In February Egypt’s population hit 100 million. Now, just eight months later, another million has been added to the total. Amr Hassan, former rapporteur of the Egyptian National Population Council, points out that this means an average of 4,250 children are born every day.

Egypt has been trying to rein in population growth for 55 years, Hassan told Al-Ahram Weekly. Countries like Iran and Turkey, which began targeting population growth at the same time as Egypt, managed to close the file 20 years ago. While at first Egypt had some success, any advances have been wiped out in the last 10 years. According to Hassan, Egypt succeeded in cutting the fertility rate from 5.3 children per woman in 1980 to 3.5 in 2000 and then to three in 2008. (Fertility rates refer to the total number of children born to each woman during her child-bearing years.)

The period between 2011 and 2014 saw a major setback, with fertility rates climbing back to 3.5 children per woman by 2014, prompting the government to launch the National Population and Development Strategy 2015-2030. The strategy targets population growth through five avenues: family planning and reproductive health; child and adolescent health; education; media and social communication; and the empowerment of women. In 2018 surveys indicated that the fertility rate had dropped slightly to 3.1 children per woman, close to the 2008 number.

Although at first glance this may appear an achievement, in reality it means that no improvements have taken place over the last 12 years, says Hassan, and it falls far short of meeting the ambitions of the 2015-2030 strategy which had set 94 million as the target population in 2020. In comparative terms, Egypt has the highest rate of population growth among Arab countries, and the third highest, after Nigeria and Ethiopia, in Africa. Globally it ranks 14th, and by 2050 is forecast to become the 11th. The Population Reference Bureau, says Hassan, has forecast that Egypt’s population will increase by a staggering 70 million between 2018 and 2050.

The optimum fertility rate for Egypt is 2.1 children per woman, which would allow the population to replace itself from one generation to the next. This, says Hassan, is important to lessen the demands of Egypt’s limited resources, not least its share of Nile water. Egypt’s quota has remained constant, at 55.5 billion cubic metres annually since 1959, a period in which the population has quadrupled. Whereas the average individual share of water was 2,000 cubic metres per capita per year in 1959, today it is 600 cubic metres, well below the 1,000 cubic metres water poverty line set by the UN.

The reasons the rise in birth rates over the past decade are multiple, according to a study by the Population Council, an international NGO. Titled “Fertility preferences and behaviours among younger cohorts in Egypt: recent trends, correlates, and prospects for change,” the study focused on individuals, aged between 15 and 34.

Several socio-economic, political, and programmatic factors may have contributed to the desire for larger families, said the study: “Political unrest following the 2011 and 2013 revolutions and the rise of the Muslim Brotherhood to power resulted in decreased political commitment to family planning, changes in Ministry of Health and Population priorities, and a shift away from a public discourse that condones and promotes family planning.”

The study posited decreased use of family planning among married women with two or more children, a shift towards short acting methods of contraception, and increased contraceptive discontinuation between 2008 and 2014 as the three main drivers of increased fertility.

The study noted “a considerable decline in exposure to family planning (FP) messages through various channels, with the percentage of women who reported exposure to FP messages through television declining from 60 per cent in 2008 to 40 per cent in 2014”, as well as the phasing out of USAID from the national family planning programme in 2008 which resulted in less funding for training and supervision as well as discontinuation of media campaigns that had been successful in raising awareness of FP.

The situation was compounded by reduced exposure to family planning messages because changing viewing patterns, with private media channels increasingly dominating broadcasting schedules, and a weakened private family planning sector, especially in terms of NGOs which catered to the needs of middle-class women in urban areas. The study also pointed to a shortage of trained physicians at primary healthcare facilities, and the rising cost and erratic supply of contraceptives.

On the positive side, the study pointed out that “the family planning programme is receiving unprecedented high-level political support along with increased governmental and international donor funding.”

In the summer of 2017 President Abdel-Fattah Al-Sisi pointed out that population growth constituted, alongside terrorism, one of the two major challenges facing Egypt. And in May 2018, USAID and the Ministry of Health and Population launched a new Family Planning Programme. The five-year, $19 million programme is being implemented in nine governorates in Upper Egypt, and in selected areas of Cairo and Alexandria. It provides technical assistance and training to the Ministry of Health to strengthen its Family Planning and Reproductive Health Programme, enhance the quality of services and improve contraceptive use.

To deal with population growth effectively, issues of governance need to be addressed, says Hassan. The multiple players and entities involved in implementing the population strategy, need to be brought together under a single body that can coordinates their work and determine who is responsible when targets are missed. It is a role the Egyptian National Population Council used to play when it was affiliated first to the presidency, and later to the cabinet. Now, says Hassan, it is affiliated to the Ministry of Health and has lost much of its leverage.

The Population Council study makes a number of recommendations. They include fostering greater collaboration between the Ministry of Health and Population and a range of stakeholders to integrate information about fertility awareness, family planning, birth spacing, and gender equality into secondary school curricula, livelihood training programmes, and worker health programmes; encouraging private TV channels to broadcast voluntary family planning messaging by granting tax incentives; and integrating family planning into medical and nursing school curricula to ensure a new cohort of service providers competent in family planning service delivery.

The study also recommended enhancing the role of the private sector in family planning service delivery.

“The Egyptian government should assist NGOs in generating funds to support the provision of subsidised FP services to women who live in urban areas who cannot afford the fees of private doctors,” and private doctors and pharmacists should receive training on counselling and contraceptive technology. “Pharmaceutical companies may play a role in offering such training as this could eventually lead to increased revenues through increased sales,” suggested the study.

“The private sector in Egypt should be encouraged to play a greater role in supporting the national family planning programme and reducing reliance on international donor funding… Large corporations could sponsor provider training programmes and media campaigns or donate equipment to Ministry of Health facilities as part of their corporate social responsibility programmes.”

*A version of this article appears in print in the 8 October, 2020 edition of Al-Ahram Weekly