DOCUMENT RESUME

ED 088 658 SE 010 503

AUTHOR Croley, H. T. TITLE Country Profiles, . INSTITUTION Columbia Univ., New York, N.Y. International Inst. for the Study of Human Reproduction.; Populaticn Council, New York, N.Y. SPONS AGENCY Ford Foundation, New York, N.Y. PUB DATE Aug 69 NOTE 7p.

EDRS PRICE MF-$0.75 HC-$1.50 DESCRIPTORS *Biographies; Demography; *Developing Nations; *Family Planning; National Programs; Populaticn Distribution; Population Growth; *Population Trends; Social Sciences IDENTIFIERS *United Arab Republic

ABSTRACT. A profile of the United Arab Republic is sketched in this paper. Emphasis is placed on the nature, scope, and accomplishments of population activities in the country. Topics and sub-topics include: location and description of the country; population (size, growth patterns, age structure, urban/rural distribution, ethnic and religious composition, migration, literacy, economic status, future trends); population growth and socio-economic development (rel?tionships to national income, size of the labor force, , social welfare expenditures); history of population concerns; population policies; population programs (objectives, organization, operations, research and evaluation); private efforts in family planning; educational and scientific efforts in population; aad foreign assistance for family planning activities.(RH) Issued by The Population Council and The International Institute Country Profiles for the Study of Human Reproduction, Columbia University U S DEPARTMENT OF HEALTH. EDUCATION & WELFARE NATIONAL INSTITUTE OF EDUCATION THIS DOCUMENT HAS BEEN REPRO August1969 DUCE D ExACTLY AS RECEIVED FROM THE PERSON OR ORGANIZATION ORIGIN ATINc, IT POINTS OF VIEW OR OPINIONS p STATED DO NOT NECESSARILY REPRE SENT OFFICIAL NATIONAL INSTITUTE OF EDUCATION POSITION OR FOLIC"( a with an average household size of UNITED ARAB 5.27 persons.' Based on preliminary reports from REPUBLIC the 1966 census there were 4,917,000 married women in the 15-49age group and 4,406,000 from 15 through 44. T Growthpatterns.The recorded THIS profile was prepared by Dr. H. T. Croley, Program Advisor,birth rate has fluctuated between 39.3 Population, the Ford Foundation, , United Arab Republic. It is pub-and 44 per 1,000 over the past 60 lished here with the permission and approval of Dr. Abdou M. Sal lam,years, with 39.3 the estimated rate Minister of Public Health, United Arab Republic. for 1967.° During the same period the death rate dropped, almost steadily, from 26 to 14.3 with a corresponding increase in the growth rate from 17 to Location and Description1 is man-made to meet the needs of the25.4 per thousand.' The United Arab Republic, or whatSuez Canal. is known to many as , is in the The Egyptian people have been RURAL/URBAN DISTRIBUTION northeast corner of the African con-and still are dependent upon the life-The U.A.R. is still primarily rural but tinent and is linked to Asia by thegiving qualities of the for sur-there has been a gradual decrease in . For the most partvival. In the past the systematicthe rural/urban ratio from 79:218 in the country is desert outside the Val-utilization of the Nile compelled the1917 to about 60:40 in 1966.° There ley of the Nile. Only 3.5 per cent ofpeople to create an advanced socialare fourteen cities with populations the land is inhabited, and only 2.5organization, from which evolved thegreater than 100,000; in 1966 Cairo per centis capable of producingfirst nation-state. The High Dam athad 4,219,853, Giza (which adjoins crops. The total area of the countryAswan holds promise for changing theCairo) 571,249, andAlexandria is 386,000 square miles (about 1,000,-U.A.R. from an agrarian state into a 1,801,056.1° 000 square kilometers). modern industrial-agrarian state. The rural/urban differential in birth The Mediterranean coastal fringe and fertility rates found in some coun- receives rain for about six months ofPopulation the year but elsewhere there are only SIZE AND GROWTH PATTERNS Personal communication with the Insti- tute of Statistical Studies and Research, light showers or no rain at all. It is Size. The population of the U.A.R. Cairo. hot during the day in spring and sum-has tripled in the last 70 years, dou- 5Malek M. El-Nomross:r, "Statistical Re- mer and very hot in the south, butbled in the last 30 years and accord-port," (Unpublished pape:), 16 December usually the temperature fans sharplying to the census was 30,075,8582 in 1966, p. 15. 6United Nations, Demographic Yearbook, after sunset. Autumn and winter are 1966.By December 1968 it had 1967, (New York: United Nations, 1968) mild by day and cool at night. Theregrown to an estimated 32,025,000.8 p. 233. are people in the oasis of the WesternThe population density of the inhab- 7Haifaa Shanawany, "Family Planning: An Equilibrium Response to Demographic Desert, the largest center of popula-ited area (3.5 per cent of the totalConditions. in the United Arab Republic tion being at Fayoum. The only etherarea) is almost 2,400 per square mile. (Egypt)," (unpublished Ph.D. dissertation, major center of population outside Number of households. The 1966 CornellUniversity, 1967), p. 21; Central the Nile Valley is on the Isthmus ofcensus reports 5,705,671 householdsAgency for Public Mobilization and Statis- tics,Statistical Handbook of theU.A.R., Suez, but even this community is 1952-1967, p. '1. watered artificially from the Nile and 8Abdd Farah, Rural Population in the U.A.R., Statistical Department, Cairo, 2 Central Agency for Public Mobilization 1963, p. 6, cited by Shanawany, op. cit.,p. 64. and Statistics, U.A.R., Evaluation of the Pop- 9Central Agency for Public Mobilization Based primarily on: Torn Little, Modernulation of the U.A.R., November 1967, p. 3and Statistics, U.A.R., U.A.R. Statistical Egypt New York: Frederick A. Praeger, (). Atlas, 1952-1966, p. 10. 1967), Chapter I. 3U.A.R. press releases. to United Nations, op. cit.,p. 208.

1 tries does not seem to obtain in thereported by the UN results in a me-the economy did not develop at a U.A.R. Shanawany " cites studies bydian of 27.75 in 1966." comparablerate.Many changes, Cleland (1906-early 1930's),Kiser which arrested this trend, took place (1931 data), and El-Badry (1947), LITERACY in the economy following the revolu- none of which found a rural urbanAlthough the literacy rate for the tion in 1952. The 1952 peg capita in- fertilitydifferential.Zikri'sstudyU.A.R. is low, particularly for fe-come of $86.00 increased by 36 per (1960) actually found a higher urbanmales, it did rise gradually from 1927cent during the next eight years. At fertility rate. Shanawany also men-to 1947 and took a sharper upwardconstant prices the annual compound tions Rizk's study of 2,000 urban, al-turn in the 1960 census. The latter israte of growth in per capita income most 700 semi-urban and 3,000 villageprobably the result of increased em-was 2.37 per cent", and from 1959-60 women (reported in Rizk's disserta-phasis on education in recent years.to 1964-65 it was 3.9 per cent.21 tion, 1959). Rizk found the rural. In 1960 the literacy rate for men was urban difference in number of live44.8 per cent and for women 16.4 per RELATIONSHIP TO SIZE OF LABOR births was not statistically significant.cent." Children below ten years of FORCE age were not included in these figures. From 1960 to 1965 the labor force RELIGIOUS COMPOSITION Urban/ruralcomparisonsarenotincreased from 6 million to 7.3 mil- The distribution of population by re-available for 1960, but in 1957 thelion but,, considering the population ligion has remained rather constanturban literacy rate for males wasgrowth, this only represented an in- throughout this century. Excludingtwice as great as for their rural coun-crease from 23 per cent to 25 per cent the frontier districts, which accountedterparts and the rate for urban womenof the total population. The per cent for 1.1 per cent of the population, thewas four times as great as for ruralemployed in agriculture decreased religious distribution in 1960 was aswomen. from 54.3 to 51.5 while the percentage follows: Moslem, 92.2 per cent; Chris- in the industrial sector increased from tian, 7.5 per cent; and Jewish, 0.3 FUTURE TRENDS 10.2 to 11.2.22 It has been estimated per cent.12 The latest government figure fol pop-that the annual addition to the man- The average number of live birthsulation growth is 2.54 per cent but itpower pow is 27 times the number of for urban and rural Moslems andis likely that the actual growth rateindustrialworkersthatcanbe rural Christians is quite similar, 7.07,is closer to 3.0 per cent. It is hopedabsorbed." 7.61, and 7.44 respectively. However,that the rate can be reduced to 1.7 urban Christians have an average ofper cent by 1975. If the rate of 1.7 per RELATIONSHIP TO AGRICULTURE 5.54 live births." cent could be achieved immediately,Land reform was one of the main and maintained, there would be 45.0socio-economic changes that took AGE AT MARRIAGE million people in 1988; if the rateplace after 1952. Although the new Data available on age of marriage areof 3.0 per cent continues there wouldgovernment may have been successful quite conflicting. Zikri" reports thatbe 58.35 million by 1988. inredistributingtheagricultural the average for women was 20.3 in The life expectancy at birth forwealth, it had a negative effect on 1947 and 19.2 in 1960. However, com- men rose from 35.65 in 1936-38 tomitigating the problems of overpopu- puting medians from age distribution51.6 in 1960; for women it rose fromlation. It resulted in increased un- data in the 1960 census results in a41.48 to 53.8.18 These changes with-employment because many families median age at last birthday of 25.6out a comparable decrease in birthpreviously employed, or under-em- for bachelors marrying spinsters andrate have resulted in the very highployed, by large landowners as per- 17.25 for spinsters marrying bache-ratio of 95 people in the non-produc-manent or casual laborers could not lors.15 Analysis of the frequency dis-tive age group for every 100 people infind employment with the new class tribution of age of marriage for menthe productive age group (15-59) inof landowners whose small holdings 1960.'9 could be cultivated by the owner- family." 11 Haifaa Shanawany, "Overall Aspects of Population Growth and Socio- thePopulation Probleminthe U.A.R. Economic Development (Egypt),"pp.9-10.(Mimeographed.) A shorter version A' this paper was published in RELATIONSHIP TO NATIONAL INCOME 20 Magdi M. El-Hammash, "An Analysis Mid-East, September-October 1968. The growth of population from al-of the Process of Development of the Egyp- 12 S.O.P. Press, Vital Statistics, Cairo, 1961, tian Economy with Special Reference to the pp. 86-87, cited in Shanawany's dissertation, most 13 million in 1917 to almost 22 Supply ApproachtoEconomic Develop- op. cit., p. 80. million in 1952 resulted in a sharp ment,"(unpublishedPh.D.dissertation, 13 Hanna Rizk, "Patterns of Fertility in Se-decline in per capita income because Duke University, Durham, N.C., 1965) p. 335, lected Areas in Egypt," (unpublished Ph.D. cited in Shanawany's dissertation, op. cit., dissertation, Princeton University, Princeton, p. 95. N.J., 1959), pp. 48,106, cited in Shanawany's xi , Sanawat El Tahoul El Ishtiraky dissertation, op. cit., pp. 81-82. Wa Takeem al-Khita al-Khammassia a/-Aula 14 Abdel-Khalik M. Zikri, "Socio-Cultural 14 United Nations, op. cit., p. 749. (Cairo: Dar El Marrif, 1966), pp. 56-61, cited Determinants of Human Fertility in Egypt, 12 Central Statistical Committee, Basic Sta-in Shanawany's dissertation, ibid., p. 96. U.A.R.," (unpublished Ph.D. dissertation, tistics, (Cairo S.O.P. Press, 1962). p. 176, cited 22 Ali Sabri, ibid., p. 74, cited in Shana- Syracuse University, Syracuse, N.Y.) p. 114. in Shanawany's dissertation, op. cit., p. 198. wany's dissertation, ibid., p. 97. 15 Department of Statistics and Census, 18 United Nations, op. cit., p. 708. 23 Attributed to Hanna Rizk, reference not Vital Statistics, 1960, Vol. II, Cairo, 1963, 12 Ibid., p. 148. Based on population by age available. pp. 290-91. distribution. 24 Shanawany's dissertation, op. cit., p. 98.

2 From 1937 to 1965 the population1953, shifted back and forth in terms Although the Charter statement of increased by 84.5 per cent, while theof support for family planning and in 1962 marked the beginning of an production of staples changed as fol-its attitude toward population as anofficial policy, it was the Presidential lows: wheat, +21 per cent; beans,asset or a liability, most of the state-Decree of November 1965 and Prime +18 per cent; rice, +180 per cent;ments by President Nasser in the six- Minister Zakaria Mohieddin's speech maize, 7 per cent." ties weye in favor of family planningat the National Assembly the follow- The Aswan High Dam will add twoand opposed torapidpopulationing month that marked the first step million acres to the six million acresincrease. in translating policy into program. previously under cultivation. How- Through its various channels ofThe Prime Minister's speech referred ever, the population increased by 23communicationtheRevolutionaryto a budget for a family planning pro- per cent during the construction ofGovernment brought hope to the peo-gram and the creation of the Supreme the dam, a period that does not in-ple, but the resulting expectationsCouncil for Family Planning. clude the time needed to bring all ofrose much faster than the Govern- There has been considerable inter- the additional land under cultivation.ment's ability to meet them. Also theest recently in emigration as a na- From 1877 to 1960 (when construc-extension of free medical care, in-tional policy. Traditionally the Egyp- tion of the High Dam began) the landcreased employment, higher wages,tians have been one of the least mi- under cultivation increased by 26 perand the redistribution of land fosteredgratory people. According to Shana- cent while the population more thanan increase in population. This in-wany it was estimated that 25,000 tripled." creasing pressure on the governmentEgyptians lived abroRd in 1937 and resulted in the following statement in100,000 in 1962. RELATIONSHIP TO SOCIAL WELFARE the National Charter of the U.A.R., EXPENDITURES 21 May 1962: Following the conflict in Information on the changes in ex- 1967, a drastic change has taken place in This [population] increase constitutes government policy. Emigration has been penditure for education and health is . the most dangerous obstacle that faces encouraged openly in the press. . . not readily available; however, onethe Egyptian people in their drive to-According to Abdel-Meguid El Abd, can obtain some idea of the change wards raising the standard of productionHead of the Central Organization of in their country in an effective and effi-Training, in a report presented to the from the increase in services. From Council of Ministers, 9,379 persons mi- 1953-54 to 1966-67, while the popu-cient way." grated within a period of four months lation increased by 50 per cent, the (January-April 1968), mostly to Arab number of classrooms and teachers This statement can be regarded ascountries. Out of these 1,342 had to and the bed capacity of hospitals al-the beginning of a national popula-return back because they did not find most doubled." tion policy. A variety of factors thatjobs." contributed to its development are Population Policy best summarized- in President Nas- Shanawany does not see emigration ser's later statement, "We must applyas a solution to the population prob- Shanawany" has divided the develop-birth control because our require-lem because it would require the emi- ment of a population policy into four gration of 250,000 annually to bring stages: the stage of indifferent aware-ments are more than the existing potentialities." 3° about a radical reduction in popula- ness (1922-51); the stage of experi- The next paragraph in the Chartertion growth." mentation (1952-61); the beginningemphasize: the serious family plan- of a population policy (1962-65); and ning effort that must be made, but itPopulation Programs the stage of attempted coordinationis not completely optimistic about the (1966). The latter stage had justpossibility of success: OBJECTIVES begun at the time of her writing. The To date a comprehensive national Presidential Decree promulgated on While the attempts at family planning plan for family planning has not been 13 November 1965 established theto face the serious problem of increasingdeveloped. In a less formalized way Supreme Council for Family Plan-population deserve the most sincere ef- policies, objectives, targets, etc., have ning. This was followed by the begin-forts supported by modern scientific methods, the need for the most rapid andemerged from the meetings of the ning of the national family planningefficient drive towards increased produc-Supreme Council for Family Plan- program in February 1966. tion necessitates that this problem bening. However, because of the pre- Although the Government, sincetaken into consideration in the processoccupation with the military situa- of production regardless of the effects which may result from the experiment oftion, no meetings were held from the time of the June War in 1967 until the 28 Central Agency for Public Mobilization family planning.n and Statistics, Statistical Atlas, op. cit., pp. first part of 1969 when a new chair- 39-51. man was appointed for the Council. 28 F. Hefnawi and A. Hanafi Mahmoud, It was not until 1967 that growth "Attempts Towards the Control of Popula- 29 The Charter (Cairo: Information Depart- tion Problem in Egypt," (unpublished paper, ment, U.A.R.), p. 61 (English translation). 1968) p. 2. ao , Address at the Pop- TY Central Agency for Public Mobilization ular Rally at Suez on the Occasion of its Na- and Statistics, Statistical Handbook, 1952- tional Day (Cairo: Ministry of National 1964, pp. 128-133; and Statistical Handbook, Guidance, 22 March 1966) p. 15, cited in 32 Shanawany, "Overall Aspects of the Pop- 1952-1967, pp. 170-173. Shanawany's dissertation, op. cit., p. 236. ulation Problem," op. cit., p. 12. 28 Shanawany's dissertation, op. cit., p.134. 31 The Charter, loc. cit. 88 Ibid., p. 12.

3 rate targets were established: 2.35 per planning methods and to advise onthe interim it hopes to provide medi- cent in 1968; 2.25 per cent in 1969media;(2)Statistical and Demo-calandfamilyplanningservice and 2.1 per cent in 1970." Various un-graphic Research Committee, respon-through mobile clinics. documented references cite a growth siblefor social and statisticalre- rate of 1.7 per cent as the goal forsearch; and (3) Guidance and Pub- OPERATIONS 1975; however, the targets mentionedlicity Committee for disseminatingPolicy-making, targets, methods of were established prior to the war inthe aims and values of family plan-implementation and similar coordi- 1967 and did not anticipate the re-ning and organizing the ways andnating functions are carried out at the sultant disrupting effect upon themeans of doing this. General andnational level. Implementation of the program. In early 1969 interest in thespecial committees can be formed byprogram and the day-to-day super- program was renewed and prospectsthe chairman of the Executive Boardvision is at the governorate level. for an acceleration of effort increased. fromthemembershipoftheseAlthough some feel the main empha- There has been some interest incommittees. sis should be on a postpartum pro- social change as a means of lowering LocationWithin the Government.gram, this is only one aspect of the the growth rate and a new marriageThe U.A.R. is divided into twenty-total family planning program that law was drafted to raise the minimumfive governorates. In 1966 the Primeincludes all health facilities. Primary age for marriage from 18 to 25 forMinister decreed that governorateimportance is given to the oral pill men and from 16 to 18 for women, levelfamilyplanning committeeswith the IUD receiving secondary but as yet it has not passed.3' were to be formed and chaired by theemphasis. The IUD programis governor with representation frommainly urban, as only 17 of the 500- ORGANIZATION severalgovernmental departments600 physicians trained for IUD inser- Structure. The Presidential Decreeand the private sector. The familytion are in rural facilities. of 13 November 1965 established theplanning committees are charged with Methods. At present oral contra- Supreme Council for Family Plan-executing the decisions of the Su-ceptives and IUDs are the only meth- ning, chaired by the prime ministerpreme Council's Executive Board,ods offered through the National and composed of eight ministers andstudying the suggestions given onFamily Planning Program clinics; the the head of the Central Agency forfamily planning at the governorateIUDs are only offered in about one- Public Mobilization and Statistics.level and 'milting difficulties that pre-fifth of the clinics, primarily urban. It The Supreme Council is the policy-vent the execution of the plan andis anticipated that more physicians making body and its decisions afterovercoming such difficulties or sug-will be trained in the fall of 1969 for approval are final aid effective for allgesting solutions to solve problems atIUD insertion, which will make this ministries,governorotes and otherthe local level. method available to a much larger governmentalorganizations.The The governorate executive bureausegment of the population. IUDs and Council is freed from all rules and(one in each governorate) has theoral contraceptives are manufactured regulations appliedto other gov-director of health as the president;locally with imported raw materials. ernmental departments, particularlythe director of the executive bureauIn addition to availability in the gov- those pertaining to personnel, salariesof family planning is the administra-ernment operated clinics, the pills are and overtime. tor. Membership consists of repre-also for sale at private pharmacies for Reporting to the Council is thesentatives of several governmental20.5 piastres ($.47) per cycle. The Chairman of the Executive Boarddepartments. The bureau is respon-plan has been to have a six-month re- who is assisted by three general de-sible for coordinating the work of theserve supply of oral contraceptives. partments: (1) Department of Tech-Executive Board and the Governor-However, this has become increas- nical Affairs; (2) Department of Pro-ate Board for Family Planning, im-ingly difficult to maintain because of vincial Executive Bureaus, to whichplementing regulations of the Execu-the shortage of foreign exchange. is attached the bureau in each of thetiveBoard, and supervising and Abortions and sterilizations may be twenty-five governorates and the ap-inspecting units administering familydone to save the life of the mother, proximately 2,700 (spring 1969) cen-planning services in the governorate.but neither are part of the family ters that provide family planning At the beginning of the program inplanning program. Recent registra- services; and (3) Department of Fi-1966 (February) there were 1,991 cen-tions from two university hospitals nancial and Administrative Affairs. ters for family planning services. Byreport two births for each abortion. In addition, the Executive BoardOctober 1968 there were 2,667 cen-Injectibles are being used in research has three advisory committees: (1)ters.36 These centers are located soprograms as are various types of Medical and Training Committee tothat they are within walking distanceIUDs. Condoms are available through sponsor studies relatedto familyof two-thirds to three-fourths of theshops and pharmacies but receive population. The government plans tovery little promotion and are not increase the number of centers so asmanufactured locally. Clinics oper- Malek Mohamed El-Nomrossy, "The Na- tionalFamily PlanningProject,October to serve all of the people, but duringated by the Egyptian Family Plan- 1965-December 1L67," pp. 126, 139 (unpub- ning Association provide other types lished paper). of contraceptives, and itis antici- 3. A ppendix of a paper prepared by the Rule 35 Malek M. EI- Nomrossy, "The Population of F.aw Research Center, Duke University, Problem and the National Family Planning pated that all health facilities will U.S.A. on family planning M the U.A.R. Date Program in the U.A.R.," (Mimeographed) offer several different types in the unknown, but after 1965. p. 6. near future.

4 Budget. The budget for 1968-69Planning Program have full-time re- facilitiesofferingfamily planning was LE 800,000 ($1,840,000). Thissponsibilities in other positions andservicesexpanded from1,991to was used for the purchase of rawreceive 30 per cent additional salary2,667.38 By October 1968 the Govern- materials and the manufacture offor time devoted to family planning.ment reported that 88,144 IUDs had contraceptives, payment of incen-During the first year of the program,been inserted (about 85,000 in urban tives, publicity, part-time salaries and98 per cent of the personnel why ereareas), and that there were 254,437 the operating expenses of the pro-working in family planning wire as-continuing users of oral contracep- gram. Expenses not included in this,signed to family planning work on atives.4° In addition 100,000 IUDs but which should be considered aspart-time basis from other govern-have been distributed to private clin- part of the contribution of the gov-mental departments." In Decemberics, and it is estimated that 50,000 of ernment toward the program, would1967 there were 3,000 doctors, 1,200these have been inserted." In 1967, be part of the cost of building andsocial workers and 4,300 nurses and800,000 cycles of oral contraceptives maintaining the units that providemidwives working in the program.38 were reported to be sold through pri- family planning services in addition Five-hundred to six-hundred phy-vate pharmacies and in 1968 this had to other services. sicians have been given specific train-increased enough to supply 120,000 Health facility personnel are noting for IUD insertion; all physicianswomen." paid for their additional three after-received some training in reproduc- It is difficult to translate these fig- noons of family planning work pertive biology and contraceptive tech-ures into number of births prevented. week except for what might be callednology while assigned to the obstet-The best one can do is to estimate a commission. The charge to the cli-rics and gynecology section as part ofthat, if all of these contraceptives ent for oral pills is 10 piastres ($.23),their internship. However, neitherwere used by married women in the which is divided between the doctorsocial workers nor nurses have re-fertile age group, 2 per cent of them (50 per cent or 60 per cent dependingceived any training in family planningthrough the national program and 1 upon whether urban or rural) andbeyond what they may have receivedper cent through private clinics had other health facility staff. The staffin their academic education and on-an IUD inserted at some time during also receive LE 1.000 ($2.30) for eachthe-job experience. Some training hasthe first 21 months of the program. IUD inserted that remains in placebeen provided to personnel working(IUDs were not available through the for one month. This is divided in sim-in data collection in the governorates.National Family Planning Program ilar fashion. In addition, each person for the first six months.) There were who recruits an IUD client receives RESEARCH AND EVALUATION 5.5 continuing users of oral contracep- 50 piastres ($1.15). Quite often thisVarious studies have been done totives for every 100 married women in goes to the social worker. learn more about the characteristicsthe fertile age group; and, if the Personnel. Most of the medical andof acceptors and their experience withmonthly sale of the orals was constant para-medical workers in the familycontraceptives but these studies arethroughout 1968, the comparable rate planning program are not recruitednot done on a regular basis. There areof continuing use of oral contracep- specifically for the program, as theyno data on continuation rates for IUDtion in the private sector was 2.6 per are already employed by the healthor pillusers that allow for inter-1C3. The average age of the oral con- ministry. Regular clinical personnelnational comparison. traceptive client was 33.2 years and (physicians,nurses, social workers Accomplishments. From Februarythe average number of living children and helpers) in each health facility1966, when the program began, untilwas 4.6. are expected to work three afternoonsOctober 1968 the number of health A study" of 62,298 women clients a week beyond theofficialclinic in 42 voluntary centers of the Cairo hours. The administrative line of au- Family Planning Association noted thority is with the Ministry of Health the characteristics shown in Table 1. and not with the National Family 37 Malek M. El-Nomrossy, "Statistical Re- The same study" reported a drop port," 30 December 1966, p. 5 (unpublished Planning Program's Executive Board.paper). in birth rate from 58.1 to 31.6 and Some of the top administrative 33 El-Nomrossy, "National Family Plan-54.3 to 37.1 from 1963-67 in two vil- personnel of the National Familyning Project," op. cit., p. 60. lages with family planning services and from 55.9 to 46.0 in a village without such service. The national TABLE 1. Characteristics of Family Planning Clients

Urban Industrial Urban 3° El-Nomrosay,''PopulationProblem," characteristic Middle Class Area Poor Rural op. cit., p. 16. 4° Ibid. Average age at clinic visit 28.5 30.7 30.2 32.1 41 Ibid. Average age at marriage 21.3 17.5 18 16.9 42 Ibid., p. 16. 9.2 12.7 13.3 Average number of pregnancies 6.6 43 M.I. Ragab and M.B. Sammour, "A Average number of living children 2.6 5.6 4.6 4.5 Socio-Medical Study on Sixty Thousand Average time period since Women Attending for Family Planning," Ain last pregnancy (in months) 15.4 12.1 8.3 10.1 Shams Medical Journal, Vol.18, No. 2, October 1967. Number of respondents 19,420 8,396 16,903 5,328 44 Ibid., p. 79.

5 birthratedeclined gradually andof Social Affairs. Then this became Foreign Assistance steadily from 42.8 to 39.3 during thethe Egyptian Association for FamilySeveralinternationalorganizations same period. Planning, and the Alexandria Familyhave provided varying degrees and The oral contraceptive programPlanning Society was founded intypes of assistance. This has taken the had stabilized by December ) 967 with1962. It was mainly late 1963 thatform of fellowships and travel awards, only 8.6 per cent of those who at-the subject of family planning wasadvisors and consultants, vehicles, tended being reported Lt,:.; newcom-brought out into the open, and theoffice and media production equip- ers.4:, "An analysis of the decrease ofCairo Women's Club started a seriesment, and support for research and newcomers in the last two years (1966 of lectures delivered in Egypt to non-training activities. Participating or- and 1967) . . indicates that themedical people on the topic. Theganizations are or have been: the Ford decrease depended entirely on the de-series provided an important sourceFoundation, the Population Council, gree of activity undertaken by thefor information on family planning tothe Pathfinder Fund, International social workers." 46 reach the Egyptian newspapers. InPlanned Parenthood Federation April 1964 a group of 22 women's(IPPF), Cooperative for American Private Efforts'' voluntary organizations joined forcesRelief Everywhere (CARE), United The development of voluntary effortsto become active in family planning.Nations International Children's in family planning in the United ArabThey formed a Joint Committee ofEmergency Fund (UNICEF), United Republic has been closely related toWomen's Organizations which, afterNations Development Program and progressintheemancipationofone year of trial using their own re-the Government of Denmark. women. As such, one can think ofthesources, was sponsored and financed beginning of the movement datingby the Ministry of Social Affairs and Publications hack to the early 1920'1, when Mrs.international agencies, and set in op- Hoda Shaarawi, founder of the Egyp-eration 28 family planning clinics. BySeveral Egyptian journals publish ar- Union,challengedspring 1969, through the Egyptianticles dealing with family planning, tian'Feminist population, reproductive biology and :',:gypl,ian society by throwing her veil FamilyPlanningAssociation,the Ministry of Social Affairs was spon-contraceptivetechnology.Among into the Mediterranean. these are: The Egyptian Population In 1953 the new government estab-soring 361 clinics. In 1968 the Egyp- tian Family Planning Association re-and Family Planning Review, The lished a high level commission, the Journal of Endocrinology and Metab- Natio: ial Committee for Populationceived LE 50,000 ($115,000) from the Problems, to undertake studies inMinistry forgeneral support andolism, Gazette of the Egyptian Society demographic and other related as-30,000 Sterling ($72,000) from theof Gynecology and Obstetrics, Bulle- Danish Government through the In-tin, Alexandria Faculty of Medicine, pects of the population problem with Journal,The ternational Planned Parenthood Fed-Ain-Shams' Medical the objective of making recommenda- Journal of the Egyptian Medical Asso- tions on population policy. Towarderation for medical equipment. Prior to the initiation of the National Fam-ciation, The Egyptian Journal of So- the end of 1955 the Committee estab- cialMedicine,Proceedings of the lished and supervised eight familyily Planning Program the clinic staffEgyptian Academy of Science, Jour- planning clinics in Cairo and Alexan- of the Association had inserted ap- nal of the Egyptian Statistical Associa- dria using the facilities of the volun-proximately 18,000 IUDs. The Asso- Proceedings of the Egyptian tary organizations working in theciation has been active in keeping tion, Statistical Conference (annual), field of social service. No publicitythe need for family planning beforeMedical Journal of Cairo University was allowed, and women heard aboutthepublic,providing training for Gazette of these clinics only by word of mouth. (incorporated with the family planning workers and operat-Kasr-El-Aini Medical Faculty), and There was so much secrecy about theing clinics. clinics that the press had no access to monthly newsletters and other pub- information on their activities. In lications by the Egyptian Family Educational and Scientific Efforts Planning Association. 1957 the Committee was transferred in Population to a non-governmental organization called the Egyptian Association forThe Central Agency for Public Mo- Summary Population Studies, although financ-bilization and Statistics is responsibleThe United Arab Republic is quite ing continued through the Ministryfor the census and related activities.fortunate in having a large network Organizations involved in researchof health facilities through which fam- and training are the departments ofily planning services can be provided. obstetrics and gynecology and publicIt has a strong and active voluntary 45 El-Nomrossy, "National Family Plan-health in the medical faculties, theassociation which operates clinics and ning Project," op. cit., p. 64. Cairo Demographic Center, the In-does much to publicize the impor- 46 Ibid., p. 70. tance of family planning. The U.A.R. 47 The material in this section is based onstitute for Statistical Studies and Re- discussions with Mrs. Aziza Hussein, Presi-search, the Social Research Center ofis unique among developing countries dent, Cairo Family Planrig Association; the American University in Cairo andin that it has a large number of well Dr. Haifaa Shanawany, Director, Egyptian Family Planning Association; papers by these the Egyptian Society for Populationtrained, highly qualified professional two ladies; and Dr. Hasan Husein's chapterResearch. Secondary schools includepeople.TheMinisterofPublic in Family Planning and Population Programs, some discussion of the populationHealth, appointed in February 1969, edited by Berelson et al., (Chicago: University is a long-time friend of family plan- of Chicago Press, 1966). problem in their geography course. 6 ning and is highly respected in thedecisions and the power to enforcefertility control as well as educational professional community.Itisex- them within the policy limitations es-programs that provide the husband pected that he will do much to re-tablished by the Supreme Council. with information and recognition of vitalize the program. Transportation Knowing the number who starthis known influence in determining and communication are good. Thecontraceptive practice is important,whether his wife adopts and how long Presidential Decree of 1965 is ideal inbut this has little meaning for num-she continues to use contraceptives. terms of establishing and giving sanc-ber of births prevented unless contin- tion to the program and providing auation rates are known. The ultimateEpilogue legal basis for considerable flexibilitycriterion of success is the lowering ofThe preceding report reflects the sta- in its implementation. Public healththe birth rate. Perhaps a populationtus of the program as of spring 1969. and obstetrics and gynecology facul-growth study is needed to obtain con-It is anticipated that the next twelve ties have taken and are continuing totinuing feedback on the effects of themonths will see considerable improve- take considerable responsibility forprogram and to obtain, on a samplingment in the organization and imple- research and training in the medicalbasis, a degree of accuracy that can-mentation of the family planning aspects of family planning. not be expected from a large nationalprogram under the leadership of the As is true of all family planningcensus. Other data of considerablepresent Minister of Public Health. A programs, the one in the U.A.R. hasvalue to the administrator, which arestep in this direction was an all-day certain problems. The shortage ofnot obtained in a census, could alsomeeting on 7 June 1969 of the foreign exchange to purchase raw ma- be gathered. who had visited family terials for the production of oral con- A full-time qualified training staffplanning programs throughout the traceptives could seriously damageis required for the pre-service andworld and/or had studied family the program by undermining thein-service training of family planningplanning and population abroad; ad- confidence of the users in the abilitypersonnel. Training should be contin-ministrators of the Egyptian pro- of the Government to guarantee aually available for new persons enter-gram; and religious, political, educa- continuing supply. A client lost be-ing the program and, equally impor-tional and other leaders. This meeting cause of unavailability of pills will betant, in-service training should con-of more than 200 people was called a difficult one to bring back and cantinue so that family planning staffby the Minister so that he could ob- become a highly vocal opponent ofcan be kept up to date on the latesttain their ideas on how the program the program. developments in the field. could be improved. This will be fol- Slowing population growth is per- Too often mass media are equatedlowed by meetings of the Minister haps more important to the economicwith education. Mass media are im-with smaller groups for more detailed future of Egypt than the constructionportant but thereisconsiderablediscussion of the specific methods for of the High Dam. The efforts todoubt that they can do any more thanimproving the program. achieve this control require just asinform. Most people need education Although this in itself will not solve much careful planning, good adminis-in addition to information. They needthepopulationproblemsinthe tration, setting of targets, evaluationto learn why family planning is im-U.A.R., such involvement of the most of progress and training of personnelportant to them and how it can helpknowledgeable and best qualified peo- as was true for the Hig:. Dam. Athem to achieve their goals. This canple in the decision-making process is national plan for family planning canbest be done on a person-to-personan important and constructive ap- provide the framework within whichbasis. The clinic social worker shouldproach to revitalizIng the program. problems can be identified and thebe trained to be more of a community means of dealing with them imple-worker so that she can recruit clients mented. from the community, not just from This is part of an information service Full time staff is needed in thethe clinic. provided by The Population Council upper administrative echelons, and Greater recognition needs to be and The InternationalInstitute for the director of the program must begiven to the importance of men in the the Study of Human Reproduction, high enough in the government hier-family planning program. Provision Columbia University, under a grant archy to have the freedom to makeshould be made for male methods of from The Ford Foundation.

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