Egypt has been making progress in reducing fertility rates which declined from 5.3 births per woman in reproductive age in 1980 to 2.85 in 2021. Over that period the use of modern family planning (FP) methods by currently married women aged 15-49 also increased from 57 per cent in 2014 to 65 per cent in 2021. However, despite the progress, the unmet needs of family planning among currently married women in their reproductive age remains at 13.8 per cent with huge variations between governorates. Unmet needs of family planning cover women at risk of pregnancy, not using FP methods, and wanting to delay the next birth or uncertain about timing. It also refers to women at risk of pregnancy, not using FP, and wanting no more children.

Egypt is committed to ensuring reproductive rights and reducing the unmet needs of family planning in its updated National Strategy for Population and Development where it said it aims for replacement-level fertility by 2030, targeting a total fertility rate of 2.1 births per woman, down from the 2021 rate of 2.85. It aims to increase contraceptive prevalence from 66.4 per cent in 2020 to 75 per cent and reduce unmet needs from 14 per cent in 2021 to six per cent by 2030.

It is important to end the unmet needs in family planning to ensure the well-being and quality of life of people, especially women, says a new report titled “Investment case towards ending unmet need for family planning Egypt 2023”. Issued by the Institute for National Planning and the UN Population Fund, in cooperation with the European Union, the report presents three scenarios detailing the resulting health outcomes, reductions in fertility rates, and the necessary resources to raise family planning interventions to achieve various levels of success.

According to the report, reduced unmet needs by 2030 will contribute to achieving Sustainable Development Goals [SDG] No 1 which is eradicating poverty by improving economic well-being by enabling smaller families and increasing female workforce participation. It also helps achieving SDG goal No 3 which refers to good health and well-being. This is realised by reducing maternal mortality, unintended pregnancies, and unsafe abortions. And it contributes to achieving SDG goal No 5: gender equality by empowering women by giving them control over their reproductive health.

Increased modern contraceptive use is projected to reduce the number of unintended pregnancies and unsafe abortions. The report estimates that between 2023 and 2030, approximately 11.5 million unintended pregnancies and 5.7 million unsafe abortions are estimated if spending continues without change. The report pointed out that there is significant variation in unmet needs across different geographic regions, with rural Upper Egypt experiencing an 18 per cent unmet need compared to 11 per cent in rural Lower Egypt. The rate rises to 22 per cent in Assiut and Sohag governorates.

According to the report, the total cost between 2023 to 2030 of FP related to the status quo amounts to LE10.3 billion. For Egypt to reduce unmet needs by 2030, aligning with the SDG target an additional investment of LE825 million is needed over the seven years, bringing the total investment to LE11.1 billion to achieve the 75 per cent CPR by 2030. That would reduce unmet needs to 8.6 per cent by 2030. The additional investment could prevent 1.5 million unintended pregnancies and 733,000 unsafe abortions.

An additional investment of LE1.3 billion between 2023 to 2030 to current spending would increase the CPR to 80.2 per cent and would reduce unmet needs for FP to 5.7 per cent, close to the six per cent targeted by the updated National Population Strategy. This scenario could prevent 2.3 million unintended pregnancies and 1.14 million unsafe abortions.

Funding is estimated to fall short by an average of 70 per cent across all scenarios, the report said, adding that “closing the gap will require exploring alternative funding sources like integrated approach, innovative financing tools, increased investment from domestic budget, and funding from donors and partnerships”.

Currently, government health spending constitutes 34 per cent of total health expenditure, an improvement compared to 28 per cent in 2019. However, Out-Of-Pocket (OOP) spending accounts for 60 per cent of healthcare costs. The rest is covered by private insurance, syndicates, firms, and NGOs, along with employers’ health spending on employees. Donor assistance also plays a role, providing support to various entities such as the Ministry of Health and Population, and health insurance organisations, as well as other ministries and NGOs, the report pointed out.

While the Egyptian government targets a health budget of three per cent of GDP by 2030, current health expenditure (CHE) in 2019-2020 stood at LE256 billion, equating to LE2,560 per capita and representing 1.6 per cent of GDP.

The governmental sector is the primary source for obtaining family planning methods, with reliance on the sector increasing from 57 per cent in 2014 to 61 per cent in 2021, the report showed.

* A version of this article appears in print in the 9 May, 2024 edition of Al-Ahram Weekly