Demographic and Health Survey 1988 Egypt National Population Council @DHS Demographic and Health Surveys Institute for Resource Development/MacroSystems, Inc. Egypt Demographic and Health Survey 1988 Hussein AbdeI-Aziz Sayed Magued I. Osman Fatrna E1-Zanaty Ann A. Way Egypt National Population Council Cairo, Egypt Institute for Resource Development/Macro Systems, Inc. Columbia, Maryland USA October 1989 This report presents findings from the Egypt Demographic and Health Survey (EDHS). The survey was a collaborative effort between the National Population Council and the Institute for Resource Development/Macro Systems, Inc. (IRD). The survey is part of the worldwide Demographic and Health Surveys (DHS) Program, which is designed to collect data on fertility, family planning and maternal and child health. Funding for the survey was provided by the Agency for International Development (Contract No. DPE-3023-C- 00-4083-00) and the Government of Egypt. Additional information on the EDHS can be obtained from the National Population Council, P.O. Box 1036, Cairo, Egypt. Additional information on the DHS Program can be obtained from the DHS Program, IRD/Macro Systems, Inc., 8850 Stanford Blvd., Suite 4000, Columbia, MD 21045, USA (Telephone 301-290-2800; Telex: 87775; FAX: 301-290- 2999). FOREWORD The 1988 Egypt Demographic and Health Survey (EDHS) is the most recent in a series of surveys carried out in Egypt to provide the information needed to study fertility behavior and its determinants, particularly contraceptive use. The EDHS findings are important in monitoring trends in these variables and in understanding the factors which contribute to differentials in fertility and contraceptive use among various population subgroups. The EDHS also provides a wealth of health-related information for mothers and their children, which was not available in the earlier surveys. These data are especially important for understanding the factors that influence the health and survival of infants and young children. In addition to providing insights into population and health issues in Egypt, the EDHS also hopefully will lead to an improved global understanding of population and health problems as it is one of 35 internationally comparable surveys sponsored by the Demographic and Health Surveys program. This report presents key results from the EDHS. It highlights basic findings relating to fertility levels, childbearing intentions, and contraceptive knowledge and use. It also looks at key maternal and health indicators including the extent to which mothers receive trained medical care during pregnancy and at the time of delivery and, for young children, the extent of immunization coverage and the prevalence and treatment of diarrheal disease. The challenge that remains is to use the information in this report as a basis for evaluating and modifying family planning and health service delivery in Egypt. The EDHS data will only truly be useful when they are employed to improve the design and implementation of population and health programs in Egypt. Finally, I would like to express my appreciation to the EDHS team for their efforts in completing the survey. Their diligence has enabled population and health policy makers and program planners to have access to this vital information in a very timely fashion. Prof. Dr. Maher Mahran Secretary General National Population Council ACKNOWLEDGEMENTS The Egypt Demographic and Health Survey (EDHS) represents the continuing commitment in Egypt to efforts to obtain data on fertility behavior and contraceptive practice. The survey also reflects the strong interest in information on key maternal health and child survival issues. The wealth of demographic and health data that the survey provides will be of great use in evaluating the performance of the family planning and health programs and in charting future directions for these programs. This important survey could not have been implemented without the participation of a large number of institutions and individuals. The National Population Council under the leadership of Prof. Dr. Maher Mahran has provided logistical support throughout the survey. Prof. Dr. Mahran has shown keen interest in the survey findings and a continuing commitment to further policy-oriented analysis. I would like to thank other institutions in Egypt for their assistance to the EDHS. Staff of the Central Agency of Public Mobilization and Statistics (CAPMAS) worked diligently to provide the census findings used in the EDHS sample selection. The Cairo Demographic Center (CDC) provided office space for the EDHS headquarters staff. International support for the EDHS is also gratefully acknowledged. U.S.A.I.D. population funds for Egypt financed the EDHS. Technical assistance and additional financial support was provided by the Institute for Resource Development through the international Demographic and Health Surveys program. Although it is not possible to acknowledge all of the individuals who contributed to the EDHS, I would like to especially thank senior members of the EDHS staff. Dr. Magued I. Osman, the EDHS Assistant Director, and Dr. Fatma Hassan E1-Zanaty, the Sampling Coordinator, were instrumental in the planning and implementation of the survey activities. Mr. Mohamed Abdel Aty, the Fieldwork Coordinator, ably supervised the field teams. Dr. Abdallah A. Abdel Ghaly coordinated the successful data processing effort. Dr. Amin Kamel Said, Dr. Effat Fakher El-Din and Dr. Abdel Monem Darwesh were instrumental in carrying out the anthropometric training. Finally, I am deeply indebted and grateful to all of the EDHS central office and field staff. Without their willing and very able assistance, the EDHS data collection and processing phases could not have been completed in such a timely fashion. Dr. Hussein Abdel-Aziz Sayed Technical Director TABLE OF CONTENTS Foreword .............................................................................................................................. iii Acknowledgements ............................................................................................................. v Table of Contents ............................................................................................................... vii List of Tables ...................................................................................................................... xi List of Figures ..................................................................................................................... xxiii Summary of Findings ......................................................................................................... xxv Map of Egypt ...................................................................................................................... xxxiv 1 BACKGROUND 1.1 History, Geography, and Economy ................................................................. 1 1.2 Population ............................................................................................................. 2 1.3 Health Policy and Programs ............................................................................. 4 1.4 Population Policy and Programs ...................................................................... 5 1.5 Objectives of the Survey .................................................................................... 6 1.6 Organization of the Survey ............................................................................... 7 1.7 Background Characteristics of Survey Respondents ................................... 15 2 MARRIAGE, BREASTFEEDING AND POSTPARTUM INSUSCEPTIBILITY 2.1 Current Marital Status ....................................................................................... 19 2.2 Age at First Marriage ........................................................................................ 21 2.3 Breastfeeding and Postpartum Insusceptibility ............................................. 28 2.4 Differentials in Breastfeeding and Postpartum Insusceptibility ................ 30 3 FERTILITY 3.1 Fertility Levels and Differentials ..................................................................... 35 3.2 Current Pregnancy .............................................................................................. 44 3.3 Children Ever Born ............................................................................................ 45 3.4 Children Ever Born and Age at Marriage .................................................... 46 3.5 Age at First Birth ................................................................................................ 47 3.6 Differentials in Age at First Birth ................................................................... 49 4 KNOWLEDGE, ATr~DDES AND EXPOSURE TO FAMILY PLANNING MESSAGES 4.1 Contraceptive Knowledge .................................................................................. 51 4.2 Attitudinal Indicators .......................................................................................... 58 vii 4.3 Exposure to Mass Media and Family Planning Messages ......................... 62 5 EVER USE OF FAMILY PLANNING 5.1 Ever Use of Family Planning ........................................................................... 67 5.2 First Use of Contraception ............................................................................... 71 5.3 Family Planning Decision-making .................................................................... 77 5.4 Discontinuation of Contraceptive