Egypt.

• Author: Galal, Salma
• Position: Reproductive & Sexual Health Rights in Cameroon, Egypt, Ghana, Malawi and Rwanda: An Advocacy and Communications Approach - Report

1.0 BACKGROUND AND INTRODUCTION

1.1 Study Objectives

The objective of this report is to carry out advocacy-based research on reproductive and sexual health rights in Egypt and to contribute to a better understanding of the conditions of the success of such a project (best practices) and to draw strategic lessons for the future through:

1. assessing progress on the implementation by national governments on their commitments to protect and guarantee women's reproductive and sexual health and rights;

2. analyzing the achievements, the constraints and lessons learned to track implementation of the ICPD;

3. assessing gender-based barriers of women's reproductive and sexual rights by women and their impact on women-in particular, cultural and religious barriers;

4. documenting strategies to address such barriers;

5. recommending laws/policies to be amended or established and measures to be taken to address such barriers;

6. identifying key messages, including those addressing cultural and religious barriers, for use at the local and national levels during national campaigns.

   1.2 Methodology

   The research was carried out in Egypt. Due to the summer vacation (July-August 2007) and time constraints, some of the key respondents were not available. In-depth interviews were done with key stakeholders and informants in governmental institutions, NGOs, international agencies and research institutions taking the six points mentioned above as the interview guide. In addition, references and IEC materials were reviewed and internet resources were researched and gathered.

   1.3 Background on Egypt

   Egypt developed its population policy within the last half century. Women's reproductive health and rights were improved in conjunction with the International Conference on Population and Development (ICPD). Egypt succeeded in reducing high fertility rates from 5.6 in 1976 to 3.1 births in 2005. Contraceptive prevalence increased from 18.9 % to 59.2 %. Maternal mortality decreased by 50% within a decade to 84 / 100.000 (2002); if is now estimated to be at 68. It is probable that the Millennium Development Goal (MDG) on maternal mortality ratio (MMR) will be reached by 2015. Infant mortality rates dropped within 40 years from 141 per 1000 births, to 33 per 1000 in 2005. Life expectancy improved to 73.6 years for females and 69.2 years for males. Antenatal care increased to 70% and delivery attended by trained health personnel to 73%. Improvement in maternal and child indicators is Egypt's success-story. There are still geographical gaps between rural and urban areas, between Upper Egypt and the Delta in addition to gaps between the poorest and richest quintiles. The population of 76 million could have risen over 90 million had the leadership not been committed and supportive of the policy. However, more needs to be done to continue improvements of women's reproductive and sexual health rights and their empowerment. Donor funding for family planning, population and reproductive health and rights is expected to decline, which might affect the achievements in years to come.

   Many laws and decrees have been issued to empower women and improve their reproductive health; however, cultural barriers impede their use and implementation.

   1.3.1 Egypt and human rights treaties

   Egyptian law recognizes equality between genders. Articles 16 and 18 of the 1971 Constitution affirm that health and education are basic rights for both genders. Egypt has adopted different international treaties pertaining to women's health rights including: CEDAW, ICESCR (International Covenant on Economic, Social and Cultural Rights), CCPR (International Covenant on Civil and Political Rights), and CAT (Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment). However contradictions in application, practice and adoption prevail. Egypt made declarations and reservations regarding article 2 of CEDAW: "The Arab Republic of Egypt is willing to comply with the content of this article, provided that such compliance does not run counter to the Islamic Sharia".

   In preparation for ICPD, the women empowerment subgroup discussed different aspects of CEDAW and studied the situation of women in Egypt regarding law, policy, work, education, health and the mass media. Women empowerment and gender were introduced to the Egyptian society through mass media. CEDAW guarantees women equal rights with men in education, employment, health care, political participation, nationality and marriage. It "affords women protection from abuses".

   Certain points are disregarded should they contradict the Islamic law (Sharia). For example under CEDAW, Egypt does not comply with article 16 which refers to the equal rights of women and men when in matters of marriage and divorce. Egypt's explanation states that the basis of spousal relations under shari'a is equivalency of rights and duties so as to ensure complimentarity which guarantees true equality between spouses, not quasi-equality that renders the marriage a burden on the wife.

   Activists in Egypt advocated for women and gender issues and have succeeded in changing laws and decrees and improved women's environment since the ICPD in 1994..

   Millennium Development Goals (MDGs)

   Egypt has achieved the MDG on eradication of extreme poverty, according to the standard UN indicator of $1 per day. Twenty percent (20.2%) of the population is below the poverty line. Between 12.3% and 22% of the households are female headed households. The per capita GDP is $ 4,211.

   Primary education enrolment is around 95% and the literacy rate of 15-24 years old increased from 61% to 85% within 15 years. In some rural areas in Upper Egypt there are differences between boys and girls enrolment. Different projects specifically target girls in Upper Egypt to educate and empower them. Over 98% of households have access to water from an improved source (EDHS, 2005).

   1.3.2 Regional treaties and strategies

   Egypt has ratified the following regional treaties:

   Arab Charter on Human Rights (1994) adopted by the League of Arab States, reprinted in 18 Hum. Rts. L.J. 151 (1997).

   * African Charter on the Rights and Welfare of the Child, OAU Doc.CAB/LEG/24.9/49 (1990), entered into force Nov. 29, 1999.

   * African [Banjul] Charter on Human and Peoples' Rights, adopted June 27, 1981, OAU Doc. CAB/LEG/67/3 rev. 5, 21 I.L.M. 58 (1982), entered into force Oct. 21, 1986:

   Since 2003, the United Nations Population Fund (UNFPA) and the World Health Organization (WHO) have a Strategic Partnership Programme (SPP) to improve the quality of sexual and reproductive health care. They developed practice guides. They seek to promote sexual and reproductive health at national and sub-national levels by supporting countries in the introduction, adaptation and adoption of selected practice guides in family planning, the prevention and control of Sexually Transmitted Infections and Reproductive Tract Infections (STI/RTI), as well as maternal and newborn health (hftp://www.emro.who.int/rhrn/pdf/SPP).

   An inter-country meeting on Promoting Reproductive and Sexual Health in the Eastern Mediterranean Region took place in Lebanon (Beirut, 8-11 December 2003).

   Major Conclusions of the Consultative Meeting on Promoting Reproductive and Sexual Health in the Eastern Mediterranean Region Beirut, Lebanon, 8-11 December 2003

   * Sexuality and sexual health is a broad area and is a concern of all people during all phases of their lives.

   * Sexual health is an integral component of reproductive health

   * Sexuality, sexual health and sex education need to occupy a high rank on the health agenda of countries of the EMR.

   * Concerted efforts of international and national parties are needed to promote sexual health

   * Investing in relevant existing programmes facilitates the achievement of promotion of sexual health

   * In most countries of the EMR sexuality, sexual health and sex education are sensitive issues, and are usually overlooked by parents, teachers and health professionals.

   * Youth and adults are left with little, no or misinformation; this jeopardizes their sexual health.

   * Prevailing silence about sexuality, sexual health and sex education in countries of the region is to a great extent due to social reasons rather than to Islamic religion.

   * Islamic religion could be utilized as a vehicle to promote sexual health and enlightened religious leaders can play an effective role to support efforts directed to promote sexual health

   * The responsibility for sex education lies in hands of parents, teachers, health professionals and religious scholars, however, they usually overlook their roles.

   * Although relevant researches have been undertaken in some countries of the EMR, yet a research gap still exists and needs to be addressed.

   * In many countries in EMR adolescents are seldom involved in planning, implementation or evaluation of programmes related to their health.

   * In many countries of the region reproductive health services are insensitive to the needs of youth and adolescents.

   Recommendations

   WHO and Other Concerned Organizations

   * Facilitate the exchange of experiences, information, research results and success stories among countries of the region

   * Endorse countries' efforts to formulate national strategies through provision of the needed technical and financial support

   * Establish a regional committee in EMRO to review, recommend, guide and backstop RSH programmes as necessary

   Member States

   * Form multi-disciplinary national committee to develop national sexual health policies

   * Establish Multi-sectoral coordination and cooperation mechanisms to insure a wide coverage of sexual health issues

   * Insure that the national health policies include polices related to sexual health

   * Give due attention to the promotion of sexual health as an integral component of reproductive health and insure that reproductive health policies include sexual health polices

   * Develop strategies to promote...