The rural communities living in isolated and high biodiversity areas in which conservation organisations work often depend on healthy ecosystems for food security, water security, and livelihoods. Pressures from population growth impact healthy ecosystems, and can also impact the health of the communities, their ability to support their families, and reduce the possibility of the long-term sustainability of conservation actions. Almost 1 in 5 women across Madagascar report unmet family planning needs: levels are highest in rural areas. Isolated communities living in the island’s priority biodiversity conservation areas often lack access to family planning and health services. Their ability to engage in sustainable natural resource management and livelihood diversification is restricted by poor health and unmet family planning needs. Rapid coastal population growth related to unmet family planning needs and lack of alternatives for subsistence in Madagascar are resulting in the unsustainable exploitation of natural resources. In response to these challenges, a holistic approach to community-based conservation and development that reflects the inextricable links between humans, their health, and the environment commonly named as PHE (Population – Health – Environment) has been developed. PHE is a holistic approach to sustainable development: so-called because of the way that it reflects the connections between people, their health, and the environment. Family planning and other health services are combined with community-based natural resource management and biodiversity conservation efforts through cross-sector partnerships between health and environmental organisations. All programs are underpinned by community education that engages men, women, youth, and children in both health and conservation topics. Family planning has been shown to enable communities to work more, earn more money, provide for their existing children, feed their families, and experience better health. More women are able to invest more time on conservation livelihood activities and are better able to provide financially for their existing children.