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In the village of al-Barsha in Minya Governorate, 55-year-old Munira Abdel Hamid reminisces about her marriage, which began when she was just 18. Six years of childless waiting were followed by a relentless succession of pregnancies that drained and exhausted her body. She gave birth to six children in just a few years, all while helping her husband run the family restaurant and shouldering household and childcare responsibilities.
A secret contraceptive
As her health deteriorated and pressures mounted, Munira asked her husband for permission to use contraception. For a large segment of women in Upper Egypt, especially those who live in villages and do not work, the decision to have children is not theirs to make. Husbands cling to the idea of having many sons and often force their wives to keep getting pregnant, especially if they don’t already have any sons. Women are expected to continue giving birth until they bear a boy, and then they are expected to conceive again to give birth to another son—so the brothers can support one another and their father, according to local beliefs.
Munira’s husband refused firmly, insisting that al-‘ozwa, a term meaning one’s progeny or lineage, was sacred.
Munira found herself with only one option: to secretly go to the local health unit and have contraception inserted, defying her fear of being discovered. “I could no longer bear to live in a body that was breaking down, to live a life consumed by childbirth, work, and home duties,” she says. “I had to break this cycle, even if it meant going against his wishes.”
Years later, her menstrual cycle stopped altogether, and she finally felt she had escaped the vortex of forced reproduction, though the memory of her struggle against patriarchal control remains vivid.
Despite the decades that have passed since Munira’s experience, the culture surrounding childbirth in Upper Egypt has changed little. In Dairut, Asyut Governorate, Mohamed Farag, a vegetable vendor whose daily income barely reaches three USD, pressures his wife, who is in her thirties, to keep bearing children, believing that “more children bring more blessings.” The family already has seven children, including quadruplets, yet the husband vehemently refuses any form of family planning.
His wife tells Medfeminiswiya, “I secretly went to get contraception, but when he found out, he beat me and forced me to have it removed at the health unit.”
Between Munira’s hidden act of defiance and Mohamed Farag’s wife’s forced compliance lies the deeper dilemma faced by thousands of women in Egypt: exhausted bodies, stripped agency, and a society that still treats them like reproductive machines rather than partners in decision-making.
She finally felt she had escaped the vortex of forced reproduction, though the memory of her struggle against patriarchal control remains vivid.
Family Planning Clinics are an educational awareness project launched by the Ministry of Social Solidarity in November 2024, aiming to improve healthcare services for women in collaboration with partner NGOs.
Rural women leaders’ strategies to combat unplanned childbirth
Amid this bleak landscape, local efforts are emerging to shift the balance. In the village of Dairut, Amina Mahmoud Badr works in a rural outreach program that has been part of Egypt’s public health strategy since the mid-1990s. It was officially integrated into the Ministry of Health’s programs in 1996 as a mechanism for reaching families in rural areas.
Today, the network covers around 14,000 rural women leaders, health workers who act as a link between health units and villages. Each leader oversees a defined residential area comprising hundreds of families. For example, the Social Solidarity Directorate in Asyut announced 774 projects for rural women’s development and the training of 1,319 women health workers at a cost of 6,617,000 Egyptian pounds, equivalent to approximately 140,000 USD, until 2024.
To persuade women to use family planning methods, Badr sometimes resorts to unconventional tactics. She tells them that failing to visit the health unit might result in the suspension of their Takaful and Karama cash assistance cards—even though that is untrue. Takaful and Karama is a conditional cash-transfer program launched by the Ministry of Social Solidarity to support low-income families.
“I had to resort to doing this with the women who refused direct advice,” Badr says, “because many of the women benefiting from this support are the ones who have the most children.”
Recent data show that Egypt’s fertility rate stood at 2.75 births per woman in 2023—the same as in 2022. In July 2025, Minister of Health and Population Khaled Abdel Ghaffar announced that the fertility rate had continued to drop, reaching 2.41 children per woman in 2024, down from 2.85 in 2021, a 15.4% decline in three years.
And a 2019 study by Dr. Hussein Abdel Aziz Sayed, titled “Trends of Fertility Levels in Egypt in Recent Years,” indicates that fertility rates in 2018 reached 2.75 in urban areas, compared to 3.52 to 3.93 in Upper Egypt and border regions, respectively.
Through her work, Badr aims to raise awareness among approximately 200 women in rural areas each month. She notes that working women are often keen to use contraception to maintain stability in their lives, while non-working and less educated women require significantly more effort to be persuaded. Between home visits and the training courses they receive every two months, rural leaders find themselves in a daily battle against entrenched mentalities that see reproduction as an end in itself, even if it comes at the expense of women’s health and lives.
“I had to resort to doing this with the women who refused direct advice because many of the women benefiting from this support are the ones who have the most children.”
But on the ground, the work of rural health workers remains fraught with challenges that are no less complex than the nature of their work itself. Sanaa Mosaad, a rural health worker at Abu Qurqas Health Unit in Minya, says she oversees six villages and regularly monitors more than 500 rural women through comprehensive campaigns that include awareness about contraception and early breast cancer detection, in addition to initiatives to raise awareness about the dangers of female genital mutilation.
“The role of the health worker doesn’t stop at the clinic door. It extends to home visits to follow up with women after childbirth or to help them change contraceptive methods to suit their health and social circumstances,” she says.
Men’s fights inside Family Planning Clinics
But these efforts often collide with deep structural barriers. The husband’s authority and the requirement of his consent transform a woman’s body into a terrain of exclusively male decision-making.
According to the Ministry of Health and Population’s document titled “Standard Criteria for Family Planning Services,” service providers must obtain prior written consent from the beneficiary before inserting long-term contraceptives such as intrauterine devices (IUDs) or implants, as part of service quality assurance and informed consent provisions.
However, a field study reveals that some health units, particularly in rural areas, still require or request the husband’s consent before providing services, reflecting a discrepancy in the practical application of the Ministry’s standards.
Sanaa Mosaad says, “Some men refuse to let their wives use contraception. If a woman comes to the clinic without her husband’s permission, it can lead to public arguments inside the clinic.”
In many cases, staff at Family Planning Clinics are required to request the husband’s presence and obtain his signature on a consent form. This practice is presented as a means of conflict management but essentially reflects continued male control over women’s bodily autonomy.
Although government health units offer contraceptives free of charge through the Ministry of Health, private clinics charge up to 5,000 Egyptian pounds (about 100 USD or 85.7 euros). As a result, many women are forced to discreetly seek short-term contraception to avoid their husbands finding out.
Thus, reproductive decisions remain contingent upon the man’s will, even though women bear the brunt of the health, social, and economic consequences.
The husband’s authority and the requirement of his consent transform a woman’s body into a terrain of exclusively male decision-making.
The implications are magnified by rapid demographic growth. Egypt’s population reached approximately 108.067 million at the end of August 2025, up from 107.937 million at the end of July of the same year—an increase of 130,000 people in just one month. This translates to an average daily increase of 4,200 births, compared to 4,400 daily in July. While the annual growth rate declined slightly to 1.25% compared to 1.4% in 2024, the geographic distribution reveals a striking disparity.
Minya alone recorded a population increase of 11,000 people in a single month, the same as Giza, while Cairo’s increase did not exceed 9,000. Looking at the national population map, it becomes clear that the Upper Egypt governorates, along with Giza, accounted for roughly 65,000 of the total monthly increase—about 50% of the national growth—even though these governorates comprise only 38.5% of Egypt’s total population.
If Egypt’s official figures show a population surpassing 108 million, with half of the population growth concentrated in Upper Egypt, this increase cannot be separated from the deeply entrenched cultural and media patterns that reproduce the crisis generation after generation.
Male-dominated media undermines family planning initiatives
In this context, we met with Dr. Magda Mohamed Helmy, a consultant obstetrician-gynecologist. Consultant is the highest professional rank for a doctor in Egypt. Dr. Helmy notes that she has spent approximately 15 years practicing medicine since obtaining her degree.
Dr. Helmy criticizes what she calls “the male voice” in Egyptian media, which places the entire burden of reproduction on women while ignoring men’s essential role as a partner in the decision-making process.
She explains that most media platforms, dominated by men, recycle traditional rhetoric that confines women to the domestic sphere: reproduction, raising children, and serving the husband.
She adds that even some female media figures reproduce this patriarchal discourse, leaving audiences exposed to messages glorifying al-‘ozwa and large families as sources of abundance and blessing. This in turn increases the likelihood of uncontrolled reproduction, especially in rural areas and villages.
From a social perspective, Dr. Samia Khadr, professor of sociology at Ain Shams University, argues that population growth is not just numbers; it reflects the absence of collective awareness and the shortcomings of media and art in addressing the issue.
“Current awareness campaigns are seasonal and sporadic,” she says. “What’s needed is a consistent, daily discourse that convinces families—especially men—that neither personal nor social resources can sustain large families anymore.”
She cites the reality of her female students at university, noting that she is sometimes surprised to see some of them arriving at lectures with two or three children in tow, which disrupts their academic progress and limits their job prospects. Addressing this phenomenon, she insists, requires a deep cultural shift: one that brings men into shared responsibility and cultivates the understanding that smaller families lead to better quality of life and more stability.
Population growth is not just numbers; it reflects the absence of collective awareness and the shortcomings of media and art in addressing the issue.
The Reproductive Counseling Initiative
At a time when the responsibility for reproduction and family planning falls almost entirely on women, the Reproductive Counseling Initiative has emerged to challenge that premise.
Launched by Hanan al-Hadary, a media and family planning officer and population educator in Alexandria, the initiative aims to redefine the role of men as responsible partners in protecting their wives’ health and ensuring family stability.
The initiative is focused on capitalizing on the moment fathers visit health units to register their newborns. They are given direct guidance on the importance of supporting their wives in accessing contraception during the first month after childbirth, with regular follow-ups to ensure its effectiveness.
“The husband must understand that having children is not solely a woman’s decision,” al-Hadary explains. “It is a shared decision that affects the lives of the entire family.”
The initiative has already had a tangible impact: some men have returned to health units with their wives to request contraception—a sign, al-Hadary says, of growing awareness that could spare women from repeated, unplanned pregnancies that endanger their health and lives.
She notes that the greatest challenge lies among less-educated groups. That’s why the initiative specifically targets these communities, aiming to dismantle the patriarchal norms that hold women’s bodies hostage to male desire.
Beyond medical awareness, the Reproductive Counseling Initiative represents something deeper: gender justice and equality within the family. It transforms women from the sole bearers of responsibility into partners supported by their husbands in the fight for women’s right to bodily autonomy.
Main picture: Family Medicine Center in el-Matareya. Photo by Shaimaa El Youssef.
This article was carried out with the support of the Tunis Office of the Rosa Luxemburg Foundation.
