Natural Fertility Planning in Egypt

Western mass media and public opinion advocate that sex outside of marriage has no harmful consequences and that birth control and abortion solve many problems of the world, rather than creating them.

In contrast, the Saint Joseph Institute for Family Pro-Life and Bioethics (SJI) advocates for Natural Fertility Awareness (NFP) as a vital educational and preventive instrument, and the Billings method of NFP has been available in Egypt since the 1980s. NFP emphasizes the centrality of the family as a cornerstone for love and life, empowers spousal love and closeness, and protects children from harmful sex education, Sexually Transmitted Diseases, and life risks. It’s the only method that empowers couples to regulate their fertility irrespective of economic status and independent of the logistics of supplies and distribution systems. NFP is unique in that it is a natural yet scientifically based technique, which a woman can use to precisely determine her fertility pattern, independent of costly or distant medical services, and free of dependence on artificial substances, with their side effects and potential health risks.

The Situation in Egypt

Egypt is the most populous country in the Middle East and the third most populous country in Africa. The Egypt Demographic and Health Survey (EDHS) from 2008 finds that many Egyptian women are having more births than they consider ideal.¹ Overall, 14% of pregnancies in the five years prior to the survey were reported as unwanted. Of these, 5% were identified as ‘mistimed’, meaning wanted later; while 9% were unwanted entirely. According to the 2008 EDHS, the overall desired fertility rate is 2.4 births per woman.

The 2014 EDHS indicated that 59% of currently married women in Egypt are using contraception. The most widely used methods are the IUD, the pill, and injectables, and 3% of these women report they use some form of NFP.

Family planning in Egypt

Contraception in Egypt is not new. The first birth control methods date back to ancient Egypt. 4000 years ago, healers advised as a method of contraception mixtures of crocodile dung and honey, or swabs of acacia honey, to be left in the vagina for long periods. A wine, garlic, or fennel-based lavender was also recommended after intercourse.²

In Egypt, especially in rural areas, it is common to hear statements like “Whatever God brings is good. I will not object”, “It’s up to God what happens to my children”, and “It depends on God’s will. If he wants me to get a baby”.

Religious Perceptions of Family Planning

Religion plays a central role in shaping the social norms, and the attitude of many Egyptians, towards fertility and birth control.

Islamic Perception

Around 90% of Egyptian society identify as Muslim (CAPMAS, 2010). A Qualitative Study to assess current attitudes and the influence of religion revealed that there are mainly two Islamic perceptions regarding family planning. The fundamentalist perspective, which is not widely observed in the community, is totally opposed to family planning,³ supported by statements (“Hadeith”) from prophet Muhammad which encourage married people to have children. The same Hadeith is interpreted less literally by religious moderates. Both moderates and fundamentalists regard abortion and sterilization (tubal ligation and vasectomies) as forbidden, since it is considered unacceptable to kill infants or to stop the ability to give birth. The Quran said in Sourah 6 El Ana’am part 8, verse 151 “Kill not your children because of poverty”.

Christian Perception

Christians represent around 10% of the Egyptian population. Christian religious leaders do not share many of the ideas adopted by Islamic fundamentalists, but the perception towards abortion is the same. Given the understanding that human life begins at conception, taking the life of an unborn child is considered no different than infanticide. Christians also believe fertility is the gift God gave women to save humanity. The study revealed that both Christians and Muslims are receptive to family planning that is based on the socioeconomic conditions of the families, and temporary contraceptives, as opposed to permanent methods, are considered acceptable.

The Experience of the St. Joseph Institute in Egypt

SJI was established in 1994, the International Year of the Family, in response to the World Population Conference in Cairo. The Cairo headquarters supported the establishment of branches in Alexandria, Minya, Assiut, Sohag, Luxor and Aswan, as well as in some countries outside Egypt. SJI has a team of teaching experts and university professors, in addition to a team of doctors, specialists and administrators. The aim of the institute is to be of assistance in the ongoing discernment of God’s plan so that the family can be faithful. The center offers diverse programs for the family, and bioethics. One of the main programs of SJI is The Billings Ovulation Method of Natural Family Planning. SJI is the only institution in the Middle East accredited by the World Organization of Ovulation Method Billing’s (WOOMB).

SJI’s teaching focus is on NFP as a lifestyle—not as a method to practice but as a concept to adopt. SJI teaches NFP within the context of bioethics as part of a six month marriage preparation course. The majority of program participants are non-Catholic (Orthodox, Protestant, Muslims). The teaching is delivered to married couples, but also to parents educating their children, youth, and seminary and religious leaders, and is multidimensional, integrating scientific, human, moral, and religious components. The program emphasizes respect for the dignity of women, and their positive creativity, especially in Islamic and Oriental cultures. Women are encouraged to take the initiative, and not feel exploited. The team of researchers at SJI has been conducting a study since late 2018 to assess the satisfaction of the married couples in premarital preparation at SJI and its effect on their marital life. The study showed that there is a huge need for those who didn’t attend the premarital preparation to receive a specific program on NFP (52%).

If NFP is so Beneficial, Why Do Few Practice It?

The EDHS (2008:63) shows that fertility awareness and understanding of the ovulatory cycle is limited among Egyptian women, with only one-fifth of the ever-married women age 15-49 interviewed in the EDHS able to answer that a woman has a greater probability of becoming pregnant if she has sexual intercourse halfway between two periods. The survey also showed that more than four in ten respondents either were unable to say when a woman is most at risk of pregnancy or believed that a woman’s risk is the same throughout the ovulatory cycle.

There are only a limited number of Billing’s certified teachers. The mainstream programs for fertility regulation rarely devote efforts to fertility awareness-based methods of family planning, despite their low cost. Many still link NFP to the church and wrongly call it the “method of the Catholic Church”. As a result, the majority of women and girls in Egypt remain ignorant about their reproductive pattern and the marvelous discovery of NFP as a way of life and love.

1 El-Zanaty, Fatma and Ann A. Way. (2009). 2008 Egypt Demographic and Health Survey. Cairo Egypt: Ministry of Health and Population, National Population Council, El-Zanaty & Associates, and ORC Macro.

2 Comparetto, Ciro & Borruto, F. (2014). The history of contraception: From ancient egyptians to the “morning after”.

3 Fertility Plateau in Egypt A Qualitative Study, 2011