In the last decade, the Egyptian state in collaboration with international donor agencies has embarked on an ambitious population control program. According to this program, Egypt’s rapid population growth is the prime obstacle to the development goals set by Egyptian authorities. Between 1980 and 1992, the program increased current contraceptive use among couples, primarily in the form of IUDs and birth control pills, from 24 percent to 47 percent. At the same time, it reduced the total fertility rate from above 5 to 3.9 percent. [1]
The process of associating reproduction and fertility with femaleness, perpetuates a private/public dichotomy and splits social analysis into female/male spheres. Such characterizations continue despite the expanded participation of women in the labor force and advances in female education that have changed the organization of the household and redefined female space and boundaries. Although feminist anthropology of the area has described the collapse of public/private dichotomies, [2] social and demographic research continues to characterize the household primarily as female space.
To promote the acceptance and use of contraceptive methods by women, internationally sponsored family planning programs have begun to focus on male partners. The endeavor to enhance male involvement in family planning decisions in Egypt by the state and international development agencies continues historical efforts to “modernize” the Egyptian poor. Thus, the family planning program as a pedagogical project is linked to constructions of gender, domestic life and the emergence of a responsible citizenry in Egypt.
Men and Family Planning
Historically, the Egyptian Family Planning Program has concentrated on women as recipients of its services. Specific surveys of women assessed the total fertility rate, the contraceptive prevalence rate, the age at marriage, the social status of women, and knowledge, attitude and practice of fertility control. This information helped policy planners assist women to make “independent choices” on the available contraceptive methods. [3] The relative invisibility of men in the debates on fertility control and contraceptive methods was perpetuated by this focus on women.
Recent attention in international family planning circles to how different cultures organize fertility decisions has induced planners to study male views on fertility control. Surveys conducted in developing countries have helped to explain male behavior in fertility regulation and to identify trends affecting future family planning policies. [4] International family planning efforts have successfully integrated male methods, such as condoms and vasectomy, into their various programs. In Egypt, however, user rates for these methods are extremely low. This failure is explained partly by evoking traditional culture, patriarchal norms, native notions of maleness, the “backwardness” of the peasant population and “Islamic doctrine.” Planners have attempted to overcome the perceived resistance to family planning through a concerted media campaign to educate men on the importance of family planning. [5]
In 1991, Macro International and the Cairo Demographic Center conducted a survey — funded by USAID — of male attitudes and behaviors in Upper Egypt and Cairo with respect to family planning. [6] The rationale for the survey was that available data from the 1988 Egyptian Demographic and Health Survey [7] indicated that the percentage of currently married women who had ever used contraception in rural Upper Egypt was almost half (26 percent) that of rural Lower Egypt (58 percent). Similarly, the current contraceptive use among women was three times higher in rural Lower Egypt (36 percent) compared to rural Upper Egypt (12 percent). [8] The 1988 survey also showed that a higher percentage of women in rural Upper Egypt believed that their husbands disapproved of family planning. The survey was based on the premise that the low current use in Upper Egypt was due to the persistence of traditional norms and the dominance of Upper Egyptian males in decision making within the household. The 1991 survey was set up as a comparison of the knowledge, practice and attitude of men from Cairo, considered more modern, and those of the more traditional of Upper Egypt — and especially rural Upper Egypt.
The first report of the USAID survey showed that the percentage of men in Cairo who have ever used or are currently using modern contraceptives with their spouses (81 percent) was twice as high as that for men in rural Upper Egypt (44 percent). [9] The survey reported that men in Upper Egypt were more “likely than men in Cairo to cite fatalistic reasons (e.g., ‘there is nothing one can do,’ ‘I accept what God gives me’) for not intending to use [contraceptives].” [10] These justifications for non-use of contraception fit, according to the survey, “with a view of more traditional men in Upper Egypt.” [11]
Other findings, however, did not confirm expectations. For example, a higher percentage of Upper Egyptian men (47.3 percent) than in Cairo (40.3 percent) had discussed fertility issues their wives. [12] Similarly, contrary to belief in family planning circles that Islam is a major hindrance to contraception, religion did not seem to stop the respondents from using family planning methods. In fact, rural Upper Egyptian men were less likely (8.9 percent) than men in Cairo (14.3 percent) to cite “religion as the main reason for not intending to use” contraception. [13]
Thus, the results challenged the predictions of the analysts. The survey found that the percentage of men in Upper Egypt who reported that using family planning methods for the first time was mainly their wife’s idea was higher in Upper Egypt (39 percent, 43 percent in ru- ral Upper Egypt) than in Cairo (31 percent). [14] The survey analysts acknowledged that the results were “contrary to expectations,” [15] and undermined the conservatism thesis. They interpreted the findings in a way, however, that obscured this conclusion, asserting that the “wife’s role was negatively related to the level of modernization.” [16]
Modernization
Although this USAID-sponsored survey did uncover some differences in knowledge,use, attitudes and decision-making practices between men in Cairo and in Upper Egypt, these differences were not sufficient to account for the difference in contraceptive use. Indeed, they often contradicted conventional culturalist expectations. Nonetheless, the report concluded that prevailing traditional social norms in urban and rural Upper Egypt influence men’s decision making role in family planning and may be responsible for the difference in contraceptive use. [17] Thus, statistical anomalies were forced to fit the culturalist paradigm.
The survey’s concluding statement clearly reveals the terms and categories in which the problem was defined and articulated. Questions about the household, who makes decisions on fertility, compatibility of responses among husband and wife and freedom of opinion and movement of women are embedded in the paradigm of modernization theory. [18]
Previously, modernization meant the establishment of a productive industrial economy, leading to a general enhancement of wealth and material welfare. Now it emphasizes the politics of representative democracy, periodic elections and free speech as practiced by people who have individual rights. [19] Using this new approach, demographic research deploys a notion of culture that links models of change to the acceptability of modern birth control. This approach adopts a narrowly construed formulation of culture as communication within the household with minimal reference to the social, political and economic forces of the larger society. [20] It also encompasses the idea that people in traditional cultures are more fatalistic and leave reproduction “to the will of God.” [21] This understanding of culture in effect places households/families and behavior patterns on a continuum of traditional to modern. Modernization of behavior may, therefore, lead to the constitution of modern families which are more open to the use of modern contraceptives.
Demographic research in this framework further purports to show that the level of education, autonomy of women and consensual companionate marriage is linked to high acceptance of contraception. In this perspective, notions of autonomous individuals, who as consenting adults, create the bond of conjugal marriage are crucial. Hence, the relationship between the individual and the state is seen to be mediated through new kinds of families where the notion of individual choice within the nuclear family is paramount. This idea of free individual choice linked to the language of rights and set in the context of a companionate marriage and a nuclear household, becomes the bedrock for most international family programs. The population planning program sponsored by the Egyptian state and international agencies attempts to socialize the domestic sphere in precisely these ways.
Following this argument, it is safe to say that although not explicitly stated, the Egyptian Male Survey (EMS) assumes the nuclear household as a progressive, positive and modern space devoid of pressures from other kin, friends and relatives on reproductive decisions. It further assumes that household to be a decision-making unit, free and open to discussion regarding fertility choice and the sole locus of social respectability. The contrast made with rural Upper Egyptian men through representative sampling is drawn precisely to study their departure from this norm. [22]
Championing Choice?
Furthermore, sensitive to local practices, Egyptian family planning policy asserts the right of the family as a unit to decide on the number of children it desires within the framework of religion and the cultural norms of society. [23] In practice, however, services are primarily provided to women and spousal consent is not required for the use of most family planning methods. [24] International donor agencies favor this approach, championing the right of the individual, in this case “the Egyptian woman,” to decide the method of contraception.
With the choice of contraception by women linked to their emancipation, the family planning program and the donor agencies present themselves as the defenders of the rights of women. [25] Nonetheless, the donor assisted family planning program seeks not only to enhance the range of individual choice available to women but to create conditions in which only certain choices can be made. For instance, the language of individual choice does not allow the option of non-choice of contraception. Yet, we could interpret some of the EMS survey results as suggesting that, in Upper Egypt, women and their “traditional household patriarchs” are equal partners in rejecting modern contraceptives connected to the authority of the state and development agencies. Be that as it may, planners have now discovered that they cannot always bypass the men.
Advertising Family Planning
A series of television advertisements in Egypt addresses men’s role in contraceptive decision making. These advertisements, produced by the State Information Services under technical guidance and financing from USAID and Johns Hopkins University, focus on men’s familial responsibilities as providers. Some of these advertisements represent men as heads of families and criticize them as conservative, traditional, and anti-modern defenders of the status quo — that is anti-birth control. Others encourage men to be flexible and uncritical towards female decisions to use contraceptives. Still others use pervasive stereotypes showing an unconcerned peasant patriarch who rides on a donkey while his wife, walking next to him, carries a big load on her head. The ads encourage men to behave better towards their Womenfolk and show images of modern urban men helping their wives in domestic household chores. Another television spot shows a sheikh admonishing a poor man for failing in his duty as a father, and for having many children without thinking of the consequences. The father is blamed for the large family and the sense of deprivation and inadequacy it creates for all.
In many advertisements, authority figures such as the sheikh and the social worker stress the responsibility of men to live up to their role as providers. By invoking this image, family planning policy makers seek to shame men into being “real men” that is to be more responsible individuals, hence have fewer babies. Family planning is presented in terms of the health and future of the wives and children, evocations with strong appeal to men. [26]
The Limits of Modernist Constructions
The Egyptian state in collaboration with international donor agencies uses its family planning program as a tool to modernize its population. The state promotes distinctive political and social practices connected to modern ideas of physical and mental health. [27] In this process the normalization of conjugal marriage and the nuclear family helps construct the modern categories of the “individual,” the “private” and ultimately “modern citizens.”
In Egypt, however, these constructions rest on slippery terrain. On the one hand, there is an effort to produce socially responsible fathers who follow the state’s advice on family planning. On the other, high unemployment, socioeconomic deprivation and an undemocratic political environment push most people to the margins of the system, creating political conflict and deep resentment. In intellectual circles as well as among the poor, questions are raised about the assumed “natural” linkage of economic development and population control. The increasing disparity in income levels that is quite independent of family size subjects the emphasis on family planning to criticism on the grounds of equity of distribution and social justice. Moreover, popular notions of the body, healing, fertility, and sexuality undermine the legitimacy of state-sponsored medical and social impositions.
Rapid socioeconomic changes do not only undermine traditional male power. As poverty levels increase, women are forced to seek employment outside their homes to help pay for the increasing costs of educating and rearing children. For women the economic insecurity of their male partners undercuts the few benefits of the “patriarchal bargain” [28] they enjoyed. Recent data show that the ill effects on nutrition and health linked to structural adjustment are worse for women and children. [29] As old support structures are disappearing new forms have yet to evolve. It is a time of much apprehension and uncertainty for the underprivileged in Egyptian society.
Finally, as the Egyptian state and international agencies link Egypt’s future economic growth to the population question, they combine high-pressure appeals for contraception with the deeper impact of socioeconomic coercion. Demographic transition may occur in Egypt. But if it does, it will be less for the classical reasons usually linked to better standards of living than to the majority of Egyptians’ diminishing opportunities to make a living.
Author’s Note: The fieldwork in Egypt was supported by a Doctoral Research Fellowship granted by the Population Council and the support of the anthropology department at the Johns Hopkins University. Institutional support while in Egypt was provided by the American University in Cairo and the Population Council Office in Cairo. The author wants to thank Talal Asad, Clarissa Bencomo, Caroline Bledsoe, Niloufer Haeri, Laura Lewis, Emily Martin, Norma Moruzzi, Syema Muzaffar, Martina Rieker, Michel-Rolph Trouillot and the editors of this journal for their thoughtful comments. However, I remain responsible for the final shape of this paper and any shortcomings therein.
Endnotes
[1] Egyptian Demographic and Health Survey (Cairo: National Population Council, 1992), p. xxiii.
[2] See Lila Abu-Lughod, Veiled Sentiments (Berkeley: University of California Press, 1985); Soraya Altorki, Women in Saudi Arabia: Ideology and Behavior among the Elite (New York: Columbia University Press, 1986); and Cynthia Nelson, “Public and Private:Women in the Middle Eastern World,” American Ethnologist 1 (1974), pp. 551-563.
[3] This emphasis on women echoed the larger trends in family planning policy elsewhere in the world; see Susan Cotts Watkins, “If All We Knew About Women Was What We Read in Demography, What Would We Know?” Demography 30/4 (1993), pp. 551-577.
[4] See M. A. Mustafa, Male Attitudes Towards Family Planning in Sudan (Sudan Fertility Control Association, 1982); Michael T Mbizvo and Donald J. Adamchak, “Family Planning Knowledge, Attitudes and Practices of men in Zimbabwe” Studies in Family Planning 22/1 (1991), pp. 31-38; Shireen J. Jejeebhoy and Sumati Kulkarni, “Reproductive Motivation: A Comparison of Wives and Husbands in Maharashtra, India,” Studies in Family Planning 20/5 (1989), pp. 274-290; Mona A. Khalifa, “Attitudes of Urban Sudanese Men Towards Family Planning,” Studies in Family Planning 19/4 (1988), pp. 236-243; and Hussein Abdel-Aziz Sayed, Fatma Hasan El-Zanaty and Anne R. Cross, Egypt Male Survey 1991 (Cairo Demographic Center, 1992).
[5] The preceding analysis is based on interviews with family planning officials in the government, international donor agencies, nongovernmental organizations and family planning reports and surveys.
[6]6. See Sayed et al., Egypt Male Survey 1991.
[7] Egyptian Demographic and Health Survey.
[8] See Sayed, p. 2.
[9] Ibid., p. 22.
[10] Ibid., p. 32.
[11] Ibid.
[12] Ibid., p. 45.
[13] Ibid., p. 32.
[14] Ibid., p: 63.
[15] Ibid.
[16] Ibid.
[17] Ibid., p. 70.
[18] Susan Greenhalgh, “Anthropology Theorizes Reproduction: Integrating Practice, Political Economic and Feminist Perspectives,” in Susan Greenhalgh, ed., Situating Fertility (Cambridge: Cambridge University Press, 1995), pp. 3-28; Susan Greenhalgh, “The Social Construction of Population Science: An Intellectual, Institutional and Political History of Twentieth-Century Demography,” in Comparative Studies in Society and History (forthcoming).
[19] See Talal Asad, “Conscripts of Western Civilization,” in Christine Ward Gailey, ed., Civilization in Crisis (Gainesville, FL: University Press of Florida, 1992), pp. 333-352.
[20] See Greenhalgh, Situating Fertility, p. 7.
[21] See Jane Schneider and Peter Schneider, “Sex and Respectability in an Age of Fertility Decline: A Sicilian Case Study,” Social Science and Medicine 33/8 (1991), pp. 885-895.
[22] By the early twentieth century, reflecting changing social and economic structures, marriage patterns by choice and “love,” were becoming common among the elite of Egypt. See Beth Baron, “The Making and Breaking of Marital Bonds in Modern Egypt,” in Nikki Keddie and Beth Baron, eds., Women in Middle Eastern History (New Haven, CT: Yale University Press, 1991), pp. 275-291.
[23] See H. Sayed as quoted in Nora Guhl Naguib and Cynthia Lloyd, “Gender Inequalities and Demographic Behavior: The Case of Egypt,” Occasional Paper Series (New York: The Population Council, 1994) and H. Sayed, “Population Policy in Egypt,” in Population Policies in the Third World: Issues and Practice (Cairo: Cairo Demographic Center, 1988).
[24] See Naguib and Lloyd.
[25] International donors view the policy emphasis on the rights of couples as a direct infringement of the individual rights of women to decide in reproductive matters.
[26] Using the rhetoric of overpopulation, Egyptian state and media proclamations continuously hold the people responsible for their own economic misery. The family planning program also allows the state to enter the domestic space of the Egyptian household. On the one hand it poses as the defender of women’s rights. On the other, it undermines the authority of the patriarch by deeming him irresponsible. Thus the state carves out the authoritative voice in relation to fertility decisions.
[27] See Asad, op. cit.
[28] Deniz Kandiyoti, “Bargaining with Patriarchy,” Gender and Society 2/3 (1988), pp. 264-272. Kandiyoti argues that by letting men enjoy some privileges women traditionally guaranteed for themselves a secure social and economic environment.
[29] Heba Nasser, “The Impact of Adjustment Policies on Nutrition in Egypt,” unpublished paper prepared for the Twenty-Ninth European Association of Agricultural Economists Seminar on Food and Agricultural Policies under Structural Adjustment (Stuttgart, 1990).
