My grandmother was pleased when I told her I was heading to Ethiopia last November for an international conference focused on population, health, and the environment.

She tells entertaining stories of volunteering for Planned Parenthood in central Ohio in the 1960s. She was what the international development community might call a “peer educator” today: a teacher and mother of three who traveled to rural areas of the county where she grew up to educate teens and women about how to plan and space their births. Can any kind of jelly, like Smucker’s grape, be an effective contraceptive? Those are the kinds of questions she answered here in the United States.

Fifty years later, she says it’s “nonsense” that every woman in the world still doesn’t have access to voluntary contraception, and “of course” access to health care, including reproductive services, is related to the health of the environment.

After working in the population, health, and environment (PHE) field for nearly 10 years, it hasn’t always felt so clear, even – or especially – among fellow development professionals, who tend to guard their sector-specific funding better than the best World Cup goalies.

However, based on the passion and interest of those I met in Addis last November, I’m happy to report that, finally, holistic PHE programming is starting to feel more accepted.

Why PHE?

Population, health, and environment initiatives, as one might expect, employ a three-pronged approach to development. Most involve efforts to concurrently improve access to health services (H), especially family planning and reproductive health (P), while helping communities manage natural resources and conserve critical ecosystems (E).

The PHE approach is rights-based and responds to development needs in a holistic way that reflects how many people around the world live their lives, rather than deploying a standard, sector-specific development methodology (e.g., only focusing on health, or conservation, or food security, or sustainable livelihoods, etc.).

Often PHE projects are implemented in areas of high biodiversity adjacent to national parks or protected areas. Residents of these remote places tend to be beyond the reach of public or private health services. It can take hours or days to travel (usually by foot) to the nearest city. Their connections to and reliance on local natural resources – for food, water, shelter, and livelihoods – is great, and so often is their desire for access to primary health care and reproductive health services.

A 2007 assessment of the first generation of PHE projects in the Philippines, Mexico, Tanzania, and Madagascar illuminated PHE’s value. Integrated PHE programs produced better results than interventions with either just health or just environment activities. Almost all of the integrated projects met most or all of their anticipated objectives within a relatively short timeframe. The projects were cost-effective. Project recipients, local leaders, and NGOs preferred integration, which they found to be an effective community mobilization and behavior change approach. And significantly, PHE promoted more involvement from men in health services and women in natural resource management.

Women’s Empowerment, Local Engagement Major Themes

Back in Addis last November, more than 150 PHE implementers, advocates, and donors gathered to share their experiences at a conference organized by the Population Reference Bureau and PHE Ethiopia Consortium, and funded by the David and Lucille Packard Foundation and USAID.

Twenty countries from sub-Saharan Africa, Asia, Central America, Europe, and North America were represented. Over half of the conference steering committee members were from the Global South, exhibiting the growth in PHE thought-leaders from lower-income countries. And the Honorable Ato Belete Tafere, Ethiopian minister of the environment and forestry, opened the event.

Fueled by rich Ethiopian coffee, the two-day conference was packed with conversations and debates among those new to PHE and long-time advocates and practitioners. Eight field projects were presented during concurrent panel sessions – there were sessions on gender and PHE, advocacy and support, innovative partnerships, monitoring and evaluation, institutionalizing PHE, communications, and more. Amidst the constant hum of discussion and tête-à-têtes in English, Kiswahili, French, and Amharic, several major themes emerged.

The first was women’s empowerment. As Karen Dubois from FUNDAECO Guatemala said, “where the environment is most fragile, so are women’s health and rights.” Putting women at the center of PHE efforts – for example, focusing on improving the overall status of women, rather than simply distributing contraceptives – has greater impact. Participants discussed addressing gender-based violence and developing woman-to-woman peer education.

Nonetheless, male participation is still critical. Many noted that increased involvement from men in household health decisions has positive long-term impacts. Sexual and reproductive health discussions with both sexes can take place through community associations, such as fishery cooperatives, community beach management units, farmer’s associations, and youth clubs.

Another major theme was the continued importance of engaging local leaders and other development organizations. Many PHE programs are making a point of working with community members, government, and regional institutions during the project design phase, which leads to more support, better coordination, and, ultimately, more sustainable and successful programs.

In addition, many conference participants pointed out that partnerships with other NGOs and governments are an undervalued opportunity for PHE. Collaboration between sector-specific organizations (e.g., a conservation organization working with a reproductive rights organization) adds complexity and requires additional up-front investments in training and coordination, but it can produce results that are more impactful than one organization doing everything.

Finally, many participants noted they are sometimes surprised at how quickly demand for contraceptives rises after peer educators start working with communities. Close alignment between PHE projects, community stakeholders, and government health systems was recommended to ensure sufficient contraceptive supplies are available quickly to meet pent-up demand.

“PHE Is Alive and Kicking!”

My grandmother was a vanguard of women’s reproductive rights, one small cog in a movement that has changed millions of women’s lives the world over for the better. Over the past 20 years, the PHE movement has trained scores of champions like her in villages and capitals where population dynamics, health, and the environment most critically intersect.

But the approach remains fairly niche. Lester Coutinho of the Packard Foundation encouraged the PHE community to look to the “next frontiers” for opportunities to expand the approach, citing women’s rights (reproductive, land, and property) as something programs could address better. “Let’s consider women’s rights and gender more and put women at the center of owning PHE programs, not just beneficiaries,” he said. A PHE program in The Gambia, for example, has turned stewardship of a critical oyster bed exclusively over to a women’s group, leading to more sustainable fishing, better health care, and improved livelihoods. More control over their lives led one woman to declare, “We have reached Grade 12; we will not go back to Grade 1.”

Others urged the community to think of ways PHE can contribute to climate adaptation and community resilience as well.

As ever, many of PHE implementers pushed each other to expand the evidence base to prove the effect of integration to those still skeptical. There are very few articles in the international peer-reviewed literature that focus on PHE, and fewer still that measure impact. Increasing partnerships with academic institutions could assist with research and evaluation and overcome measurement challenges.

But what struck me most about the conference was that it felt like the leadership baton was being passed from largely U.S.-based advocates to local champions in places like Ethiopia, Uganda, the Philippines, and the Lake Victoria Basin. This is an important shift that hopefully presages more locally and regionally driven growth. As ECSP’s Roger-Mark De Souza aptly said in the final plenary of the conference, “PHE is alive and kicking!”

Momentum, excellent tools, local ownership, and new partners – the components for continued growth of this important approach to development are all in place.