Connecting Family Planning, Rights and the Environment for Planetary Health

By: Suzanne York and Robert Engelman

The concept of planetary health connects many different sectors and issues, most especially that of conservation and health. Environmental sustainability and healthy people go hand in hand.

For the past 70 years, the dominant paradigm of our global society has been based on ever increasing levels of population and economic growth — and with it, unsustainable rates of consumption and extraction of natural resources. This has taken a toll on both people and the planet, with our society approaching or even exceeding many critical planetary boundaries.

Some of the places of greatest biodiversity on the planet also have some of the poorest or most disadvantaged human communities. Even if surrounded by lush resources, and even more so when critical resources are degraded, far too many people are unable to meet their basic needs or provide adequately for their families.

© Ben Honey, Blue Ventures

Reproductive Health Is Planetary Health

People everywhere must be able to exercise their rights to water, food, and health. The challenge is to assure this exercise of rights without compromising the health of future generations by degrading Earth’s natural systems. Time is of the essence. Since the rise of civilization, according to one recent study, the increase of human population and activities have led to an 83 percent decrease in the biomass of wild mammals, while quadrupling the total mass of mammals generally due to human and livestock expansion. Of all the mammals on Earth, 96% are livestock and humans, and only 4% are wild mammals.

The Rockefeller Foundation–Lancet Commission on Planetary Health defined planetary health as “the health of human civilization and the state of the natural systems on which it depends.”

The planetary health concept can be strengthened even further when it includes addressing women and men’s sexual and reproductive health and rights, thereby empowering people to make the best decisions for themselves. In this context it’s worth noting that according to the Guttmacher Institute, a respected think tank on reproductive behavior and health, approximately two out of five pregnancies worldwide were unintended by parents in 2012.

If couples were empowered to make their own reproductive choices, and provided with the means to choose the number and timing of their pregnancies, the resulting impact on human fertility would powerfully alter future trajectories of population growth and its environmental impacts, while also adding to the health and well-being of families and communities. Due to the well-recognized multiple benefits of family planning, reproductive health is a critical component of planetary health, and a multi-sectoral approach is needed to best balance the needs of people and the planet.

The Population, Health and Environment (PHE) development model offers a well-documented means to balance human health with that of a flourishing environment.

PHE is an integrated approach linking family planning, health and conservation that recognizes the interconnectedness of people, their health and their local environment. It is an acknowledgement of direct connections between the reproductive health of individuals — women, men and youth — along with the well-being of communities in remote, biodiversity-rich areas, and the health of the natural environment upon which all life depends.

Integration Leads to Success
Many PHE projects are located in Sub-Saharan Africa and Asia, in areas where there are pressing environmental problems such as droughts, floods and deforestation, combined with economic and food insecurity, and combined with a high unmet need for voluntary family planning. This means that women would like to prevent or delay pregnancy but are not using contraception, either because they lack access to and information about services, or because they face cultural, religious, family or other obstacles.

The main components of PHE address the following:

  1. Population: The United Nations’ report World Population Prospects: The 2017 Revision projects world population to reach 8.6 billion by 2030, 9.8 billion by 2050 and 11.2 billion by 2100. PHE projects, however, do not actually act in any direct way on population. Rather an expected outcome of their activities is healthier populations that are less likely to grow rapidly through high fertility that results from unintended pregnancy and that are better able to engage in sustainable use of natural resources.
  2. Health: access to healthcare, including (but not restricted to) voluntary family planning services, is especially critical for women, and helping assure this is an essential activity of PHE projects. In developing countries, an estimated 214 million married women want to avoid pregnancy but are not using a modern contraceptive method. Unknown numbers of other women worldwide are at risk of pregnancies and births they would prefer to occur later or not at all. Meeting their needs and reducing the rate of maternal and child mortality should be a global priority.
  3. Environment: The world is facing incredibly serious natural resource and environmental challenges caused by human pressure. Often the best solutions to environmental problems are local and based on traditional knowledge. PHE initiatives include efforts to support communities to manage natural resources sustainably, and protect the ecosystems upon which their well-being depends.

PHE is a holistic strategy that helps people and communities meet their needs for education, health care and sustainable livelihoods, as well as to manage their natural resources to better protect the environment.

PHE: On the Ground in Madagascar
One of the flagship PHE programs is run by Blue Ventures in Madagascar. This organization works with local communities to conserve threatened marine ecosystems and protect coastal livelihoods. The organization has long understood that there is a connection between population growth, poor natural resource management, environmental degradation, lack of healthcare, and food insecurity.

In the Velondriake region, a majority of residents depend upon coastal and marine resources for their livelihoods. As a result of an unmet need for family planning, infant and child mortality is high, and the fertility rate is 6.7 per woman. In response to identified health needs Blue Ventures is addressing marine conservation and sustainable livelihoods alongside a rights-based approach to family planning and community health. Blue Ventures provides health services to 50 villages through a network of local women trained as community health workers. The network serves as a source of information on voluntary family planning services.

© Garth Cripps, Blue Ventures

This community health service, which includes sexual and reproductive health services, maternal and child health care and safe water initiatives, is fully integrated with Blue Ventures’ projects on sustainable fisheries management, locally-led marine conservation and aquaculture enterprises.

According to Vik Mohan, Medical Director with Blue Ventures:

What we see is that women are healthier, and because they are better able to look after and provide for their children, their children are healthier. By addressing the health needs of some of the hardest to reach people, we’re removing a fundamental barrier to their engagement in conservation and natural resource management: poor health. We believe that integrating health services with natural resource management efforts in this way gives communities the best chance of being able to live in harmony with their environment.

There are many other successful PHE projects around the world, including PHE Ethiopia Consortium, Conservation Through Public Health in Uganda, and Path Foundation Philippines.

“Everything Is Connected”
People live interconnected lives. As the world’s population continues to grow, the importance of this interconnection becomes even greater. The PHE approach creates a positive and empowering model for people all around the world. It emphasizes gender equity, health, and protection of natural systems. As such it is an important tool in the planetary health toolbox.

Per the PHA website, “Everything is connected. What we do to the world comes back to affect us, and not always in ways that we would expect. Understanding and acting upon these challenges calls for massive collaboration across disciplinary and national boundaries to safeguard our health.”

Humans are part of the web of life. While nature can exist without people, people cannot exist without nature. From Madagascar to California, policies that recognize the links between population growth, health, rights, and conservation will lead to lasting sustainability and ultimately, planetary health.


Suzanne York is Director of Transition Earth and Robert Engelman is Senior Fellow at the Population Institute and former President of the Worldwatch Institute.


Disclaimer: The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the Planetary Health Alliance or its members.