Lessons from Iran: Reducing Personal Opposition to Contraceptive Use in Egyptian Women

Background: Since the 1980s, Egypt has experienced a reduction in total fertility rate from 5.6 (1976) to 2.8 (2008) and an increase in contraceptive prevalence rate from 18.8% (1976) to 60.3% (2008). Yet 12% of women intending and 6% of those not intending to utilize contraception reported personal opposition to use because of perceived religious prohibition. Methods: We critically reviewed relevant literature and analyzed available data regarding the role of Egyptian religious leaders with respect to contraception use. Findings: Religious leaders are viewed favorably by 81% of Egyptians, especially those in rural low-income populations, where contraceptive prevalence is lowest (48.4% in rural Upper Egypt versus 62.4% in urban Upper Egypt). However, only 1.2% of married women have heard a family planning (FP) message from a religious leader in the past six months. Furthermore, both Christian and Muslim local leaders reported a poor understanding of FP issues. In a survey of community religious leaders who attended a FP workshop in Upper Egypt, less than 20% demonstrated correct prior knowledge of FP issues. Recommendations: Local religious leaders and their wives should receive health education that clarifies the religious permissibility of FP and explains its health and social impact, including facilitating birth spacing and reducing STI transmission. They should be encouraged to discuss FP through individual and couples counseling, community meetings, and sermons. Engagement of religious leaders in FP programs will reduce stigma associated with FP and improve contraceptive prevalence.