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Linking Family Planning and Global Development

Kristen P. Patterson

Population Reference Bureau | Program Director, People, Health, Planet
Tuungane Tanzania Cheryl Margoluis

The Tuungane project in western Tanzania was a perfect match for the Evidence Project’s research because the social and environmental challenges facing local communities along the forested shores of Lake Tanganyika provide a good case study for examining resilience. Photo: © Cheryl Margoluis, Pathfinder International.

The development community’s interest in enhancing the resilience of individuals, households, and communities in lower- and middle-income countries so they can better contend with environmental and human-made shocks and stress is growing. While good health at the population and individual level, and the ability to space and plan births, are thought to contribute to resilience, existing resilience-building frameworks have largely ignored the role of population dynamics. The potential contributions of family planning to resilience have remained unknown—until now. Newly published research on a project in western Tanzania provides evidence that family planning is positively associated with multiple components of resilience.

Do Community-Based Development Projects Contribute to Resilience?

Community-based development projects that simultaneously address livelihoods, natural resources management and conservation, primary health, and reproductive health in an integrated manner are commonly known as population, health, and environment, or PHE, projects. These integrated projects have typically not collected quantitative data on resilience, and in 2015, the Evidence Project’s PHE Synthesis report pointed to a need for research into how to define and measure PHE projects’ contributions, if any, to building resilience among rural communities.

Early the next year, Population Reference Bureau (PRB) gathered a small group of people under the USAID-funded Evidence Project at a workshop in Arusha, Tanzania, to start the process of measuring whether and how PHE projects build resilience. The workshop’s goal was to figure out how to identify and measure PHE projects’ ability to increase resilience—the capacity to cope and adapt to environmental and other shocks and stressors—at the household and community level. This workshop provided the starting point for what would become innovative research on how to measure the association between family planning and resilience.

We first had to agree on the key components of resilience, drawing on a thorough literature review and our collective knowledge from working in the environmental conservation, reproductive health, economics, climate adaptation, and sustainable development fields. We sought to quantify resilience to shocks that households in economically and geographically isolated regions adjacent to protected areas typically face and often must resolve on their own: health crises, food insecurity, and natural resources management within the context of climate change. We focused on indicators of resilience that can be measured at the family or household level rather than, for example, community or institutional resilience.

The Tuungane Project Proves an Excellent Match for Research

The Tuungane project in western Tanzania was a perfect match for the Evidence Project’s research because the social and environmental challenges facing local communities along the forested shores of Lake Tanganyika provide a good case study for examining resilience. The project had a solid baseline survey from 2011, a strong multidisciplinary measurement and evaluation team, and staff were open to working closely and collaboratively with us.

Tuungane Tanzania kids 2011

The Tuungane project's findings provide strong evidence to support including family planning and maternal and child health in holistic community development programs to build individual, household, and community resilience. Photo: Kristen P. Patterson (Buhingu, Tanzania), 2011

The Tuungane project began in 2012 with the aim to improve the health of people, forests, and fisheries by strengthening local governance, improving access to social services (particularly health services), and promoting more sustainable use of natural resources. At the project baseline, the under-five mortality rate was among the 20 highest in the world, and only 16 percent of married women used a modern method of contraception. The Greater Mahale Ecosystem where the Tuungane project operates is home to more than 90 percent of Tanzania’s chimpanzees and over 250 endemic fish species that have evolved in the isolation of Lake Tanganyika for more than 10 million years. No roads exist in the region—the lake is the only major means of transportation.

The Data Show Family Planning Can Impact Resilience

Using our defined components of resilience, we collaborated with the Tuungane Project to design survey questions to assess the pathways through which family planning could impact resilience and other PHE project activities. The questions covered hygiene, family planning, climate change, diet and food security, and social cohesion, and were included in the project’s 2016 follow-on quantitative survey. The survey’s reproductive health section was also expanded to allow for an evaluation of healthcare facilities and services, and the farming section was expanded to better assess current farming practices.

In addition to the 2016 survey, the Evidence Project and others supported qualitative data collection through focus group discussions with community members. The survey and focus group results were synthesized in a report, Changes in Household Well-Being and Resilience 2011-2016, that explains the changes found between the 2011 baseline survey and the 2016 survey. The Evidence Project also wrote a synopsis summarizing key findings from that report that relate to family planning and other resilience components.

PHE Holbrook sunset

Community-based development projects that simultaneously address livelihoods, natural resources management and conservation, primary health, and reproductive health in an integrated manner are commonly known as population, health, and environment, or PHE, projects. Photo: Kimberly Holbrook, The Nature Conservancy, 2018

To confirm that our identified components of resilience accurately measured potential household resilience, we created a multicomponent model of resilience. This model used Confirmatory Factor Analysis in a Structural Equation Modeling context to define and measure resilience within PHE programming, and quantify the link between resilience and family planning. It repeatedly tested different variables and components.

The research results confirm that resilience can be enhanced and measured through PHE and other integrated community-based development programming. It also provides evidence that family planning with access to maternal and child health care is positively associated with multiple components of resilience.

Including Family Planning in Holistic Community Development Programs Can Enhance Resilience

This research is a first-of-its-kind effort to define and measure resilience within the context of PHE multisectoral programming, and identify and quantify the link between family planning and resilience. Measuring these indicators over time can help assess whether social resilience is increasing in PHE project areas and can inform the design and implementation of holistic programs to strengthen resilience.

Our research demonstrates that family planning alone is positively associated with all components of resilience in the context of a rural multisectoral community development project. The findings provide strong evidence to support including family planning and maternal and child health in holistic community development programs to build individual, household, and community resilience.

I would like to acknowledge the key contributions of all my coauthors to this research—we all learned from each other through the challenging questions that we tackled together as a team. The research was a multidisciplinary, collaborative effort between colleagues from seven different institutions with expertise in reproductive health, environmental conservation, sustainable development, monitoring and evaluation, and structural equation modeling. In addition, special thanks to the enumerators who gathered the data, and, of course, the people in the Tuungane project area, without whom this work would not have been possible.

You can learn more with a fact sheet summarizing the research and the published article detailing it in full.

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