- Some 215 million women in the Global South have an unmet need for modern contraception, with many of them living in remote communities that may lack basic health care services.
- To meet some of this need and reduce pressure on the environment, some conservation groups have started providing health and family-planning services.
- But critics, including some women’s rights advocates, contend that it’s difficult for organizations to ethically mix conservation and family planning.
Family planning can prevent unwanted pregnancies, increase birth spacing, and improve women’s reproductive rights. All of this can reduce human populations, theoretically taking pressure off local environments. In recent years, some conservation organizations, seeing a win-win for women and ecosystems alike, have been widening their remits to include the provision of family planning services for local communities. But the path is fraught with controversy.
The organizations involved are diverse. Big players like the World Wildlife Fund (WWF), Conservation International (CI), and the Jane Goodall Institute (JGI) have been involved, as have numerous less well-known NGOs. The groups often combine family planning information, contraceptive delivery, and other health services with environmental education in a development framework known as Population, Health, and Environment (PHE).
Some 215 million women in the Global South have an unmet need for modern contraception, with many of them living in remote communities that may lack basic health care services, according to the Guttmacher Institute, a U.S.-based NGO working to advance reproductive health.
In addition to meeting some of this need in order to reduce pressure on the environment, conservation groups have also become interested in providing health services as a way of gaining communities’ trust and opening up discourse to engage them in conservation practices.
Yet empirical evidence to support these concepts is somewhat scarce. Conservation NGO Blue Ventures helps coastal communities in Madagascar manage their marine resources. Blue Ventures began training local women to deliver family planning services, which the communities lacked. The group reports anecdotally a 45-percent increase in family planning use over a five-year period, estimating that it has prevented more than 800 unwanted pregnancies.
PATH Foundation Philippines (PFPI) has been integrating conservation with family planning since 2000, simultaneously educating and training communities in coastal resource management and family planning. PFPI was the first to report solid empirical evidence supporting an integrated approach to conservation and family planning
“We started doing conservation work and family planning as a result of large families and being able to address all of the factors that were leading to poor health and poor environmental systems and services,” Joan Castro, Executive Vice President of PFPI, told Mongabay.com.
In a 2010 study, PFPI staff compared an integrated approach to delivering either conservation or family planning alone. They found that at integrated sites there was a greater uptake of family planning services alongside greater improvements in coral and mangrove environments.
“Support of the men is key to the women also accepting [family planning]. When we work with the fisher[men] that are doing marine protected area management, we educate them as well on the importance of family planning, then they are able to support the women,“ explained Castro.
Women at the integrated sites were also more empowered and involved in resource management because, said Castro, “they have more time because they are able to space their children; they are not always pregnant.”
However, a WWF-led analysis of eight PHE projects in six countries found that while communities did increase their use of family planning thanks to the projects, the assumption that this would lead to women having fewer children or reducing their use of natural resources was not backed up by evidence. The researchers note that this is somewhat expected, considering that the projects were fairly young and it would take decades to see such results. But they also point out that in general, reports tend to be conducted by implementing organizations rather than independent bodies, so any disadvantages have received little attention in the literature.
In addition to the limited evidence for success, thinkers on reproductive rights have criticized conservation groups for taking on family planning interventions. One chief concern is that programs may actually endanger the health of the women they seek to empower.
A number of conservation programs involved in family planning offer Depo-Provera, an injectable contraceptive administered every three months. It’s the contraceptive being promoted by the U.N.-hosted Family Planning 2020 initiative, which pledged in 2012 to reach 120 million women by the year 2020.
Depo-Provera is cheap and easy for minimally trained healthcare workers to administer. The drug has also been packaged in a product named Sayana Press that eliminates the need for healthcare workers altogether. However, it also has several serious side effects, including bone mineral loss after prolonged use and a potential increased risk of HIV.
“[W]hat this means is that women are being given these contraceptives with known dangers and debilitating side effects in contexts where they have absolutely no access to healthcare support,” Kalpana Wilson told Mongabay.com. Wilson is a senior fellow at the Gender Institute of the London School of Economics and Political Science.
Blue Ventures, Conservation Through Public Health (CTPH) in Uganda, and the Jane Goodall Institute in its Democratic Republic of the Congo project are among the conservation groups offering Depo-Provera. WWF identifies injectables as the third most common contraceptive on offer though PHE programs after condoms and pills.
Most PHE projects integrate health services, which should alleviate some of this concern. However, funding is often short term, which risks community members needing follow-up health care, only to find that services are no longer available.
For instance, CI integrated family planning into its programs in Madagascar, the Philippines, and Cambodia until recently when funding ran out. In CI’s absence, women who had participated in the programs would probably have to seek health services further afield, Edmond of CI said. “[B]ut it’s not like when our projects ended the access ended. Most of them are going to the health services that the government was running, so it’s not like they are totally cut off.”
One of the health organizations CI partnered with in Madagascar, Action Socio-Sanitaire Organisation Secours, required at least minimal health care services to be available in an area before it agreed to engage.
Another concern is whether these family-planning programs are conducted in an entirely rights-based way, where women have full and informed choice over what happens to their bodies.
“I think any sort of program which has a starting point of ‘population growth is a problem’ is not a good way or a possible way of providing reproductive justice for women,” said Wilson. “There is an urgent need for women in low income households in the Global South to have access to safe contraception which they can control. But for this to happen, women’s needs and demands have to be made the starting point.”
The very existence of a target for the Family Planning 2020 collaboration rings alarm bells for some because of previous violations of women’s rights, as with an Indian program focused on achieving numerical targets for sterilization and contraception. However, all the organizations Mongabay.com reached emphasized their commitment to a rights-based approach.
“We have targets for program planning, but for our volunteers…we don’t,” said Castro from PFPI, which trains community volunteers to provide family planning education.
“I don’t know how it works with other overseas aid agencies but I would be highly doubtful that there are targets because there is a specific U.S. law that says you can’t have targets,” said Edmond of CI. “If there are targets that are being set, that is a violation that is reportable to congress.”
Yet even if individual organizations have good intentions, their funders can be influential, warned Wilson. USAID, a funder of many PHE projects, offers financial “performance based incentives” to health practitioners for achieving new and continued use of certain contraceptive methods. For instance, in an Indian health program it offered the rough equivalent of $15 for convincing a husband or wife to adopt permanent contraception methods and $7.50 for convincing a couple to space their births a number of years apart. Participants have raised concerns over the potential for staff to make decisions based on financial reward rather than fulfilling a woman’s rights.
It’s unclear whether such incentives turn up in USAID-funded PHE projects in general, but neither CI nor PFPI, which received USAID money, uses them. “We did not encounter that at all, it would be a violation of the regulations,” said Edmond from CI.
Beyond targets and financial incentives, rights experts have voiced concern that conservation projects could create an environment in which participants feel pressured, for instance if they have to take part in one aspect of the project in order to benefit from the other.
“A particular concern is the use of ‘social marketing’ practices such as community goal setting and participatory monitoring of outcomes, which can potentially create pressures on individuals to participate in family planning and other program activities,“ writes James Oldham in a 2006 review of PHEs. “Additionally, when health care is linked to biodiversity conservation goals, there is a risk that health care can shift from being treated as a right to becoming a reward which can be withdrawn if conservation goals are not met.”
It is important to ascertain that a community actually wants family-planning services to avoid imposing Western values where they aren’t welcome, according to Oldham. Therefore, the first step towards a rights-based approach is to ensure that the “unmet need” for contraception is highlighted by the community and not the organization or funder.
While most projects do seem to offer classes that integrate family planning and conservation messages, Castro from PFPI said that if a person only required one service PFPI would not turn them away. For its part, Blue Ventures states in a 2012 paper that the community it works with expressed concern over declining fish stocks, which they themselves linked to their growing population.
And a representative of JGI, whose family planning and health initiative in conjunction with environmental education and training is on hold awaiting a second round of funding, told Mongabay.com that the group has not required people to participate in environmental activities or education in order to receive family planning services. Access to these services and contraceptives was “completely voluntary with the principle of free, prior and informed consent strictly respected,” the representative said. (JGI founder Jane Goodall is a member of Mongabay’s advisory board.)
However, Gladys Kalema-Zikusoka, founder and CEO of Conservation Through Public Health (CTPH) in Uganda, told Mongabay.com that it was the funding body USAID that initially approached her with the idea of offering family planning services and that she was reluctant at first, which suggests a top-down process in some cases.
CTPH works to conserve gorillas in Uganda’s Bwindi Impenetrable National Park. Kalema-Zikusoka explained that despite her reluctance, CTPH conducted surveys that showed that Bwindi families had an average of ten children and were unable to give them proper health care or education, which encouraged the spread of disease between people and gorillas.
“It started to make sense to add family planning onto our integrated conservation and public health efforts,” said Kalema-Zikusoka.
Some PHE projects seem to get caught in a circular argument in justifying their work. For instance, in a preliminary study to assess the need for a PHE project near Tanzania’s Saadani National Park, researchers found that most respondents to their survey wanted more children and were well aware of contraceptives, and that condoms were available in local shops. Yet they concluded that because locals wanted more children despite environmental problems, they needed more education.
The organizations Mongabay.com spoke to expressed commitment to upholding a rights-based approach in their family planning offerings. But even if they achieve this, some rights experts still question whether fertility should, fundamentally, be linked to conservation in the first place.
The idea that a burgeoning human population will harm the environment dates back to Thomas Robert Malthus’s 1798 book An Essay on the Principle of Population. Since then figures as prominent as BBC Natural History presenter Sir David Attenborough have advocated for the control of human populations, which he called a “plague on the Earth.
Some organizations have identified local population as the disruptor of environmental equilibrium, especially when human numbers are unsustainable in their project areas. However, according to Betsy Hartmann, Senior Policy Analyst at the Population and Development Program and Professor Emerita of Development Studies at Hampshire College in Massachusetts, this can shift the focus from larger forces that are often behind ecological problems.
“In the case of Madagascar, for example, commercial and illegal logging, mining, and fishing operations are doing far more to destroy the environment than the traditional farming and fishing practices of local communities. Spreading the message that family planning is the solution to environmental problems there diverts attention and blame from the powerful economic and political interests involved in environmental degradation,” Hartmann told Mongabay.com.
Not only does this distort the blame on a local scale, but it could draw attention away from the real drivers of biodiversity loss at a global level, too, she said.
Nobody is arguing that humans aren’t to blame for the current state of the planet. Fish stocks are collapsing, forests are dwindling, and our waste practices cause pollution around the globe. But some believe that perpetuating the idea that the sheer number of people is to blame for these things shifts the blame away from corporate entities and prevents fundamental reform.
This is not to suggest that people in the Global South should not have access to contraception until the North gets its consumption under control. However, it is the linking of the two lines of conversation that both Wilson and Hartmann find so problematic. Do they believe conservation groups should withdraw from the family planning arena entirely?
“Given the broader situation I think it would be better if they weren’t involved, quite honestly,“ Wilson explained. “I think if they want to work on reproductive rights they really have to do that independently of any conservation goals that they have. I think entwining the two is just too dangerous.”
Indeed, some conservation organizations have stayed clear of family planning. For instance, Flora and Fauna International has chosen not to engage, focusing on other causes of species and habitat loss. “Every organization has to consider its niche,” Rosalind Aveling, the group’s Deputy Chief Executive, told Mongabay.com.
While recognizing the benefits that come from connecting family planning and the environment, including raising awareness of the importance of environmental health within agencies that might tend to discount it, Aveling pointed out that the PHE approach, with elements that can seem unconnected to local people, can also send conflicting messages.
Carina Hirsch, Advocacy and Policy Manager with the Population and Sustainability Network (PSN), told Mongabay.com that, for some environmental organizations, family planning is sidelined as an issue. “There’s a lot of fear and stigma associated with it, which is unfortunate,” she said.
But PSN insists that despite the pitfalls, conservation organizations can deliver rights-based family planning if they take extra precautions. PSN brings together member organizations from around the world, coordinating and sharing information among the whole network.
“Before [our network members] join we ask them to give us evidence to show that they are fully committed to an approach to family planning and projects that respect and protect human rights…So we ask our network members to subscribe to a record of full commitments,” explained Kathryn Lloyd, PSN’s Project and Communications Manager. Members must investigate when concerns are raised over, for example, safe and continuous delivery of hormonal contraceptives.
The distance between conservation groups tackling family planning and their critics seems vast. At every step, good individual intentions are countered by concerns over bad global practices. Hartmann suggested that to be confident that conservation groups can do family planning ethically, on-the-ground investigation into how programs work is needed—investigation that is not currently being conducted. Without this, the environmental goals of PHE projects leave some women’s rights advocates unconvinced.
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