Egypt's Family Planning Program is Beginning to Show Results

By Angela Stephens

"Abu Ktiir," whose name means "father of many," is the paternal character in a series of Egyptian cartoon messages encouraging family planning. His son, Wahid, complains about how there is no place for him in a home filled with six other children and an ever-pregnant mother. Another ad features a boy of about 10, covered in motor grease, working in a car repair shop and daydreaming. He envisions himself in new school clothes, skipping through a field with a backpack, enjoying the carefree childhood he is missing. The message is that planning a family protects children from a burdensome youth.

One New Baby Every 24 Seconds

Since the 1960s, runaway population growth has been recognized by the government as the biggest threat to the health of the nation. Last year, Egypt's population rose by 1.3 million, an increase of one baby about every 24 seconds. At present growth rates, the current population of nearly 58 million is expected to double by the year 2015. President Hosni Mubarak has repeatedly warned that overpopulation threatens to spoil government efforts at economic reform.

Longstanding state programs promoting family planning and child spacing still face such challenges as religious opposition, misuse of birth control methods and misinformation about pregnancy. Therefore, the State Information Service opened a center in 1979 to encourage family planning. Called the IEC (Information, Education and Communication Center), it airs messages on television and radio promoting consulting a doctor rather than relying on information from friends and relatives, and spacing births by at least two years. Its messages over the past three years have illustrated birth control methods, including the IUD, oral contraceptives and condom packages.

When the IEC was founded, only 24 percent of married Egyptian women were utilizing contraceptives. The number increased to 30 percent by 1984, to 38 percent by 1988, and to 48 percent by 1990. By now the Egyptian government can point to a statistically significant decline in fertility rates since it began promoting family planning. While women had an average of 5.2 children in 1980, the number was down to 4.4 by 1988.

Numbers vary by region and educational level, however. Only one woman in 10 in rural upper Egypt was practicing family planning when the demographic and health survey was conducted in 1988 by the National Population Council, an organization founded in 1985 in part to spread family planning services.

"In upper Egypt, they prefer to have a female doctor and, if there is no female doctor, the husband may refuse to have her examined," says Mohamed Amin, the IEC's director of interpersonal communication and local programs.

Relatively low use of birth control methods is not for lack of knowledge about the products. Ninety-eight percent of married Egyptian women aged 15 to 49 know of at least one method of birth control. However, only 60 percent of those surveyed had ever used a family planning method. Although women's stated ideal family size averaged 2.9 children, half of the women questioned were not using a birth control method at the time of the survey.

In addition to underutilization of methods, another problem is misuse. Many women are not using oral contraceptives correctly. One in six women who had discontinued using the pill in the five years before the survey had become pregnant while on the pill. Some women believe they should only take the pill "as needed," presumably when they are having sexual relations with their partners, instead of every day.

The IEC's goals are to encourage women to space childbirth for their own health, as well as to bridge the communication gap between husbands and wives. One-third of the couples interviewed for the survey had never discussed family planning.

Another obstacle the message makers confront is religious opposition to birth control. "Religious opposition is very strong, especially in upper Egypt," Amin says. Some people believe birth control is contrary to Islam, while others accept political rumors claiming that family planning is promoted because the West wants to reduce the number of Muslims in the world, he adds.

Amin is directing efforts to influence village and religious leaders about the need for family planning, supported by verses from the Qur'an that encourage breast feeding, and by extension, child spacing.

Traditional beliefs stand in the way of family planning policies as well. "Some people believe, especially in the rural areas, that the more children they have, the better their economic situation, because they can push them to work," says Dr. Khaled Abdel Aziz Khaled, executive director of Family of the Future.

Family of the Future was established in 1980 to market contraceptives throughout Egypt. All the IUDs, oral contraceptives and condoms sold by Family of the Future are provided free by the U.S. Agency for International Development (USAID). The contraceptives are basically affordable to everyone. An IUD that would cost $140 in the United States costs less than $1 in Egypt. The IUD is the most popular birth control method in Egypt, promoted because it is not subject to misuse like oral contraceptives.

However, USAID has only promised free contraceptive supplies through mid-1993, so Family of the Future is now making plans to become an independent, non-profit business. Khaled is worried about the prospect of purchasing contraceptive devices and having to resell them at the government's subsidized prices. "They have to set [the prices] free, this is the only option," Khaled says. "Otherwise, we won't be able to buy our own products and resell them on the market."

Khaled says Family of the Future now distributes about half the contraceptives in Egypt.

Family planning organizations will spend a week in July analyzing results of an 18-month campaign in Minya governorate in central Egypt, funded in part by Johns Hopkins University. They plan to use the governorate as a model for extending family planning programs elsewhere.

The government's strategy now is to conduct more person-to-person programs. "It's not enough to provide the services," says Dr. Nabil Nasar, undersecretary for family planning at the Ministry of Health. "There are still some people who need direct-contact, outreach programs."

Angela Stephens is an American member of the editorial staff of Cairo Today, an English-language Egyptian publication.