Egypt - Birthrate Rises as Population Control Policies Vanish

In fact, officials have avoided public discussion about population and dropped the awareness campaigns of the past, in an early indication of how the Islamist leadership is approaching social policy in the most populous Arab state.

After two decades of steady declines and modest increases, the birthrate in 2012 reached about 32 for every 1,000 people — surpassing a level last seen in 1991, shortly before the government of the longtime president, Hosni Mubarak, expanded family planning programs and publicity campaigns to curtail population growth that he blamed for crippling Egypt’s development. Last year, there were 2.6 million births, bringing the population to about 84 million, according to preliminary government figures.

The new government of President Mohamed Morsi has continued financing for family planning programs. But health officials have taken a starkly different view of climbing birthrates, presenting the problem as one of economic management — not the size of the population. Population experts are increasingly alarmed by the government’s silence and its lack of focus on the issue.

“The birthrate is important. It is not right to ignore the population problem,” said Hassan Zaky, a demographer who teaches at Cairo University and the American University in Cairo. “Before, there was a clear policy. Now, we don’t know where we are going. We don’t know the view of the state.”

Government officials blame Egypt’s chaotic transition for the lack of public discourse. But the shift in priorities also reflects a longstanding critique by Islamists of Mr. Mubarak’s population policies. For decades, the Muslim Brotherhood and ultraconservatives chafed at Mr. Mubarak’s almost single-minded focus on contraception and two-child families as a core component of public policy. Mr. Mubarak used family planning — a foreign imposition — to mask the government’s failed strategies, some Islamists said.

“The real problem is with us, as an administration,” said Hamid al-Daly, a representative of the ultraconservative Nour Party and a member of the health committee in Egypt’s upper house of Parliament. “The population in China is over a billion, but there is good management and good utilization of resources. The population is a blessing if we use it well, and a curse if we mismanage the crisis.”

Many public health workers agree that Mr. Mubarak’s approach, which was backed by international aid donors, was never a solution on its own. But they said the current government’s silence on the population threatens only to make the situation worse.

“No one is saying we should concentrate only on family planning, or only on development,” Mr. Zaky said. “We need a mix. We don’t want the new regime to focus on one thing.”

Over decades, Egypt’s climbing birthrates have helped choke its cities. Fertile land along the Nile disappeared under new buildings, as Egyptians crowded ever more tightly together on the tiny percentage of the country that the government bothered to develop. Egyptians chastised their leaders with taunts that illustrated the crisis: While presidents dressed in the latest fashions, “we live seven to a room,” a chant went.

The state’s formal role in family planning began in the 1960s under President Gamal Abdel Nasser. In the late 1970s, the United States Agency for International Development became the main supporter of family planning programs in Egypt, spending about $1.5 billion on population and other health programs over several decades. Efforts to rein in the birthrate intensified after 1994, when Egypt hosted an international conference on population and development.

Thousands of primary clinics were built around the country, providing family planning and other health services that were credited with decreasing the fertility rate as well as maternal and infant mortality rates. The outreach efforts of that period included advertisements on state television and banners on Cairo streets — with slogans like, “Before you have another baby, secure its needs.”

Dr. Nahla Abdel-Tawab, the Egypt director of the nonprofit Population Council, said of the Mubarak years: “The president himself used to talk about population increases. It was in the newspapers, in the prime minister’s speeches.”

Now, population has seemed to vanish from public discussion. Health workers said they were stunned when Dr. Abeer Barakat, an assistant minister for health who is responsible for family planning, made no explicit mention at a United Nations conference in December of population or family planning in describing the Health Ministry’s priorities.

In an interview on Thursday, Dr. Barakat said she had simply been trying to inject balance into the debate about population and planning, to reflect the new government’s priorities. “What was shocking for them was that I talked about family health, and family planning as part of family health,” she said.

Dr. Barakat, a former official in the Muslim Brotherhood’s political wing before joining the Health Ministry, said she was seeking to redress imbalances in the previous government’s approach to health care. Mr. Mubarak, she said, “was biased” toward family planning and ignored urgent concerns like cancer and hepatitis C.

And while she said that family planning programs would continue to be a part of health policy, she also said the government should play no role in encouraging families to limit the number of children they have. “Assigning a number is against reproductive freedoms, and against human rights,” she said.

“They are not rabbits, to stop giving birth,” she said. “Manpower is a treasure.”

Among the members of a large family in Greater Cairo, the new government’s approach is more popular than Mr. Mubarak’s.

Mohamed Rabia Ali, 62, a construction worker who lives with seven members of his family in a cramped apartment, said that Mr. Morsi could establish new communities in the desert to alleviate the housing crisis, and focus on providing more jobs for young people. The government does not need to tell Egyptians how many children to have. “The creator takes care of the created,” he said.

But for the moment, grand development plans that could alleviate overpopulation have taken a back seat as the beleaguered government focuses on keeping the lights on and feeding its citizens. “The primary issues are food and security,” said Dr. Atef El Shitany of the state-run National Population Council. As a result, he said, the political commitment to population issues “is decreasing.”

In the meantime, experts are trying to determine whether the latest birthrate spikes represent a reversal of Egypt’s long-term trends, including declining fertility rates. They are working in the dark because the uprising delayed Egypt’s most comprehensive demographic survey. The birthrate had started to creep up during the last five years of Mr. Mubarak’s rule, as fertility rates held steady.

The latest population spikes could represent behavioral shifts resulting from the revolution, “because people are under pressure,” said Hisham Makhlouf, who teaches demography at Cairo University.

“That’s one theory,” he said. “The other is that it’s because no one talks about the population problem like before.”