The Last Mile: Empowering Families to Choose a Sustainable Future

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On the distant shores of Lake Tanganyika, people are in crisis. Children are dying. Women struggle to survive childbirth. And the natural resources families rely on for food and jobs are depleted like never before. But there is hope. It starts with choice.

“I was very sick,” says Zainabu, a female farmer from a remote village in western Tanzania. Zainabu is the mother of nine children. With each new pregnancy, she suffered frequent and extreme complications.

Zainabu did not want to get pregnant again. She believed her family’s survival depended on it. But what choice did she have?Imagine getting pregnant in one of the hardest-to-reach places on earth. There are no roads. No phones. And if you have an obstetric emergency, there is no doctor in your village to save your life. You must travel by boat—for seven hours—to reach the nearest hospital. If the lake is stormy, you must turn back immediately. If you are lucky enough to survive the journey, you may find the hospital’s one surgeon is not there.

“We made so many trips,” says Zainabu’s husband, a local fisherman named Peter. “Each time, it cost us a huge amount of money—30,000 shillings.” That’s about $18. For families living in extreme poverty, it can mean the difference between feeding their children or not.

“Four of my children died before they turned one,” Zainabu says softly. “Malaria was the main killer. I had it too, during many of my pregnancies. Eventually I said enough is enough.” Zainabu did not want to get pregnant again. She believed her family’s survival
depended on it. But what choice did she have?

Addressing Urgent and Growing Needs

In these communities, 41 percent of women want to prevent or delay pregnancy, but do not have access to contraception. This threatens their health and wellbeing. It violates their basic human rights to make fundamental choices about their bodies. The inability for people to make choices—about whether or when to have children—can have harmful effects on the sustainability of entire communities.

On average, women here give birth to more than seven children, and their households are nearly 30 percent larger than Tanzania’s national average. This contributes to a population of 590,000 people in this remote area.4 And that number is expected to increase by 4.9 percent each year.

These demographic trends—combined with poor health and extreme poverty—place enormous stress on these communities. Families like Zainabu and Peter’s are running out of food and water. To care for their children and end their chronic hunger, parents must constantly search for food and ways to earn income. Often, they are forced to resort to overfishing the lake and clearing forests for their farmland and firewood, depleting the natural resources they depend on for survival.

Every year, an estimated 11 percent of the area’s dense forest cover is lost. The last of Tanzania’s wild chimpanzees are pushed from their habitats, and erosion muddies the once-pristine lake threatening the source of families’ drinking water.

Right now, communities face two interconnected crises—how to protect their health and the environment they depend on. The problems are complex. And Pathfinder is up to the challenge.

The Tuungane Project: Where Health Meets Conservation

Lake Tanganyika, which holds 1/5 of the earth’s fresh water, forms the western boundary of the Greater Mahale Ecosystem. The area is marked by rich biodiversity, including nearly 200 species of fish that exist nowhere else in the world.

In 2011, Pathfinder joined two international leaders in conservation—The Nature Conservancy and the Frankfurt Zoological Society—to design a project like nothing we’d done before. Tuungane means “Let’s unite!” in Kiswahili. And that’s exactly what we’re doing. Our three organizations are working together to empower communities with the knowledge and tools they need to live healthy lives in balance with their environment.

Why We Do This Work

At Pathfinder, we see a natural connection between the reproductive health work we do and a sustainable environment. Our 55+ years of experience in 125 countries has shown us that sexual and reproductive health affects everything. It can mean the difference between life and death for a woman and her children. It can determine her ability to complete her education and earn much-needed income for her family. And it allows her to balance her family’s size with its resources, so she can invest more in each child’s wellbeing and future.

“I am so happy to use family planning,” says Zainabu. “Today I am healthy.” She is hard at work in her garden, smiling and showing off her produce. “I want continued health for my children and grandchildren.”

Peter agrees. With the help of Pathfinder-trained community health workers, who visited the couple with contraceptive information and services in their home, he and Zainabu were able to make the choice that was right for them.

“We decided to use family planning because of everything we experienced. But most of all,” says Peter, “it is hard to afford education for so many children. We knew we wanted all of our children to be able to go to school and be healthy. Now all of them are.”

With these words, Peter reveals the true message of our work—there is hope for a better future.

To learn more about Pathfinder’s innovative “Population, Health, and Environment” work, visit

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