United Nations Population Fund

10th Country programme for Egypt (2018-2022)

Egypt was one of the first countries to sign an agreement with UNFPA to initiate population activities. The country office was established in 1972 and UNFPA has supported Egypt through eight 5-year country programmes ever since. The proposed programme is aligned with national development priorities outlined in Egypt’s Vision 2030 and National Population Strategy; United Nations Partnership and Development Assistance Framework (2018-2022), and builds on recommendations of the ninth country programme evaluation.

The programme aims to assist the country in achieving the goals of “Egypt’s Vision 2030” and is relevant to the 2030 Agenda. It contributes primarily to the progressive achievement of SDG Goals 3 and 5. The programme target groups are women, adolescents and youth, particularly those most in need, including disabled, rural communities, migrants and people affected by emergencies. It will use a differentiated approach by targeting selected governorates with the poorest sexual and reproductive health indicators. Egypt has also recently committed to Family Planning 2020, a global movement that supports women’s and girls’ rights to freely decide when and how many children they want to have.

The programme supports building resilience and anticipating shocks that could undermine progress, whether they come from natural hazards or instability. Humanitarian assistance is delivered in the context of resilience and broader sustainable development priorities.

The overall goal of this programme is to reduce fertility rates from 3.5 to 3.2 by scaling up family planning programmes in Egypt, focusing on strategies tailored for young people, particularly young women and adolescent girls.

Egypt at a glance:

The population of Egypt witnessed a dramatic increase during the last decade, with an estimated population of 94.7 million, compared to a total of 72 million people in 2006. In absolute terms, the population has increased by over 20 million in 10 years. There is also extreme pressure on the limited land and water resources, with 97 per cent of today’s population living on 7.8 per cent of the territory. This steady increase of 2.4 per cent per year threatens to hinder development efforts, with major implications on security and quality of life, basic services, education, health, housing and water.

Egypt has made significant progress in improving the health of women and children. The recent maternal mortality figures show a continued decrease, as the ratio reached 46 deaths per 100,000 live births, indicating that Egypt has achieved Millennium Development Goal 5. The government is fully committed to continue investing in maternal and child health in order to further decrease maternal mortality rates.

The surge in population is mainly driven by the recent increase in the total fertility rate, following decades of progress in lowering fertility levels. The total fertility rates rose from 3.0 per cent in 2008 to 3.5 per cent in 2014. This increase, along with a decrease in percentage of currently married women using modern contraceptives (from 58 per cent in 2008 to 56.9 per cent in 2014), and the persistently high contraceptive discontinuation rate (around 30 per cent) are indications that the family planning programme in Egypt has lost momentum and must be reinvigorated.

The unmet need for family planning increased from 11.6 per cent in 2008 to 12.6 per cent in 2014. In Upper Egypt, these rates reached 16 per cent in urban areas and 17 per cent in rural areas, indicating major regional disparities and gaps in access to and provision of adequate family planning services. Poverty and living in rural Upper Egypt are highly associated with large families and low contraceptive prevalence and fertility levels.

A closer look and analysis of the quality of and accessibility to sexual reproductive health services highlight a number of challenges in structural and organizational as well as delivery levels. These include verticality of the family planning programme and their separation from maternal, child health and other primary health care services, inadequate capacity and high turnover of service providers, insufficient capacity for forecasting, and lack of robust logistics information management system.

With 62 per cent of its population below the age of 29, the country is reaching the peak of the “youth bulge”, the largest cohort of young people in its history. This can translate into serious challenges or opportunities, depending on the investments made in this group. Especially crucial is investing in young women who face inequalities that result in disparities in education, protection, employment and access to services, including sexual and reproductive health services. Investment in young Egyptians is essential to turn the “youth bulge” into a demographic dividend.

Social norms, cultural beliefs, conservative voices, maintenance of traditional gender roles in society, as well as still prevalent harmful practices of female genital mutilation and early marriage, tend to affect childbearing trends, encourage families to bear more children, and decrease demand and use of family planning services. The prevalence of female genital mutilation for married women aged 15-49 years is 92.3 per cent, with a decrease in the 15-17 age group (down from 74 per cent in 2008 to 61 per cent in 2014).

Child, early and forced marriage and teenage childbearing in rural parts of Egypt have increased over the last decade, and presents a threat to the rights, health and lives of young girls. Moreover, this leads to an increase in fertility rates and contributes to a prolonged childbearing period, with related complications for pregnancy and childbirth, and will eventually lead to increased population growth if not addressed. The Demographic and Health Survey indicated that 14.4 per cent of girls aged 15-19 years are married while the percentage of young women aged 15-19 years who are mothers or pregnant with their first child increased from 9.6 per cent in 2008 to 10.9 per cent in 2014. This reflects an increasing trend in fertility – 56 live births per 1,000 women aged 15-19 years in 2014, compared to 48 live births per 1,000 in 2005 and 50 live births per 1,000 in 2008.

Accordingly, the country program has three outputs:

Outcome 1: Sexual and reproductive health

Output 1: Strengthened capacities of line ministries and civil society at governorates and national levels for the provision of high-quality, integrated and rights-based reproductive health and family planning services, including for youth, and in humanitarian settings. This will be achieved by:

(a) Building national capacity for improved reproductive health commodity security;

(b) Providing technical assistance for establishment of functional logistics management information system, including last-mile tracking, forecasting and monitoring sexual and reproductive health commodities

(c) Advocating for integration of family planning services into routine maternal and child health services

(d) Advocating and providing technical support to the Ministry of Health for development, revision and monitoring of reproductive health clinical protocols and standards to increase access of women and youth to evidence-based high-quality services at primary health-care level;

(e) Advocating for quality assurance in all service delivery elements to ensure client-centered care

(f) Supporting development of national monitoring frameworks for SDGs, focusing on sexual and reproductive health, to galvanize government political and financial commitments, and using census and survey data

(g) Advocating and supporting line ministries to expand access to high-quality family planning services in underserved and rural areas for women and youth who are furthest behind, including in humanitarian settings

(h) Advocating for provision of the Minimum Initial Service Package for reproductive health in humanitarian settings.

15. Output 2: Increased demand for informed and voluntary family planning products and services for women and men of reproductive age. This will be achieved by addressing norms and social determinants of sexual and reproductive health:

(a) Utilizing entertainment education approaches to promote family planning

(b) Building national capacities for integration of community workers into the primary health-care system to promote use of family planning

(c) Strengthening partnership and coordination among line ministries and community-based organizations to scale up implementation of outreach interventions in family planning, especially in rural areas

(d) Advocating for and supporting sensitization and awareness programmes for religious and community leaders on family planning and population issues

(e) Advocating strengthening of coordination among line ministries, civil society and the private sector for effective implementation of the national population strategy and scaling-up of family planning services

(f) Partnering with civil society in the design and implementation of effective outreach interventions, and monitoring their delivery, focusing on rural areas

(g) Advocating for premarital educational counselling courses targeting future and newly married young couples.

Outcome 2: Adolescents and youth

Output 1: Strengthened capacity of relevant governmental institutions and youth-led civil society for development and implementation of multidimensional youth strategies that facilitate access to reproductive health knowledge, information, skills and services for the most vulnerable and marginalized young people.

The programme will employ the following strategies:

(a) Advocating for and supporting integration of adequate package of soft skills and information on population, migration, reproductive health, and gender-related concerns and harmful practices, into extracurricular activities in secondary schools and universities

(b) Advocating and supporting development and monitoring of an evidence-based, comprehensive multisectoral youth strategy, incorporating principles of youth, peace and security, and in line with Security Council resolution 2250

(c) Advocating for and supporting establishment of population awareness and reproductive health clubs in 600 youth clubs in 27 governorates

(d) Developing analytical statistics capacity for policy and programming formulation in youth sexual and reproductive health

(e) Supporting the preparation of demographic dividend advocacy instruments and building national partnerships for increased investments in young people.

C. Outcome 3: Gender equality and empowerment

Output 1: Enhanced capacity of the Government and civil society to prevent and respond to gender-based violence, with particular attention to harmful practices affecting women and girls, including those affected by emergencies. This will be achieved by:

(a) Supporting development, implementation and monitoring of behavioral change communication interventions addressing sociocultural norms and religious misinterpretations upholding gender-based violence and harmful practices

(b) Strengthening the capacity of civil society, youth-led organizations, faith-based organizations, service providers and community leaders to reach out and raise awareness to abandon gender-based violence, including harmful practices

(c) Enhancing capacities of law enforcement entities in monitoring, documenting and reporting on gender-based violence, including harmful practices

(d) Advocating for integration of gender-based violence multisectoral responses into protection and response services by relevant line ministries, including development of referral pathways

(e) Supporting intersectoral coordination for implementation of relevant national strategies at governorate levels; and

(f) Strengthening coordination of the gender-based violence sub cluster to better combat gender-based violence in humanitarian and development spheres.