Introduction

Christine does not know how old she is. She has 16 children and lives on a remote island off the south-western coast of Madagascar. She and her children, like other members of the Vezo ethnic group, a semi-nomadic seafaring people, depend entirely on the ocean for their survival. Her husband, a fisherman, struggles to catch enough to feed his family, catching fewer and fewer fish even as he fishes for longer and longer periods.

In this isolated area, most girls have their first child before the age of 18, and families with 10 children or more are commonplace, due to a lack of reproductive health education and care. But since our marine conservation NGO, Blue Ventures, launched a family planning program in 2007, couples and women like Christine are able to make their own reproductive health choices. Blue Ventures’ integrated approach, which combines reproductive health care and education with conservation and alternative livelihood programs, offers these communities—and the marine environment on which they depend—the best possible chances of survival.