Family Planning and the Environment: Connected Through Human and Community Well-Being

This issue of Outlook provides an overview of the family planning/environment (FP/E) relationship, including lessons learned for integrated programmes and case studies of tested approaches for extending family planning into remote and economically poor rural areas.

Historically, the Programme of Action (POA) from the 1994 United Nations (UN) International Conference on Population and Development (ICPD) in Cairo, Egypt, endorsed principles of sustainable development, including balancing resource availability and population growth as well as integrating an emphasis on women's sexual and reproductive health and rights. In the 1980's and 90's, when non-governmental organisations (NGOs) offered select economic and health interventions to communities surrounding certain protected areas, the interventions included FP among the health interventions supported to meet community needs in at least some countries (e.g., Madagascar). Among communication lessons from the early efforts are these:

• Engage community men in family planning discussions and action.
  
• Engage community women in discussions and action regarding natural resource management.
  
• Improve gender communication by bringing men and women together.

Evaluation of the effectiveness of programmes using the linkages of FP/E showed, as reported here, "impressive increases in contraceptive prevalence in the two countries [Madagascar and the Philippines] where, previously, family planning use was low, simultaneous with reductions in negative environmental practices....Improvements in food security were also observed - a key underlying rationale for linking interventions." United States Agency for International Development (USAID) funding began to support country training in population, health, and environment (PHE) approaches and development of a PHE toolkit as part of the Knowledge for Health Portal.

A case study from the Philippines focuses on the decline in marine fish as a food source of islanders. In eight provinces of the Southern Philippines, a programme of the NGO Integrated Population and Coastal Resource Management addresses the issue of food security “[t]hrough training teen peer educators ... [about] how to promote the concept of stewardship within a dual context - stewarding both the environment and their own sexuality. Adult peer educators serve in a similar capacity, sharing information about family planning and safe sex practices with all community members, and encouraging men to refrain from destructive fishing methods.... Contraceptive supplies are made available through support to small store owners." The programme includes alternative livelihoods training, micro-credit, and conservation warden training. In a study of three sites - one working with only FP programme goals, one with only environmental goals, and the third with linked programme goals - the linked programme scored highest in several indicator areas: contraceptive use during first sexual experience, biophysical condition of corals and mangroves, and sustainable fishing practices.

In a second case study in Bwindi, Uganda, a site where wildlife conservation is a key issue, Conservation Through Public Health (CTPH) has worked with local groups to create plays for the community, incorporating interwoven themes of livelihood, family size, family health, and gorilla health. PHE community volunteers give village health talks and peer education. Specially trained community volunteers provide additional counselling and methods to interested users, and work with peer educators to educate their communities about family planning, tuberculosis, HIV/AIDS, good hygiene, and sanitation. Of the 2,000 houses visited, there was a four-fold increase in contraception use, facilitated in part by the community-based provision of contraceptive injectables by trained volunteers.

The issue states: "Integrated FP/E interventions are a particularly effective entry point to help secure community trust: for example, when community theatre or counseling materials interweave messages; when community meetings and project planning cover two or more domains; or when volunteers are trained and function in cross-discipline roles (e.g., agricultural extension workers distributing both crop seeds and condoms). The above also have potential to involve women in sustainable development and men in family planning - in other words, to cross the gender divide, a barrier to family planning uptake and potentially a root cause of environmental degradation."

The issue concludes that: "Slowing population growth by addressing unmet family planning need within a well-being context reinforces the broader goals of equitable and sustainable development and justice." It notes that rather than beginning with the assumption that environmental conservation simply emphasises limiting population, there are multiple areas of mutual benefit for integrated FP/E programming in the context of human well-being, including a freedom and choice component that is relevant to environmental conservation, reproductive health, and women’s rights and empowerment actors. Slowing population growth can mean addressing unmet family planning needs. Since both environmental changes and lack of access to family planning impose a heavier burden on economically poor rural women, collaboration on these issues aimed at reducing inequities would better ensure sustainable community development as well as the right of individuals to achieve what they value.