Family planning

Access to safe, voluntary family planning is a human right. Family planning is central to gender equality and women’s empowerment, and it is a key factor in reducing poverty. Yet, globally at least 222 million women who want to use safe and effective family planning methods are unable to do so because they lack access to information, services, commodities or the support of their partners or communities. Most of the women with an unmet need for family planning live in 69 of the poorest countries on earth.

Access to safe, voluntary family planning is a human right. Family planning is central to gender equality and women’s empowerment, and it is a key factor in reducing poverty. Yet, globally at least 222 million women who want to use safe and effective family planning methods are unable to do so because they lack access to information, services, commodities or the support of their partners or communities. Most of the women with an unmet need for family planning live in 69 of the poorest countries on earth.

UNFPA works to support family planning by: advocating for evidence and human rights based family planning policies; ensuring a steady, reliable supply of high quality contraceptives; strengthening national health systems; gathering data and funding research   to support this work. UNFPA also provides global leadership in advocating for improved access to family planning, by convening partners – including governments – to develop evidence and policies, and by offering programmatic, technical and financial assistance to low and middle income countries.

Family planning in Egypt

Egypt is the most populous country in the Middle East and the thirds most populous country in Africa. The current fertility rate is at 3.5 which constitute a rise from earlier years, reaching a level last seen in 2000 according to the preliminary findings in the Egypt Demographic Health Survey 2014.

The Egypt Demographic and Health Survey (EDHS) from 2008 finds that many Egyptian women are having more births than they consider ideal. Overall, 14 percent of pregnancies in the five years prior to the survey were reported unwanted. Among these, 5 percent of births were identified as 'mistimed', meaning wanted later; while 9 percent were unwanted entirely. According to the 2008 EDHS, the overall wanted fertility rate is 2.4 births per woman. The study concludes that: ‘if unwanted births could be eliminated, the total fertility rate in Egypt would decline by around 20 percent’.

Egypt’s government-led national family planning programme has succeeded in raising the Contraceptive Prevalence Rate, from 48 percent in 1991 to 59 percent in 2014 according the preliminary results from the DHS. Furthermore, the Total Fertility Rate has been slowly declining from 4.4 live born children per woman in 1988 to 3 in 2008 and then risen again in 2014. The government has attributed the high rate of contraceptive use to efforts to inform women about health services. Yet, the 2014 DHS found that one in eight married women was in need of family planning at the time of the survey. According to 2014 data, the unmet need for family planning in Egypt is 12.6 percent.

According to the same survey, only 30 percent of women were counseled on postnatal birth control methods. The lack of information can place women at risk of unwanted pregnancy soon after a previous birth, which may carry health risks and cause complications and death during pregnancy. Child spacing continues to be a challenge especially among young mothers, overall about 20 percent births occur within 24 months of the previous one.

Moreover, the rate of adolescent pregnancy has increased from 8.5 percent in 2000 to 9.6 in 2008 of women aged 15-19 who are pregnant or have had their first child. The percentage of adolescent pregnancy is in rural areas is almost twice that in urban areas. Only 2 percent of ever-married women aged 15-49 regard use of family planning before a woman’s first pregnancy as appropriate.

Modern family planning methods

The 2014 EDHS indicates that around 59 percent of currently married women in Egypt are using contraception. The most widely used methods are the IUD, the pill, and injectables, and three percent of these women cited that they use traditional methods. Thereby, 41 percent of married women were, as of 2014, not utilizing any family planning method.

The extents to which women utilize modern methods vary across regions. Urban women were more likely to be using modern contraceptives than rural women, and the lowest modern contraceptive use is among women residing in rural Upper Egypt.

The extents to which women utilize contraceptive methods also vary within age groups, whereby only 21 percent of married women aged 15-19 use contraception, compared to 73 percent among married women aged 35-39. Only two percent of ever-married women aged 15-49 regard use of family planning before a woman’s first pregnancy as appropriate.

Programme Overview:

Reproductive health (RH) is defined as a state of physical, mental, and social well-being in all matters relating to the reproductive system, at all stages of life. Everyone has the right to enjoy reproductive health, which is the basis for having healthy children, intimate relationships and happy families.

Reproductive health encompasses key areas of UNFPA vision: that every child is wanted; every birth is safe; every young person is free of HIV; and every girl and woman is treated with dignity and respect.

Reproductive Health is a core area for UNFPA, as well as a priority for the Egyptian government. UNFPA strives to support a sound RH policy that promotes access to quality RH services to broaden the opportunities of women and men to enjoy healthy lives.

Reproductive health, including family planning, is as an essential component for the wellbeing of the population; it has been receiving increasing attention and has now been adopted in almost all countries of the world.

Research, surveillance and data use for evidence-based decision-making and advocacy are strategic priorities for reproductive health. This programme serves the first outcome set in the UNFPA’s 9th Cycle Country Program “Women in reproductive age, men and young people have increased access to quality FP/RH services”. The programme seeks mainly to accelerate the achievement of universal access to reproductive health services through the reduction of inequities in accessing safe deliveries, and family planning services and to assist Egypt to meet the goals of MDG 5 around maternal health. Systems enhancement, advocacy and evidence based policy dialogue will be conducted at the central level, while capacity development and community-based interventions will focus on Assiut and Sohag.

Hence, for its 9th Country Programme Action Plan (2013-2017), Egypt and UNFPA have decided to focus on Assiut and Sohag, the 2 governorates with poor maternal health, poverty and health human resources indicators.

Egypt Situation:

The 2014 DHS indicates that fertility rate significantly has increased after more than 20 years of decline. Between 1980 and 2008, Fertility dropped from 5.3 children per woman to 3.0 children per woman. But since2008, fertility has risen (by half a child) to 3.5 births after experiencing a plateau of 3 births for years (3.8 in rural areas, 2.9 in urban areas).

  • 11% of women (15-49) years are pregnant or have had a live birth.
  • One fifth of non-first births were born within 24 months of a prior birth interval.
  • Contraceptive prevalence rate is 59% and desired fertility among ever-married women 15-49 is still at three children.
  • According to 2014 data, the unmet need for family planning  is approximately 13%
  • There is a slight shift in family planning methods mix from long to short term contraceptives.
  • There are misconceptions around fertility and family planning, in addition to concerns about side effects of contraceptives.

UNFPA interventions:

  • Attempt task-shifting of certain duties, including family planning counseling mainly in Assiut and Sohag. This was done through training nurses on the newly developed counseling tool “Decision Making Tool”. Proper and effective counseling is expected to reduce unmet need for family planning, increase demand on contraceptives (especially long acting methods) and hence reduce total fertility rate.
  • Revision of the family planning standard of practice to integrated reproductive health components and effective referral supported. The integrated package of reproductive health services will be extended to include post abortion care reproductive tract infections and effective referral systems. This would be a base for future capacity building activities of service providers.
  • Strengthening the contraceptive security system - with focus on method mix - to improve the management system of contraceptives, avoid stock outs of commodities and monitor service provision.
  • Advocacy component targeting policy makers, community and religious leaders, media, service providers, and women through the following: Meetings with the governors & policy makers, Awareness sessions, Media campaign (TV spot, a documentary, website & social media), Outreach campaigns, National Family Planning conference. Additionally, a conference was carried out to enhance post-partum family planning that included 150 experts, Ministry of Health officials, academia, professionals, media and key stakeholders. A relevant policy paper to enhance post-partum contraception developed that aims to integrate services provided to the woman starting at the antenatal care, directly after giving birth and during immunization to enhance usage of contraceptives as early as possible after delivery.
  • Research and knowledge management: Study on factors associated with early discontinuation of Implanon in Assiut Governorate is being conducted, this would give an insight about how users and providers perceive this method of family planning and detect gaps in service provision.
  • Capacity building of MoH (Ministry of Health) personnel on conducting research in related fields, especially reproductive health, this resulted in increased capacities of the trainees on how to interpret data and understand basic concepts of knowledge generation. Further training is required to help national capacity in effective conduct of research activities.

UNFPA Partners:

UNFPA is partnering and working hand in hand with Family Planning and Reproductive Health Sector, Ministry of Health and Population.