The discourse around population is a source of general panic both in Egypt and worldwide, it is a continuation of an anxiety that was first manufactured in the United States in the 1960s (Seltzr, 2002). News reports regularly cite <a href="https://www.youm7.com/story/2020/2/13/%D8%A8%D8%B9%D8%AF-%D8%A7%D9%84%D9%85%D9%88%D9%84%D9%88%D8%AF-%D8%B1%D9%82%D9%85-100-%D9%85%D9%84%D9%8A%D9%88%D9%86-%D9%85%D8%B5%D8%B1-%D8%AA%D8%B3%D8%AA%D9%82%D8%A8%D9%84-4000-%D8%B7%D9%81%D9%84-%D8%AC%D8%AF%D9%8A%D8%AF/4629324">alarming</a> figures measuring x% of population growth in y number of months, but simply tossing numbers off left and right without contextualizing broader spikes, plateaus, or shrinkages is misleading and tells only half the story.&nbsp; 
<h3>What do reproduction statistics say?</h3>
Last March, the 2021&nbsp;<a href="https://www.capmas.gov.eg/Pages/Publications.aspx?page_id=5109&amp;Year=23639">Egypt Family Health Survey</a> (EFHS) was published after a prolonged pause, &nbsp;offering much needed, updated measures on access to sexual and reproductive health services, attitudes toward female genital mutilation, contraceptive uptake, family planning decision making and nutrition, among other issues. Since the cancellation of the 2018 Demographic Health Survey (DHS), the latest available dataset for sexual and reproductive measures in Egypt is the 2014 edition of the DHS (Abuelsoud, 2020).
The 2021 EFHS shows that the total fertility rate fell from 3.5 children per woman in 2014 to 2.85 children per woman (CAPMAS, 2023). Three out of 10 women stopped using contraceptives in the first 12 months of usage, with the majority of respondents citing the side effects of the contraceptive methods as the reason. Contraceptive uptake reached 66% among married women, marking an 8% increase on the 2014 DHS. Meanwhile, 14% of married women have unmet needs for modern contraceptives, which is a sizable demand (CAPMAS, 2023). &nbsp;
The EFHS also finds that one in every five children was either unwanted or unplanned in the five-year period preceding the survey. The total desired fertility rate is 2.14 children per woman: less than the actual total fertility rate (2.85 children per woman); less than the desired total fertility rate (2.4 children per woman) of 2014; and less than the goal of 2.4 children per woman set by <a href="https://www.arabdevelopmentportal.com/sites/default/files/publication/sds_egypt_vision_2030.pdf">Egypt 2030</a>. This shift in people&rsquo;s attitudes toward family size is worth exploring.&nbsp;
<h3>Denied pregnancies</h3>
Unintended and unwanted pregnancies are two main indicators of the inaccessibility of sexual and reproductive health services. Such pregnancies can have significant adverse impacts on the lives of women, children, and families in both the short and long term, including worse socioeconomic outcomes, poor health, and complications from unsafe abortions (UN Population Division, 2022). As per the EFHS, the desired fertility rate for the lowest wealth quintile is 1.77 children per woman, while the actual TFR is 2.75. On the other hand, for the wealthiest quintile, the desired fertility rate is 2.16 children per woman compared to an actual rate of 2.66 children per woman.
A comparison of the desired number of children in the lowest and highest wealth quintile inevitably raises a question: why have poorer women been selected as the primary target group for national population control interventions since 2018, even though as a whole, they want fewer children than wealthier women? The desired TFR for the lowest wealth quintile is well within the target of the &ldquo;Two is Enough&rdquo; program, for example. Instead of burdening impoverished women with national population targets, we should instead consider the structural barriers that prevent them from making their own reproductive choices. The EFHS lists side effects as the main reason for contraceptive discontinuation, and women become more at risk of unwanted and unplanned pregnancies and unsafe abortion if they discontinue or swap contraceptive methods (UN Population Division, 2022). Another barrier is the low quality of family planning services, identified in the 2008 and 2014 DHS as one of the reasons why women do not seek family planning services (Abdel-Tawab et al., 2020).
<h3 style="text-align: justify;">National population strategy</h3>
Over the past few years, the Egyptian government prioritized population control policies and practices, framing population issues as the primary barrier to development. On February 28th, 2022, <a href="https://www.sis.gov.eg/Story/164868/National-Project-for-Development-of-the-Egyptian-Family?lang=en-us">the National Project for Development of the Egyptian Family </a>(NPDEF) was launched to address the &ldquo;overpopulation crisis.&rdquo; As part of the NPDEF, the Ministry of Planning and Economic Development and the Ministry of Finance signed a mutual protocol in March to offer monetary incentives&mdash;EGP1,000 (&asymp;USD31) per year&mdash;to women who have no more than two children before the age of 45 (Egyptian Streets, 2023). Given the gravity of the current <a href="https://resurj.org/reflection/heba-egypt-food-security/">economic moment</a> in Egypt, with runaway inflation creating hardship for millions of families, many women may come to see these monetary incentives as alluring opportunities to weather difficult socioeconomic turbulence.
Given that the bulk of population increase until 2050 will be driven by the momentum of past growth, further government efforts aimed at reducing fertility would then do little to slow the pace of growth until 2050 (UN Population Division, 2022). Moreover, two-thirds of the projected increase in global population by 2050 is attributable to the rapidly increasing number of young people. Such growth would occur even if the TFR in today&rsquo;s high-fertility countries were to fall immediately to around two births per woman. Global population statistics managed to predict the size of Egypt&rsquo;s current population as far back as a few decades ago (UN Population Division, 1995).
Egypt is not the first country to forgo an approach that responds to families&rsquo; needs and attempts to shift cultures around family-making for the sake of population control. India&rsquo;s Family Welfare Program offers a sobering example of the dangers of linking welfare with demographic objectives. Initiated in the 1960s, the program gave incentives to health workers for achieving set targets of contraceptive uptake, under pressure of achieving targets, health workers reported inaccurate contraceptive uptake to meet state targets. In the 1970s, the state approach evolved, introducing monetary compensation for people undergoing sterilization. Later still, public officials threatened to withhold the salaries of public-school teachers who did not consent to sterilization (Seltzr, 2002; Riley &amp; Chatterjee, 2023). Despite the Indian government&rsquo;s focus on punitive measures, last April, India surpassed China as the world&rsquo;s most populous country, in line with earlier UN projections (UN Population Division, 2022).
Diverting population policies from people-centered approaches to monetary incentives undermines Egypt&rsquo;s commitment to uphold reproductive rights, defined by the Cairo Program of Action as the basic right of all couples and individuals to decide freely and responsibly the number, spacing, and timing of their children and to have the information and means to do so, and the right to attain the highest standard of sexual and reproductive health. As millions of families are struggling to make ends meet in Egypt (EIPR, 2023), the NPDEF&rsquo;s conditional cash program undermines their reproductive autonomy (Senderowicz, 2020) by seeking to limit and orchestrate their reproductive decisions, offering them a &ldquo;choice&rdquo; that few may be in a position to refuse. Recently, the Ministry of Supply and Internal Trade <a href="https://www.almasryalyoum.com/news/details/2856419">adjusted</a> eligibility criteria for ration cards, capping it at four individuals per family, denying the third child access to subsidized services and commodities. Yet again, this deterrent to childbirth deprives low-income families of basic rights and services; like the NPDEF program, it shifts responsibility for any &ldquo;extra child&rdquo; from the government to low-income families. For them, this pregnancy is denied, whether it is a result of contraceptive failure, illegal and inaccessible abortion services, or a reproductive decision. High-income families are allowed to have as many children as they desire and are not punished for contributing to the &ldquo;population problem.&rdquo; It is only poor women and their families who must pay the price for denied pregnancies and structural barriers. They are punished for not sticking to a top-down plan, even when it goes against their fertility intentions (Seltzr, 2002; Riley &amp; Chatterjee, 2023).
<h3>Where can we go from here?</h3>
Egypt should learn from past population control policy experiments in India and China, where millions of women were involuntarily sterilized or lost their lives because of unsafe abortion (Seltzr, 2002; Riley &amp; Chatterjee, 2023). There are better ways to address structural barriers and uphold reproductive equity while tackling concerns over population in Egypt. For starters:&nbsp; 1- In order to address structural barriers, secondary data analysis needs to be conducted to identify best practices from national family planning campaigns that contributed to the decline of TFR over the past years, in order to incorporate these practices in programs and campaigns where applicable.
2- The Egyptian government should support data collection and research initiatives, to yield evidence-based recommendations and progress.&nbsp;
3- Financial resources should be allocated to ensure high quality family planning services and to maintain rigorous monitoring and evaluation practices.
4- The Ministry of Health and Population, the Ministry of Social Solidarity, and the National Population Council should provide fair and decent pay to health workers, including women community leaders, at all points of service.&nbsp;
5- Lastly, evidence shows a relationship between women&rsquo;s access to the job market and the TFR, as shown in the 2014 DHS and recently reiterated by the minister of health (El Mal News, 2023). Instead of enacting unproductive population control practices such as monetary incentives, deterrences, or <a href="https://www.madamasr.com/en/2021/05/27/feature/economy/predatory-for-profit-loans-dominate-egypts-microfinancing-sector/">microfinancing</a>, the Egyptian government should strengthen and guarantee women&rsquo;s access to employment and decent pay.&nbsp;
Next year marks the 30th anniversary of the International Conference on Population and Development (ICPD). Hosted in Cairo in 1994, this landmark assembly coined the term &ldquo;reproductive rights,&rdquo; setting in motion the historic shift from population control policies to people-centered interventions. In turn, this shift massively and positively impacted millions of people in Egypt and across the world by securing access to sexual and reproductive health services and the right to safe and accessible contraceptives. The reversion to more coercive population control practices is extremely worrying.&nbsp;
<hr>
References
<ul>
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</ul>

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