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Maternal Health in Egypt
This interview is with an Egyptian doctor who worked in southern Egypt in maternal and child health centers. She views women's high maternal mortality rate as one of the biggest health problems women face in Egypt.
Women in Egypt are not all the same:
Egypt is two parts: rural and urban. In rural areas, most women are just housewives. They don't work and they have a little formal education, no more than primary school. They depend entirely on men. In urban areas, there are many women who are working. Most are teachers, doctors, clerks, nurses, a few number of lawyers.
The Health Problem: High Maternal Mortality Rate
Maternal mortality rate measures the number of women that died from causes related to pregnancy and delivery per 100,000. Worldwide, more than one woman dies every minute from complications of pregnancy and childbirth. Southern Egypt, especially rural Egypt, has certain circumstances which make pregnancy more risky for these women.
Listen for reasons why rural Egyptian women face more risks during pregnancy.
Giving birth at home, under the care of a dayah (a traditional birth attendant) could lead to infection if the home or instruments used are not sanitized. If the birth has complications, it may be difficult for the woman giving birth to get to a hospital because there is not good transportation. Complications like severe bleeding and anemia are more likely if a woman has had more than 4 pregnancies.
Possible Solutions
Training for dayahs: Dayahs have been delivering babies in Egypt for 7000 years. This tradition is very strong, and it would be difficult to end it at this point. If dayahs are still going to be used, they could be trained about when to refer women to the hospital or obtain licenses to have better credibility with doctors.
Hear about the conflict between dayahs and doctors, and how licensing might help ease that conflict.
Licensing and formal training should probably come from the local government's Ministry of Health. Training from doctors might not be received well, especially by older dayahs. The local government can design training that fits the needs of local dayahs.
Better transportation to hospitals: Dayahs should refer women with difficult pregnancies to the hospital. However, even if a dayah decides to refer a woman to the hospital, there must be transportation available for women to get to the hospital. Especially in rural areas, there is not adequate ambulatory care. A better ambulance system would allow dayahs to make more referrals to hospitals in time.
More women doctors in rural areas:
In rural areas, it is a conservative community. Men prefer their wives to go to a female. I think Ministry of Health should look to redistribute recently graduated doctors, looking to assign more females to rural health posts to work for OB/GYN.
The Ministry of Health in Egypt assigns recently graduated doctors to health posts for two years. If they make assignments on the basis of gender, they could ensure that more rural communities had at least one female doctor for pregnant women to see. Women make up about half of the doctors graduating from medical schools, so there should be enough female doctors for rural communities.
Current Programs
Spacing pregnancies: Spacing pregnancies is a method of natural family planning that encourages breast feeding as a method of birth control. By spacing pregnancies at least 2 years apart, women can have healthier babies and decrease their own risk of dying from pregnancy.
Hear how spacing works to prevent pregnancy, and how it is difficult for many women to maintain 24-hour breast feeding for 2 years.
Family planning: Some women do not use non-natural methods of family planning, because it may cost too much or they may believe it will kill them. However, many women, especially in urban areas, do use family planning methods such as the Intra-Uterine Device (IUD) and birth control pills or shots. The International Planned Parenthood Foundation lists that 46% of Egyptian women of childbearing age use a modern form of contraception. Some women may be interested in using family planning, but their families are more interested in having more children:
They don't refuse to use family planning methods, but their men or their families prefer to have more numbers [of children]. We could say, we are not going to prevent you from having more children, but we want the woman to take a rest between one child and the next, which is spacing.
In recommending spacing or family planning, it is important to give the woman several options, get men involved in the decision making, and talk with the woman about the health benefits for her and her baby. A mass media campaign, especially in the form of short media plays featuring famous actors, could help women hear about family planning and spacing pregnancies from someone besides a doctor. An example of this type of drama series is "Wa ma zala anneel yagree [And the Nile Flows On]." The introduction of this successful series about family planning can be viewed online.
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Websites referenced:
- Safe Motherhood Initiative. (1998). Maternal Mortality. The World Health Organization.
http://www.safemotherhood.org/facts_and_figures/
maternal_mortality.htm - Department of Reproductive Health and Research, World Health Organization. (1999).
Health Benefits of Family Planning. Geneva: World Health Organization.
http://www.who.int/rht/documents/FPP-95-11/
fpp9511.htm - International Planned Parenthood Federation. Country Profiles: Egypt.
http://www.ippf.org/regions/countries/egy/index.htm - Johns Hopkins Center for Communication Programs. (February 25, 2000). Egypt: Wa ma zala anneel yagree [And the Nile Flows On]
http://www.jhuccp.org/ee/feb25.stm
Dawn Haney, December 2000
Last Modified: 2/03/2001
Contact: Dawn Haney
haneydaw@arches.uga.edu