For more than a quarter-century, beginning in the late 1970s, the number of children born to a woman in Egypt had been declining, on average, to about 3.0, in line with declining fertility rate trends in much of North Africa. Then, in the last six or seven years, the rate in Egypt, the Arab world’s most populous country, began to reverse, jumping to 3.5 live births per woman by 2014, according to the most recent data. Only in major urban areas did the rate remain below 3.0.
Ironically, the data do not match the preferences of the women surveyed, all currently married, who thought that 2.8 births was a desirable number, or no more than three children in a family. Six in 10 of the women did not want another pregnancy, according to the 2015 Egypt Demographic and Health Survey, part of the USAID, which plotted changes in fertility from 2008 through 2014. One underlying factor: “More than one-fifth of married women believe their husband wants more children than they do,” the survey found. “Overall, 16 percent of births in the five-year period were not wanted at the time of conception.”
Gamal Serour, a leading Egyptian authority on fertility and family planning, is a professor of obstetrics and gynecology and the director of the International Islamic Center for Population Studies and Research at Al Azhar University, the premier center of Sunni scholarship. He was recently named to the independent Guttmacher-Lancet Commission on Sexual and Reproductive Health and Rights in the Post-2015 World, as reported in PassBlue. In an interview by email from Cairo, Serour analyzed what has been happening to women’s reproductive rights and choices and why.
A winner of the 2013 United Nations Population Award, Serour and some colleagues founded the reproductive health training center at Al Azhar in 1976. He charts the political and social influences on women and family planning as a uniquely qualified insider.
“I was not surprised to learn that fertility decline has stalled and to some extent reversed in Egypt,” he said. “This started a few years before the 2011 revolution. During the last few years of President Hosni Mubarak’s government there was shortage of finance to provide commodities for family planning. The Minister of Finance did not release enough money to the ministry to buy commodities. This resulted in a drop in contraception prevalence, increase in fertility rate.”
Called to a cabinet-level meeting with Ahmed Nazeef, the prime minister at the time, the proponents of greater investment in family planning “pointed out to the minister of finance that every dollar spent on family planning will save more than four dollars spent on other health issues, and much more on housing, education, roads, drainage and the environment.”
Egyptian demographers and environmentalists were warning that a country with limited land for cultivation along the Nile was perilously close to widespread shortages of food crops. On the rights of women and girls, Suzanne Mubarak, the president’s wife, had taken up causes such as family planning and the outlawing of female genital mutilation, with the backing of Islamic scholars.
Setbacks followed, Serour said. “After the revolution, and when the Muslim Brotherhood got in office, there was a serious setback in many issues of reproductive and sexual health, including family planning and FGM [female genital mutilation]. Some Egyptian sociologists and demographers said [in interviews with me in 2011] that young Egyptian men returning from work in the Persian Gulf states, especially Saudi Arabia, were bringing radicalized Islamist concepts back to Egypt, and many of the results were felt most negatively by women.
“Certainly what happened in Egypt was reflected also in other countries of the region,” Serour continued. “We all know that reproductive and sexual health services get disrupted in areas of armed conflicts and violence. Women and children, particularly the female child, are the most vulnerable groups in these areas of armed conflict. This was coupled by the fact that most, if not all, who led the violence and got into office represent the extremists.”
Serour argues that there is no place for these negative beliefs and trends in Islam.
“Family planning is not contrary to Islamic Sharia,” he said. “There is no text in the Holy Quran which forbids family planning. On the contrary, coitus interruptus was used as a method of family planning at the time of the Prophet Mohammed, peace be unto him, by his companions and he did not forbid them. Applying the Islamic Sharia rule of Analogy (Kias), temporary methods of contraception available today would be permissible. Permanent methods of contraception are also permissible to save the life of the mother or for prevention of serious fetal abnormalities.”
Egyptian women in cities, many well educated and working professional jobs, have been the least affected in terms of reproductive health, according to the new survey. “The setback in family planning happened mostly in rural areas and to a smaller extent in urban areas, mostly among the low income groups who could not afford the expensive services the higher income groups enjoyed,” Serour said.
Al Azhar University remains supportive of Serour and his work. “However, there are some extremists who are not qualified issuing unauthenticated fatwas forbidding family planning,” he said. “Such fatwas do not resonate or have a major impact among the majority of Egyptians and Muslims at a global level. Family planning programs have been adopted in Egypt since the 50s and early 60s, at the time of President Nasser and are well accepted by the vast majority of Egyptians. For the Shia Muslims, Ayatollahs in Iran also allow family planning.”
Changes are coming for girls and young men and women, who in the past have often had no education in matters of sexuality, personal relationships, women’s rights and family life.
“Reproductive and sexual health and sexuality education is being introduced in the curricula of the schools and universities,” Serour said. “Social media is another source of information for young Egyptians, so the young have a much better understanding about reproductive and sexual health. Certainly, human fertility matters very much to individuals, families, communities, nations and the world at large and therefore it should be in the center of our development plans.”