On the remote southwestern coast of Madagascar, home to the semi-nomadic seafaring Vezo ethnic group, most girls have their first child before the age of 18, and families with 10 children or more are commonplace. But since the 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' Vik Mohan, Rebecca Hill, and Alasdair Harris argue that their integrated approach, which combines reproductive health with conservation measures, offers these communities-and the marine environment on which they depend-the best possible chances of survival.