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We work with some of the world’s poorest and most isolated coastal communities, whose access to health services is severely limited.

The unmet family planning needs of Madagascar’s semi-nomadic Vezo fishing communities are particularly acute, with clinics located up to 50 kilometres away from some villages; an unfeasibly long walk through dense spiny forest. Public health centres are chronically under-staffed and under-stocked, and the country is regressing on progress towards Millennium Development Goal 5; achieve universal access to reproductive health.

Community health photoLess than a third of Vezo women are using contraceptives, despite up to 90% wanting to be able to plan their pregnancies. This leads to high fertility rates, inadequate birth spacing, and poor maternal and child health outcomes.

Malagasy women face a 1 in 45 lifetime risk of maternal death, and almost 1 in 5 children in the regions where we work die before their 5th birthday. Addressing unmet reproductive health needs within this context can reduce maternal and child mortality by up to 30%.

Our community health programme, called Safidy, meaning ‘the freedom to choose’ in Malagasy, has been developed in direct response to the unmet family planning needs of Vezo communities. It aims to uphold their reproductive rights by offering couples the information and contraceptive options they need to freely choose the number and spacing of their births.

A community-based model

We started providing health services by running outreach clinics in remote villages, and these still continue in some areas. In order to scale up service delivery, we also train and support local women to offer community-based family planning services through a sustainable social enterprise model. We provide them with contraceptives at cost price to sell in their villages for a small income, in partnership with Population Services International.

Our network of community-based distributors offer counselling and products including condoms, hormonal pills and injections as well as mosquito nets, water purifying solution, diarrhoea treatment kits and antenatal medication.

We also partner with Marie Stopes Madagascar’s mobile outreach teams to offer long-acting reversible contraceptives on a quarterly basis, and our community-based distributors in the Velondriake area have been trained to provide antenatal and postnatal education. 

We facilitate a diverse range of peer education activities to support the uptake of services. Activities target people at all stages of the behaviour change process, from raising awareness to influencing attitudes and encouraging the sustained adoption of healthier practices. 

Radio shows, small group discussions, interactive village presentations, youth club sessions and school workshops using theatre, sports, music and film engage communities in health and conservation topics ranging from sexual, reproductive, maternal and child health to fisheries management. These initiatives aim to foster critical awareness about local health challenges and their root causes, and support community members to come together to take action to address these. 

Our impact

We enable couples to make their own reproductive health choices, and equip them with the skills they need to manage their marine resources sustainably. Gaining access to family planning services improves maternal and child health outcomes, allows girls to delay their first pregnancy until after they have completed their education, and affords women more opportunities to become economically active.

Safidy large infographic
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. Coastal communities are able to live more healthily and sustainably with their marine environment, building social and ecological resilience to climate change.

Part of an integrated approach

Village outreach tour illustrationSafidy is a key component of our integrated Population-Health-Environment (PHE) approach, which addresses the interconnected challenges of poor health, unmet family planning needs, gender inequality, food insecurity, environmental degradation and vulnerability to climate change in a holistic way.

This integrated model is underpinned by our educational village outreach tours, which engage communities in a variety of topics. Combining health and environmental messages enables us to reach broader audiences, for example, discussing family planning with men by relating food security concerns to reproductive health.

In order to drive the adoption of this holistic approach, 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 model through cross-sector partnerships.



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Reproductive health factsheet

Safidy year 6 report (2012-2013)

Safidy 6 year summary (2007-2013)


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Safidy year 5 report (2011-2012)

Safidy year 4 report (2010-2011)

Safidy 3 year summary (2007-2010)

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Safidy year 3 report (2009-2010)

Safidy year 2 report (2008-2009)

Safidy development plan (2009-2011)

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Safidy year 1 report (2007-2008)

Pushing against an open door: establishing a family planning service in Andavadoaka (2007)