At Pathfinder, we know that World Contraception Day is about far more than contraception. It’s about strengthening health systems and working with communities to alleviate barriers to sexual and reproductive health.Mohamed Abou Nar, Senior Country Director, Egypt
Letter from Mohamed Abou Nar
Each year, people across the globe celebrate World Contraception Day, a day designated to recognize the rights of all couples and individuals to decide freely and responsibly if or when they want to have children. At Pathfinder, we know that World Contraception Day is about far more than contraception. It’s about strengthening health systems and working with communities to alleviate barriers to sexual and reproductive health, so that the goal of World Contraception Day can hold true.
In Egypt, we face numerous challenges and barriers to upholding the ideals of World Contraception Day. Persistent gender inequities place women and girls at significant economic, social, and physical disadvantage. And, the country is highly vulnerable to climate change, which disproportionately impacts women and girls by exacerbating existing gender inequalities and disrupting access to sexual and reproductive health care.
Pathfinder is actively working to mitigate these challenges, at the workplace, within communities, and through the country’s health system.
Two recently launched programs, funded by USAID, will proactively work to shift the tide of challenges facing women in the country by increasing their agency to make decisions about their futures. Pathfinder’s USAID-funded Women’s Economic and Social Empowerment Program will encourage women’s participation in the workforce, increase financial inclusion, and reduce the socio-economic impacts of violence against women. It will do so by generating demand for financial services; promoting tailored, market-based solutions to women’s economic empowerment; and strengthening gender-based violence prevention and response so that women become more economically and socially resilient. Through partnerships with the government of Egypt, private sector, and civil society organizations, the program will build upon and leverage existing national initiatives to maximize impact and ensure sustainability.
Our USAID-funded OSRA (Arabic for family) activity, which launched last month, will work to improve family health outcomes by reinforcing the national family planning and reproductive health program in partnership with the Ministry of Health and Population and other local stakeholders. This work will include increasing women’s and men’s uptake of family planning services, in both the private and public health sectors. It will also equip youth with the knowledge and skills necessary to make healthy life choices and support improved gender dynamics within communities to increase women’s agency.
In this issue of Pathways, you will also read about our program, Ma’an (meaning together), which has spent four years strengthening the skills of local service providers to respond to the reproductive health needs of young married women and first-time parents. Today, we are growing Ma’an by focusing on climate resilience. We are making health clinics “green” through approaches like adoption of solar panels, water-efficiency practices, recycling, and training health providers to address health risks posed by climate change.
In 2020, Egypt ranked:
- 134th out of 153 countries in global gender gap index.
- 140th out of 153 countries in women’s economic participation and opportunity.
For nearly 40 years, Pathfinder has partnered with the government and local partners to bring contraception, and, with it, hope and opportunity, to the doorsteps of Egypt’s hard-to-reach communities. We have done this work through local teams and in close partnership with local leaders who are deeply trusted by the communities they serve and carry out approaches and programs that are sustainable, lasting long beyond Pathfinder’s support.
Today, we are building on that legacy. Over the next five years, Pathfinder’s locally led programs will reach millions of Egyptians across the country, building sustainable approaches to increasing women’s agency and choice through a foundation of widespread access to sexual and reproductive health care, including contraceptive choice.
This work goes far beyond supporting the goals of World Contraception Day. Our programs in Egypt support Pathfinder’s larger goal of allowing all Egyptians to choose their own paths forward.
Mohamed Abou Nar
Chief of Party, OSRA Activity
Senior Country Director, Egypt
Ma’an Project: Together for Egyptian Families
Ma’an At A Glance
- Project Date: 2018 – 2022
- Funder: Merck Sharp & Dohme Corp (Merck for Mothers Program)
- Country: Egypt
Telling Her Story
Hagar was participating in a storytelling workshop, one of the many approaches of Pathfinder’s Ma’an project. Ma’an has worked for four years to strengthen the capacity of local service providers to respond to family planning needs in four districts of the Sohag governorate in Egypt.
Storytelling sessions, like the one Hagar attended, give women safe spaces to speak up about issues that are largely kept silent in Egyptian society, such as forced marriage, female circumcision, and gender-based violence. Hagar’s story was difficult to tell. She was under the legal age for marriage in Egypt, and when she did get married, she didn’t receive any legal documentation.
“I got pregnant after 20 days of my marriage,” she says. “I went to the doctor, and she told me, ‘Congratulations! You are pregnant.’ But at the time, I knew absolutely nothing about pregnancy and childbirth.”
Hagar’s story is not unusual. Sohag governorate has one of the highest fertility rates in Egypt, where women have an average of more than four children.1 In Egypt, only 8% of women and 10% of men believe it is appropriate for a couple to use family planning before having their first child.
I wasn’t planning to get married,” said Hagar, when she began telling her story to a room full of women. “My elderly sister had recently refused someone. And my uncle said to my mother, ‘any girl should marry this man’!Hagar Mohamed Ahmed
Ambassadors of Change
Pathfinder’s Ma’an project has worked to reach women like Hagar, supporting them to raise their own voices, while at the same time, working with “Ambassadors of Change” to become advocates for sexual and reproductive health and rights in the community. Through interactive theater performances, discussions with religious leaders, storytelling workshops, and initiatives that help secure the support from family and community members for sexual and reproductive health and rights, Ma’an has reached thousands of community members, building support for women to make their own reproductive health decisions.
The program reached Sharbat Hosni, who participated in a Ma’an initiative called “My Mother-in-Law is My Life.” Families participating in Ma’an suggested this specific initiative, recognizing that the decision to have children often involves mothers-in-law.
“Before I attended the initiative,” says Sharbat, “I always said I wanted to have grandchildren, and I said to my son’s wife—have as many grandchildren as you can!” But then Sharbat started attending sessions through Ma’an. “I liked it so much,” she says. “After the initiative I stopped interfering. I realize they must live their lives, as we lived ours. We must respect their opinion, and as for their children, I’m now convinced that they should raise them the way they see fit.”
Making Their Own Choice
Hisham Rabea and Ola Shehata felt pressure from their families to have a large family. “Before participating in the project,” says Hisham, “I initially wanted to have many children with my wife. I used to believe that having many kids is “ezwa” (an Arabic word describing power, pride, and strength, elements which could help a person in moments of weakness). I used to tell my wife continuously that we should have more children.” Ola also felt pressure from Hisham’s mother. “My mother-in-law told me that I should have more children. According to her, the two children we had were not enough. She felt that my husband would be lonely if we did not have more children.”
Hisham and Ola were one of the ‘core’ families identified by Ma’an at the onset of the project, families that then became ambassadors within their communities. Through their participation, they both started to feel a shift in their thinking. Says Hisham, “I admired the initiatives presented, and especially the theater initiatives, the consultant kiosks on the street, and the initiative for mothers-in-law. When I participated at the project consultancy kiosk in the street, I discovered that there are many people who do not know the meaning of family planning. And when I participated in the family interaction day, I was satisfied, there were no barriers between my wife and I… I found myself free!”
In Arabic, Ma’an means together. As a Ma’an facilitator, Hamdia Yassin Ahmed led trainings on family planning and peer mentoring, encouraging men and women to work together to strengthen families. She has shared vital health information about breastfeeding, maternal health, child health and nutrition, family planning, gender equality, and much more.
She has brought families closer through innovative games called Family Interaction Days, filled with music, dancing, and activities highlighting important reproductive health messages. “Many of the families who attended Family Interaction Day told me: ‘I wish this day had happened years ago’ and others have said, ‘we have never been out together or played together before like this’,” Hamdia recalled.
It wasn’t always easy. One of Hamdia’s biggest challenges was getting men to participate in Family Interaction Day. “Many men were rejecting the idea of learning about sexual and reproductive health. I worked with leaders in the village and influencers to solve this problem. The men grew to learn that it was really important to attend because they gained lots of health information related to family planning. Now men are actively participating and helping us educate other families.”
Hagar sometimes wishes she had known what she now does. “Now I am not yet 20 years old, and I am a mother of two daughters. I really can’t afford to educate them, or guarantee a decent life for them.”
Statements like this one are why Pathfinder is under-taking the complex work of building support from leaders and influencers in the community. Today Sharbat is one of these leaders. “I am now convinced,” she says, “that people should use family planning methods. In the past, we thought these methods were harmful, but it turns out that they give women time to regain their health after deliveries, take care of themselves, and raise their children more easily.” Sharbat is also an active advocate for Pathfinder’s trainings. “I still remember all the information I learned, and I advise my neighbors and community. We need to understand the harm of early marriage and the benefits of family planning.”
And Ola and Hisham have learned how to discuss their decisions with their families. Says Ola, “Now I have more awareness, and I explained to my mother-in-law that by having more children, my health will suffer, and no one will be able to take care of my kids if something happens and we have many children. My own mother also wanted us to have more children, but my husband talked to her, saying that this is our life as a couple, and that we should be the only ones deciding what is best for us. He also told her that we wish to provide our children with the best quality of life to contribute to our society!”
The Nawara series is an animated series aiming to create awareness within families, to address the importance of family planning and maternal health. Nawara is a newly married, educated rural wife, always striving to learn, develop herself and serve her community by sharing what she has learned. One of her activities was attending the “Ma’an” project sessions, which had a prominent role in shaping her awareness and the awareness of those around her.
Across the project, women, couples, and families are learning how to better communicate, and couples are given more agency to make choices that work for them. Ads Ola, “The project taught us to make decisions together as a family, such as giving ourselves sufficient time between having one child and the next. It also taught us to have discussions before we make any decisions pertaining to our life together. We are truly glad that we had the opportunity to spend time with peer families in the program. We would like to seize the opportunity to thank Pathfinder for this project, which has changed a lot of things, both in our family, and in others… things that were difficult to change. These initiatives changed my life completely and made me a fully optimistic person.”
Highlights from Ma’an Program:
- Religious leaders conducted awareness and education sessions for men and women on the importance of reproductive health from a religious perspective. 26 sessions held, reaching 866 community members.
- 900 participants attended interactive theater performances, and more than 150 attendees came to Pathfinder storytelling sessions.
- At Family Interaction Days, men, women, and children participated in games, dancing, and health-related activities. Pathfinder reached 350 family members through games.
- 1,162 community members visited “Counseling Kiosks,” where they received information on sexual and reproductive health and rights.
- The “Words of Gold” initiative reached 270 people, addressing rumors and misconceptions about family planning by conducting interviews on the street about types of family planning methods and how to use them.