For over a decade community-based projects linking family planning, health, and environment efforts have been active in Fianarantsoa province, Madagascar. Explored in this brief is the evolution of cross-sectoral approaches and projects in Fianarantsoa province. The early cross-sectoral initiatives recognized that conservation and management of natural resources could be undermined by high fertility rates, and that addressing health needs would lead to a connection between communities and development practitioners. Evaluations have demonstrated that these projects have reached new audiences, were efficient, and fostered greater community involvement.