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We recognise the links between poor health, unmet family planning needs, gender inequality, food insecurity, environmental degradation and vulnerability to climate change.

As a holistic response to these interconnected challenges, we have developed an integrated Population-Health-Environment (PHE) approach combining reproductive health services with marine conservationsustainable fisheries and coastal livelihood initiatives.

david-attenborough-2-sizedA model for everyone working to conserve the natural life-support systems of our troubled planet."

Sir David Attenborough - Renowned naturalist, broadcaster and presenter of the BBC's Madagascar series


The interconnected challenges in Madagascar

Madagascar is a critical biodiversity hotspot, with a spectacular array of endemic and endangered species. It also has one of the world’s fastest growing human populations, with an average fertility rate of almost 5 births per woman.

Community health photoThe southwest coast supports one of the largest coral reef systems in the Indian Ocean, and is home to semi-nomadic fishing communities whose livelihoods and cultural identity are intimately tied to the sea.

Due to a severe lack of access to reproductive health services in this isolated region, the fertility rate is even higher than the national average, at nearly 7 births per woman. With the population doubling every 10-15 years, Vezo communities are finding it increasingly difficult to provide for their growing families.

Overfishing and destructive fishing practices pose significant threats to the marine ecosystems upon which their livelihoods depend. The PHE approach offers these coastal communities a way of living more healthily and sustainably with their marine environment, building social and ecological resilience to climate change.

Empowering coastal communities to live with the sea

We first developed a PHE programme in the Velondriake area of southwest Madagascar from 2007, and started replicated this approach further north along the coast in Belo sur Mer from 2013. In addition to our locally led marine conservation initiatives, we offer voluntary family planning services that allow couples to freely choose the number and spacing of their births.

PHEOur fully integrated PHE approach encompasses:

Locally led marine conservation
Sustainable fisheries management
Aquaculture enterprises
School and university scholarships
Voluntary family planning services
Community health education

Radio shows, small group discussions, interactive village presentations, youth club sessions and school workshops using theatre, sports, music and film engage communities in a variety of conservation and health topics, and promote sustained behaviour change.

Our impact

84% of people in the Velondriake area believe that there will not be enough resources to go around if they don't use family planning; our integrated PHE approach responds to community needs in a holistic and pragmatic way.

Couples are empowered to plan and better provide for their families; improving food security, boosting local conservation efforts and allowing them to create their own paths out of poverty.

Since the programme began in 2007, the proportion of women in Velondriake using contraceptives has increased more than fivefold, while the general fertility rate has fallen by over a third. 

Combining family planning services with conservation activities generate synergies that result in the more effective achievement of both health and environmental objectives. It produces greater impacts than if either issue were tackled in isolation, and maximises cost efficiency through the coordination of activities and staff between projects.

Integration also broadens community engagement, for example, enabling us to discuss family planning with men and involve women in fisheries management.

Driving adoption

Aquaculture training-18All of our programmes move through a research and development lifecycle in which they are tested, refined and replicated by us before being taken to scale by partners. We facilitate the adoption of our models by building networks of thought leaders in conservation and development, forging new partnerships and growing movements for change.

We have presented the results and lessons learned from our integrated PHE approach worldwide, including at the World Conservation Congress, the International Congress for Conservation Biology and the International Conference on Family Planning.

Our work has been recognised by the St Andrews Prize for the Environment in 2014, received an Excellence in Leadership for Family Planning (EXCELL) award in 2013, and won the Buckminster Fuller Challenge prize in 2011. Our integrated PHE approach has been endorsed by the Woodrow Wilson Center, Population Reference Bureau, UNFPA, WWF, USAID, DFID and Oxfam. 

In order to support the broader uptake of this PHE model, we have convened a network of health and conservation agencies working in some of Madagascar’s most biodiverse and under-served areas to explore opportunities for scaling up the implementation of this integrated approach through cross-sector partnerships.