I’ve just returned from the International Conference on Family Planning (ICFP) in Ethiopia where integrated population, health, and environment (PHE) programs had a strong showing. More than 16 sessions over three days at the conference incorporated PHE themes, including panels on communicating complexity around family planning, conservation and human rights; how PHE helps accelerate the fertility transition in rural Ethiopia; and meaningful ways of linking population and family planning to climate change and sustainable development in Africa. Blue Ventures, one of PHE’s strongest voices, was given one of the first ever Excellence in Leadership for Family Planning awards. At this global meeting of family planning experts, PHE was clearly and squarely at the center.

Despite this progress, I was also reminded of some of the myths that persist regarding the PHE approach. The reactions of colleagues from different fields to the work Blue Ventures and others are doing around the world, connecting conservation and poverty-reduction efforts with reproductive health, were telling. Three stood out to me in particular:

Myth #1: PHE Is Simplistic and Malthusian

Reality: The PHE approach is rights-based, community-driven, and embraces complexity.

One reaction to a session we organized was quite blunt: PHE is “simplistic and Malthusian,” said one audience member. It’s easy for practitioners who have been working on these integrated programs to forget that others might interpret PHE programs in this way, but it’s important not to overlook it.

In fact, the PHE field has worked very hard to establish three key elements that move it above and beyond this type of criticism: a focus on voluntary family planning and preserving individuals’ right to choose the number and spacing of their children; responding to community needs and priorities as identified by the community itself; and taking into account the complexity of on-the-ground realities.

In the same way that family planning advocates recognize that their history includes coercive approaches that current programs disavow, the PHE community should not forget the problematic Malthusian roots that some assume underlie today’s PHE programs.

Both the PHE and family planning communities have indeed come a long way from fears of “overpopulation,” but that history is part of the context in which this work is implemented. PHE programs need to continue to convey the message of who they are and what they represent to combat this perception.

Myth #2: PHE Is Difficult, If Not Impossible, to Implement in Some Places

Reality: PHE integration is possible, and the energy and commitment needed to meet challenges are fully evident.

I shared a ride one day to the conference center with the CEO of one of the largest family planning NGOs in the world. As we discussed PHE programming, he lamented that it is really too difficult to do. Indeed, some may consider it impossible.

But one clear take-away from ICFP is that PHE is not only possible, it’s been highly successful. Blue Ventures reported that by working across sectors, its project has empowered women, supported active engagement in natural resource management, and greatly improved access to family planning. In six years, the contraceptive prevalence rate in the project’s remote areas of Madagascar has increased more than fivefold, from 10 percent in 2007 to 55 percent in 2013.

PHE is emerging as a valid approach to development in many areas of the world, as presentations, discussions, and evidence from ICFP sessions demonstrated. Let’s be clear: there is a lot work to be done, particularly on improving monitoring and evaluation and bridging different specialties, but we have the energy and determination to meet these challenges.

Myth #3: PHE Isn’t Really Taking Root

Reality: PHE projects are achieving results in key countries – and it is a scalable approach.

One participant asked me whether PHE is really taking root. I believe so. PHE projects implemented by Path Foundation Philippines, Inc., the Guraghe People’s Self-Help Development Organization, and Blue Ventures are achieving important results in countries of high significance – Madagascar, the Philippines, and Ethiopia. Equally important are the new partners coming on board. More organizations like FHI360 and Conservation Through Public Health are examining these issues and seeing value in adjusting their own programming as a result. Some, such as the Jane Goodall Institute, Population Action International, and the Population Reference Bureau have adopted PHE as one of their signature approaches. And regional partners like the Lake Victoria Basin Commission are contributing too. It doesn’t mean that the PHE community doesn’t have more to do, but PHE is clearly getting good traction.

While PHE is taking root, it is not yet a large-scale intervention. A very young field, with limited funding, it is achieving excellent results at the level and scale at which it is being implemented. It’s important for PHE practitioners to take the time to develop and test their efforts to build the strongest basis for scaling up.

Future Directions

One colleague said to me that he rarely sees anything new and innovative at these big family planning conferences. I had news for him. PHE is such an approach, and Blue Ventures winning the conference’s EXCELL award certified that. One seasoned family planning practitioner announced that PHE was the highlight of the conference and that she is looking forward to engaging with PHE further.

Clearly current PHE practitioners are not the only ones who are excited by the growing momentum. Still the persistence of these three myths should make PHE practitioners sit up and take notice. So what’s next? I believe there are three critical questions to be answered that will help address these concerns:

1. What is the collective impact of PHE? The PHE field needs to continue documenting the collective impact of their work. Individual projects are doing good work and advancing innovative and creative solutions. But PHE needs to demonstrate its aggregated impact. What is the overall effect of these projects? And how does that support advancing PHE as a valid development approach?
2. Where is PHE not taking root and why not? PHE has been successful in many contexts, but it is still mostly implemented in very poor, rural areas with high biodiversity. For places where the PHE approach would make sense but is not being considered, do we know why? What sectors could make good partners but are not engaged, and why – for example, the gender, climate, and resilience communities?
3. What is the intentionality of PHE? Is PHE in danger of becoming its own “silo,” so to speak? One partner at the conference noted that they renamed PHE as “EHP” since their project’s initial focus was on environmental issues, rather than population. Should PHE be reshaped according to each program’s focus? Does the community need to move beyond the label to get at the heart of meaningful integrated and transformational development programming?

In answering these questions, the PHE community will help move the approach out of the shadows and into the limelight. PHE is a responsive, community-driven, innovative approach to comprehensive and integrated development programming, and there is a great deal of evidence that it is reaping benefits for many rural and under-served communities around the world. Let’s make sure everyone knows it.

Sources: Blue Ventures.

Photo Credit: Used with permission courtesy of David Colwell/Bill and Melinda Gates Institute for Population and Reproductive Health.