With a newborn every 15 seconds Egypt has one of the highest population growth rates in the world. According to the 2017 census, there are now 104 million people, meaning Egypt ranks 13th worldwide in terms of population. Egypt has grappled with population growth for years. In 2000 it embarked on intensive efforts to reduce growth rates but following the 2011 uprising they began to climb again. To get back on track a new set of policies is being adopted, including the population and development strategy 2015-2030. 2 Kefaya (Two [children] is enough), a project developed by the Ministry of Social Solidarity, is being launched as part of this strategy. The two-year project works with women covered by the Takaful programme and encourages family planning, Randa Fares, coordinator for population programmes and volunteerism at the Ministry of Social Solidarity, told Al-Ahram Weekly. The Takaful programme provides income support to poor households with children aged up to 18. It also seeks to improve access to jobs, stabilise accommodation and offer literacy courses. According to Fares, the ministry's access to the targeted women via the monthly financial support it already provides and ministry representatives are trusted by the target group. 2 Kefaya project will begin by working with 1.2 million women with between one and three and aims to stabilise birth rates. For women who have one child, says Fares, the importance of spacing child births will be stressed and suitable birth control methods provided. The project will attempt to dissuade mothers of two to three children from raising larger families. The programme seeks to raise awareness and correct misconceptions. Around 60 per cent of the women in the programme are illiterate, says Fares, and many believe children offer support and that large families are stronger. There can also be, she says, “competition between sisters-in-law over who has the most children”, and concerns that if they do not give birth to a son husbands may take another wife. Women spurn birth control methods not out of any health concerns but because they want to have children. “Before speaking about health we have to voice convincing messages to change these misconceptions,” says Fares. One message the programme will stress is that birth control can help lift families out of poverty. A smaller family means the family's income is spread less thinly and can help parents allocate more resources to each child's health and education. The ministry is cooperating with 100 local NGOs to provide door-to-door messaging. Seminars will be held in the 10 governorates with the highest birth rates — they include Beheira, Giza, Beni Sweif, Qena, Luxor and Aswan — and 350,000 home visits are planned. Family planning clinics are being developed in coordination with the NGOs. Equipment will be supplied by the Arab Organisation for Industrialisation. A survey of the targeted women found that 12.6 per cent complained of inadequate access to birth control services. They may be willing to plan their families more carefully, says Fares, but are deterred from doing so by the absence of support. Neighbourhood clinics could help overcome the problem, and mobile clinics serving more remote areas. Alongside improvements in services a comprehensive media campaign, including billboards, will be launched promoting family planning. Even tuk tuks will be branded with family planning messages, says Fares. The project is a cooperative endeavour. The Ministry of Health will provide birth control methods free of charge and medical convoys to distant villages as well as overall supervision of the programme. The Population Council will review the messages being disseminated and monitor and evaluate results. The United Nations Population Fund (UNFPA) is supporting the programme with LE10 million for the training of doctors and nurses who will work in the clinics. The role of nurses, says Fares, is particularly important given up to 30 per cent of women may stop using birth control because they cannot access advice when it is needed. “Catering to those 30 per cent, and to others who want to use birth control but do not have access to services, will make a huge difference to birth control efforts,” she says. UNFPA is also training volunteers who make home visits. The NGO Support Fund, affiliated with the Ministry of Social Solidarity, is providing LE75 million of support to NGOs taking part in the programme. The programme focuses on advocacy and the provision of services. Nothing is forced upon the women, stresses Fares. A Population Situation Analysis (PSA) carried out in 2016 by the National Population Council, UNFPA and the Egyptian Centre for Public Opinion and Research (Baseera) concluded that political instability between 2011 and 2014 had impacted on health services delivery, including reproductive health and family planning. “The lack of advocacy activities supporting the two-child policy and spacing between births coupled with a conservative mindset contributed to turning stalled fertility levels between 1995 and 2005 to an increase in total fertility from three to 3.5 child per women in 2014,” it said. Not only is the birth rate at its highest in years, says Fares, this is happening when there are 18.5 million illiterate individuals and an unemployment rate of 12 per cent. Population growth places severe restrictions on development efforts, eroding positive effects. Every pound spent on family planning efforts, says Fares, saves LE56 from the budget. According to the 2016 PSA the population of Egypt, based on a medium scenario, will be 151 million by 2050. The increase will have a significant impact on natural resources, particularly water and energy, and has serious implications for food security, poverty and social stability. *A version of this article appears in print in the 7 June 2018 edition of Al-Ahram Weekly under the headline: ‘Two is enough'
