in the form of animals. Then they would pay back the loan and have a profit to keep. It broke the cycle of the middleman: 80 percent of the population was rice farming, and the problem was that (as usual with the poor) there were moneylenders in the poor communities who would tide them through, but at 3 percent per month (36 percent per year), continuing the cycle of indebtedness and poverty. The PDA rate is 1 percent per month, to be repaid in 3-6 months. Many of these programs use revolving loans. We link family planning participation to acceptance for the loan. We use incentives."
Under a similar but separate government program, monetary loan funds were also set up in several villages. Jodi Jacobson of the Worldwatch Institute further explains the loan system:
"Initially, loans to individuals were based on character, credit-worthiness, and the project to be carried out. After the program became established, preference was given to applicants who were practicing family planning. Members of the loan fund received shares and dividends on the basis of the contraceptive method used; more effective methods had higher values. As the level of contraceptive prevalence within a village increased, so did the total amount of the loan fund.
"The Thai program was designed to prevent coercion. Money was not subtracted from a loan fund if contraceptive prevalence fell; shares in the loan fund and the right to borrow were not taken away from those who chose not to continue using contraceptives. And interest rates were similar to those prevailing in the Thai government’s rural credit program" (Worldwatch Paper #80, "Planning the Global Family," 1987).
When it became clear that the Thai program was working, international workers in family planning development came to take a look. PDA developed a 3-week training course for people from other countries. Newhall describes the training: "The course included proposal writing, innovative planning, and field trips to observe the community-based family planning system. It was fertile learning ground for other countries to think about how they might be doing this. We brought in Catholic countries, like the Philippines, and places where women would find this most inappropriate, like Bangladesh. We’re trying to push them and jar them to adjust their thinking."
The Thai government’s support of family planning through education and economic development has given the Thai people the message that family planning is a way of improving quality of life. Since the official population policy was announced in 1971, per capita income in Thailand has nearly doubled. Not only has the new revenue allowed the government to continue to expand health and family planning services, but the economic security within individual Thai families has allowed them a greater variety of choices.
As Sara Newhall explains, "[The poor village women] know that birth destroys their health, that their babies are starving. The issue is, can you sustain the family? How many children can you have and still be a sustainable family unit, from a health, economic, and livability standpoint?" Thanks to the efforts of the PDA, the Thai government, and especially the Thai people, millions of couples are now able to answer that question for themselves.