Madagascar health-environment - Discover

A broad human rights-based approach is vital for removing barriers to community engagement in conservation.

This is the striking conclusion of new research evaluating Blue Ventures’ integrated health-environment programme in Madagascar.

People-Health-Environment (PHE) programmes combine family planning and other health services with community-based natural resource management and livelihood diversification initiatives.

These programmes are thought to generate important benefits for communities while advancing conservation.

There are three main theories (detailed below) for how health services advance conservation outcomes.

Yet robust evidence to support these theories is limited.

Social scientists from Blue Ventures set out to explore these theories by studying a long-standing PHE programme in coastal southwest Madagascar.

The study looked at how the provision of family planning and other health services might be advancing conservation in the Velondriake locally managed marine area.

Almost 300 household and individual surveys were conducted.

20% of households

10% of the adult population

Closed (quantitative) and open (qualitative) questions covered a number of topics, from family planning use and livelihood activities to engagement in marine management.

The findings provide evidence to support parts of all three theories. They also highlight some important limitations and assumptions that do not hold true in this context. Awareness of these limitations can allow implementers to refine their programmes to mitigate any unintended consequences and enable greater community engagement in conservation.

The goodwill effect

Hover over the boxes to reveal evidence for/against each step in this theory of changeA theory of change is a flow chart outlining step-by-step how programme activities are believed to generate certain outcomes. Each arrow shows how one thing is thought to lead to the next thing.

Provision of health services

✓ Community health workers trained and supported to offer basic health services

✓ Marie Stopes' mobile outreach teams invited to offer long-acting contraceptives

Appreciation of health services

✓ Overwhelmingly positive response to provision of health services

✓ Strong uptake of contraception

Community goodwill towards conservation organisations

? Community members did not associate health services with Blue Ventures unless reminded so any goodwill generated may not be directed at the organisation

Community engagement in conservation initiatives

✓ Health services are the first point of introduction to Blue Ventures for 1 in 5 women

? The study design didn't allow us to investigate whether health service provision has advanced overall community engagement in conservation

Key insights

If community health services are delivered locally by community members trained as community health workers, they may not be perceived as being provided by the conservation organisation and this may reduce the possibility of any goodwill effect.

For goodwill to be generated for the conservation organisation and/or environmental initiatives, it may be helpful to make it clear that health services are being supported as part of a holistic approach to working with communities.

The fertility effect

Unmet family planning needs satisfied

✓ Strong uptake of contraception

Unintended pregnancies averted

✓ Decline in the general fertility rate

Demand for natural resources reduced

? Demand for natural resources was not quantified as part of this study, however no one suggested that they were able to fish less

Less fishing activity

! People are better able to care for their children and feed their families

? Fishing effort was not measured as part of this study - some individual family planning users reported fishing more but further research is needed to investigate potential long-term changes in fishing effort at the household / community level

Key insights

Community members are striving to improve their living conditions from a very low baseline. Any increase in local consumption levels should be welcomed from an equity and poverty reduction perspective.

If women are more able to engage in income-generating activities because of birth spacing, this should be met with sufficient support and opportunities for engaging in non-extractive livelihoods in order to avoid any increasing pressure on natural resources.

The empowerment effect

Women use family planning to space or limit their births

✓ Strong uptake of contraception

! Reported benefits include improved health and increased incomes

Women have more free time

✓ Women report having more time to work

Women pursue alternative livelihoods and participate in marine management efforts

! Many women appreciated being able to fish more
! Women using family planning reported earning twice as much money and having longer-term priorities compared to those who weren’t current users
? Few women are using their free time to pursue alternative livelihoods, however participation in alternative livelihoods was limited by the availability of these initiatives
? Individual family planning users were not more likely to participate in marine management meetings

Key insights

Family planning use was associated with significantly increased income and longer-term priorities. However it may not automatically lead to greater engagement in marine management for individual women: complementary initiatives to promote more inclusive and egalitarian gender norms may be needed.

These findings suggest that the provision of family planning and other health services is highly valued by communities for numerous reasons, yet may not have immediate or direct conservation benefits.

In the areas where Blue Ventures works, many communities are unable to engage in marine management or alternative livelihoods without improvements to their health.

Nevertheless, it’s unrealistic to expect increased access to health services to automatically lead to increased community engagement. Good health is necessary but not sufficient for engagement.

This is why a holistic approach is needed

This study has reinforced our commitment to a holistic approach while drawing our attention to areas that we can work on refining with communities and partners.

We have three important lessons to share:

Putting down roots with communities

Increasing access to health services is a long-term strategy and a true commitment to human rights means that support cannot be withdrawn if linear expectations of ‘success’ are not met. People’s right to healthcare should be upheld on principle – not as a means to an end.

Questioning assumptions about population-environment dynamics

Voluntary uptake of family planning can certainly prevent unintended pregnancies but this doesn’t necessarily reduce demand for natural resources in the short-term – particularly in resource-dependent contexts where people are rightly trying to raise their living standards from a very low baseline.

Considering livelihoods as a third dimension to health-environment programming

Upholding one right can only go so far in advancing sustainable development and conservation. Family planning and reproductive rights are not a panacea – other rights (such as those relating to food and decent work) are also relevant. Support for livelihood diversification can mitigate the risk of family planning services leading to increased natural resource extraction.

We move forward from this research with a renewed commitment to the communities that we serve – recognising that a full constellation of human rights must be upheld in order to remove barriers to their engagement in sustainable fisheries management and marine conservation.

Conservation, contraception and controversy:
Supporting human rights to enable sustainable fisheries in Madagascar

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