حملات تنظيم الأسرة فى مصر:(1979-2018) السبع سنوات السمان والسنوات الأخرى العجاف
د. فرج الكامل
Introduction
Family planning campaigns in Egypt over approximately 40 years (1979-2018) are reviewed, discussed and analyzed in this article, which will provide an answer to the important question of why some of these campaigns succeeded while others didn’t. The article will uncover the role that competing theoretical and methodological approaches may have had in shaping various campaigns during this extended period of time. The role of television in causing the desired behavioral changes, and the impact on the population growth and on mother and child mortality will be discussed in some detail, as well as the cost-benefits of family planning in Egypt.
A picture is worth a thousand words, and the graph featured in figure (1) below may in fact summarize this entire article. The graph is constructed from longitudinal data that have been collected by various national and international organizations and published by the World Bank Development Indicators (2020)[1].
Egypt’s Population Problem
The theory of demographic transition refers to a historical shift from high birth rates and high infant death rates in societies, to low birth rates and low death rates as these societies become more developed. This shift occurred in Western countries gradually with both rates declining simultaneously. But the process of demographic transition occurred on a different scale in developing countries, due to much faster declines in mortality rates with no subsequent declines in birth rates.[2] Because the decline in the mortality rate was much faster and wasn’t accompanied or even followed soon enough with a similar decline in the birth rate, developing countries experienced what came to be known as the “population explosion” since the second half of the 20th century.
As in many other developing countries, this transition began in Egypt with a sharp fall in mortality rates following the end of World War II, due to improvements in nutrition and access to safe water, sanitation and health services, as well as other socio-economic arenas such as education and housing.[3] The result was entering a period of rapid population growth which continued for decades.
During the United Nations first and second global conferences on population and development in 1954 and 1965, experts warned that rapid population growth could exacerbate poverty and hinder development in countries with limited resources. This applied to Egypt where rapid population growth was beginning to put high pressure on the economy and environment and made the Egyptian government face serious challenges in providing for the basic needs of its citizens, including adequate housing, sanitation, health care, education, and employment.
By 1960, the crude birth rate of Egypt was almost 47 per 1,000 live births, and the annual population growth was 2.7%. In 1962, the government adopted a national charter that laid out the basic assumptions and guiding principles for Egypt, and identified rapid population growth as a threat to the economic betterment, stating that “population increase is the most dangerous obstacle that faces the Egyptian people in their drive toward raising the standard of production in their country in an effective and efficient way.”[4] In 1965, Egypt became the first country in the Arab world to launch an official family planning program. Despite the program’s early establishment, political support was inconsistent and fertility remained high until the 1980s.[5] In addition to introducing birth control services and methods to limit the family size, the family planning program also aimed at encouraging child spacing and discouraging early marriages.
More serious attention to family planning communication began in 1979, when the USAID cooperated with Egypt to launch the first national campaign through the newly established Information, Education and Communication Center (IEC) of the State Information Service (SIS). Over the course of the following 30 years, numerous campaigns were launched and different approaches were utilized. This article reviews the different phases in which these efforts were made and analyzes their varying approaches and relative impact on Egypt’s population growth rate.
A consistent methodology will be applied in discussing and analyzing these phases, where the population growth rate and the crude birth rate of the first year in each phase will be compared with the same indicators of the last year in the same phase. The difference between the two measures will be considered as an indication of performance during that phase, and additional research results will be used to interpret this performance.
Since some of the campaigns that are reviewed in this article were based on the author’s theoretical framework and methodology and also included his active involvement in the planning and development of their creative work, the utmost level of transparency and scientific integrity is observed in presenting their results and impact. The author will therefore refrain from using data from his own research studies, and will only use research data and findings that have been collected and published by other researchers and institutions in reporting the results and impact of all campaigns that are discussed here, whether they had followed the author’s approach or not.
The First SIS Family Planning Campaign (1979-1985)
A major item from that campaign was the poster featured in figure (2). The same poster was used in billboards and as a newspaper advertisement, as the campaign mostly used print media despite the high level of illiteracy. Posters were placed in Cairo, regardless of the fact that the majority of the target audience were elsewhere. The featured advertisement has this caption on top: “Look around you”. The subtitle says: “We have a population problem”, and more text adds: “we have three new children born every minute, 4,320 born every day, and 30,240 new born children every week.” After this introductory lesson in mathematics, and another set of gloomy statements, the poster warns that this rate of increase is scary and that it wipes out any potential for improvement in housing, education, medical care, etc. It then tells the Egyptian citizen “the solution is in your hand” and asks him to “start to solve the problem today”.
This print material was later supplemented by a four-minute-long television advertisement featuring popular singer Fatima Eid, with two upper Egyptian brothers, named Hasaneen and Mohamadeen; the first one is miserable because he has seven kids, while the other brother, who has only two is the happy one! The video however didn’t provide any indication of the means that one could use in order to avoid having that many children or that miserable fate.
Parlato et al. (1988) reported on a survey evaluation of this campaign and two sequel ones. He said: “between 1979 and 1986, SIS tried three different approaches to television advertising: the first through a popular song, the second through animation, and the third used a strong fear appeal. In addition to television advertising, SIS has continued to use posters, booklets, billboards, sponsored radio and TV programs, as well as interpersonal communication in the form of public rallies organized by the local offices of SIS. For most of this period, however, there were two conspicuous difficulties with message strategy for family planning: the lack of focused messages and a tendency to undervalue social science findings as a basis for message development.”[6]
Donald Bogue (1983), a renowned sociologist and head of the organization that was contracted by USAID to assist the State Information Service with the first campaign, also became critical of how it was conceived and executed. He wrote: “The radio and television messages in the late 1970s and early 1980s were broadly educational, stressing the theme of excessive population growth as a national problem, but made little effort to relate this national problem to listeners’ and viewers’ day-to-day social and economic concerns. The messages also lacked any specificity concerning contraceptive methods, benefits of use, sources of supply, or possible problems”[7].
Longitudinal data which has become recently available (The World Bank Development Indicators, 2020)[8] indicate that there was no real impact on Egypt’s population growth rate during the period from 1980 to 1985. The rate of population growth was 2.319% in 1978, before the first campaign started, and continued to rise steadily throughout the life cycle of these three campaigns to reach 2.654% in 1985, which constitutes an actual increase of 14.4% in the population growth rate during that period. The crude birth rate (CBR) declined slightly by 3.6% during the same period.
The following table which is constructed from the World Bank Development Indicators (2020) shows the rate of annual growth of Egypt’s population right before, during, and right after the SIS series of campaigns from 1980 to 1985.
Table (1) Annual Population Growth and Birth Rate of Egypt: 1978-1985
| Indicator / Year | Annual Population Growth Rate (%) | Crude Birth Rate (per 1,000 people) |
| 1978 | 2.319 | 39.179 |
| 1979 | 2.374 | 39.098 |
| 1980 | 2.434 | 39.017 |
| 1981 | 2.488 | 38.914 |
| 1982 | 2.533 | 38.763 |
| 1983 | 2.577 | 38.537 |
| 1984 | 2.620 | 38.211 |
| 1985 | 2.654 | 37.749 |
Family Planning Campaigns in Egypt from 1986 to 1992
During the period from 1986 to 1992, the author was responsible for planning, conceiving and producing almost all of the family planning campaigns in Egypt. This included four consecutive campaigns that were sponsored by USAID and the State Information Service (SIS), in addition to several contraceptive social marketing campaigns for Family of the Future (FOF), the Clinical Services Improvement Project (CSI) and the Health Insurance Organization (HIO).
Television campaigns which were developed during this time period shifted away from the general slogans of previous campaigns to more specific and carefully designed messages that were based on research findings, and designed to combat rumors and misinformation on specific contraceptives; explain how to correctly use them; and tackle wrong beliefs regarding early marriage, child spacing, as well as women’s responsibility for determining the baby’s gender, etc. During this phase, the first campaign was in 1986-1987 and was followed by three other campaigns in 1988, 1989, and 1990-1991.
The 1986-1987 National Family Planning Campaign
This campaign consisted of a series of 15 TV spots, and came to be known as the “Zannana” or “the nag”. The significance of this campaign is that it was developed and aired after a period when all family planning advertising on TV was suspended in Egypt, because the leading advertising agency in the country had produced and aired a TV spot on condoms. The message was considered insensitive to the Egyptian culture, and two lawyers from Alexandria, Egypt, succeeded to get a court order in 1985 that forces the ministry of information to ban all family planning commercials on TV. The lawyers case claimed that such commercials were indecent and that the TV spot appeared to encourage unmarried youth to engage in sinful pre-marital sex. This was a typical example of how social marketing communication may fail if it didn’t understand and respect the local culture of the target audience. In this case, for example, the slogan which said that “the condom is”the man’s method for birth control” appeared to have missed one crucial word which would’ve avoided this situation. That word is “married!” It’s quite probable that had the slogan said “married man” instead of just “man”, the spot would not have been taken off the air, and the family planning campaign wouldn’t have been suspended.
The “Zannana” campaign was therefore the first series of TV spots to break through that ban. Interestingly enough, this campaign, which consisted of 15 TV spots, included a spot on condoms, which was fully accepted by the television station and the audience. Based on research results, the campaign was planned to address prevalent rumors and misinformation about family planning in general and contraceptive methods in particular. Sanaa Yunis, a comedian who often played the role of a silly and naive person, was selected to play the ill-informed mother-in-law who always volunteered wrong information, but was immediately confronted with corrections from a doctor, her son-in-law, or even her own daughter.
The strategic premise of this campaign was that women lack practical information regarding contraceptive use and often perceive the health risks of too many pregnancies to be less serious than that of contraceptives themselves. Health hazards of non-spaced pregnancies were addressed, and false rumors concerning contraception were dispelled. The need to use an appropriate method correctly was also emphasized.
The campaign was based on the conceptual approach described in the “Knowledge and Social Change”[9], which indicates the importance of identifying the target audience’s knowledge, attitudes, social norms, and media habits. It therefore started with a secondary analysis of available research findings, and conducted focus group discussions with health experts and target women from urban and rural areas. Concepts, scripts and videos were all pretested to make sure that messages were medically correct and that they will be understood and culturally accepted.
Pressing issues that were identified through research were presented in dramatic scenes where the Zannana would consistently volunteer wrong information and advice. For example, she tries to advise her daughter and son-in-law to have another child right away so that she can “play with”. In another spot, she advises her daughter to have plenty of children in order to “tie her husband down”. In another spot, also advises a bride in the neighborhood, on her wedding night, to have plenty of children, one after the other. She tells her older daughter in another spot not to use contraceptives as long as she is breastfeeding because she is “safe”. Another situation has the Zannana trying to arrange a marriage for her 16 year old niece. In another spot, she volunteers wrong information about the oral pill saying that it is not to be taken daily, but only when the woman has sex. All of these situations are of course carefully studied so that these rumors and misinformation are corrected and responded to right away and in convincing ways.
An added worry was making sure that the humorous environment in the spots that are were planned to tackle rumors and misinformation which had long plagued the family planning situation in Egypt, would not be counterproductive, as there was a risk that the audience might in fact believe the misinformation instead of refusing it. This was an added reason to follow a strict systematic methodology in the development and production process.[10]
The Academy for Educational Development (AED) contracted an independent research company (Wafai and Associates) to evaluate the campaign. The table below illustrates the findings of that study which was conducted on a national study of 1800 households to evaluate the “Zannana” campaign.[11]
Table (2) Learning from the Zannana Campaign One Month After Campaign Launch
| Indicator | % |
| Knows the content of at least one spot | 98.0 |
| Can repeat lines from the spots | 74.0 |
| Didn’t believe the “nag” | 97.0 |
It is quite interesting, as shown in table (3) that this campaign resulted in larger knowledge gains among the less educated segments of the population, which is precisely what a family planning program in Egypt should aim to achieve, since the problem is often more serious among this sub-population. The following table shows how much different educational segments learned from this campaign.[12]
Table (3) Ability to Repeat Lines from Campaign by Educational Level
| Educational Level | % Correct Knowledge |
| Total | 74.0 |
| Illiterate | 77.0 |
| Read & Write | 79.0 |
| Less Than High School | 76.0 |
| Less Than College | 70.0 |
| College | 71.0 |
The 15 spots aired several times a day for five months and public reaction was quite positive.
A more extensive evaluation study was conducted in 1988 (one year after the campaign launch) which measured the level of family planning knowledge, attitudes, and practices. The study showed a substantial increase of 79.9 percent in contraceptive use since the last documented figure of 1984.[13]
All of this campaign’s 15 TV spots can be viewed with English subtitles here: https://www.youtube.com/playlist?list=PLxwmH-xqgi_cABa1jghW1KMepa11Xe9Zb
The 1988 National Family Planning Campaign:
This campaign consisted of 10 TV spots that focused on particular segments of the target audience, including workers, farmers, and low-income urban residents. The same theoretical framework and systematic methodology that had been used in the first campaign were applied here as well. The 1988 campaign focused on the concept of child spacing, the baby boy complex, suitable selection and correct use of contraceptive methods, early marriages, child labor and negligence, availability of different contraceptive methods, need to consult a doctor and to ignore rumors about contraceptives, and the concept of planning in general.
This campaign was evaluated through a national survey of 2,400 cases, and the study found that almost all respondents had seen the television spots. Even more importantly, the study[14] found no differences in viewership of these spots among the different educational levels, and viewership was similar in urban and rural areas. According to the study, the majority of viewers were able to repeat the messages of the campaign correctly and there were no urban-rural or educational level differences among respondents in this regard. The 10 spots of this campaign can be viewed (with English subtitles) in this link: https://www.youtube.com/playlist?list=PLxwmH-xqgi_eLxfyClyuvIs5V8aWQT8dj.
The 1989 National Family Planning Campaign
Film and TV drama star Karima Mukhtar was selected for this campaign, after she had proved to be a great success in the ORT campaign that we had developed since 1984. She played female doctor in this series of 10 television spots, where she corrects misinformation and rumors, and conveys useful advice on the correct uses of contraceptives. The spots also address more complex issues such as fatalism, starting child spacing after the first child is born, as well as men’s involvement in and support of family planning decisions.
All 10 spots of this campaign can be viewed (with English subtitles) here: https://www.youtube.com/playlist?list=PLxwmH-xqgi_cOme77OcJlXMLJc_fcBZMD
The 1990-1991 National Family Planning Campaign
Monitoring and evaluation feedback on the previous campaign was quite positive which enhanced the decision to develop this new series of spots with the same star. In this campaign, the “doctor” Karima Mukhtar leaves her office in the city and goes to meet women in a rural area, upon the request of its village chief. The new series of TV spots continued the focus on the correct selection and use of appropriate contraceptive methods, and included a spot on how men should treat their women with compassion; respect and dignity, not as “rabbits” that are intended to merely have an offspring. The last spot in the series had a clear call for “everyone” to do their part, including policy makers and other officials.
All 12 spots of this campaign can be viewed (with English subtitles) here: https://www.youtube.com/playlist?list=PLxwmH-xqgi_fz-TKPbTHOVhX2hgH_KTHj.
Most of the TV spots that were produced in the context of the four campaigns described above continued to be aired on national television channels throughout 1992-1993
Impact of the 1986-1992 Campaigns
Evaluation studies and national surveys which were carried out in Egypt as well as vital statistics for live births show that media campaigns have had a remarkable impact during this phase of seven years. Egypt’s birth rate took a sharp downward turn simultaneously with these campaigns from 1987 to 1991. In an interview with The Times, the Egyptian Minister of Population said: “the sharp increase in the rate of family planning practice from 38% in 1988 to 47% in 1992 could be attributed to the IEC program with convincing family planning messages, particularly to the effective use of television since the illiteracy rate is still high in Egypt”[15].
The graph shown in figure (6) summarizes the impact of Egypt’s family planning campaigns during this period. The graph, which is published in the UNFPA report, Population Situation Analysis, Egypt 2016[16] shows a considerable decline in Egypt’s Crude Birth Rate (CBR) during the period from 1986-1992, which reflects the impact of these campaigns. This magnitude of decrease in CBR has never occurred over any similar time period in Egypt’s modern history, and has a near perfect relationship with the increase in the use of contraceptives during the same period. According to El-bakly and Hess (1994)[17], “Television has contributed decisively to the rise in contraceptive prevalence. The 1992 Egyptian Demographic and Health Survey (EDHS-92) showed that 73% of men and 71% of women cited television as their first source of information about family planning.”
As table (4) indicates, during these seven years which witnessed the four national campaigns and other contraceptives social marketing campaigns described above, the rate of population growth decreased by 24.1% and the birth rate decreased by 18.9%.
Table (4) Annual Population Growth and Birth Rate of Egypt: 1986-1993
| Indicator / Year | Annual Population Growth Rate (%) | Crude Birth Rate (per 1,000 people) |
| 1986 | 2.691 | 37.118 |
| 1987 | 2.709 | 36.325 |
| 1988 | 2.671 | 35.393 |
| 1989 | 2.569 | 34.352 |
| 1990 | 2.427 | 33.249 |
| 1991 | 2.272 | 32.141 |
| 1992 | 2.140 | 31.080 |
| 1993 | 2.043 | 30.110 |
Family Planning Campaigns in Egypt from 1993 to 2002
This author discontinued his work in family planning campaigns in Egypt after the 1990-1991 campaign described above.
Between 1993 and 2002, family services continued to develop, enhanced by the operation of various USAID-funded projects. In the meantime, various campaigns were launched during this new phase, including one starring the famous actor Ahmed Maher. He played the role of a father who had so many children; he became unable to provide for them, or even to remember all their names. He would conclude the TV spot with the statement “A man is not only held for his words, but also for the care of his family.”
As catchy as this phrase was, the campaign fell again in the same trap of spreading untested and overly general messages.
Another campaign that appeared during this phase, was an in-house production by the ministry of health, where again the focus was on limiting the number of children to only two, otherwise the husband will be driven away and may start to consider marrying another woman. This add can be viewed here: https://youtu.be/gesUpbXrfKE
Both campaigns didn’t address the real message needs of the target population, nor was there any attention given to the main issue of knowledge and the correct use of contraceptive methods.
Table (5) Annual Population Growth and Birth Rate of Egypt: 1994-2001
| Indicator / Year | Annual Population Growth Rate (%)[18] | Crude Birth Rate (per 1,000 people)[19] |
| 1994 | 2.009 | 29.256 |
| 1995 | 2.006 | 28.526 |
| 1996 | 2.013 | 27.903 |
| 1997 | 2.009 | 27.352 |
| 1998 | 1.996 | 26.845 |
| 1999 | 1.967 | 26.381 |
| 2000 | 1.930 | 25.958 |
| 2001 | 1.901 | 25.578 |
As table (5) indicates, the impact of these campaigns and others during this phase on the birth rate and population growth rate of Egypt was mild, as documented in census data and vital statistics. The rate of population growth decreased during this period by 5.4%, and the birth rate decreased by 12.6%. Some of this impact might even be attributed to the residuals of the campaigns in previous years.
Family Planning Communication During 2002-2009
The CHL Communication Program
Since 2002, USAID changed its approach of supporting “vertical” family planning communication programs in Egypt and started to channel its support through the “Communication for Healthy Living” (CHL) umbrella. An evaluation of this program was carried out in 2009 which raises some serious questions. Since this author was a member of the three-person international team which was selected by USAID to conduct the evaluation, and consistently with the rule we stated earlier regarding relying in this article only on data that have been gathered and published by other researchers and institutions, the author will abstain from using data that have been collected by the team during this mission, and will only use other published data. The final report on the “Communication for Healthy Living” (CHL) project, which was submitted in February 2009, is however available from USAID[20].
The CHL used a wide variety of channels to disseminate messages; including IEC printed materials, television spots and “Enter-educate” programs, radio, telephone, events, outreach and interpersonal communication. Together with SIS and MOHP, CHL launched a number of campaigns, e.g., “Sahetak Tharwetak” (Your Health, Your Wealth) public sector campaign and the “Isaal Istashir” (Ask, Consult) private sector campaign. It should also be acknowledged that significant improvements were attained during this phase in service provision; and there was an increase in the number of rehabilitated health facilities. There has also been an increase in the number of districts implementing the Integrated Management of Childhood Illness (IMCI) strategy from 87 in 2003 to 237 in 2008[21]. The USAID report indicates that these changes have been made by the government and are independent of the CHL project[22].
According to the Egypt Demographic and Health Surveys, exposure of currently married women to family planning messages sharply declined from 90.8% in 2005 to 66.8% in 2008[23]. This decline perhaps reflects the nearly thirty percentage points decline in the percentages of women who reported exposure to family planning messages on TV: from 88.5% in 2005 to 58.1% in 2008 [24]. Data from the Village Health Survey[25] also show that anti natal care messages reached less than half of the least educated group. The EHCS 2008[26] reports that 66% of women recalled the messages disseminated through CHL, but only 32% recalled what may be the most important message that of the danger signs during pregnancy. In addition to the drop in exposure to family planning messages, changes in the Total Fertility Rate (TFR) and Modern Contraceptive Prevalence Rate (MCPR) were minimal between 2003 and 2008. The Total Fertility Rate (TFR) decreased by a marginal 0.2% between 2003 and 2008.
Several factors may account for these unexpected outcomes, but the author can only make a reference in this regard to the report submitted to USAID[27] as mentioned earlier.
Wakfa Masrya (An Egyptian Stand)
This campaign overlapped with CHL program as it was launched in the Summer of 2008, when various ministries were requested by the ruling National Party of Mubarak to pool resources and for a new national campaign that was called “Wakfa Masrya” or an Egyptian Stand! This was a literal translation of Mubarak’s remarks who had said that we needed to have a stand against the population problem. The government’s communication officials translated his instructions quite literally!
The main campaign advertisement had the big title “Wakfa Masrya” or an Egyptian Stand, with a secondary title that says “If we use our brains”. Various issues were then listed with visuals in posters, lampposts and billboards. There were six issues (or promises if we use our brains):
- We would all get an education.
- We would all be well-fed.
- We would all be treated
- We would all have healthcare
- We would all have water to drink.
- We would all get jobs.
Because these were all government messages, they had to include what the government was spending to subsidize each of these various services. The ultimate catch was the slogan at the bottom of the poster which says: “before we have a new baby, we have to be sure that we can provide for him.”
As mentioned above, individual outdoor signs were dedicated to each one of those six issues. An example is provided in figure (9).
So, what was wrong with that campaign? A short answer is: everything! Top-down communication, non-specific or actionable messages, putting the blame on the citizens, addressing the wrong audience, incorrect choice of media and wrong placement of the advertisements were only some of the problems. The campaign relied heavily on street banners, lampposts and billboards, which were mostly placed in well-off neighborhoods, including the streets around the presidential palace.
It is quite interesting to note here the resemblance in the approach between this campaign and that of the early 1980s as well as that of the 1994-2001 phases, which were discussed earlier. All of those campaigns didn’t seem to pay much attention to research-based message development, media selection, or audience segmentation and targeting, among others elements of good campaign development.
Dr. Dorria Sharafeldin, who was president of Egyptian TV at one point, wrote the following in “Almasry Alyoum” newspaper on 15/7/2008:[28] “Who engineered this campaign? Who choose that slogan? Who was it that scattered the messages on plenty of lampposts on bridges and neighborhoods that do not have any population problem? We need to know who did that in order to know who is in fact causing the population problem in Egypt.” She then goes on to say: “I have asked some of those who would be typical targets of such a campaign if they had noticed any new advertisements on the streets. Most of them said that they didn’t, and the few who did said that they thought that the signs were promoting a new TV show.” Other critics pointed out that the visuals in the advertisements had absolutely nothing to do with reality. The buses that were featured in the ads were neat and with plenty of empty seats, the characters looked like advertising models, and even the loaf of bread was not at all similar to that which people can find anywhere!
No wonder that this campaign too, like the one of the early 1980s, became a mockery of the Egyptian people, who turned the campaign visuals and slogans into something else that more accurately reflected the more pressing issues which they believed to be the ones which the society was facing at the time. The following three examples show how Egyptians reacted to the campaign:
The most reliable indicator that we could use to evaluate the impact of family planning in Egypt during this phase is the same measure that was used to evaluate the previous phases, which is the extent to which the birth rate and the population growth rate were affected. The following table documents both rates during the seven years of this phase[29]. It’s obvious from the table that there was a negative impact on Egypt’s population birth or population growth rates during the period. The rate of population growth increased by 0.9%, and the birth rate increased by 5.2%.
Table (6) Annual Population Growth and Birth Rate of Egypt: 2002-2009
| Indicator / Year | Annual Population Growth Rate (%)[30] | Crude Birth Rate (per 1,000 people)[31] |
| 2002 | 1.881 | 25.258 |
| 2003 | 1.859 | 25.015 |
| 2004 | 1.831 | 24.864 |
| 2005 | 1.806 | 24.849 |
| 2006 | 1.772 | 25.024 |
| 2007 | 1.752 | 25.393 |
| 2008 | 1.779 | 25.930 |
| 2009 | 1.864 | 26.584 |
Other Family Planning Campaigns
As if impossible to learn from past mistakes, the same ineffective approach was repeated in another government-sponsored TV advertisement during a 2019 campaign staring Akram Hosney (Abo Shanab.) Like the Hasaneen and Mohamadeen music video of 1980, this one too is too long (4:27 minutes) and addresses Upper Egyptians with a general message that focuses on limiting family size. Comments of viewers indicate that they considered the videos as entertainment rather than educational or motivational material.
The video and comments by viewers are here: https://www.youtube.com/watch?v=reZHd7w1MsE
Discussion and Conclusions
A report by UNFPA documents the changes in the use of contraceptive methods during the time span of 30 years which was discussed in this article. The report concludes that “the trends of current use of family planning methods during the period 1984-2008 clearly show that the major jump occurred during the period of 1984-1992 where the rate increased more than 50% from 30.3% in 1984 to 47.1% in 1992. During the period 1992-2000, the contraceptive prevalence rate increased by almost 19% from 47.1% in 1992 to 56.1% in 2000. However the national rate has been leveling off during the period 2003-2008 at around 59-60 percent.”[32]
These figures should raise another question on the quality of contraceptives use after 1993, since that increase in the percentages of contraceptive users was not reflected on the population growth or birth rates after 1993. Questions on the quality of use, spread of rumors, and contraceptive methods choices and other possible causes should be investigated.
The importance of contraceptive use in causing the desired impact on the population growth rate in Egypt has been investigated by Scott Moreland, who thoroughly examined factors that may have led to the decrease in fertility levels over 25 years from 1981 to 2005, and concluded that among these possible factors, changes in the use of contraception is the single most important factor responsible for fertility decline.[33]
It’s quite saddening that a quarter of a century after the completion of the “seven years of great plenty” from 1986 to 1992, subsequent campaigns didn’t yield any further progress in reducing the population growth or birth rates in Egypt. In 1986, when we launched the first national campaign, the growth rate was 2.7% which was reduced to 2.043% in 1993, after the completion of the campaign airing. By the same token, the birth rate, which was 37.12 in 1986, was also brought down to 30.11 by 1993. However, 25 years later, the situation remains the same as we left it. The annual growth rate of Egypt’s population in 2018 is 2.033, which is almost the same as it was in 1993, and the birth rate in 2014 is 31.0, which is even higher than the corresponding rate in 1993[34]!
Some causes of this paradox may have been explained in this review. However, further analysis and explanations by other researchers may still be needed.
An objective measure of the changeable impact of family planning and communication activities during the 30 years from 1979 to 2009 is illustrated in figure (1) which illustrates longitudinal data that had been compiled by various national and international agencies, and was published by the World Bank (2020).[35]
The graph clearly shows that the early 1980-1985 campaigns had no substantial impact on the population growth of Egypt, which has been explained earlier in our discussion of that campaign. On the other hand, the graph quite clearly shows that the period from 1987-1993 witnessed a most remarkable rate of decrease in the population growth rate, a change that was unprecedented at the time, and remains unmatched. Finally, the graph shows that family planning campaigns have had little or no impact on the population growth rate of Egypt during the period from 1993 to 2009.
Accordingly, the following four phases can be clearly drawn from the discussion and data presented in this article. It should be noted that each one of distinctive four phases listed below includes eight years, however the first year in the relevant phase is considered as the baseline against which progress during the following seven years is consistently measured.
- The first seven years of famine (1978-1985). This period started with the first SIS campaign, followed by two other campaigns by the same organization. The rate of population growth actually increased by 14.4% and the birth rate decreased by 3.6% during this phase.
- The seven years of great plenty (1986-1993). The period witnessed four national campaigns and several contraceptives social marketing campaigns. The rate of population growth decreased by 24.1% and the birth rate decreased by 18.9% during this period.
- The seven years of mild impact (1994-2001). During this period, various campaigns were carried out by various organizations including the Ministry of Health, and the Ministry of Social Affairs. The rate of population growth decreased by 5.4% and the birth rate decreased by 12.6% during this phase.
- The second seven years of famine (2002-2009). The dominant activities in family planning communication during this period were carried out by the CHL program. The rate of population growth in fact increased by 0.9% and the birth rate also increased by 5.2.0% during this period.
The date presented in figure (18)[36] illustrates the differences in annual population growth rate, as expressed in the percentage of change between the first and the last year of that phase. It is because of this pattern, which is clearly visible in the graph, that we are calling these phases as the first seven years of famine, the seven years of great plenty, the seven years of slow motion, and the second seven years of famine!
Cost-Benefit and Impact on Mother and Child Mortality
The benefits from the family planning program and its communication campaigns, especially those that succeeded have had a major impact on Egypt. Reducing the birth rate was achieved at a total cost of LE 2,402 million that were spent on family planning between 1980 and 2005. This amount, however “was more than offset by the LE 45,838 million estimated cost savings in child health, education, and food subsidies. These cost savings have allowed Egypt to maintain and improve the quality of public services in these sectors and ultimately the quality of life of Egyptians. Undoubtedly, as other studies have shown, other sectors, such as general health, housing, employment, and the economy, have also benefited from the family planning program”[37]
The strong influence of child spacing on childhood mortality has been well documented. The 1988 Demographic and Health Survey results shows that the most significant differentials in both infant and child mortality are associated with the length of the preceding birth interval. Child mortality is almost three times higher when the interval between the child and his next older sibling is under two years than for intervals of two to three years or more. Infant mortality decreases from 153 deaths per thousand births for birth intervals of less than two years to around 58 per thousand for birth intervals of two-three years. In addition, mortality is 31% higher among children born to mothers who are less than 20 years old[38]. These differentials suggest that mortality risks for Egyptian children are substantially reduced as a result of the key messages in the communication campaigns which have resonated with the target audience.
Finally, assessment of the impact of fertility decline in Egypt on child and maternal mortality reveals that the benefits of family planning in Egypt till 2005 have been substantial, resulting in a population that is smaller by 12 million; a lower infant mortality rate, resulting in more than three million fewer infant deaths during 1980-2005, a lower under-5 child mortality rate, resulting in about six million fewer early-childhood deaths during the same period; and fewer maternal deaths, with 17,000 mothers’ lives saved over those 25 years.[39]
References:
[1] World Bank, World Development Indicators. https://data.worldbank.org/indicator/SP.POP.GROW?contextual=max&end=2018&locations=EG&start=1960&view=chart
[2] J. Van Bavel, The world population explosion: causes, backgrounds and projections for the future. Facts Views Vis Obgyn. 2013; 5(4): 281–291. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3987379/
[3] Alyaa Awad and Ayman Zohry, The End of Egypt Population Growth in the 21st Century: Challenges and Aspirations The 35th Annual Conference On Population and Development Issues Current Situation & Aspirations. Cairo Demographic center, 20 – 22 December 2005, p.2
[4] Makhlouf, Hesham H., ed. 2003. Population of Egypt in the Twentieth Century. Cairo: Cairo Demographic Center.
[5] Radovich E, el-Shitany A, Sholkamy H, Benova L (2018) Rising up: Fertility trends in Egypt before and after the revolution. PLoS ONE 13(1): e0190148.https://doi.org/10.1371/journal. pone.0190148
[6] Parlato et al. 1988. Communication Makes a Difference: Final report on the Egyptian Population Project. AED, Washington, D.C
[7] Bogue, Donald J. “How to Evaluate a Communications Campaign for Family Planning: A Demonstration Based on Data from the SIS Program in Egypt, 1980–82.” Research Report 6, Carolina Population Center, Chapel Hill, NC: University of North Carolina Press, 1983.
[8] World Bank, World Development Indicators, op. cit.
[9] Elkamel, Farag. Knowledge and Social Change: The Case of Family Planning. PhD Dissertation, Department of Sociology, University of Chicago: 1981.
[10] Elkamel, Farag. Communication Strategies and Programs: A Systematic Approach, UNICEF MENA Regional Office, 1986.
[11] Parlato et al. 1988. Communication Makes a Difference: Final report on the Egyptian Population Project. AED, Washington, D.C
[12] Ibid
[13] Ibid
[14] Parlato et al, op. cit.
[15] N. Rakia, We will solve the problem: An interview with Population and Family
Welfare Minister Prof. Maher Mahran. Integration. 1994 Sep; (41):4-7.
[16] UNFPA 2016. Population Situation Analysis, Egypt
[17] El-bakly S., Hess R.W. “Mass Media Makes a Difference,” Integration, 1994 Sep; (41):13-5.
[18]World Bank, World Development Indicators, ibid.
[19]World Bank, World Development Indicators, ibid.
[20] The full and detailed report is available from USAID, Egypt
[21] USAID/Egypt. Population and Health Performance Monitoring Plan, January 2009
[22] Ibid.
[23] CHL internal document, “Exposure to Family Planning Messages (2005-2008)”
[24] Egyptian Demographic and Health Survey (EDHS) 2008
[25] The Village Health Survey 2007: Menya and Fayoum
[26] El-Zanaty, Fatma et. al. EGYPT HEALTH COMMUNICATION SURVEY, 2008.
[27] The full and detailed report is available from USAID, Egypt
[28] https://to.almasryalyoum.com/article2.aspx?ArticleID=113312
[29]https://data.worldbank.org/indicator/SP.POP.GROW?contextual=default&end=2018&locations=EG&start=1960&view=chart
[30]The World Bank, World Development Indicators, https://data.worldbank.org/indicator/SP.POP.GROW?contextual=max&end=2018&locations=EG&start=1960&view=chart
[31]The World Bank, World Development Indicators, https://data.worldbank.org/indicator/SP.DYN.CBRT.IN?locations=EG
[32] Policies to address fertility Plateau in Egypt Final Report, Social Research Center The American University in Cairo January 2012
[33] Scott Moreland, Egypt’s Population Program-Assessing 25 Years of Family Planning. USAID, 2006
[34] The World Bank, World Development Indicators, ibid.
[35] The World Bank, World Development Indicators, https://data.worldbank.org/indicator/SP.POP.GROW?locations=EG
[36] The World Bank, World Development Indicators, Op.Cit.
[37] Ibid.
[38] The Egypt Demographic and Health Survey, 1988 and Full Report, DHS, 1988, p.133. https://www.dhsprogram.com/pubs/pdf/SR6/SR6.pdf
[39] Ibid.
Farag Elkamel 