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A Hard Pill to Swallow: Stigmas Surrounding Birth Control in Egypt

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A Hard Pill to Swallow: Stigmas Surrounding Birth Control in Egypt

Credit: Amr Abdallah Dalsh- Reuters

“Birth control is permissible”. Dar al Ifta’s latest campaign message is strikingly clear with an aim to address religious controversy around contraception in the wake of Egypt’s looming population crisis. But how much impact will this campaign have on attitudes towards use of contraception and family planning in Egypt, and what other societal stigmas surround birth control?

The campaign, which was launched in February to address anti-birth control religious discourse, was publicised in a series of posts on Facebook and Twitter. Dar al Ifta, one of the most prominent Islamic advisory bodies in Egypt, claims that “the control of birth or its regulation is not interfering in God’s will”, and that “all legal rulings from the Quran and Sunnah include no texts that prohibit the control of birth”. According to a fatwa issued on their official website, ‘azl, commonly known as the withdrawal or pull-out method, was performed at the time of the Prophet Muhammad and is permissible according to the Qur’an. Dar al Ifta considers modern contraceptive methods comparable to this, and therefore acceptable.

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Mohamed Mokhtar Gomaa, Minister of Awqaf which is responsible for Islamic endowments in Egypt, recently praised the discussion around birth control claiming that it is “at the core of renewing religious discourse.”

Dar al Ifta’s re-emphasis of the fatwa follows a speech from President Abdel Fattah Al Sisi at the inauguration of a number of new hospitals in February 2021. He claims that overpopulation is a “national security matter” and stresses the need to cut annual population growth from 2.4 million to 400,000. Egypt’s current population in 2021 is estimated to be around 104,000,000.

The impact of the campaign remains to be seen, yet some are certain of its potential to bring change. Ahmed, a young pharmacist practicing in Cairo, believes the campaign has potential to be “very impactful.”

“People have a lot of trust in religious authorities like Dar al Ifta – the effects could be global, maybe reaching as far as the Muslim population of Indonesia,” he explains.

When asked if he thought this would lead to an increase in over-the-counter sales, he agrees, “especially amongst those with initial hesitancy.”

Ahmed was also keen to stress that Dar al Ifta’s campaign was riding the wave, not necessarily creating it.

The 2014 Egyptian Demographic and Health Survey (EDHS) survey revealed that 59 percent of women married at that time were using contraception, with the IUD (intrauterine device) and injectables among the most popular methods.

Ahmed mentioned that over the past few years he has noticed that Muslim women are becoming more and more interested in these long-term options specifically, and expects the recent campaign to only heighten this.

Mohamed, a consultant gynaecologist and obstetrician practising in Cairo, has also noted this trend. From his experience, Muslim patients used to voice their religious objections to birth control methods when offered them.

“About five years ago they’d often say, ‘no doctor, you know that’s against our religion’,” says Mohamed. “Now they’re starting to listen more. I can feel a change coming, I can almost touch it.”

But the stigmas surrounding birth control in Egypt extend beyond merely religious ones. Ahmed describes the “vast misconceptions” about the side effects of birth control from a number of female patients.

“Rather than asking about the legitimate side effects, many women have fears of disfigurement of children and infertility – ideas debunked years ago.”

Salma, a 29-year-old English teacher who has been on birth control pills for three and a half years, since her marriage described how her family and friends’ often express concern about her health as a result of using birth control.

“They ask me, why are you on pills?,” explains Salma to Egyptian Streets. “You’re going to ruin your body, and you might not be able to have kids later.”

For Salma, the main controversy surrounding birth control is not about the methods themselves. She doesn’t want to have children yet, and has found that the pressure to do so is sometimes enforced by doctors, who have often recommended her temporarily being on birth control, for six months at a time for this reason.

“The stigma is about women not having kids. You get married, you maybe wait for a year maximum, have the first kid, take a break for a couple of years, have the second kid, maybe stop then, or have the third, the fourth… That’s the pattern. And if you don’t fit the pattern, you start getting questions,” says Salma.

This is something Mohamed has noted in his years of practice. He believes the root of reluctancy around using birth control is pressure from the outside.

“Many try to come to the clinic alone, as mothers often try to accompany them and push for shorter term contraceptive options.”

This idea was clear in the 2014 EDHS, which reported that just two of ever-married women aged 15-49 regarded use of birth control before a woman’s first pregnancy to be acceptable.

There is also much to be said for social taboos surrounding specific methods of birth control, such as the emergency contraceptive pill.

Ahmed describes it as “the most stigmatised and least talked about” contraceptive. Only one brand, “Contraplan” is available in Egypt for EGP £19.5. Many other contraceptives have been heavily subsidised by the government in this way. Reuters reported in 2017 that intrauterine devices can be purchased for as little as EGP £2 in rural areas in a bid to halt exponential population growth.

Despite being so affordable, many pharmacies are reluctant to sell Contraplan to anyone: if you’re married, then don’t you want the child? If you’re unmarried, then how did you get yourself into this situation? Some pharmacies also claim they are out of stock, which forces many women to attempt to find more expensive, imported variations.

“I once served a girl who had been refused the emergency pill from every other pharmacy she’d visited that day”, says Ahmed. “She had been subjected to taunting comments. They told her it was her own fault and that she had to deal with the consequences.”

Contraplan II is an emergency contraceptive widely available in Egyptian pharmacies for approximately 20 EGP (1.2 US$). Source: omnia-health.com

Notable taboos also surround condom use. The Egyptian Health Issues Survey, conducted in 2015 by the Ministry of Health and Population, revealed that whilst 95 percent of Egyptian women aged 15-24 had heard of using the contraceptive pill, just 34 percent knew about condoms. Mohamed struggles to understand this, claiming that condoms are the cheapest, most effective, and easiest method of birth control. According to him, “the stigma is not about morals, it’s about the fear of being judged.”

He described the situation of a married male patient who insisted on buying condoms from a pharmacy miles away from his home as he feared the assumptions that may be made about him, as condoms are routinely associated with promiscuity and sex outside of marriage.

Unsurprisingly, women face even greater difficulties purchasing condoms in Egypt.

“If women buy condoms, those selling them look down on you, they judge you a little bit, maybe pass a comment, so they ask their male friends to go and buy them. They usually get no reaction at all,” describes Nada, a young university student living in Cairo.

The burden that women carry in relation to birth control is a reality which also resonates with Fatima, a woman living in Cairo who has been married for four years.

As far as contraceptives are concerned, “the pressure is totally on the woman, not the guy,” she says.

As a consultant gynaecologist and obstetrician, Mohamed strongly advocates for these stigmas to change.

“We must work on men’s attitudes. We have to change the mentality,” says Mohamed. “For example, men often act as the decision makers for their wives’ in terms of contraception, but rarely use condoms because they don’t want the responsibility.”

Mohamed believes that those working in the medical community has a level of responsibility for these stigmas.

“We have to recognise that women are shamed. Many doctors will openly shout at and judge young women who come to the clinic seeking sexual health advice. They focus on self-interpretation and not professional medical views.”

Whilst attitudes towards birth control have changed in recent years in Egypt, the concept remains shrouded in numerous and diverse stigmas which are felt across society. When asked how these can be overcome, the conclusion is always the same: education. For Fatima, contraception is a difficult subject in Egypt “because we don’t really know much about it.”

Over the past few years, a number of sexual education initiatives have appeared in Egypt and across Arab society to attempt to combat the gaps left by the national curriculum’s approach to teaching this type of content. Egyptian Streets spoke to the founders of The Sex Talk in 2018, an online campaign raising awareness about sexual health. Activist and founder Fatma Ibrahim explained that “we don’t have enough online content about sex education and sexual health. We, as Arab women are quite vulnerable, especially with no knowledge whatsoever about this topic.”

Despite the positive impacts that Dar al Ifta’s campaign can bring, many agree that more must be done.

“We must educate and empower- simultaneously,” explains Mohamed.

“We can overcome these stigmas by raising a generation of children who learn to respect women and empower them – we have to invest in this.”

Some names have been changed for anonymity reasons.

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Olivia is currently studying in Cairo as part of her undergraduate degree in Middle Eastern Studies at the University of Cambridge. She has worked on a number of student-run publications, such as Varsity and The Cambridge Language Collective, and is passionate about exploring Egyptian culture, history and society through journalism.

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