Simon Watson: Incentives do not need to be morally suspect

This week an American drug charity paid a man in Leicester £200 to have a vasectomy. The man is addicted to heroin and the rationale of the charity is that it is better to pay him not to have children than to have a child born into the world of an addict. Clearly, this is fraught with ethical and moral complexities and the issues around addiction and parenting will not be solved by such a simplistic approach.

But rejecting this crude approach doesn't mean we shouldn't consider payments or incentives to achieve a positive social outcome. Barnardo's Scotland recently created You First; a 20-week programme for young first-time mothers in the poorest areas of Scotland which gives training, education and practical advice on the challenges of being a parent.

These are young women under 21 who have a baby under the age of one, living at the sharpest end of poverty. There is a high risk of their children having health issues or being significantly behind their peers by the time they reach school.

As part of the programme, participants receive 20 per week when they attend. This has no conditions but we help identify where it may do most good. When we designed this programme many asserted the money would be spent inappropriately, with no direct benefit to the children.

In fact, more than 75 per cent of mothers defer their weekly grant to the end of the programme and use it to support their transition to work, improve their accommodation or simply create savings.

The use of incentives to improve social outcomes is gaining a foothold in current thinking and should be a valuable tool in deficit reduction.

Paying people to make the right choice early on is more cost-effective than paying for the consequences of the wrong choice: the long-term costs of smoking are greater than a programme that pays people to quit.

But there are boundaries to where incentives can and should be used, and birth control for vulnerable people with no power over addiction is definitely one example that crosses the line.

• Simon Watson is head of development at Barnardo's Scotland