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Studies examine impact of family planning on women's lives in Egypt

July 30, 1998

RESEARCH TRIANGLE PARK, NC — In Egypt, one in 10 women marries while she is still in her teens. And many young women become pregnant shortly after marriage. However, adolescents have little information about reproductive health services that might be available to them.

Those are some of the findings from six studies conducted in Egypt to explore the impact of family planning on women's lives. The studies were done as part of the Women's Studies Project (WSP) at Family Health International (FHI). Ten countries participated in the WSP, which was funded by the U.S. Agency for International Development.

Married adolescents in Alexandria

In one study, researchers from the High Institute of Public Health, Alexandria University found that fewer than 30 percent of the women surveyed were familiar with the term "reproductive health," which includes sexual health and well-being. All women knew about family planning methods, though older women knew about more methods than did adolescent women.

The researchers interviewed 450 adolescent married women (under age 20) and 450 older married women (over 20) living in 80 squatter areas in Alexandria to compare knowledge, attitudes, and practices related to reproductive health care. In addition, researchers studied male perceptions of reproductive health and family planning. In addition to the survey, four focus group discussions were held with younger and older women and their husbands.

In this study, 95 percent of the women in both groups approved of the use of family planning, recommending it because, "life is expensive," and "women who have many children suffer from bad health." Women generally thought family planning use should be a joint decision between husband and wife or within the wife's purview. One educated, older wife stated, "The husband and wife together should agree, decide, and go together."

Women said the mean ideal age for marriage was 20 years old. However, women often married and began having children before age 20. The mean age of first pregnancy was 17.6 years for adolescent wives, and 19.3 years for older women.

Approximately one-fifth of the husbands interviewed knew about male family planning methods. Yet, fewer than 3 percent had actually used condoms. Men preferred that their wives have a child as soon after marriage as possible, believing that children are an investment in the future and represent security in old age. According to an illiterate husband of an adolescent wife, "Educated people consider first to establish themselves, but for us, we like to have children soon after marriage." Husbands preferred more children than did their wives.

Adolescents in Assiut

More than 1,600 adolescents were interviewed in this study, which looked at reproductive health attitudes, knowledge and practices. While most study participants had heard of AIDS, few had heard of other sexually transmitted diseases, such as syphilis. Seventy-nine percent of the respondents approved of female circumcision. This varied from 89 percent among less-educated respondents to 69 percent among more-educated respondents.

Adolescents' ideal age for marriage varied according to sex. Young people said the mean ideal age was 21.2 years for females and 25.6 for males. "The female is able to have children and raise them up properly while she is still young and in good health," said one study participant. Another said having children early in the marriage was important "because it is better for the woman to test herself to see if she is fertile or not."

Some 95 percent of all study participants approved of family planning, and nearly 99 percent of all participants had favorable attitudes toward child spacing. Among study participants who had children, 27 percent were using family planning at the time of the survey, and the more children a couple had, the more likely they were to use family planning. Fifteen percent of couples with one child used family planning, compared with 79 percent with four or more children. One study participant said, "Life became very expensive and many children need a lot of money, and from where can we get money in this hard time?" The intrauterine device was the most popular contraceptive method.

Family Treatment of Boys and Girls

A study of childrearing practices in Egypt conducted by the Faculty of Nursing, Alexandria University, compared treatment of boys and girls in large and small families. A total of 644 women, recruited from among clients at several health and family planning facilities in Egypt, were interviewed. Questions included preferences for sons or daughters; education of boys and girls; celebration of birthdays; children's participation in household chores; and health care.

Researchers found that discrimination did exist in some families, with boys typically receiving preferential treatment. For example, boys often received more food and better food (milk, eggs, and chicken) than girls, and boys were breastfeed longer than girls. Mothers also were more likely to take sons who needed health care to a private physician. Girls usually performed indoor chores, such as cooking and cleaning, while boys performed tasks outside the house, such as shopping for household items. In families where mothers had less than a secondary education, women were more likely to say girls should serve their brothers and brothers had the right to punish sisters if they misbehaved.

Better-educated mothers treated their children more equitably, and children in small families (three or fewer children) were more likely to receive equitable treatment than were children in larger families (four or more children). Researchers concluded that making family planning more widely available would result, not only in smaller family size -- which would mean more financial resources distributed among fewer family members -- but in fairer treatment for boys and girls within the family.

Unintended pregnancies

Do children born as a result of unplanned pregnancies receive less care from their parents? Are they as healthy and educated as their planned siblings? Previous studies outside of Egypt have found that some unplanned children, especially girls, are more likely to suffer negative health, education, and economic effects as a result of parental neglect. This study examined outcomes of unintended pregnancy for the mother, the child, the husband, and the family, as well as the effect of the unintended pregnancy on subsequent use of family planning methods.

Data were analyzed from two recent Egyptian studies, which included 1,300 women with unintended pregnancies. In addition, in-depth interviews were conducted with 20 women in both urban and rural areas to help researchers understand how pregnancies affected the lives of women and their families.

One of the more surprising findings was that most women who had experienced an unplanned pregnancy were using contraception or believed they were not at risk of conceiving when they became pregnant. This suggests that women may be using contraceptives incorrectly or ineffectively and highlights the need for better family planning services. Women were more upset to learn about the unplanned pregnancy than their husbands, although fathers did express concern about financial support for the new baby. Abortion is illegal in Egypt, but one-third of the women reported trying to terminate the pregnancy.

In spite of women's initial negative feelings about their pregnancies, children born as a result of unintended pregnancies did not suffer from a lack of affection or care, mothers said. The majority of women surveyed said they received the same health care during their unplanned pregnancy as during planned pregnancies. Most babies weighed about the same as their siblings, and unplanned babies were breastfed as much or more than their siblings. Two-thirds of the women interviewed said unplanned children received as much affection as planned children; one-third of the women said their unplanned children received more affection. Some women did report that the quality of their own lives had been affected by the unplanned birth. They had less time to take care of their health and appearance, to do the household chores, and to take care of their other children. Some had to quit their jobs to care for their babies, whereas others were forced to go to work to earn the extra income needed for the additional child.

Family planning and women's quality of life

This study, conducted by the American University of Cairo, surveyed more than 4,500 married women of childbearing age in Upper and Lower Egypt. Data from the survey have not yet been analyzed. However, preliminary results from focus group discussions with 96 women showed that a majority of women knew about family planning. Yet, many women who started using methods discontinued them because of side effects, including headaches, bleeding between menstrual periods and weakness.

When discussing other aspects of their lives, women said that they consult their husbands on almost all decisions, including children's education. Less-educated women were likely to consult their husbands on all maters, including visiting family or purchasing items for the household, while more educated women were likely make some decisions on their own.

Women also said education and employment were important for women's independence, autonomy and self-esteem; however, they noted that work outside the home brings dual responsibility. "The woman now plays the role of the worker, the teacher, the housewife the responsibility is shouldered by the woman children's school, work and health," one woman said. "The burden that a woman carries is heavy." In addition, women said their children were very important to them.

Children perpetuate the family name and give parents prestige and happiness. Many said they would advise their daughters to use family planning, but only after they had proven their fertility through the birth of their first child.

Women as family planning employees

The Cairo Demographic Center, in collaboration with FHI, carried out this investigation, which studied women who work in family planning programs. The study included three components: compiling statistical information from employment data on workers, conducting focus group discussions, and conducting in-depth interviews with leaders in the family planning program.

Of the more than 19,000 employees working in the country's six family planning programs, 82 percent are female, although percentages differed according to job classification. More than half the physicians are male, even though clients at family planning clinics said they prefer female physicians.

In the focus group discussions, female family planning employees expressed concerns similar to women working in any other occupation -- too little time for personal needs and stress about performing many roles inside and outside the home.

However, women also said their jobs gave them pride and satisfaction. They felt the professional and technical skills they had acquired by working in family planning had given them credibility and enhanced their decision-making autonomy in their own families. Some women said that their experiences in organizing their work lives carried over to planning in other areas of their lives, such as managing the family budget. Female employees said work outside the home brought them respect inside the home. One social worker in Sohag said, "The word 'planning' does not apply to contraception only. It applies to planning in every aspect of family life. They have seen that the women can organize the family budget with very little income." One family planning leader said, "Working in family planning is like swimming against the tide. This is what creates a leader because it needs great effort and strong character."

Other workers said they were hurt by criticisms, leveled at them because they stepped out of the traditional female role. Some clients' relatives blamed family planning workers for contraceptive side effects. "Some men say bad words and some husbands and mothers of clients do not meet us nicely and quarrel with us if anything happens as a result of using contraception."