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

Robert Engelman

The Unexpected Linkage

Since 1992, Population Action International has disseminated research and convened conferences on the linkage of reproductive health, including family planning, with the conservation of natural resources in developing world communities. The linkage could be seen as an operational or programmatic subset of the larger field of population and the environment, “P and E in the field,” though this may be a distinctly “Northern” view typical of donor agencies and analytic frameworks. There has long been confusion and disagreement about how to define what it is we’re talking about with this linkage. Many project linkages grew out of community members’ interests and requests, with no conscious connections of population dynamics and environmental problems, for help with environmental problems and a lack of access to family planning methods.

For some observers, encouraging or enabling improved provision of contraception in remote and marginalized communities nonetheless can appear to be a new approach to “population control” that effectively blames the poor for environmental degradation. The peer-reviewed science journal Conservation Biology featured a discussion that touched on this perception in two issues (October 2005 and August 2006, with a response in the second issue by the original researchers). The discussion turned in part of the question of who wants reproductive health services to be available in communities — donors and implementing agencies, or the women and men of the communities? The authors of one of the articles — representing PAI, the Population Reference Bureau and the University of North Carolina — argued that such projects overwhelmingly respond to the expressed needs of community members for such services, and that the services improved health outcomes regardless of their impact on local fertility rates. Under the best circumstances, PHE integration literally occurs “from the ground up,” with women in communities asking development agencies in their communities how they can improve access to needed reproductive and broader health services.

In a contrasting view, scholar Kendra McSweeney of Ohio State University did not dispute this point but argued that some women may want to have large families. She urged funders and implementers of integrated projects not to see declines in fertility as likely sources of environmental improvement in areas where indigenous people lived. For others, this discussion misses a larger point. It’s too limiting, some community development practitioners argue, to focus on the linkage of family planning or even reproductive health generally — defined as a general state of sexual and reproductive well-being and including maternal and child health and prevention of sexually transmitted disease and, where legal, access to safe abortion as well as the capacity to choose the timing of pregnancy and birth. These observers argue for, at a minimum, a broader linkage to primary health services such an diarrhea and malaria prevention that are critically needed in rural communities.

Integration by Any Other Name

This diversity of opinion is reflected in the fact that there is no consensus on what to call this concept, innovative as it is. Like the blind men probing the elephant in the ancient folk tale, perceptions differ on what is being linked to what and for whom. In the mid-1990s, Population Action settled on the term community-based population and environment (CBPE). The term was selected to clarify that this was a way of making population-environment linkages a pragmatic reality within communities, especially in the lives and well-being of women. Although other researchers and some groups adopted this term, it was never broadly accepted to characterize all the projects to which PAI applied it. World Neighbors, the Oklahoma City-based development international organization that pioneered the linkage beginning in the 1950s in the marginalized communities in which it worked, calls the linkage reproductive health/natural resources management, a term that has the advantage of precision even if it is a mouthful. More commonly, the linkage is today simply called PHE, for population, health and the environment — stressing the broader connection between environmental conservation and the improvement of human health. USAID and the community of its contractors, grantees and projects use this term. For consistency with other accounts, this essay will as well.

But why stop, some argue, with even the broad concepts of population, health and environment? There’s education, and women’s empowerment, and most critically and already commonly the encouragement of sustainable livelihoods — like an intriguing activity WWF is supporting in the Kiunga Marine National Reserve in Kenya.

Along the Indian Ocean beaches there, school boys and other young people clean the beaches of washed up flip-flops. These are undoubtedly the cheapest and most popular footwear humanity has ever produced. And they are the most readily discarded and easily lost. Untold tons of these sandals float across the Indian Ocean, sometimes choking marine animals and eventually washing with the prevailing winds and currents onto the beaches of East Africa. By cleaning the beaches, youthful flip-flop collectors clear the way for critically threatened green turtles to lay their eggs out of reach of the waves, and for the resulting hatchlings later to wriggle their way unencumbered back to the water. More importantly to human interests, the youths offer the raw material to groups of women who take this beach debris and craft it into beautiful crafts that can be sold — from bracelets to room dividers.