Senior Demographer at Avenir Health
People living in poor remote communities often face multiple challenges; in many cases, these include access to health and family planning/reproductive services, sustainable sources of income, and the means to sustainably use natural resources. Population, Health, and Environment (PHE) projects apply an integrated approach to improving the health and well-being of individuals, their communities, and the resources upon which they depend.
The Tuungane Project
In rural villages in Western Tanzania near Lake Tanganyika and Mahale Mountains National Park, communities have little access to voluntary family planning and other health services, and consequently, high fertility and poor health. Since almost everyone in the area grows their own food, farms are expanding to meet the needs of a growing population, which can drive soil sediment into Lake Tanganyika and have negative impacts on fish populations upon which people depend for sustenance and livelihoods.
Population Reference Bureau (PRB), through its participation in the Evidence Project, works in partnership with a PHE project in this region called Tuungane (Kiswahili for “Let’s Unite!”). The Tuungane Project tries to help communities find a balance between meeting people’s needs and practicing sustainable natural resource management. Project activities include improving fisheries management, offering contraception to those who want it, raising awareness about healthy practices such as hand washing, and establishing financial saving systems. Together, these activities will improve quality of life for people in the communities, and may also promote resilience that helps them adapt to the consequences of climate change.
I met with members of the Tuungane Project team to collaborate and investigate the links between building resilient individuals and communities and family planning. When the project started five years ago, the Tuungane Project conducted a baseline survey to assess people’s knowledge, attitudes, and practices surrounding family planning, health services, land use, conservation, and the environment. The investigation continues with a follow-on survey to gauge people’s perceptions of how the Tuungane Project has changed their lives over the past five years. Results will be available in 2017.
Survey Results Yield Important Findings
While the survey enumerators were in the field, I teamed up with colleague Christopher Hale to analyze the Tuungane baseline data, collected in 2011 before the majority of program interventions began. Chris and I wanted to understand the links between fertility desires (how many children people want); contraceptive use; access to land; water, sanitation, and hygiene (WASH); and knowledge and attitudes towards conservation. What we found was fascinating, and you can read the full report.
The most interesting findings were:
- Knowledge of family planning was low, at only 43 percent! In national surveys from Tanzania, knowledge of family planning is almost universal. This finding illustrates how remote the villages in the Tuungane Project are, and how few reproductive health services are available.
- Knowledge of contraception was related to age: Nearly half (48 percent) of those age 35 and under had heard of family planning, compared to only 38 percent of those over age 36.
- The need for family planning was high among women. Half of recent mothers said they did not want to get pregnant at the time they did. And 87 percent of women who are not pregnant and not using contraception did not want to get pregnant at the time of the survey. This level of unmet need for contraception in 2011 was much higher than the 18 percent of women with an unmet need in the 2010 Tanzania Demographic and Health Survey. Increasing and maintaining access to family planning is critical for the health and well-being of the women and children in these villages.
- A desire for smaller families was more common for younger people. Among those age 35 and under, half want five or fewer children, while half of those over age 35 want eight or more children.
- The community recognized that population growth can have potentially negative consequences. “Not enough land” was the main negative consequence reported. In the area, more than 95 percent of households farm, but most people have only three acres or less.
- Natural resources are important. While pressure on the land is great, people also agree that natural resources should be protected. Mahale Mountains National Park is a protected park, and over 80 percent of people believe the park—as well as the village forest lands and wildlife—should continue to be protected.
Insights Can Build Support for PHE Projects
In Tuungane, 95 percent of households are barely able or unable to meet their daily needs with the resources that exist. The results show that people want to protect their natural resources and that they want health and family planning services. The new data will help illuminate the ways that the Tuungane Project is meeting the needs of the communities. And, we’ll be able to answer questions about if and how the project is helping communities become more resilient to climate change.