It all began when some women asked for contraceptive advice from a pair of doctors working for a small international research group surveying the oceans in southern Madagascar. At the time, Blue Ventures was a conservation group made up of scientists and volunteers who were gathering data on coral reefs and fisheries in Velondriake, a remote and poverty-stricken part of the country. The doctors were there to provide medical assistance to divers, but they soon found their services were also required by women from the local villages.
“The medics had women coming to them, talking about their reproductive health needs,” says Laura Robson, the health and environment partnerships manager for Blue Ventures. “They [the doctors] were struck by the situation they observed in the community.” The women had little or no access to a regular doctor, so when they heard there was an international medic in the area, they came to ask for supplies and health advice, particularly on accessing birth control.
Around the same time, the researchers began to realize their conservation work would have limited impact if they didn’t find a way to make it relevant and important to local communities. The group had already had some success working with a village to close off and rejuvenate a small section of its octopus gleaning area. Blue Ventures saw the dearth of family planning services as an opportunity to forge even stronger ties with the community and decided to recruit health partners to help meet the villagers’ medical needs. In 2007, the group launched a community health program in Velondriake in partnership with Marie Stopes and Population Services International.
“Initially clinics were run by international medics, but we soon realized that was unsustainable,” says Robson. “So we moved into training local women to become community health workers.”
The health program – named Safidy, which means “choice” in Malagasy – was closely tied to Blue Ventures’ work with villagers on fisheries management. Women who visited the health clinic were actively encouraged to take part in community meetings about preserving marine areas and fisheries management and, likewise, local fishermen were encouraged to take part in sessions on family planning as well as to make use of the health facilities.
When the programs first launched, fears about contraception were widespread, with many people – particularly men – believing birth control could be harmful to a woman’s health. Just 10 percent of the population of the Velondriake region was using contraception in 2007. Six years later, that number had increased to 55 percent, nearly doubling the national average of 29 percent.
Today, Blue Ventures has vastly scaled up its programs, offering year-round access to the pill and condoms supplied by locally trained health workers to several rural communities. Four times a year, Marie Stopes also sends a mobile clinic to these areas to give villagers a chance to try longer-acting contraceptive methods, including the coil and implants. Blue Ventures has started up a countrywide network of local and international conservation and health organizations who are hoping to similarly integrate their services, and the group is also in the process of launching a sister program in Mozambique.
It’s not the first time the need for population management has been linked to conservation work. Population, Health and Environment programming, known in the industry as PHE, has been around since the early ’90s. But it’s only recently – partly thanks to the success of the Blue Ventures initiative – that PHE has really started to gain traction.
There are now several other examples in East and southern Africa where health services and conservation projects are being integrated, often in areas of unique biodiversity like Madagascar. In Ethiopia, a project in the Bale Mountains has been successful both in increasing the number of people accessing contraception and in empowering women to become more involved in community and environmental matters.
Another project with communities on the shores of Lake Tanganyika in Tanzania reported 892 new family planning clients in the first few months of launching, after it recruited 66 new health workers to advise families on maternal and child health and discuss options for spacing births.
Despite clear progress, PHE remains a small-scale industry, with organizations working in largely isolated locations in a very context-specific way. Nicola Ann, an expert in human-wildlife conflict based in the U.K., says the discussion in conservation circles is increasingly turning to ways of tackling over-consumption and the need to reduce the burden on natural resources. However, she admits there is an awkwardness when it comes to including population control in a conversation about the developing world.
“Because conservation as an industry was born from a rich, white, Western perspective, it can sometimes still be perceived as a neocolonialist import,” she says. “Conservationists are aware of how they are seen and are cautious of directly referring to population control.”
But that shouldn’t stop organizations from approaching both issues in an integrated way, she says. There is a direct link between increasing populations and decreasing space and resources and, Rust says, PHE could be a real solution. As long as the subject is handled sensitively. “It’s certainly not as simple as a group of conservationists handing out condoms,” she says.
Another reason PHE has been slow to scale up is the fact that small projects with a combined approach to programming have found it hard to monitor the effectiveness of their work, according to Karen Hardee, director of operations at The Evidence Project, a global initiative that uses science to improve family planning services worldwide.
“To get accepted as a mainstream strategy, PHE needs to become part of climate change funding,” she says. Most funders currently offer money for health or climate change, but rarely both.
“The fact that many of these projects are so small means it has been hard to produce strong evidence of outcomes to attract more funding,” Hardee says. “But this is something that is changing.”
Two of the most successful projects – Blue Ventures in Madagascar and the Tuungane project on Lake Tanganyika in Tanzania – have started adding questions to their annual surveys about the climate-change resilience of the communities they work in. This, says Hardee, could provide more evidence of the effectiveness of integrating services and encourage funders to take the programs seriously.
“The moment you mention population, people think of control. But the irony is that’s the opposite of what we do,” says Hardee. “It’s not about control at all, it’s about giving people access and giving women a choice. The sooner we change the way we approach this, the sooner it can become a mainstream phenomenon.”