The Korean Mothers' Club ProgramAuthor(s): Hyung Jong Park, D. Lawrence Kincaid, Kyung Kyoon Chung, Dal Sun Han and SeaBaick LeeSource: Studies in Family Planning, Vol. 7, No. 10 (Oct., 1976), pp. 275-283Published by: Population CouncilStable URL: http://www.jstor.org/stable/1966343 .

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The Korean Mothers' Club Program HYUNG JONG PARK, D. LAWRENCE KINCAID, KYUNG KYOON CHUNG, DAL SUN HAN, and SEA BAICK LEE

In 1968, the Planned Parenthood Federation of Korea (PPFK) initiated the reorganization of indigenous women's groups in rural villages into family planning Mothers' Clubs. The basic purpose of this reorganization was to use the existing systems of interpersonal communication and local leadership to promote the goals of the national family planning program. Since the first year of the Mothers' Club Program, the number of clubs has increased from 12,650 to over 28,000 in 1975, involving over 700,000 women from most of Korea's rural villages. Because of the size of the program, its rapid growth in the eight years of its existence, and its contribution to family planning, the Korean Mothers' Club Program has received considerable attention in recent years throughout the world. The idea of organizing women into clubs for promoting family planning has stimulated similar programs in Colombia, Egypt, Bangladesh, and the Philippines.

This "movement" to organize indigenous groups of women for the purpose of educating people on such subjects as family planning, nutrition, and maternal and child health is a very positive response to three of the world's highest priorities: socioeconomic development, reduction of population growth, and improvement of the status of women. A great deal of diversity is evident across countries, in both the way the groups are organized and in the cultural and socioeconomic conditions under which they function. As long as the differences are kept in mind, much can be learned by studying the valuable experiences of other countries. The purpose of this paper is to report Korea's experience with the Mothers' Club Pro- gram in order to help others assess the limitations and benefits of this approach.

Historical Development of the Program

The traditional Korean village always has had a village council that conducted any business of interest to the village as a whole, such as managing community property, cleaning wells, repairing roads, and weeding the village's fields. Al- though the old patterns of participation in village affairs have changed substantially over the last 25 years, women have traditionally been excluded from direct participation in the affairs of the village council. In the past, women were consid- ered to be strictly "inside persons" and were discouraged from taking too much initiative outside of their own homes, often by invoking traditional proverbs such as, "Misfortune falls upon the house in which the hen crows like the rooster."

Nevertheless, for some time Korean women have formed groups and informal associations of their own. After the Korean War, the most important women's organization in rural areas became the kae, or money club. The Korean kae is a rotating credit association, which has been defined most generally as a group of participants, "each of whom agrees to contribute a specific amount at regular intervals into a lump sum fund, which is given at specified times and at fixed

intervals, in whole or in part, to each member of the association in turn" (Kurtz, 1973; Geertz, 1962; Ardener, 1964). A kae may be organized for an indefinite period of time to accumulate funds for general purposes or for a limited period of time for special purposes such as a trip, new household furnishings, weddings, funerals, educational expenses, and so on.

The leader, or organizer, of the kae is the most important member, since she is responsible for calculating the members' regular payments and interest, keeping the records, and insur- ing that the members selected for the kae continue their participation (and payments) until everyone has shared in the funds. The traditional money kae offered village women a unique opportunity to assume positions of leadership that otherwise would have been unavailable. Geertz (1962) consid- ers such associations to be "middle rung" economic institu- tions that bridge the gap between agrarian and commercial economic patterns and between peasant and trader attitudes toward money and its uses. Today's Mothers' Clubs-and their use of modern banking and credit institutions-are, to a great extent, derived from the common experience, collec- tive spirit, and achievement of mutual aid of this traditional women's organization.

The first official attempt to organize village women occurred after World War 11, when all women over age 18 were organized into a national network of women's clubs for the purpose of reestablishing the Korean language and culture. The Korean War interrupted this activity, but it continued unofficially until 1961, when the National Reconstruction Movement organized 45,000 family planning/maternal and child health classes at the level of natural villages, giving members training in organization and guidance of group dis- cussions. About US$0.75 was donated by the government to each group every month to cover the expenses of their meetings. One of the topics discussed in groups during this period was family planning. These early efforts were ap- parently so successful that a 1964 family planning knowledge, attitudes, and practice (KAP) survey, just two years later, discovered that rural women were more familiar with family planning than were urban women (Copp and Worth, 1972). Most of these groups lasted only one year, however, terminat- ing soon after the government's monthly donation was discon- tinued.

The government shifted its attention in 1964 to the organi- zation of village banks, run mostly by village men, and to nonformal educational programs (Yang and Worth, 1974). At the same time, the Office of Rural Development expanded its programs for women, offering education for better family life. Their rural development workers continued to assist village women in developing their clubs by holding meetings to discuss ways to improve nutrition, housing, clothing, and so forth. Meanwhile, researchers at Yonsei University began conducting field experiments in Koyang County to see if special education through organized mothers' clubs would

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improve family planning acceptance (Yang et al., 1972). Overall, the results were favorable, especially in villages where acceptance had previously lagged behind the average. A national network of mothers' clubs was recommended about the same time that plans were being made to introduce oral contraceptives into the national family planning program.

By 1968, the information and education activities of govern- ment field-workers and the mass media had created a favorable climate for the family planning program. It soon became evident, however, that although a large proportion of the target population were familiar with the concept of family planning, many were still ignorant of the contraceptive methods required for actual practice. Moreover, where family planning methods were adopted, the drop-out rate was found to be as high as 50 percent in some areas. The job of bridging the gap between knowledge and practice and reducing discontinuance could not be adequately accomplished by the mass media alone. The heavy burden naturally fell on the shoulders of govern- ment family planning field-workers-the only official channel of interpersonal communication available at that time. The national family planning program was well organized, with field-workers assigned as far down as the township level. In each of the more than 45,000 natural villages, however, there was no one individual having responsibility for such family planning program activities as recruiting acceptors and main- taining contact with the township health workers. Theoret- ically, each field-worker was responsible for serving approxi- mately 2,200 eligible couples spread out over 50-60 natural villages.

Since it had become obvious that field-workers were much too overburdened to accomplish the task alone, in 1968 the Planned Parenthood Federation of Korea, under authority from the Ministry of Health and Social Affairs, began trans- forming traditional village women's groups into official family planning Mothers' Clubs. Originally, clubs were organized in administrative villages, comprised of one to three natural villages, and each club was limited to about 12 women, under the assumption that a limited membership would enhance the club's prestige within each village and increase the members' sense of solidarity and cohesiveness. A woman had to satisfy several criteria for membership: (I) to be able to read and write, (2) to be affiliated with at least one other community activity, and (3) to be a mother between the ages of 20 and 45. Thus, in the beginning club members tended to be older and to have more education and a higher social status than other women in the village. By the end of 1968, approximately 12,650 Mothers' Clubs had been organized.

The original goal of the Mothers' Club Program was to expand the family planning program into rural areas of Korea by creating local, voluntary organizations of mothers who would:

1. Encourage family planning practice and continuation by example and by giving social and emotional support to accep- tors;

2. Aid over burdened field-workers in recruiting new ac- ceptors and supplying contraceptives (pills and condoms);

3. Aid in the introduction of a new method (the pill) to the family planning program; and

4. Encourage participation of women in community devel- opment activities.

The main strategy behind the program was to accelerate interpersonal communication about family planning at the village level and to legitimize family planning practice among rural women.

Mothers' Club leaders were appointed initially by the village chief and members were recommended by community leaders from among eligible village women. Each club was expected to hold at least four meetings a year, which were subsidized by a donation of 500 won (US$1.25) quarterly from PPFK to cover some of the expenses.1 This donation was replaced eventually by monies from sales of oral contraceptives.

During the first year, 139 male Pill Administrators and Community Organizers (PACOs) were selected and trained by PPFK and placed in county health centers throughout the country. They were responsible for supporting Mothers' Club activities and for collecting money from the sale of orals (at US$0. 11 per cycle). In 1972, several basic changes were made in the program's personnel and financial procedures. The number of PACOs was reduced to 50, and the responsibility for pill administration and distribution was transferred to the senior family planning worker in the county health centers. The title PACO was officially changed to Information and Guidance Officer (IGO), reflecting the shift in their duties to overseeing the activities of the clubs. Although some IGOs continued to maintain offices in the county health centers, they were all made directly responsible to the PPFK provincial branch offices. Their reduced number meant that each IGO became responsible for assisting an average of 400 clubs over an area of two to three counties. The problem for guidance officers of covering such a large area was solved in 1973 with the arrival of new motorcycles donated by the Swedish Inter- national Development Authority (SIDA). Besides the field- workers in each of the county health centers, the PPFK Information and Guidance Officers are the most important change agents, or motivators, working with the Mothers' Clubs today.

By 1973, inflation, necessary salary increases, and the ever-increasing number of clubs were exhausting the money provided by the sale of pills. Today, individual clubs no longer receive subsidies, but most clubs are able to meet expenses from their own source of funds. Some financial assistance (US$1.25) is still provided quarterly for the Township Mothers' Club Associations, each of which consists of all the village club leaders in a township.2 The senior family planning worker is also given US$2.50 per month for her assistance to the clubs.

In addition to this local support structure, PPFK provides training programs for Mothers' Club leaders and produces most of the public information, education, and mass com- munication materials for the national family planning program. They produce and distribute Happy Home, a monthly maga- zine, to each Mothers' Club leader. This is one of the major publications of PPFK, with articles and interesting stories

'Initial funding for the Mothers' Club Program came from USAID (through the Population Council) and the Korean government, totaling approximately US$25,000. The Swedish International Development Authority (SIDA) provided an initial 130,000 cycles of orals.

2The leaders of the Township Associations are also organized into County Mothers' Club Federations. Although PPFK wants to avoid a national hierarchy that might destroy the program's grass-roots character, there have been two annual meetings (by 1975) of the county leaders at the national level.

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relevant to all phases of home life in addition to family planning. It usually has a photo-story about one successful Mothers' Club in each issue to encourage other clubs. Circula- tion has grown from an initial 20,000 to over 60,000 copies. With the help of the IGO and field-worker, Happy Home is used today by Mothers' Club leaders to improve the quality of their monthly meetings and to sustain their members' motivation for family planning and home improvement.

Other Village Women's Groups

Several other national organizations also support women's groups on the village level. The Women's Affairs Section of the Ministry of Health and Social Affairs has organized village groups known as "Housewives' Clubs" through provincial and local governmental units. Their purpose is to encourage cooperative activities by village women and to help them with various social programs. These clubs are supervised by a woman staff member in the county office with the cooperation of the village chief. The Extension Service of the Ministry of Agriculture and Forestry also has organized village women into "New Life Clubs," which concentrate on basic home economics education (nutrition, cooking, sewing, kitchen im- provement, home sanitation, etc.). They are supervised by home demonstration agents from the county Extension Service offices.

President Park, through the Ministry of Home Affairs, launched the New Village Movement in 1972 in order to accelerate development of the rural sector and improve its standard of living relative to the urban sector. This is the dominant development program in Korea today, to which all others are expected to contribute. This program included the organization of yet another women's group in rural villages- the New Village Movement Women's Clubs-to help accom- plish the goals of this program. In two provinces an effort was made to establish these as multipurpose women's clubs to coordinate the activities of the other women's clubs. Em- phasis was placed on interorganizational cooperation, espe- cially among village-level workers, in order to eliminate over- lap and any dysfunctional competition. Thus, hypothetically at least, the record-keeping and reporting functions could be simplified, with each meeting accounted for in the reports to each agent's headquarters.

This kind of bureaucratic overlap and competition at the village level is prevalent in many countries today. It has led to a recent movement toward more "integrated rural develop- ment programs" (Webster, 1975).

The proliferation of different women's clubs in each Korean village is one indication of the success of the basic idea. It may appear as though so many different organizational efforts might lead to confusion and conflict among village women and increased antagonism toward outsiders in general. In most villages, however, there is actually only one women's group consisting of the same women, who merely assume the name and functions of each club depending upon the main topic of the meeting or the outside agent who happens to be visiting at the time. Since leadership is a scarce resource, the same woman usually serves as leader for each club function. In some villages, the official New Village Movement leader may be a different woman than the leader of the other women's groups, but at this time the overall pattern is unknown and

is probably still undergoing change. There is serious concern that the increase in the respon-

sibilities of the Mothers' Clubs will be detrimental to the family planning function, but it should be remembered that many clubs have been active in other development projects since they were established (Kincaid et al., 1975). In fact, one of the primary functions of the clubs should be to integrate family planning into other personal, family, and village goals, and to help village women assimilate the sometimes uncoordinated inputs from a variety of outside agencies.

Characteristics of the Mothers' Clubs

The most recent information about the Korean Mothers' Club Program comes from an extensive national survey con- ducted in 1973 (Park et al., 1974). The information that was collected in this study represents the first comprehensive assessment of the growth of the program since its initiation in 1968. The description presented here is a summary of the findings, which were based on a probability sample of 450 Mothers' Club leaders selected in three stages: (I) a random sample of 25 out of 150 counties, (2) a random selection of two out of about ten townships within each of these counties, and (3) a random sample of an average of nine village leaders from each county. From the total sample of 450 leaders, 383 were interviewed. To supplement these data, a census of all married women up to age 49 was conducted in one repre- sentative village in each of the 25 counties selected for the sample of club leaders. The total number of women inter- viewed in this special village sample was 1,014 (from which 14 cases were later dropped because of incomplete data).

The annual growth of the Mothers' Club Program has been phenomenal indeed. In the first year, 12,650 clubs were officially organized. In succeeding years, the following number of clubs were added: 2,057 in 1969; 1,943 in 1970; 2,000 in 1971; 2,883 in 1972; and over 1,000 by April in 1973, for a total of 22,533 clubs. By 1975, the number of clubs was estimated at over 28,000. The exact number is difficult to determine because the level of activity has to be taken into account. Not all of the clubs reported the same level of activity. Using data from the survey of Mothers' Club leaders (N= 383) regarding the regularity of club meetings, level of attendance, and frequency of meetings, it was estimated that about 10 percent of the clubs were very active, 38 percent were active, 37 percent were moderately active, and 15 percent were inactive.3

The average number of members per club has risen gradually since the program's beginning. There were an average of 23 members per club in 1968, but this had grown to 30.5 members by 1972. There is a noticeable tendency for membership to increase the longer the club has been in existence. In 1973, the clubs formed in 1968 had an average of 41 members, four-year-old clubs averaged 33 members, three-year-old clubs averaged 30 members, two-year-old clubs averaged 25 members, and one-year-old clubs averaged 21 members.

Over one-third of the leaders interviewed said that there were other wives in their village who wanted to become

3A number of club leaders (67) did not respond to the survey. Thus, probably a picture of somewhat greater activity and participation is created than would be the case if all 450 leaders in the sample had been interviewed.

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members of their club. Only 9 percent said that they would refuse new members in order to maintain their club at its present size. When nonmembers in the 25 villages were asked why they had not joined, two-thirds replied that they had never been encouraged to join. Sixteen percent said they had been asked to join but were uninterested. Other reasons for not joining included lack of time, opposition to family plan- ning, being new in the village, and lack of money to invest in the Mothers' Club Bank.

There were two main types of admission procedure used by the clubs: (I) decision by the leader (37 percent) and (2) a joint decision based on consensus at a meeting (38 percent). The remaining clubs either had no policy (15 percent) or simply did not allow new members to join (9 percent). Most of the club leaders (83 percent) reported no problems with members leaving the club, and those clubs that had dropouts stated such reasons as low involvement from the beginning, family objection, contraceptive failure, bad relationship with other members, and pregnancy.

A majority of the clubs (70 percent) held regular meetings at least once a month, and the rest either met every two months or irregularly when necessary. Only a very small proportion of the clubs required field-workers (3 percent) or other outsid- ers (7 percent) to summon members for a meeting. Most meetings were called by the club's leader (65 percent) or by the assistant leader or IGO (25 percent).

Attendance at club meetings was very high in most villages. The average attendance rate for all clubs was 76 percent, and almost half of all of the clubs had at least 90 percent of their members in attendance at every meeting. To some extent, high attendance was due to the use of small fines (US$0.25-$0.50) for being absent. At the time of the survey, 66 percent of the clubs were meeting at the leader's house, 22 percent at the village community hall, 9 percent in a school or other public building, and 3 percent in their own Mothers' Club meeting hall.

In 1973, almost all of the clubs kept a record of members' names (89 percent), attendance records (70 percent), a finan- cial account book (73 percent), and a collection of Happy Home magazines. Accurate records and account books are very important for good management, and the high percentage of clubs that maintained all four kinds of records (41 percent) is quite an achievement in such a short period of time. It indicates that very capable organizations are being developed in many of these villages.

Although family planning was reported as the most impor- tant topic of discussion during Mothers' Club meetings (63 percent), many clubs were actively involved in New Village Movement development projects and their own savings cam- paigns. According to the 1973 national survey of club leaders, 30 percent of the clubs were working on New Village Move- ment projects, 9 percent were currently operating cooperative enterprises such as village stores, 12 percent were working together as laborers on neighboring farms, and 6 percent were providing mutual assistance to neighbors. Given the strong government emphasis on the New Village Movement since this survey, the percent of clubs working on village develop- ment projects has undoubtedly increased.

To attain a better picture of the scope of these other Mothers' Club activities, we conducted a brief content analysis of the "Mothers' Club of the Month" feature in the PPFK

Activity Reports from May 1971 to July 1973. These unusually successful clubs were chosen for their accomplishments in general village development as well as family planning. Aside from family planning, their activities fell into three broad categories:

1. Cooperative agricultural projects: Fruit and vegetable gardens, greenhouses, small-livestock projects, mulberry plants for silk worms, and pine tree projects.

2. Community construction projects: Special buildings for club meetings, weddings, and other village activities; concrete bridges; street pavement; playgrounds; replacement of thatched roofs with tile, and so on.

3. Income-producing projects: Cooperative stores, rope- making and noodle factories, clothes-making in the home, and so forth.

The foundation and stimulus for many of these projects often seems to be the mutual savings and credit union spon- sored by the village Mothers' Club. Approximately three- fourths of the existing Mothers' Clubs either had, or were organizing, a Mothers' Club Bank, which functions as their own savings and credit union. Over half of the clubs already had some funds-on the average about 38,900 won (US$97.25). Although this may seem like a meager beginning, if we aggregate the average-size fund for just one-half (11,266) of the total number of Mothers' Clubs in 1973, the total comes to over one million US dollars. The large number of Mothers' Clubs suggests that they offer a tremendous potential for future rural development in Korea. If invested wisely, this previously untapped source of capital should begin to contribute substan- tially to economic development in the rural sector.

The introduction of official Mothers' Club Banks probably encouraged the clubs to increase their membership. A club of 40-50 members provides a much better foundation for savings and credit than one with only 12-15. Membership requirements have been relaxed accordingly, so that today the only official requirement is that a member be a mother between the ages of 20 and 45.

THE TYPICAL MOTHERS' CLUB LEADER

Using data from the survey of Mothers' Club leaders, a profile of the "typical" leader has been created by using the average or modal response category for selected questions. (Of course, it is unlikely that any one leader would have all of the characteristics of our "typical" leader.)

The typical Mothers' Club leader is approaching 40 years of age.4 She has two sons and one daughter, and she practices family planning in order not to have any more children. She is twice as likely to use the IUD as oral contraceptives. She thinks that the ideal family would consist of two sons and one daughter.

The typical leader is better informed than other villagers and other members of the Mothers' Club about available contraceptive methods. She is familiar enough with the IUD, orals, condoms, vasectomy, and tubal ligation to explain these methods to others, but she is less familiar with the diaphragm, withdrawal, basal body temperature, and rhythm methods.

4The average age of leaders is 38.8 years, whereas the average age of family planning field-workers is 27.3 years (Park et al., 1974).

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She is a family planning opinion leader in her village: more people say they would go to her first to get information about a "new" method of contraception than to anyone else in the village. She has personally persuaded more than nine mothers to adopt either orals or the IUD, and she currently supplies orals and condoms to village mothers.

Like most rural wives in Korea, she was born and raised in a different village than her husband, but she is from the same county. Her husband's occupation is more likely to be in agriculture than government service, commerce, or skilled manual labor. Our typical Mothers' Club leader has graduated from primary school, has no religious affiliation, and perceives herself as belonging basically to the middle socioeconomic class within her village.5 She visits the nearby city more often than most village mothers.

Although she has been the leader of her Mothers' Club for almost four years, she has not yet attended PPFK's voluntary training program for leaders in Seoul. She has been invited, but her responsibility for household duties has kept her from attending. She thinks that her club will continue to develop and improve in the future. Although in the past she had occasional problems with a lack of cooperation and discord among members and with financial procedures, she reports that there are no serious problems today and everything has gone as smoothly as was expected. She feels that her involvement as a leader has been a worthwhile experience.

One of the main methods that PPFK has used to improve the program has been intensive training programs for Mothers' Club leaders, assistant leaders, and secretaries. By mid-1973 approximately 1,900 leaders had participated in one-week training courses on family planning, credit union management, and record-keeping procedures. Since then, training has shifted from Seoul to the provincial branch offices in order to reduce the amount of time that leaders spend traveling and away from their own homes. It is also very likely that more emphasis will be given in the future to training leaders from the Township and County Mothers' Club Associations since their potential impact covers a much larger area.

Almost 50 percent of the Mothers' Club leaders who were originally appointed in 1968 had been replaced by 1973. PPFK's current policy allows leaders to hold office for only two years, and the club must hold a new election before a leader's term can be extended. The turnover rate for leaders has increased somewhat since 1971-72, and in 1973 half of the leaders were in their first or second year of office. According to Park et al. (1974, p. 235), "This appears to be the result partly of local adjustments stemming from PPFK's program to strengthen the Mothers' Club and partly of organizational strengthening resulting from the New Village Movement."

Impact of the Program

A fair evaluation of the Mothers' Club Program is not possible without some knowledge of the overall growth and change that has occurred in Korea since 1960. Between 1960 and 1970, the average rate of growth in gross domestic product was 8.9 percent; per capita gross domestic product doubled, from US$152 in 1960 to US$304 in 1972. Industrialization was

accompanied by such rapid rural-urban migration that, by 1973, almost 50 percent of Korea's 35 million people lived in urban areas. As a result, one of the world's most densely populated countries actually has suffered a mild labor shortage in the rural sector during the last few years.

According to Cho's (1973) estimates, the crude birth rate in South Korea declined from 43 per 1,000 in 1960 to 33 in 1966, and then to 29 in 1970:

The 33 percent decline in the South Korean crude birth rate in the period 1960-70 is one of the most rapid population changes observed in the history of mankind. . . . More significantly, the rate of the fertility decline in the rural areas was about the same as in urban areas (p. 17).

A multipurpose survey in 1973 estimated the birth rate at 28 per 1,000 and the crude death rate at 8-9 per 1,000, yielding an annual growth rate of 1.9-2.0 percent (Chang, Worth, and Michael, 1974).

Approximately 40 percent of the decline in the birth rate between 1960 and 1970 was due to changes in the age-sex structure of the population and to a rise in age at marriage. The average age at marriage for men rose from 25 years in 1960 to 27 years in 1970; for women it rose from 22 years in 1960 to 23 years in 1970. In urban areas, 45 percent of the decline was due to reduced marital fertility, but in rural areas almost 60 percent of the decline was due to lower marital fertility (Cho, 1973). A survey conducted in 1971 (Moon et al., 1972) revealed that the use of induced abortion among ever-married women aged 15-54 was much lower in rural areas (19 percent) than in urban areas (34 percent) and in Seoul (40 percent). The Korean family planning program appears to have been relatively successful in rural areas, where tradi- tionally people are most resistant to family planning.

The Korean Mothers' Club Program was begun, then, in a socioeconomic and demographic environment conducive to achieving the program's goals. Rapid economic growth and urban migration, for example, made it much easier for some clubs to increase their savings funds by working on neighboring farms or by starting their own production and marketing cooperatives. Any evaluation of the Korean program should be done within this context, especially if it is to be compared with similar programs in other countries. Our evaluation of the program is based upon (1) the extent to which it has accomplished its original objectives and (2) the extent to which it has improved family planning knowledge, attitudes, and practice (KAP).

ACHIEVEMENT OF ORIGINAL GOALS

Informal reports from field-workers and family planning officials, as well as national survey data (Park et al., 1974), show a very strong record of achievement of the program's original objectives. From an assortment of informal village associations, the Planned Parenthood Federation of Korea in cooperation with the Ministry of Health and Social Affairs and other agencies has organized over 25,000 clubs, with higher levels of organization on the township, county, and national level. The high rates and regularity of attendance and record- keeping, the high percentage of clubs with low drop-out rates (83 percent), and the large proportion of clubs (63 percent) who say family planning is the most important topic at meetings

5At least 64 percent of the leaders surveyed had completed primary school, but only 20 percent had finished middle school and 4 percent high school.

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indicate that the goal of establishing a viable, voluntary movement of mothers on the local level has been achieved.

In general, Mothers' Clubs, especially their leaders, en- courage the practice of family planning. Furthermore, club leaders who were surveyed reported that they had personally persuaded an average of nine women to adopt either the pill or the IUD. That other factors (or persons) may also have influenced these women to practice family planning does not diminish the program's achievement of this objective. Most of the leaders surveyed helped with the distribution of orals and condoms. The census of village mothers showed that 52 percent had recommended family planning to their neighbors, and most of those who had done so were Mothers' Club members. At the same time, as many as 67 percent of village mothers have been advised by someone else in the village to practice family planning. Only 13 percent said that they had been advised not to practice, II percent had received both kinds of advice, and 9 percent claimed they had received no advice (Park et al., 1974).

Earlier research on the program concluded that the clubs were providing stable contacts at the village level during a period of general program difficulties and high field-worker turnover: "They have at least made the field-worker's job easier and this should not be underrated as an achievement in its own right" (Yang et al., 1972, p. 51). The willingness of the Ministry of Health to have their senior field-workers take over the distribution of orals from the program's IGOs and the fact that the IGOs could be reduced in number also suggest that the clubs have made field extension work easier to do. Perhaps the strongest evidence of the program's suc- cess, however, has been the desire of other development agencies to use the Mothers' Clubs for their objectives and the strong response of many clubs to the New Village Move- ment and more general development activities.

EFFECT ON KAP LEVELS

The Mothers' Club Program has contributed substantially to the operation of Korea's family planning program at the local level. Whether or not the program has affected family planning knowledge, attitudes, and practice, however, has been a controversial question ever since the program began. An early field experiment conducted in the Gyeonggi-Yonsei area in 1969-70 concluded that, "Neither in the study areas nor (as far as has been measured) nationwide do mothers' classes appear to have been very effective in increasing contraceptive use" (Yang et al., 1972, p. 51). However, some of the field-workers in the control areas of this experiment had heard about the idea of Mothers' Clubs and liked it well enough to organize their own clubs unofficially. In addition,6 the field-workers in the control areas made more home visits, thereby compensating for the assistance provided to field- workers by the clubs in the experimental areas. In both experimental and control areas, achievement was approxi- mately at the target level, partly because strong administrative pressure ensured near-target performance, while budgetary restrictions prevented performance beyond the target level. These sources of contamination and the possibility that the

TABLE 1 Percent of Mothers' Club members and nonmembers having detailed knowledge of contraceptive methods: Korea, 1973

Contraceptive Leaders Members Nonmembers method (N=383) (N=446) (N=554)

IUD 98 87 74 Pill 98 80 68 Condom 93 71 53 Vasectomy 94 67 50 Rhythm 57 38 26 Withdrawal u 28 14 Tubal ligation u 21 19 Diaphragm u 9 4 Basal body

temperature 15 6 5

u = unavailable. SOURCE: Adapted from Park et al., 1974, p. 115.

clubs had not been in operation long enough to influence contraceptive practice make the results of this study inconclu- sive.

The 1973 national survey of Mothers' Clubs also attempted to determine the effect of the clubs on family planning knowl- edge, attitudes, and practice (Park et al., 1974). Tables 1-3 compare KAP among club leaders, members, and nonmembers in 25 villages.7 Because the percent of eligible women and leaders who had "ever heard of" contraceptives is so high (75-98 percent for the IUD, pill, condom, and vasectomy), only the proportion of women having "detailed knowledge" about how to use each method is presented in Table 1. In general, the majority of both members and nonmembers of clubs know how to use the IUD, pill, and condom, but for each of these methods there is a statistically significant dif- ference in knowledge between members and nonmembers.8 A much higher percentage of club leaders have detailed knowledge of each method than either members or non- members.

Table 2 shows an almost complete consensus among the women surveyed that the idea and practice of family planning is good. There is a dramatic drop, however, in the proportion of women who said they approved of specific contraceptive methods, which probably reflects both real problems with the available methods and some misunderstanding about them. Only 41 percent of club members and 28 percent of non- members said they thought the IUD was a good method. Even among the leaders, only 54 percent thought it was a good method. Although most of the remaining women in the sample (over 40 percent) said the IUD was a bad method to use, 17 percent of club members and 24 percent of nonmembers answered that they did not know or had no idea. This pattern of responses is similar for the other contraceptive methods listed in Table 2. For all three categories of respondents, the method most widely approved is the condom. As with knowl- edge, there are significant differences between members and

6Credit is due Walter Watson of the Population Council for the following two observations.

7It should be pointed out that the survey design allows us to compare levels of KAP within villages having clubs but not to compare villages having clubs with those having none.

8The chi square values for each of the main methods by membership are significant beyond the .01 level of statistical significance (where degree of free- dom = 1, N = 1,000).

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TABLE 2 Attitudes of Mothers' Club members and nonmembers toward family planning and contraceptive methods: Korea, 1973 (in percents)

Good Bad Don't know/no idea

Non- Non- Non- Leaders Members members Leaders Members members Leaders Members members

Method (N=383) (N=446) (N=554) (N=383) (N=446) (N=554) (N=383) (N=446) (N=554)

Family planning 100 99 95 0 1 3 0 1 3 IUD 54 41 28 37 41 47 9 17 24 Pill 46 37 28 43 46 51 12 17 21 Vasectomy 53 34 19 38 42 46 9 24 36 Condom 60 41 29 26 24 21 14 31 50

NOTE: Percents may not sum to 100 due to rounding. SOURCE: Adapted from Park et al., 1974, p. 163.

TABLE 3 Percentage distribution of Mothers' Club members and nonmembers by current contraceptive status: Korea, 1973

Leaders Members Nonmembers Status (N=383) (N=446) (N=554)

Current users by method IUD 15 18 10 Condom 12 4 2 Pill 1 6 11 9 Other 24 13 7 Total 67 46 28

Current nonusers by reason Pregnant 2 5 11 Want to get pregnant 3 13 25 Pong-eema 16 30 29 Recent induced abortion 0 0.2 0.9 Unknown 12 6 6 Total 33 54 72

All women 100 100 100

aPong-eem means "not taking responsible action." Here, it refers to women who do not want additional children but are not practicing family planning. SOURCE: Park et al., 1974, p. 166.

nonmembers in proportions approving each contraceptive method.

Differences in knowledge and attitudes between members and nonmembers of the Mothers' Clubs extend to levels of family planning practice as well (Table 3). The proportion of women currently practicing contraception was substantially higher among club members (46 percent) than among non- members (28 percent). Among club leaders the current practice rate was 67 percent. For the family planning program as a whole, these results are very favorable, especially when we consider the additional finding (not shown) that as many as 83 percent of club leaders, 72 percent of club members, and 46 percent of nonmembers had practiced contraception in the past. Among the sample of village women (that is, excluding club leaders), 42 percent had never practiced contraception. Forty-four percent of these women said they had not because they wanted another son or another child of unspecified sex, 5 percent said specifically that they wanted another daughter, and 32 percent claimed they were infertile. Only 19 percent gave reasons suggesting lack of knowledge or opposition: 8 percent said they believed the methods to be harmful to their health; 8 percent said they did not know which method was best or where to go for services; and 3 percent said their husbands or parents-in-law opposed family planning. It would appear, then, that some of the reasons for not practicing contraception that are the most difficult to counteract-fear,

ignorance, and opposition by others-had largely been elimi- nated in these villages by 1973. The majority of women not practicing family planning gave reasons that are quite rational from their point of view and that do not suggest opposition to contraceptive practice-they either wanted additional chil- dren or thought they could no longer conceive.

As Table 3 shows, almost one-third of the women in the village sample were not currently practicing contraception even though they claimed they did not want to get pregnant. This important group of women are described as pong-eem, which means ".not taking responsible action." Perhaps the most surprising finding of the study is that the proportion of pong-eem women among Mothers' Club members is as high as among nonmembers. Of course, many of these women may believe they are infertile, in which case it is not fair to judge their behavior as "irresponsible." These women should receive medical attention to determine whether they are fecund. Other women in this category may have relatively easy obstacles to overcome in order to begin practicing con- traception. They may be embarrassed about going to the clinic or feel it is inconvenient or have fears of specific contraceptive methods. The village Mothers' Club should be able to help these women to overcome their problems through the sharing of common experiences and the accompanying of women to clin- ics. New research has been initiated by the School of Public Health at Seoul National University to learn more about pong-

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eem women and their contribution to the so-called KAP gap. The significant differences between members and non-

members of Mothers' Clubs in family planning knowledge, attitudes, and practice suggest a positive impact of the program within each of the 25 villages sampled, but unfortunately the survey findings do not allow us to compare KAP in villages with clubs with KAP in villages that never had clubs. Standard survey methods were used, rather than a well-controlled field experiment, which would have taken into account which changes occurred first and the influence of extraneous vari- ables.

It is just as likely, for instance, that the difference in KAP between members and nonmembers may have resulted be- cause village women who were already more favorable toward family planning were more inclined to join the club in the first place. Furthermore, we know that club members tend to be older on the average than nonmembers. Since older mothers are more likely to have completed their families, we would expect them to have more knowledge of contraception and higher rates of practice than younger mothers. Age alone may be enough to account for most of the differences found between members and nonmembers. In order to conclude definitely that club membership has had an impact on KAP, the difference between members and nonmembers should be much larger, except for one final twist to the argument. If the Mothers' Clubs actively promote family planning among nonmembers as well as members in their village, then success- ful clubs would probably diminish differences between members and nonmembers within their village.

Statistical controls could be used to determine the relation- ship among those variables for which measures are available. A statistical analysis of club effects, however, would shift the unit of analysis to the village level, so that conclusive results would probably require a sample much larger than 25 villages. An experimental design would solve many of these problems, but the Korean program is much too widespread and too well developed today to conduct new field experi- ments. At this point in time, villages without clubs are probably too atypical in other ways for a valid comparison. The Korean experience should forewarn researchers in other countries to prevent contamination of their control villages and to look for excessive treatment variations among the villages in which clubs are organized (Lumsdaine, Kincaid, and Hilton, 1975).

Conclusion

It would be incorrect to suggest that the Mothers' Club Program "caused" rural mothers to adopt family planning and lower their fertility. It is more realistic to conclude that the clubs supported, complemented, and enhanced the psy- chological, social, and economic changes that were already in process. The Mothers' Clubs were organized when they were most needed by both village women and the family planning program.

Their history sheds considerable light on the relationship between general socioeconomic development, family plan- ning, and the value of children. Older village mothers, deter- mined to prevent the hardship caused by an additional child, were turning to contraception long before the clubs were organized. In the beginning, however, many of these women had to practice contraception secretly to avoid severe criticism or even beatings by their own husbands. Secrecy and ignorancee

undoubtedly led to serious contraceptive problems, and when they occurred, who could village mothers turn to? Once established, the Mothers' Clubs gave village mothers an offi- cially sanctioned public forum to discuss mutual concerns, such as contraception, without the shame and secrecy of the past. Field-workers could now openly teach a group of inter- ested women instead of talking privately and separately to women. Negative side effects could be discussed more quickly after they occurred. Members could decide to go to the clinic in groups and encourage one another to follow through. Successful mothers could explain to others how they per- suaded their husbands to accept family planning. Once effec- tive leadership emerged and the members became a more cohesive group, the Mothers' Clubs were in a good position to take advantage of the many economic opportunities being created after a decade of unusual growth in the cities (Kincaid et al., 1975).

The women who pioneered the acceptance of family plan- ning in rural villages had not limited their families to two or three children, irrespective of their sex, as the national slogan advocated. It was too late for them-but not for their daughters-in-law or younger village mothers. But why would these women begin using contraceptives after having two or three children rather than six? Through the influence of example. The Mothers' Club has served as both a model for new patterns of behavior and as a means to new kinds of social and economic enterprise for village women. For many it has meant relatively large sums of money for the first time-to improve their kitchens, to invest in money-making projects, to better educate their children, or simply to take a tour of their capital city. When women become very active outside the home, many adjustments are required within their homes. Husbands have to accept these changes, and this is easier once the social and economic benefits of the clubs become more apparent. Infant children still need their mothers' care. As the number of meetings and work projects increases, child care and other home responsibilities soon become obstacles to active participation (Kincaid et al., 1975). Some Mothers' Clubs met this new challenge by organizing their own day-care centers. Today, the New Village Movement is encouraging other villages to consider doing the same.

At some point in this chain reaction of events and changes, it becomes apparent to rural couples that large families are no longer necessary, beneficial, or desirable. Older mothers begin advising younger ones to have just two or three children and avoid the mistake they made before contraceptives were acceptable. Why produce more children simply to watch them migrate to the cities? By having fewer children, rural families in Korea are beginning to see the reality (rather than the promise) of providing a better education for their children and creating a village environment and lifestyle in which their children will be happy to live as adults (Kincaid et al., 1975).

We should not expect rural families to have smaller families by merely promising them it will improve the quality of their lives. The order in which change occurs is crucial. People first need to experience some improvement in the quality of their lives, ideally through their own efforts, and then see for themselves the potential for more improvement if they have smaller families. This conclusion obviously implies that widespread, voluntary fertility reduction is difficult to achieve. The experience of most family planning programs supports this conclusion. Beyond supplying basic services, one of the

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primary tasks of family planning programs should be to provide the support and opportunity for such a chain reaction of changes to take place more easily. The Mothers' Club Program has made a significant contribution in this respect to the family planning program of the Republic of Korea.

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Chang, Kyung Shik, George C. Worth, and Peter H. Michael. 1974. "Korea (South)." Studies in Family Planning 5, no. 5 (May): 152- 156.

Cho, L. J. 1973. The Demographic Situation in the Republic of Korea. Paper No. 29. Honolulu: East-West Population Institute.

Copp, B. E., and George C. Worth. 1972. "Korea's family planning Mothers' Clubs." Seoul: Population Council, unpublished.

Geertz, C. 1962. "The rotating credit association: A middle-rung in development." Economic Development and Cultural Change 10:24 1-263.

Kincaid, D. Lawrence, et al. 1975. Mothers' Clubs and Family Planning in Rural Korea: The Case of Oryu Li. Case Study No. 2. Honolulu: East-West Communication Institute.

Kurtz, D. V. 1973. "The rotating credit association: An adaptation to poverty." Human Organization 32, no. 1, pp. 49-58.

Lumsdaine, A., D. Lawrence Kincaid, and E. Hilton. 1975. "Evalua- tion research methods." In Evaluation Research on Family Planning Communication. Edited by E. M. Rogers and R. Agarwala-Rogers. Paris: UNESCO Technical Report.

Moon, H. S., et al. 1972. Fertility and Family Planning: An Interim Report on the 1971 Fertility-Abortion Survey. Seoul: Korean Insti- tute for Family Planning.

Park, Hyung Jong, et al. 1974. Mothers' Clubs and Family Planning in Korea. Report to the Asia Foundation. Seoul: School of Public Health, Seoul National University.

Webster, L. (ed.). 1975. "Integrated communication: Bringing people and rural development together." Honolulu: East-West Com- munication Institute. Mimeo.

Yang, Jae Mo, et al. 1972. The Final Report of the Gyeonggi-Yonsei Mothers' Class Project, Yonsei University. Korea: Center for Popu- lation and Family Planning.

Yang, Jae Mo, and George C. Worth. 1974. "Mothers' Clubs in Korea." In Population and Family Planning in the Republic of Korea, vol. 2. Seoul: Korean Institute for Family Planning, pp. 237-247.

ABOUT THE AUTHORS Hyung Jong Park, M.D., Ph.D., for- merly the dean of the School of Public Health, Seoul National University, is the president of the Korea Health Development Institute. D. Lawrence Kincaid, Ph.D., is a research associate at the East-West Communication Institute, East-West Center, Honolulu. Kyung Kyoon Chung, M.A., and Dal Sun Han, M.D., M.P.H., are professors at the School of Public Health, Seoul National University. Sea Baick Lee, M.P.H., is cur- rently a Ph. D. candidate at the University of Michigan.

ACKNOWLEDGMENTS As the references indicate, this article is based on earlier reports by the same authors published by the School of Public Health, Seoul National University, and the East-West Communication Institute. A filmstrip also has been produced in cooperation with Sang Jo Kim of the Planned Parenthood Federation of Korea, and it is available at cost from the East-West Communication Institute in Honolulu. It presents in depth the unique experience of one Mothers' Club in the village of Oryu Li (approximately 25 minutes with synchronized cassette tape).

This work would not have been possible without the close cooperation of the Planned Parenthood Federation of Korea, the Asia Foundation's sponsorship of Seoul National Univer- sity's national survey of Mothers' Clubs, and USAID's sup- port of the East-West Communication Institute's case study of the Mothers' Clubs. The authors are grateful for the important contributions of the following researchers, who are now completing their graduate studies in the United States: William S. Puppa, formerly at Seoul National University, and Chin Chuan Lee and June Ock Yum, formerly at the East-West Communication Institute. And finally, the authors wish to thank C. C. Lee, chairman, Board of Trustees of PPFK; Duck Chun Yoo, former member, Board of Trustees of PPFK; George Worth, Population Council resident advisor in Korea during the program's development and research; Dr. Everett M. Rogers of Stanford University's Institute for Com- munication Research; and the many courageous leaders, members, and field-workers who made the Korean Mothers' Club Program worth studying.

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