Sustainability from the Ground Up - Working on Reproductive Health and the Environment in Communities

Robert Engelman

Evaluating Impact

In 2004 USAID and the Packard Foundation collectively commissioned John Pielemeier, a USAID veteran and an experienced consultant in the family planning field, to conduct an initial assessment of the PHE field. Reviewing the field broadly but focusing on projects jointly funded by both donors in Madagascar and the Philippines, Pielemeier emerged from six months of research in 2005 with several conclusions:

• Integration was challenging for donor and implementing agencies, but communities adapted readily and community members reported time savings and related efficiencies.
• Most completed projects had met their stated objectives.
• Most had managed to provide integrated services less expensively than if the services had been provided independently and separately, using community-mobilization efforts that demonstrated results within a year or two.
• Perceptions of female status had improved measurably in project communities.
• Integrated projects proved successful in involving men and boys in reproductive health activities and involving women and girls in environment and conservation activities. Integrated projects proved successful in involving men and boys in reproductive health activities and involving women and girls in environment and conservation activities.
• Several models of project integration had demonstrated some success and replicability in other projects.
• Communication and advovacy is especially needed for integrated projects. Where it has been tried — for example, in the Philippines with the training help of the Population Reference Bureau — it has improved the odds of project success.

Less positively, Pielemeier identified a key problem: Few if any projects could demonstrate that they could survive without outside funding. And related to that, few if any governments of project countries had demonstrated a sustained interest or capacity in supporting such work without outside donor funding.

Pielemeier’s was hardly the last word on the topic. Many projects are planning their assessment methods from the conception of the project. PATH-Philippines’ IPOPCOrM project is one example. And USAID continues to support efforts by its grantees and contractors to find tools for measuring the impact of integrating reproductive and other aspects of health services with natural resource conservation, especially in the biodiversity “hotspots” to which Congress directed its support for linked-service projects.

The Right Linkage? The Right Places? The Right Time?

So where does that lead this intriguing but hard-to-categorize approach to community development?

In the publications included here, PAI argues that the connection between access to contraception and environmental sustainability is especially catalytic. When women are able to time their pregnancies and childbirths as they choose, they’re in a far better position to do everything else they dream of doing, whether in work and livelihood, environmental stewardship, or local political activism. Women’s overall health and that of their children is more likely to be sound. Births spaced at least two years apart and not occurring over very young or relatively older women are strongly correlated with higher maternal and child survival. The smaller families that result from widespread use of family planning, along with the fact that women tend to bear children later in their lives, is an added benefit to individuals, families and communities, as well as to nature and to humanity as a whole. Fertility in remote and marginalized communities in developing countries tends to be the highest in the world, well over the two or three children that eventually would stabilize populations in such areas.

This is hardly an abstract concern about the planet having “too many people.” Most of the areas in which PHE projects are operating are passing the limits at livelihoods based on natural resources are tenable. Plots of farmland, as in Kenya, are too small, too eroded or too mined of nutrients to support large families. Fisheries are inadequate to the hunger for fish, a nutritious and formerly cheap source of complete protein. Loss of forested slopes is endangering villages at the feet of hills and mountains. Research indicates that in such areas, most women want to space or limit pregnancies but are unable to gain access to family planning services. Significant proportions of pregnancies are not intended or sought.

A recent study by British-based researchers showed how important addressing reproductive health concerns to such fundamental health and livelihood issues as the provision of safe water in many developing countries. New water taps in several Ethiopian communities saved women hours a day previously spent walking to and from distant water sources, the researchers found. An unintended consequence, however, was that because of their own lowered exertion and improved health, their childbearing increased and the time periods between births decreased. While more children survived their early years, household resource scarcities increased and child nutrition and health actually decreased.

“Development intended to improve human welfare that does not include a family planning component can actually undermine the long-term well-being of the target population,” the researchers wrote. While the particular study dealt with clean-water supply, the conclusion may well be applicable to many areas of human development and poverty alleviation.