There's what experts have called a "quiet revolution" underway in the Middle East, one that doesn't involve protests on the street or the toppling of governments. This revolution, happening in the privacy of locals' own homes, is concerned with fertility rates in the region. The total fertility rate, or TFR - the rate refers to how many babies a female has between the ages of 15 and 49 - has more than halved in the Middle East since the 1960s. Falling fertility rates are a global phenomenon. Over the past decade, those numbers have kept falling.
According to World Bank statistics, in 2023, five of the 22 member states of the Arab League were operating with a TFR below 2.1, the number of babies per woman required to maintain population levels, and another four were coming close. For example, the United Arab Emirates has a TFR of just 1.2, well below population replacement levels.
Egypt, home to more than 107 million people, is the 13th most populous country in the world. Egypt's population still grows each year by approximately 1.5 million people, or the equivalent of the population of a country the size of Kuwait. United Nations projections indicate that the population will grow from 62.3 million in 1995 to 95.6 million by 2026 and will reach 114.8 million before it stabilizes in the year 2065-an increase of approximately 84.4 percent over the current total.
Speaking at the 2025 World Population Day event in Cairo, Abdel-Ghaffar described the decline as a “tangible positive result” of ongoing efforts to manage population growth. Abdel-Ghaffar added that Egypt’s birth rate also fell to 18.5 births per 1,000 people in 2024, down from 26.8 in 2017.
Recently, some Egyptian scholars have questioned the continuing need for government support of family planning programs. High fertility and population growth, they contend, are no longer serious concerns in Egypt. However, deeper examination of current trends suggests that population growth should still concern Egyptian policymakers. If the fertility declines of recent decades are to be sustained and the government of Egypt is to achieve its goal of reducing fertility to replacement level by 2016, it must support a strong family planning program that can continue to provide high-quality services and reach more potential users.
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The government attributes this decline to its long-running efforts to raise awareness about family planning. Egypt’s focus on controlling population growth began after the 1952 regime change, which saw a socialist government take power. In 1956, Presidential Decree No. 4075 established the Supreme Council for Family Planning, officially launching the government’s response to the issue. In 1973, the government introduced its first national family planning plan, which continued throughout the era of ousted President Hosni Mubarak. In 2023, authorities launched the National Population and Development Strategy (2023-2030), followed by a short-term 2025-2027 action plan.
However, many argue that the economic crisis, particularly high inflation, has played a bigger role. This financial strain has only worsened due to a currency crisis, further exacerbated by the genocide in Gaza. This led to a sharp increase in inflation, which had already been rising for over a year.
Experts have come up with a number of hypotheses as to why this is happening. The former includes things like war and political uncertainty - people don't want to bring children into an unsafe world. Economic changes, including things like the removal of national subsidies in Egypt and Jordan, inflation, or fewer public sector jobs in oil states, mean it's becoming more difficult to pay for marriage and children. It also likely involves urbanization. For example, in rural areas in Jordan and Egypt, the fertility rate has regularly been double that in larger cities.
All of these factors are interconnected, say experts like Marcia Inhorn, a professor of anthropology and international affairs at Yale university in the US, who has extensively researched changing attitudes to children and marriage in the region. There's also a growing cohort of women who are waiting for the right partner or who may never to get married, she continued. "And across the region, there's also been a decline in interest in having large families," Inhorn added.
Demographic Trends and Their Implications
According to the total fertility rate in 1998, the average Egyptian woman would give birth to 3.4 children in her lifetime-well above the rate needed to reach population stabilization. Fertility rates are especially high in the poor rural areas of Upper Egypt, which are least able to support rapid population growth. Even after the country reaches replacement-level fertility-just over two children per woman-the population of Egypt will continue to grow for a number of years. This is because of population momentum.
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Momentum occurs when a large proportion of women are in the childbearing years. When this is the case, the total number of births can increase even though the rate of childbearing per woman falls. Momentum is a powerful demographic force; it is predicted to account for about half of Egypt's population growth over the next 100 years. The share of reproductive-age women (15-49) was 23.1 percent of the total population of Egypt in 1986 and increased to 25.7 percent in 1996. This number is expected to rise to 26.5 percent of the total by 2025.
Around eight in ten married women in Egypt want no additional children or want to delay the next birth for at least two years. Yet a sizable percentage of these women do not use contraception. Data from the Egypt Demographic and Health Survey (DHS) in 1998 suggest that the percentage of Egyptian women of reproductive age who want to limit family size or have no more children but are not using contraception is 16 percent. This is a sizable number of women and represents the target group that family planning programs are trying to reach.
The gap between stated preference and actual behavior is a measure of what demographers label the "unmet need for contraception," which refers to the behavior of women who want no more children or want to delay their next pregnancy but do not use contraception. Demographers categorize unmet need in two types: a need for birth spacing and for limiting family size. Furthermore, a number of Egyptian women are having more children than they consider optimal.
Enabling women to achieve their reproductive preferences will increase their age at the first birth, increase the spacing between their births, reduce the number of unintended pregnancies, reduce fertility rates, and decrease the rate of population growth. Reductions in fertility can reduce the risk of mortality and morbidity associated with childbirth, a risk magnified by many successive pregnancies. Maternal mortality in Egypt is high.
Maternal mortality and morbidity can also be reduced by enabling women to delay first births until age 20 or later and to space births at least two years apart. Reducing the incidence of unintended pregnancy will reduce the number of unsafe abortions, which may follow such pregnancies, and in so doing reduce the maternal morbidity and mortality associated with these abortions. Abortion in Egypt is illegal except when medically necessary. A recent study by the Population Council has shown that approximately one out of five patients of the obstetrics/gynecology department of public-sector hospitals were admitted for treatment of postabortion complications.
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Lower fertility produces healthier children. The majority of married women in Egypt (77 percent) have the potential of giving birth to a child at elevated risk of mortality. Children born less than two years apart are twice as likely to die in the first year of life as those born after an interval of at least two years. Furthermore, closely spaced pregnancies are more likely to result in low-birthweight (LBW) babies. Such babies have a substantially greater likelihood of dying in the first year of life; those who survive are more likely to suffer developmental impairments later. Furthermore, treating LBW babies is expensive.
Allowing women more control over their fertility can enhance their choices in settings where educational and economic opportunities are expanding. For example, the major reason behind the high dropout rate among Egyptian schoolgirls is economic. Families with inadequate incomes and large numbers of children are more likely to withdraw their children from school. Moreover, if the family's economic circumstances are so difficult that only some children can be educated, girls-older girls in particular-are likely to be withdrawn from school first so that they can help care for younger siblings.
Reducing the proportion of school-age children in the population reduces the burden on schools. Reducing child dependency also allows families and nations to invest more in education, improving the quality of the future labor force. Achieving the fertility-reduction goal of the Egyptian government, i.e., reaching replacement-level fertility in 2016, will reduce pressures on the environment and provide a grace period for dealing with other kinds of pressures.
A reduced rate of population growth would provide the opportunity to provide such public services as piped water and sanitation to a greater number of households. Population trends will also have a significant impact on the amount of water available per person in the future. The aforementioned projections show that, at the current level of fertility, the annual amount of water available per person would be reduced to nearly half of today's levels by 2026-falling from 980 cubic meters per person per year today to 570 by 2026. However, the available amount would drop only to 670 cubic meters if reduced fertility is achieved, which would allow each person to consume 100 extra cubic meters, or 18 percent more water per year.
Another way in which lower fertility can promote socioeconomic development is by reducing the proportion of dependent children in the population. At present, children under age 15 constitute 24 percent of the total population of Egypt. Reducing fertility to replacement level by 2016 will reduce this percentage to 21 percent. On the other hand, continuing at the present fertility level will raise the proportion of children to 30 percent of the total population in 2016. With fewer children, families will have more disposable income to save or invest.
This constitutes a "demographic bonus," which may help to spur economic growth, create jobs, and in turn reduce unemployment. However, some caution is in order when drawing connections between lower fertility and socioeconomic development. The "demographic bonus" is not automatic but depends on appropriate policy in other areas.
The decreases in fertility that have occurred in Egypt since 1965 attest to the success of family planning and related efforts to improve the education of women. The reduction in fertility from 7.0 children per woman in 1965 to 3.4 in 1998 was accompanied by an increase in the contraceptive prevalence rate (the percentage of married women of reproductive age who use contraception) from 7 percent to 51.7 percent. Egypt's family planning program has led to sharp increases in the use of a variety of contraceptive methods, including intrauterine devices, birth control pills, and condoms.
To achieve the government's goal of reducing fertility to replacement level by 2016, it will be necessary to increase contraceptive prevalence to 70 percent. Most of this increase can be achieved by meeting current unmet need, estimated in 1998 to be 14.5 percent of all women. However, meeting current total demand for contraception (which equals the 51.7 percent current users plus the 14.5 percent who have an unmet need for contraception) would only increase contraceptive prevalence to 66.2 percent.
The government has begun addressing these barriers by introducing a wider variety of methods as well as promoting wider knowledge about proper contraceptive use and low health risks, improving the quality of counseling services, encouraging employment of female physicians in family planning clinics, and increasing access to contraception and subsidizing contraceptives.
Egypt has an extremely young population. According to the 1996 census, 46 percent of the population was 20 years of age or younger, up from 42.7 percent in 1960. Nearly 13.3 million females were under age 20, and about one-third of them were in Upper Egypt. By 2020, 14.3 million women will be in the prime childbearing ages of 20-40, compared with 9.2 million in 1999. It also means that population growth will be highest in the poorest regions of Egypt.
The number of women of childbearing age will continue to increase before it gets smaller. This means that the family planning program will need to serve a larger number of people. Even in regions where fertility is relatively low, access to contraception is still important because it can help reduce unwanted pregnancies and the unsafe abortions that sometimes follow them. Current population projections assume that fertility will drop-that is, that family planning programs will continue to increase the use of contraception.
Family planning programs have enjoyed widespread success and popularity in Egypt. However, the continued levels of unmet need for contraception in several areas of Egypt and the increase in the number of women reaching childbearing age indicate that the work of family planning is not finished. However, the current policy climate raises concerns about the future of family planning in Egypt.
There is a need to emphasize among health care providers that effective family planning contributes to women's health. Given the uncertainty of future donor funding levels, Egypt must be prepared to assume a greater share of the burden and anticipate playing a larger role in program operations. The Egyptian government needs to intensify its efforts to make this transition happen smoothly.
Recent Trends and Factors Influencing Fertility Rates
In 2014, Egypt’s Demographic and Health Survey (EDHS) documented an increase in the total fertility rate (TFR) to 3.5, up from a low of 3.0 recorded by the 2008 EDHS. The increase has been anecdotally attributed to the social upheaval following Egypt’s January 2011 revolution, but little is known about when fertility first began to increase and among which sub-groups of women.
Though the pace of decline may slow at later stages, the transition from high-fertility to low-fertility regimes is generally understood to be a one-way street: once started, fertility declines tend to continue .The recent increase in fertility in Egypt is an unusual and worrying change of direction for the most populous country in the Arab world, whose population has doubled since the early 1980s to reach 84 million in 2014 .
Despite the program’s early establishment, political support was inconsistent and fertility remained high until the 1980s. Former President Hosni Mubarak was a strong supporter of family planning to lower fertility, seeing rapid population growth as hindering socio-economic progress .
Since the first World Fertility Survey (predecessor to the EDHS) in 1980, Egypt’s TFR declined from 5.3 to 3.0 in 2008. In early 2011, mass protests in Cairo, Alexandria and other cities led to the ousting of Mubarak, who had ruled Egypt for 30 years, and widespread political instability. In the wake of three tumultuous years, results from the 2014 EDHS showed a considerable increase in fertility levels. The TFR recorded in the three years preceding 2014 increased to 3.5 from a historic low recorded in the 2008 EDHS of 3.0-reversing a 25-year trend of fertility decline .
The rise in fertility rates is widely believed to be linked to post-revolution social and political upheaval, potentially due to disruptions in family planning services or an increasing proportion of young women married in response to safety concerns-a factor that has been observed during periods of conflict in other Middle Eastern countries . Postponement and declines in the proportion of women married have played significant roles in the transition to lower fertility across much of the Arab world as early marriage lengthens exposure to the risk of pregnancy and is associated with higher levels of childbearing .
Marriage remains nearly universal and divorce relatively rare in Egypt, and virtually all childbearing occurs within marriage . As a cross-sectional measure, TFR reflects the interaction between both timing (tempo) and level (quantum) of childbearing, and its sensitivity to changes in tempo of childbearing in the absence of a change in quantum is well documented . During periods where women shift childbearing toward younger ages, the TFR is elevated, despite no actual change in completed family size.
With more than 80 million people, Egypt’s rapid annual population growth rate of 2.6% threatens economic development, the environment (particularly regarding serious shortages of fresh water) and provision of services, including education and healthcare . By 2030, Egypt's population is projected to reach 120 million .
The link between increased education and lower fertility is well established, and Egypt has made great strides in women’s education over the last 10 years. However, Bongaarts (2003) demonstrated that fertility differentials by education level tend to diminish at later stages in the fertility transition. The stalling fertility decline in Egypt observed in the early 2000s has been suggested to be related to the significant proportions of women with little or no education at the time .
While education is still far from universal, the 2014 EDHS documented substantial advancements: 52% of ever-married women age 15-49 had completed secondary school compared to 31% in 2000 and 20% in 1992 . More educated women tend to marry at older ages than those with little or no formal schooling, though the differences across education levels is less pronounced in Egypt than in other Arab countries .
Birth history data up to 10 years before the interview for each of the seven surveys was used to calculate TFRs by calendar year from 1990-2013 to show the trends in fertility leading up to and immediately after the 2011 revolution. There is considerable variability in TFR estimates for single years when calculated from individual surveys, but as seen in Fig 1 (panel A), the confidence intervals overlap, except in the periods five and six years before each survey, where estimates are significantly lower or higher, respectively.
Several studies have shown that enumerators sometimes omit or displace births to avoid completing the child health module for births within the last five years . Due to this issue, the calculation of single-year fertility rates in the periods five and six years before each EDHS omit that survey. Thus, no TFR estimates were produced for the years 2008 and 2009 as these are five and six years before the 2014 survey.
Analysis of TFRs for women aged 15-44 using pooled data revealed that the steep fertility declines of the early 1990s were followed by slower overall declines until 2005. During the 24-year period under investigation, TFR reached its lowest point in 2005 at 3.04 (95% CI: 2.94-3.15). Compared to 2005, the TFR in 2007 increased significantly to 3.28 (95% CI: 3.18-3.38) and remained at levels comparable to 2007 until 2013, when it rose again to 3.55 (95% CI: 3.41-3.69).
TFRs for urban women were lower than for rural women throughout the period under examination. Fertility among rural women declined dramatically from 5.03 (95% CI: 4.69-5.37) in 1990 to 3.94 (95% CI: 3.75-4.12) in 1994. This was followed by a much slower decline over the next 12 years to a low of 3.26 (95% CI: 3.12-3.40) in 2006, before reversing course. TFR for rural women then rose to 3.78 (95% CI: 3.59-3.96) in 2013-the highest level since 2001. Among urban women, fertility rates fluctuated but showed a slight overall decline to 2.63 (95% CI: 2.48-2.78) in 2005 before rising between 2006 and 2007 to 3.04 (95% CI: 2.88-3.19). From 2011 to 2012, urban fertility dropped below 3.0 before rising again in 2013 to 3.15 (95% CI: 2.95-3.35).
At the beginning of the period under examination, there was a clear divide in fertility levels between women with less than a secondary school education and those with secondary school or higher education. Secondary or higher educated women had nearly two children fewer than less educated women in 1990. Among less educated women, the TFR declined by 1.9 children in 16 years, from a high in 1990 of 5.19 (95% CI: 4.99-5.39) to a low in 2006 of 3.25 (95% CI: 3.09-3.40). Fertility then increased to 3.65 (95% CI: 3.44-3.86) in 2010 before declining slightly.
Fertility among women with secondary or higher education showed little change from 1990-2006, fluctuating around a level of 3.0. From 2003 onward, fertility among women with secondary or higher education increased steadily, reaching 3.68 (95% CI: 3.49-3.87) in 2013, surpassing the TFR of less educated women.
The secular rise in fertility after 2005 is seen clearly among 20-24 year olds, where rates increased from a low of 174 births per 1000 women (95% CI: 165-184) in 2005 to a high of 211 (95% CI: 199-224) in 2011. Fertility rates for women age 25-29 and 30-34 increased in 2007 from lows recorded in 2006 (for 25-29 year olds) and 2005 (for 30-34 year olds). ASFRs for these two age groups slightly declined in 2011 (though rates remained above pre-increase levels) compared to the 2007 increase, before rising again in 2013. Among women aged 30-34, ASFR increased to 148 per 1000 women (95% CI: 135-161) in 2013.
The 2007 increase in TFR was observed among women age 20-34, and the 2013 increase was seen in sustained fertility rates above 2007 levels among 20-24 year olds and additional increases among women age 25-34. Fertility among 15-19 and 35-39 year olds declined until 2003 before plateauing.
In contrast to the plateau observed among 15-19 year-olds in Fig 4, there was a clear increase in fertility rates in the second half of the study period among more educated women.
Why fertility and birth rates are falling - The Global Story podcast, BBC World Service
| Year | Value |
|---|---|
| Most Recent Year | 2022 |
| Most Recent Value | 2.765 |
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