title: Effectiveness of the population health and environment approach in improving family planning outcomes in the Gurage, Zone South Ethiopia.
abstract: BACKGROUND
  Family planning is a strategy of balancing population growth with economic development for sustainable use of natural resources. A high population growth induces increased demand for resources and the rate at which these resources are exploited. Population, health and environment are connected inextricably. Population growth unbalanced with economic development leads to food insecurity which exposes households to the consumption of food with reduced quality and quantity leading to increased risk of malnutrition and poor health. Food insecurity again obliges people to encroach into the natural environment leading to a spiraling progress to destitution. A study in the Philippines provided concrete evidence that integrated development programming incorporating population, health, and the environment (PHE) can be more effective in lowering population growth rates and preserving critical coastal ecosystems than single-sector development interventions". Although the PHE approach has been implemented for 5 years (2008-2012) Guraghe Zone of South Ethiopia, its outcomes have not been evaluated. The objective of this study was to evaluate the effectiveness of PHE approach for achieving family planning (FP) outcomes in Gurage Zone.
  
  
  METHODS
  A comparative cross-sectional study was conducted in October, 2012. A total of 962 married women in the reproductive age group were included in the study. Data were collected using an interviewer administered Amharic version questionnaire. Descriptive statistics and multivariable logistic regression analyses were performed to compare the PHE and non-PHE Woredas (district) based on family planning parameters adopted from Measure Evaluation Manual.
  
  
  RESULTS
  Comparison of non-new family panning acceptor women showed that PHE Woreda had a significantly high CPR compared to non-PHE (78% vs 52%, P < 0.0001). Among these sub-groups, women in the PHE Woreda were over four times more likely to use family planning methods during the study period (P < 0.0001) compared with women in the non-PHE Woreda. Women whose husbands' supported their use of family planning methods were 17 times as likely to use family panning methods (AOR: 17.2, 95 % CI [11.1, 26.8]), P < 0.0001. This was even increased to 20 times more when we did sub-group analysis only for women who were not new acceptors (AOR: 20.4:95% CI [9.7, 42.7]), P < 0.0001. The qualitative results showed that there was a better integration of FP, health and environmental issues into the grassroots level interventions in the PHE Woreda through using students as a medium for reaching parents on family planning and environmental issues.
  
  
  CONCLUSIONS
  The findings suggest that overall; PHE has positive outcomes in FP behaviors both among married women and their husbands. Integration of population, health and environmental issues need to be strengthened and scaled up to sustain the positive FP behaviors such as support of FP use. Strategies used in the PHE Woredas such as using schools and students as medium for integrated PHE interventions are commendable approaches that need to be strengthened.
authors.affiliation: Nursing Department, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia. makedasinaga@gmail.com.
authors.forename: Makeda
authors.initials: M
authors.lastname: Sinaga
authors.affiliation: PHE Ethiopia Consortium, Addis Ababa, Ethiopia. phe.program2@gmail.com.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Mohammed
authors.affiliation: PHE Ethiopia Consortium, Addis Ababa, Ethiopia. negashteklu@gmail.com.
authors.forename: Negash
authors.initials: N
authors.lastname: Teklu
authors.affiliation: PHE Ethiopia Consortium, Addis Ababa, Ethiopia. kstelljes@gmail.com.
authors.forename: Kristen
authors.initials: K
authors.lastname: Stelljes
authors.affiliation: Population and family health Department, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia. teferabelachew@gmail.com.
authors.forename: Tefera
authors.initials: T
authors.lastname: Belachew
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D004777:Environment; D005002:Ethiopia; D005193:Family Planning Services / Q000458:organization & administration* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008393:Marriage; D015397:Program Evaluation; D036301:Qualitative Research; D055815:Young Adult