Why urban areas did not complete their transition to ...schools.aucegypt.edu/research/src/Documents/population_conf/Studies_new/Paper Hanan...3 these policies did not succeed in stopping

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Why urban areas did not complete their transition to replacement levels and how to influence this transition?1

Hanan Girgis, Ph.D. Project Officer, Evidence-Based Population Policy Project

Acknowledgment: I am greatly indebted to Dr. Magued Osman, Professor of statistics, Faculty of economics and political science, for providing me with the main idea of the paper, following up the progress of the paper and commenting on its first draft.

Introduction

Bongaarts (2003) defined seven stages of transition from high to low fertility levels relying on the observed TFR. According to this definition, Egypt was moving slowly in the mid-late transition stage during the last two decades. DHS data show that TFR decreased in Egypt from 3.9 in 1992 to 3 children per woman in 2008. Studying TFR of urban and rural areas shows that the reduction in TFR resulted from the reduction in TFR of rural areas, where the TFR declined from 4.9 to 3.2 children per woman while it fluctuated during the same period around 3 children per women in urban areas (Figure 1). Thus rural Egypt moved from the mid transition stage to the mid-late transition stage while fertility stalled in urban Egypt. The first look at the trend of the TFR in urban upper Egypt and urban lower Egypt reveals different patterns that suggests in-depth studies for the different urban areas in Egypt. Different types of urban administrative units also act differently regarding fertility preferences and achieved fertility levels.

Figure 1 TFR of ever married women (15-49) by type of place of residence

Source: DHS 1992 - 2008 1 This paper was done under the project “Policies to address fertility plateau in Egypt” coordinated by the Social Research Center (SRC) of the American University in Cairo (AUC) and supported by the United Nations Population Fund (UNFPA), Cairo Office.

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1992 1995 1998 2000 2003 2005 2008

Urban Rural Egypt

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The objectives of this paper include 1) reviewing the urban areas in Egypt, 2) investigating the characteristics of urban women that affect contraceptive use, and hence, fertility, and presenting the trends of these characteristics, 3) finding out whether urban areas are homogeneous in their population characteristics and fertility determinants, and 4) suggesting policy recommendations to deal with the fertility stall in urban areas.

Section 2 of this paper sheds light on the urban areas in Egypt and section 3 presents the methodology of the paper. Section 4 presents the levels of fertility and contraceptives use in urban area and section 5 investigates the variables that affect contraceptives use in urban areas. The trends of these variables as well as the determinants of fertility in different urban areas are presented in sections 6 and 7 respectively. Section 8 summarizes the conclusion and presents the policy recommendations.

Urban Areas in Egypt

As shown in the 2006 census results, urban population size approaches 31.4 million representing 43% of the Egyptian population. When reviewing the status of urban areas in Egypt, some issues should be considered. One of these issues is the definition of urban areas. Urban areas in Egypt are defined in the United Nations reports as Cairo, Alexandria, Port Said, Ismailia, Suez, frontier governorates and capitals of governorates and districts (Marakez). The Central Authority for Public Mobilization and Statistics (CAPMAS) uses the same definition except that it does not consider Ismailia and frontier governorates among urban governorates. In most of the world countries, urban administrative units are defined according to one or more of the following characteristics: population size, population density, the ratio of agriculture to non-agriculture workers, socio-economic and administrative infrastructure and public and municipal services (United Nations, 2007) , while in Egypt there are no clear criteria to define urban areas upon. If we considered the population size as the criteria of classification, we will find many administrative units that are considered as cities and capitals for districts while many other administrative units in the same districts with larger population size are considered as villages (rural). Administrative units are transformed from rural to urban usually by administrative decrees without reviewing their characteristics. A flagrant example for these cases is Youssef Al-Sediq city in fayoum which was transformed from a village to a city with a prime minster decree in 2002 to be the capital of the new Markaz Youssef Al-Sediq (prime minster decree No. 185 for year 2002) without having the largest population size or the best civil services among the other villages in that Markaz.

The second issue that should be tackled in urban areas is the wide spread of slum areas. Slum areas are informal and unplanned clusters with poor services and high density. The slum areas in Egypt rapidly increased in the past 60 years. Many policies were considered to develop the slum areas and improve their conditions, and others to provide formal settlements to be inhabited, but

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these policies did not succeed in stopping the growth of slum areas. For example the area of the slums in greater Cairo jumped from 6.6 Km2 in 1950 to 119.5 Km2 in 2006 with annual increase of 1.4 Km2 between 1950 and 1977, 4.4 Km2 between 1977 and 1991 which equals the average inhabited area of 5 Shiakhas in Cairo, and 0.8 Km2 between 1991 and 2006 which equals the average inhabited area of one Shiakha in Cairo. Slum areas reform 5% of the inhabited areas in greater Cairo, on which about 35% of greater Cairo population live. These percentages rise in Cairo to about 21% and 39% respectively. Overall Egypt, about 12.2 million people live in 1221 slum areas (CAPMAS, 2007). Studies show that the characteristics of population and fertility preferences differ between slum areas and non-slum areas. Greater Cairo slums study indicated that women in greater Cairo slum areas tend to be poorer and less educated than women in all urban greater Cairo (El-Zanaty and Way, 2004).

The third issue is that most of the small urban administrative units are located within rural areas. The urban administrative units could be classified according to their population sizes into 3 categories; Capital/Large cities: including cities with population size greater than 1 million people, Small cities: including cities with population size greater than 50 thousand and less than 1 million people, and Towns: including cities with population size less than 50 thousand people. Applying the previous definition on the results of 2006 census shows that Egypt has 3 capital/ large cities representing 1.2% of the inhabited urban administrative units and about 41% of urban population lives in them while towns represent about 57% of the urban administrative units and their population represents about 11% only of urban population. Small cities and Towns are often the capitals of districts (Marakez) and hence, they are located among rural administrative units (villages). The GIS appendix shows the distribution of the large cities, small cities and towns all over Egypt.

Methodology To achieve the study objectives, different indicators were studied in urban and rural areas. To reveal the differences among different urban areas urban administrative units were classified according to their size into 3 types; Capital/Large city, Small city and Town as previously mentioned. Urban areas were also classified into 6 regions: Urban Greater Cairo: includes urban areas in Cairo, Giza and Qaliubia, Urban Governorates: includes urban areas in Alexandria, Port Said and Suez, Urban Lower Egypt: includes urban areas in all lower Egypt governorates except Qaliubia, Urban North Upper Egypt: includes urban areas in Beni Swef, Fayoum and Menia, Urban South Upper Egypt: includes urban areas in Assyout, Sohag, Qena, Luxor and Asswan,

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Urban Frontier Governorates: includes urban areas in Matrouh, North Sinai, South Sinai, Red Sea and New Valley. DHS Wealth quintiles of 2005 and 2008 were used in the analysis. For DHS 1995 and 2000, the wealth index was calculated in this paper using the available data about household (HH) substances and dwelling characteristics. Factor analysis was used to assign a score for each HH using principle component method. The 1st factor was used as an indicator for the relative economic level of the HH. HHs were then divided into 5 categories represents 5 quintiles. Category of wealth index of each HH was assigned to each of the HH members. Fertility and Contraceptive Use

Fertility Level

Mean number of children ever born for urban women (45-49) reached 3.7 children in 2008. It was higher in towns than in other types of urban areas and in south upper Egypt than in other regions. It decreased in urban between 1995 and 2008 with 1.4 children. The level of decrease differed among different types of urban regions. The highest decrease was witnessed in towns (1.7 children) which is very close to the decrease witnessed in rural (1.8 children), The decrease also differed among different regions. The highest decrease was witnessed in urban south upper Egypt (2.1 children) while urban governorates witnessed the lowest decrease (0.8 children).

Table 1 Mean children ever born for ever married women (45-49 years) Region 1995 2000 2005 2008 Residence Urban 5.1 4.6 4.0 3.7 Rural 7.0 6.4 5.7 5.2 Egypt 6.0 5.5 4.9 4.5 Type of urban administrative units Capital/ large city 4.7 4.2 3.7 3.5 Small city 5.2 5.1 4.1 3.9 Town 6.1 5.4 5.0 4.4 Urban regions Urban Greater Cairo 5.1 4.3 3.9 3.4 Urban Governorates 4.5 4.2 3.5 3.7 Urban Lower Egypt 4.8 4.8 3.7 3.6 Urban North Upper Egypt 5.8 5.9* 4.6 4.6 Urban South Upper Egypt 7.2 6.1 5.5 5.1 Urban Frontier Governorates 5.9* 6.2* 4.5 4.5 *Less than 50 cases

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In 2008, towns witnessed also the highest TFR among the different types of urban areas (3.1 children per woman compared to 2.8 in small cities and 2.6 in large cities). TFR in towns was very close to the level in rural areas2.

TFR witnessed different trends in the different types of urban areas. While TFR stalled in small cities between 1995 and 2008 at 2.8 children per women, it decreased from 2.9 to 2.6 in large cities and from 3.6 to 3.1 in towns in the same period.

Figure 2 TFR of ever married woman (15-49 years) by type of urban administrative units

Source: Calculated from DHS 1995-2008 raw data

TFR of slum areas also differ from that of non-slum areas. While the TFR of urban greater Cairo was 2.3 children per woman in 2003, it reached 3.1 children per woman in the slum areas of greater Cairo (El-Zanaty & Way, 2004).

Data of 1996 and 2006 censuses on population size in urban greater Cairo were used in this paper to estimate population size in the slum and non-slum areas of this region in the reference period of DHS 2003. The ASFR of the slum areas and all urban areas published in the report of the DHS 2003 greater Cairo slums, and the distribution of the population by sex and age calculated from the DHS data of the slum areas and all urban greater Cairo along with the births’ statistics were used to estimate the ASFR and the TFR of the non-slum areas in greater Cairo. The results of this exercise revealed that the TFR of the non-slum areas in greater Cairo reached 1.9 children per women in 2003. This reflects that non-slum areas in greater Cairo succeeded in reducing their TFR below the replacement level in 2003, and that slum areas are the main source of high fertility rates.

2 The author thanks Dr. Mohamed Abou El-Ela for his help in the calculations of TFR by type of urban area.

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Figure 3 TFR in slum and non-slum areas of urban greater Cairo, 2003

Contraceptive Use and Unmet Needs

In 1995, percentage of ever married women who never used a contraceptive in urban areas reached 22%. This percentage decreased between 1995 and 2008 with 5 percentage points to reach 17%. Almost one third of those who never used contraceptives in urban areas have 2 children or more.

Percentage of ever married women who never used a contraceptive decreased in all types of urban areas. The lowest decrease was witnessed in small cities (1.6 percentage points compared to 6.2 percentage points in Capital/large cities and towns). This low decrease explains the fertility stall witnessed in small cities. Regions showed a different pattern since this percentage increased in urban frontier Governorates while it decreased in all other regions.

Contraceptives Prevalence Rate (CPR) increased in urban between 1995 and 2008 from 56% to 64% with an annual increase of only 0.6 percentage points. The increase level didn’t differ among different types of urban areas while it differed highly among different regions. It ranged from almost a level-off in urban frontier governorates to an increase of about 19 percentage points in urban north upper Egypt. The increase in contraceptive use was mainly due to increases in modern contraceptives prevalence rate (MCPR).

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Table 2 Percentage of ever-married women (15-49 years) who never used contraceptives

1995 2000 2005 2008

Residence Urban 21.8 19.2 16.4 16.8 Rural 40.0 29.3 23.2 21.3 Egypt 31.6 24.9 20.4 19.4 Type of urban administrative units Capital/ large city 22.4 18.0 14.9 16.2 Small city 18.6 19.9 16.7 17.0 Town 25.9 21.4 23.7 19.7 Urban regions Urban Greater Cairo 22.3 16.8 14.9 15.9 Urban Governorates 19.7 19.9 14.2 17.4 Urban Lower Egypt 15.9 16.3 16.2 14.5 Urban North Upper Egypt 29.9 25.4 15.1 17.7 Urban South Upper Egypt 34.4 31.0 27.3 22.7 Urban Frontier Governorates 24.7 30.4 22.5 26.2

Source: calculated from EDHS 1995 – 2008 raw data

Table 3 CPR and MCPR among currently married women (15-49 years) MCPR (%) CPR (%)

1995 2000 2005 2008 1995 2000 2005 2008

Residence Urban 53.6 58.9 59.8 61.6 56.3 61.1 62.6 64.3 Rural 38.5 49.9 54.2 54.8 40.5 52.0 56.9 57.5 Egypt 45.5 53.9 56.5 57.6 47.9 56.1 59.2 60.3 Type of urban administrative units Capital/ large city 55.0 60.0 60.7 62.6 57.6 62.8 63.8 65.3 Small city 53.8 58.7 60.1 61.6 56.8 60.3 62.6 64.3 Town 48.5 55.3 54.1 56.3 51.2 57.3 56.9 59.3 Urban regions Urban Greater Cairo 54.5 61.2 60.6 62.8 56.8 63.5 63.8 65.5 Urban Governorates 56.6 60.3 61.5 60.2 60.0 63.3 64.0 62.9 Urban Lower Egypt 55.7 61.8 61.4 65.6 59.0 63.8 63.2 67.5 Urban North Upper Egypt 43.2 53.2 60.5 60.1 45.9 53.8 63.9 64.6 Urban South Upper Egypt 41.4 42.8 50.6 52.4 43.7 44.8 54.0 56.0 Urban Frontier Governorates 50.6 47.9 50 49.3 53.1 49.6 53.2 52.8 Source: calculated from EDHS 1995 – 2008 raw data

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The increase in the CPR was accompanied with a decrease in the unmet needs. Unmet needs in Egypt are mainly needs for limiting births. Percentage of women with unmet needs decreased between 1995 and 2008 in urban areas. The highest decrease in urban areas was witnessed in urban south upper Egypt (9.3 percentage points). The highest unmet need in 2008 was witnessed in towns where it reached 10% which is very close to the level of the unmet needs in rural areas (Table 4). Table 4 Percentage of currently married women (15-49 years) who have unmet needs 1995 2000 2005 2008 Residence

Urban 11.5 8.4 8.5 6.7 Rural 19.9 12.5 11.6 10.9 Egypt 16.0 10.7 10.3 9.2 Type of urban administrative units Capital/ large city 10.6 6.6 8.8 6.2 Small city 11.4 9.6 8.0 6.5 Town 14.4 11.2 8.4 10 Urban regions Urban Greater Cairo 11.1 6.8 8.3 5.9 Urban Governorates 9.4 6.6 8.6 6.4 Urban Lower Egypt 10.3 8.9 7.6 6.8 Urban North Upper Egypt 15.3 10.3 9.6 7.5 Urban South Upper Egypt 19 15.9 10.2 9.7 Urban Frontier Governorates 13.6 12.6 8.0 10

Source: calculated from EDHS 1995 – 2008 raw data

Determinants of Contraceptive Use in Urban Areas

DHS 2008 data were used to find out the variables that affect the current use of contraceptives among currently married women in urban areas. Eleven variables were examined using a logistic model. These variables are Urban Regions (Urban Gov. , Urban lower Egypt, ….), Type of urban administrative units (Capital, Small city, Town), Age, Woman’s Education level, Wealth quintile, Woman’s work status, Age at first marriage, Number of children ever born, Ideal number of children, Exposure to FP messages and Husband’s Education level. Some variables had no significant impact on contraceptive use while others had. Results show that number of children ever born and ideal number of children are the factors that mostly affect contraceptive use. The higher the number of children ever born and the lower the ideal number of children are the higher the probability to use contraceptives is.

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Woman’s education level is a ruling factor in contraceptive use followed by age, living in a certain urban region, husband’s education level, woman’s work status, exposure to FP messages. Type of urban administrative units was not one of the factors that have impact on contraceptive use according to this model.

The model was reformed again after omitting Urban Region from the variables examined. The variables that had impact on contraceptive use were the same and the type of urban administrative units appeared to be one of the factors that affect contraceptive use. These results assert that living in a certain urban region has a higher impact on contraceptive use than living in a certain type of urban administrative units. In both of the models the correct classification rate reached 76%.

The following section discusses the trends of the factors that affect contraceptive use and fertility levels between 1995 and 2008.

Characteristics of Urban Areas The percentages of ever-married women (15-49 years) decreased slightly in urban between 1995 and 2008, to reach 65% in 2008, and no significant differences were witnessed among different types and regions of urban areas. Women’s Education Percentage of ever married women who have no education is higher in rural areas than in urban areas. The pace of decrease was higher in rural areas than in urban areas since the percentage decreased between 1995 and 2008 with about 16 percentage points in rural areas compared to only 9 percentage points in urban areas. Urban regions are not homogeneous in their education characteristics. This percentage is higher in towns than in other types of urban areas. The percentage is also higher in urban north upper Egypt than in other regions. Table 5 shows that the percentage of ever married who have no education ranges from 12% in urban lower Egypt to 26% in urban north upper Egypt in 2008. The percentage did not change between 1995 and 2008 in urban frontier governorates. It decreased in the other regions and in the different types of urban administrative units. The highest decrease was witnessed in urban governorates and capital/large cities.

Percentage of ever married women with secondary or higher education increased in both urban and rural areas with the same amount. The highest increase in urban was witnessed in small cities (25 percentage points) and urban lower Egypt (27 percentage points) while the least increase was witnessed in urban frontier governorates (9 percentage points).

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Table 5 Percentage of ever-married women (15-49 years) with no education and with secondary or higher education

No Education (%) Secondary or higher (%)

1995 2000 2005 2008 1995 2000 2005 2008

Residence Urban 26.5 25.9 19.6 17.1 36.4 45.8 55.0 59.1

Rural 58.5 57.0 45.1 42.6 12.6 18.4 29.7 34.9

Egypt 43.7 43.2 34.6 32.1 23.6 30.5 40.1 44.9 Type of urban administrative units

Capital/ large city 26.4 23.7 20.1 16.4 35.7 47.4 52.6 56.4

Small city 23.1 27.1 17.4 15.9 39.7 45.2 59.7 64.4

Town 33.6 30.4 27.3 25.1 32.4 41.8 48.2 54.7 Urban regions

Urban Greater Cairo 26.1 24.3 20.6 16.4 36.8 47.6 53.5 58.2

Urban Governorates 29.3 23.9 17.4 17.0 30.6 45.9 50.2 53.7

Urban Lower Egypt 21.6 25.8 14.1 12.2 41.3 47.7 64.0 68.1

Urban North Upper Egypt 32.2 30.7 24.2 26.0 37.2 38.3 54.3 59.8

Urban South Upper Egypt 32.9 34.6 27.7 24.8 31.4 37.1 51.6 53.9

Urban Frontier Governorates 25.0 28.6 24.6 25.3 45.2 43.7 47.7 54.0 Source: calculated from EDHS 1995 – 2008 raw data

Women’s Socio-Economic Levels Table 6 shows that a higher percentage of rural population belongs to the poorest quintile if compared to urban population. The gap between urban and rural is quite wide and steady between 1995 and 2008. Women in urban regions are not homogeneous in their socio-economic level either. Women in towns are poorer than women in other types of urban areas. There are also clear differences among different urban regions. While 16% of women in Urban North Upper Egypt belong to the poorest quintile of Egyptians, only 2% of the ever married women in Urban Greater Cairo and Urban Lower Egypt belong to the same quintile. Percentage of population in the poorest quintile increased between 1995 and 2008 in urban upper Egypt and urban frontier governorates.

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Table 6 Percentage of ever-married women (15-49 years) in the poorest quintile

1995 2000 2005 2008 Residence

Urban 2.4 3.3 4.2 4.0 Rural 36.5 33.6 28.2 28.4 Egypt 20.8 20.3 18.3 18.3 Type of urban administrative units Capital/ large city 0.8 1.2 4.1 2.2 Small city 1.7 4.4 3.2 4.8 Town 9.1 8.4 9.3 11.1 Urban regions Urban Greater Cairo 1 0.8 4.5 1.7 Urban Governorates 1.5 2.1 1.7 2.8 Urban Lower Egypt 2.0 3.5 1.2 1.8 Urban North Upper Egypt 10.8 14.9 14.2 16.3 Urban South Upper Egypt 10.9 10.7 6.2 14.3 Urban Frontier Governorates 2.4 4.8 18.3 9.3

Source: calculated from EDHS 1995 – 2008 raw data

Women’s Working Status Table 7 shows that in 2008 only one fifth of the urban ever-married women were working for cash. The percentage of ever-married women currently working for cash didn’t change between 1995 and 2008. This stability was witnessed in different types and regions of urban areas with slight increase in urban south upper Egypt and a decrease in urban frontier governorates. DHS 2008 data show that small cities had the highest percentage of women currently working for cash among all types of urban administrative units. Comparisons of different regions show that urban north upper Egypt had the highest percentage.

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Table 7 Percentage of ever-married women (15-49 years) currently working for cash 1995 2000 2005 2008 Residence Urban 21.1 21.3 22.8 20.6 Rural 10.9 9.3 12.8 10.9 Egypt 15.6 14.6 16.9 14.9 Type of urban administrative units Capital/ large city 19.3 21.0 20.9 17.8 Small city 25.7 22.4 25.8 25.0 Town 18.6 19.2 20.2 20.0 Urban regions Urban Greater Cairo 20.0 21.2 21.8 18.7 Urban Governorates 17.4 19.7 21.0 17.3 Urban Lower Egypt 25.6 24.0 28.4 25.0 Urban North Upper Egypt 26.1 20.9 23.1 26.5 Urban South Upper Egypt 20.3 17.0 17.7 21.8 Urban Frontier Governorates 29.8 26.2 24.6 24.8

Source: calculated from EDHS 1995 – 2008 raw data

Husbands’ Education Percentage of husbands with no education decreased in urban between 1995 and 2008 with about 7 percentage points. Percentage of husbands with secondary or higher education increased in the same period in urban area with 17 percentage points to achieve in 2008 a percentage higher than that of 1995 with about 40% while this percentage have doubled in rural areas in the same period.

Urban areas differ in these percentages. The percentage of husbands with no education in 2008 ranged from 11-12% in urban governorates and urban lower Egypt to 17% in urban upper Egypt (north and south) and the percentage of husbands with secondary or higher education ranged from 54% in urban governorates to 65% in urban lower Egypt. The highest increase in the later percentage between 1995 and 2008 was witnessed in urban north upper Egypt (25 percentage points).

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Table 8 Percentage of ever-married women (15-49 years) whose husbands have no education or secondary or higher education

No education (%) Secondary or higher (%)

1995 2000 2005 2008 1995 2000 2005 2008

Residence Urban 18.9 18.6 14.9 12.3 43.5 50.4 56.9 60.7

Rural 40.4 39.2 29 28.2 21.4 28.0 38.7 42.8

Egypt 30.5 30.1 23.2 21.7 31.6 37.9 46.2 50.1

Type of urban administrative units Capital/ large city 17.7 16.6 14.8 11.7 42.9 52.6 55.9 58.2

Small city 18.6 19.9 14.8 12.1 45.7 48.4 58.8 64.4

Town 23.3 22.4 16.7 16.6 41.4 47.9 54.2 59.9

Urban regions Urban Greater Cairo 17.5 16.6 16.0 12.2 45.2 53.7 57.1 61

Urban Governorates 19.1 18.2 12.3 11 34.6 48.3 50.2 54

Urban Lower Egypt 17.4 19.5 12.2 10.5 47.7 48.8 61.9 64.7

Urban North Upper Egypt 28.7 25.1 15.5 16.6 39.7 44 57.6 64.3

Urban South Upper Egypt 26.3 22.8 20.4 16.9 42.3 46.3 54.7 60.1

Urban Frontier Governorates 16.7 19 12.3 15.9 57.1 52.4 62.3 60.9 Source: calculated from EDHS 1995 – 2008 raw data

Determinants of Fertility

Ideal Number of Children

According to the latest DHS, TFR is higher that the mean ideal number of children in rural while in urban they are almost the same. This gives rural areas a great chance to decrease their TFR since women in rural feel that they should have less births than they already achieved, while the equality of the two indicators in urban reflects that women may be convinced that they have the appropriate number of births and those who didn’t reach that number are not obliged to have less than it.

While mean ideal number of children leveled-off between 1995 and 2008 in rural areas, it increased in urban areas from 2.6 in 1995 to 2.8 in 2008. Comparing different types of urban administrative units reveals that towns witnessed in 2008 the highest ideal number of children reached 3 children which is the same ideal number of children in rural areas. Small cities had witnessed the highest increase in the ideal number of children from 2.6 to 2.9 between 1995 and 2008. Different regions showed slight changes (about 0.1 children) in the same period.

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Table 9 Mean ideal number of children among ever-married women (15-49 years)

Region 1995 2000 2005 2008 Residence Urban 2.6 2.7 2.7 2.8 Rural 3.0 3.1 3.0 3.0 Egypt 2.8 2.9 2.9 2.9 Type of urban administrative units Capital/ large city 2.6 2.6 2.6 2.7 Small city 2.6 2.8 2.8 2.9 Town 2.9 3.0 3.1 3.0 Urban regions Urban Greater Cairo 2.6 2.6 2.7 2.7 Urban Governorates 2.5 2.6 2.6 2.6 Urban Lower Egypt 2.6 2.7 2.7 2.7 Urban North Upper Egypt 2.9 2.9 2.9 3.0 Urban South Upper Egypt 3.1 3.3 3.1 3.2 Urban Frontier Governorates 3.1 3.2 3.1 3.2 Source: calculated from EDHS 1995 – 2008 raw data

Age at First Marriage

Table 10 shows that age at first marriage among ever-married women (15-49 years) increased between 1995 and 2008 in both urban and rural areas but with slightly higher increase in rural (1 year in urban vs. 1.2 year in rural). Different types of urban administrative units witnessed the same increase while different regions witnessed different values of increase. The highest increase was witnessed in urban upper Egypt and the lowest was witnessed in frontier governorates followed by lower Egypt. Meanwhile, in 2008, urban governorates witnessed the highest mean age at first marriage (22.2 years) and urban north upper Egypt witnessed the lowest mean age at first marriage (20.7 years).

An opinion poll conducted by the IDSC in 2010 under the “Evidence-Based Population Policy Project (EPDI)” on the Egyptians’ perceptions towards the population problem indicated that almost half the married household heads in urban believe that the ideal age of marriage for females is between 18 and 21 and about 46% believe it is between 22 and 24 (EPDI, 2010). This reflects that mean age at first marriage will not witness a significant raise unless policies succeed in changing population perceptions towards the ideal age of marriage.

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Table 10 Mean age at 1st marriage among ever-married women (15-49 years)

1995 2000 2005 2008 Residence Urban 20.5 20.8 21.3 21.5 Rural 18.0 18.3 19.0 19.2 Egypt 19.2 19.4 20.0 20.1 Type of urban administrative units Capital/ large city 20.7 21.2 21.5 21.6 Small city 20.6 20.5 21.2 21.5 Town 19.7 19.8 20.2 20.7 Urban regions Urban Greater Cairo 20.4 20.9 21.3 21.3 Urban Governorates 21.1 21.5 22.0 22.2 Urban Lower Egypt 21.0 20.6 21.5 21.7 Urban North Upper Egypt 19.2 19.4 19.9 20.7 Urban South Upper Egypt 19.5 19.7 20.3 20.9 Urban Frontier Governorates 20.5 19.9 20.9 20.8

Source: calculated from EDHS 1995 – 2008 raw data

Exposure to Family Planning Messages

Exposure to family planning messages is one of the variables that affect using a family planning method. FP messages are important not only to provide information about the different methods of FP but also to convince both wives and husbands with the right reproductive behaviors, raise their awareness about dangerous reproductive behaviors and to update them with the new RH information.

In this paper woman was considered to be exposed to FP messages if she heard about FP from radio or TV or Newspaper or had been visited by a health facilitator during the 6 months preceded the survey.

In 1995, about 79% of ever married women in rural areas were exposed to FP messages compared to 93% in urban areas. Exposure to FP messages increased between 1995 and 2000 as a result of promoting the mass media role in the family planning strategies since 1992 to reach 99% in urban and 95% in rural in 2000. This percentage decreased in both urban and rural area between 1995 and 2008 but with higher decrease in urban (34 percentage points in urban vs. 16 percentage points in rural) to reach a lower level in urban than in rural (Figure 4). This decrease could be partially attributed to the fallback of the local TV channels against the satellite channels.

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Studying different types of urban administrative usints shows that capital and large cities witnessed the highest decrease. Exposure to FP messages decreased in different urban region. The highest decrease was witnessed in urban governorates as the exposure decreased to reach in 2008 less than half its value in 1995. In 2008, exposure was higher in upper Egypt and lower Egypt than in other regions.

Figure 4 The decrease witnessed between 1995 and 2008 in exposure to FP messages

Source: calculated from EDHS 1995 – 2008 raw data

Family Planning Health Units

Availability and quality of family planning services have impacts on family planning practice. The success of some countries in achieving their family planning objectives was a result of spreading heath units all over the country. For example, Iran established a wide spread network of 16000 health units which led to density of 1500 persons per unit in rural area. This helped Iran to reduce its TFR from 5.6 children per woman to 2.1 children per woman in less than 15 years (EPDI, 2010).

As per 2009 statistics, Egypt has 6366 family planning units spread all over Egypt (The national population council, 2009), about 36% of them are located in urban areas. The number of women per FP unit reached 2012 women per unit in Egypt. This ratio was lower in rural than in urban (1745 per unit in rural and 2501 women per unit in urban). The ratio increased between 2005 and 2009 in both urban and rural but the increase was higher in urban than in rural (6.4% vs. 3.7% respectively). Urban greater Cairo and urban governorates are the most deprived regions considering this indicator.

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Figure 5 Estimated number of married women (15-49) per FP unit, 2009

• Frontier Governorates Include urban and rural

Source: Calculated from the System of Services Statistics, NPC

Conclusion and Recommendations

1- Some areas in Egypt are considered urban areas while their characteristics are greatly different from the characteristics of other urban areas. Those areas include towns and slum areas.

Towns are the urban administrative units with population size less than 50 thousand people. Most of the towns are located among rural areas which makes their characteristics closer to the characteristics of rural areas. Towns women have the lowest education and socio-economic levels, the lowest contraceptive use, the highest unmet needs, age at first marriage, ideal number of children, TFR and number of children ever born among all types of urban administrative units.

Despite having many definitions, slum areas have a main characteristic which is being built far from legislations and discipline. Structure and characteristics of slum areas population differ also from those of the non-slum urban population. The available studies on slum areas show that women in slum areas are less educated and poorer than women in non-slum urban areas. Fertility levels are also higher in slum areas than in non-slum areas.

3768

2607 2226 2313

2105

740

0

1000

2000

3000

4000

Urban Greater Cairo

Urban Governorates

Urban Lower Egypt

Urban North Upper Egypt

Urban South Upper Egypt

Frontier Governorates*

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2- Different urban regions are not homogeneous in their characteristics. Urban south upper Egypt, urban north upper Egypt and urban frontier governorates have the lowest characteristics and the highest fertility levels compared to other urban regions in Egypt.

3- The direction and pace of improvement of different population characteristics were better in rural areas than in urban areas. The slow improvements, sometimes retrogression, in the characteristics and fertility determinants of urban women cause the fertility stall that urban areas witnessed during the last 15 years while rural areas continued moving forward across transition stages.

4- Education of the woman and her husband appeared among the most important factors that affect contraceptives use. Despite the improvement achieved in these indicators during the last 15 years, about two fifth of women and husbands did not enroll in secondary school and about one sixth of women and husbands are uneducated.

5- Women’s socio-economic level, work status, age at first marriage, number of children ever born, ideal number of children, living in a certain region and a certain type of urban administrative units are the characteristics that mostly affect contraceptive use and fertility level.

6- Total fertility rate in urban areas does not differ from the mean ideal number of children that was reported by urban women.

7- Exposure to FP messages is one of the variables that affect contraceptive use and, hence, fertility levels. It decreased during the past years in all urban areas especially in urban governorates and large cities may be due to the retrogression of Egyptian TV channels against satellites.

The following recommendations are suggested to deal with the status of urban areas in Egypt: Issue: Classification of urban areas:

1- Egypt needs to review the definition of urban areas. Criteria upon which areas are classified as urban or rural should be determined, cleared, published and used to re-classify different administrative units in Egypt. As a result, the classification of towns and slums as urban areas might be reconsidered in the light of their population characteristics and the civil services available in these areas.

2- Government in collaboration with private sector should also work on improving the characteristics of those areas including their infrastructure and available civil services.

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Issue: Improving the characteristics of urban population:

1- Improving the characteristics of urban population through encouraging education among different population groups. This in turn will result in changes in women participation in labour force and socio-economic status as well as fertility preferences of couples, which may lead to further reductions in fertility.

2- Policies should pay more attention to improve the demographic characteristics and fertility preferences of women in slum areas, towns and upper Egypt especially south upper Egypt.

Issue: Exposure to and content of FP messages:

1- Total fertility rate in urban areas does not differ from the mean ideal number of children that was reported by urban women. This fact asserts the need to review the family planning messages to change urban population beliefs and convince couples of the importance and benefits of the small family and the consequences of repeated childbearing on mother and birth.

2- Diversify the mass media messages and find new message delivery approaches to reach women in different urban areas in order to promote the adoption of the 2-child policy. Messages should address the dangers of early marriage, the dangers of early and late child bearing and the importance of the 3-5 year spacing intervals.

3- Population problem must be discussed and promoted extensively in different contexts to convince Egyptians that an additional child certainly is a burden not only on the family but also on the country with all its utilities, especially with respect to scarcity and inadequacy of country natural resources.

Issue: Density and quality of FP services:

1- There is a great need to increase the number of health units that provide FP services in urban areas.

2- Improve the quality of the services provided in the units and insure the existence of a female health provider in each unit. Training courses should be provided to doctors working in health units that provide RH services to enable them to serve women regardless of their education and socio-economic levels.

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References

Bongaarts, John, 2003, “Completing the fertility transition in the developing world: The role of educational differences and fertility preferences”, Policy Research Division Working Papers, No. 177, Population Council, New York, USA.

Central Authority for Statistics and Public Mobilization (CAPMAS), 2007, www.capmas.gov.eg/pepo\New Folder\7.xls, accessed on April 2011.

El-zanaty, F. and Ann Way, 2009, “Egypt Demographic and Health Survey 2008”, Ministry of Health and Population and National Population Council.

El-Zanaty, F. and Ann Way, 2004, “Greater Cairo Slums: A profile based on the 2003 Egypt demographic and health survey”, Ministry of Health and Population and National Population Council, Cairo, Egypt.

Evidence-Based Population Policy Project (EPDI), 2010, “Population status in Egypt: Towards achieving the objectives of the national population program”, Cairo, Egypt.

National Population Council, 2009, “The annual statistical report on family planning services”, Cairo, Egypt.

National Population Council, 2005, “The annual statistical report on family planning services”, Cairo, Egypt.

United Nations, economic and social affairs, 2007, “World Urbanization Prospects, The 2007 Revision, Highlights”, New York, USA.

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GIS Appendix

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