The untold cost of cost-effectiveness in family planning

Monday, 10 July 2017 07:15 GMT

A woman gleans for octopus with an infant on her back in coastal southwest Madagascar, where marine conservation organisation Blue Ventures has been integrating family planning services with local fisheries management initiatives for a decade © Garth Cripps/file photo

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Environmental and health groups working together on family planning - a partnership that delivers for people living in remote areas

Against a backdrop of unprecedented funding cuts, top policymakers and funders from more than 50 countries are gathering at the Family Planning Summit in London tomorrow, racing to accelerate global efforts to reach 120 million more women and girls in the poorest countries with contraception by 2020.

With mounting pressure from policies introduced by U.S. President Donald Trump that cut funds for family planning programmes worldwide, providers are being forced to deliver more with less.

Such pressure often results in the prioritisation of easily accessible urban populations at the expense of people living in remote rural areas. 

Yet the pioneering work of environmental groups partnering with health agencies is drawing attention to people living in isolated areas, who fall outside of the laser focus on cost-effectiveness and are at risk of being left behind, by providing an elegant solution for meeting their needs.

A Marie Stopes nurse preparing to travel by motorbike to reach an isolated community near the Anjanaharibe-Sud Special Reserve, northeast Madagascar © Lemur Conservation Foundation/File photo

From Tanzania to Indonesia, the experiences of health and environmental organisations working together in biodiversity hotspots across the world demonstrate that resourceful mechanisms do exist for reaching overlooked and under-served populations and advancing equitable access to contraception for the most marginalised women and girls.

This is evidenced by a vibrant cross-sector movement in Madagascar where groups including Marie Stopes, the Wildlife Conservation Society and the Lemur Conservation Foundation are collaborating to increase access to family planning services in extremely isolated areas, reaching some 135,000 people to date. 

Environmental organisations are inviting health agencies to piggyback onto their operational infrastructure and community relations, thereby enabling mobile service delivery and strong family planning uptake in areas previously deemed too difficult or expensive to reach.

Women now make up more than a third of the community representatives tasked with governing the Velondriake locally managed marine area (LMMA) in southwest Madagascar, where contraception use has increased more than sixfold since access to family planning services was provided by Blue Ventures and its health partners in 2007 © Johanna Medvey/File phot

Eugène Andriamasy, the partnerships coordinator of Marie Stopes Madagascar, explains how these cross-sector partnerships work: 

"We collaborate with environmental groups who share our desire to ensure full access to free and informed family planning choices for the communities with whom they work on local conservation initiatives. Sometimes our mobile teams use the transport of these environmental groups to reach remote communities, for example, travelling by boat to coastal villages inaccessible by road during the rainy season or even by motorbike on narrow tracks to communities deep inside forested areas."

“We train the staff of these environmental groups to offer basic information about contraceptive options and reproductive rights so that they can raise awareness of our services within communities before our mobile teams arrive, often engaging men as well as women in discussions about family planning through natural resource management meetings and other forums,” Andriamasy explains.

Although addressing the needs of these isolated populations can be more costly than serving their urban counterparts, a recent International Planned Parenthood Federation report suggests that doing so can generate significant impacts for other key health and sustainable development goals. 

Indeed, results from the integrated health-environment programme of marine conservation organisation Blue Ventures in Madagascar show how increasing access to family planning services for remote coastal communities can lead to significant uptake of contraceptives while achieving progress in other areas such as gender equality in natural resource management

So at a time when it would be all too easy to overlook hard-to-reach populations in the pursuit of ambitious family planning goals, these collaborative health-environment initiatives should serve as a courageous reminder for global health actors: it is possible to balance a drive for cost-effectiveness with a greater concern for contraceptive equity, and an appreciation of the wider value of investing in family planning for the most marginalised.

Laura Robson is a global health professional who has been working with environmental groups for over 7 years. She currently manages the health-environment partnerships of marine conservation organisation Blue Ventures in Madagascar.