By Charles Levinson
Sunday, May 2, 2004
A U.S.-funded reproductive health program in Egypt upgrades rural care and helps women understand contraception. Aimed at curbing population growth, it is the last program of its kind and threatened by U.S. foreign aid policy.
MINYA, Egypt (WOMENSENEWS)--Throughout Minya, a rural region a three-hour's drive south of Cairo, filthy, under-funded, poorly supplied clinics are getting makeovers by the Tahseen Project.
At a not-yet-renovated clinic in Minya the rooms are gloomy, with rusting holes in the floor for toilets, piles of rotting garbage inthe garden, flies in the examination rooms, andlaboratories like storage closets in a biology classroom of an inner-city high school, complete with an antique microscope and a half-dozen cracked test tubes.
A few miles away, at the recently renovated Tayiba Clinic, the newly tiled floors sparkle, and U.S. Agency for International Development U.S.-flag stickers are plastered to new desks, chairs, cabinets, and examination tables. The Tayiba Clinic is freshly painted, well lit and clean. A new sphygmometer, for measuring patients' blood pressures, is still in its box on the desk of Dr. Moussa Adel Fam, the clinic's doctor.
"The whole place has changed," said Fam, who lives above the clinic. "Before the floors were dirty, there was no lighting, there was no hot water, there were no curtains on the window, the doors had fallen off their hinges."
In the waiting room, a dozen women, most with infants in their arms, wait their turn. They wear brightly colored robes called galabiyyas and headscarves. They say they have noticed a difference not just in the facilities, but in the way that the staff interacts with them.
"The way the doctors deal with us is different, the nurses care about us more," said Mariam Arees, a 25-year-old mother.
A $28 million Tahseen Project (Tahseen means "improvement" in Arabic) is empowering women to take charge of family planning issues in Egyptian villages. It is training doctors to deal with sensitive issues that few are comfortable discussing in rural Egypt.
The year-old program is scheduled to last through 2007, and eventually encompass seven rural governorates. It was originally intended as a mere outreach and education program to educate women about family planning issues such as contraception and the benefits of waiting three to five years between births. The program now includes a more ambitious scope, educating health care providers and renovating rural health clinics.
Marwa Mukhtar is a veiled 17-year-old Egyptian in training to be a peer educator as part of this reproductive health program in Egypt funded by the U.S. Agency for International Development, or USAID. It is the last U.S.-funded program of its kind in Egypt. The United States is Egypt's largest foreign donor, providing Egypt over $50 billion in economic and military aid since 1975.
Peer educator Mukhtar now speaks boldly about issues rarely broached by her peers, such as menstruation, contraception and the misconceptions about sex rampant in her bucolic Nile village.
Sitting for an interview over tea in a Nile side cafe, a water buffalo bleating in the background, Mukhtar says that she never thought she would have had the courage to speak about such things. "I have learned to break the wall of shyness, and to talk about things which were improper to talk about before because of our customs and our traditions. But these are not things that contradict with our religion."
Mukhtar lives in Minya, among the poorest of Egypt's 26 governorates. Here, on the banks of the Nile, much of the population is poorly educated and few women are able to read and write. Countrywide, over half of Egyptian women are illiterate and rural areas like Minya rank near the bottom in national literacy rates.
Two months ago, Mukhtar thought menstruation was the body's means of ridding itself of rotten blood. She thought pain medication to combat cramps caused infertility. She had never heard of a condom.
In her misconceptions she was typical. Female teens across Egypt recently stopped taking iron supplement pills when word spread that they caused infertility, according to Rania Mustafa, an Egyptian physician working with USAID. On another occasion, thousands stopped using sanitary pads after rumors abounded that Procter and Gamble Co. had coated them with an infertility spray.
"About 90 percent of the information that we knew about these issues was wrong," Mukhtar said. "Even my mom had 90 percent of the information wrong. She thinks female genital mutilation is correct and not an unhealthy thing."
According to a 1998 study 8 out of 10 Egyptian women wanted no more children, or wanted to delay the next child for two to three years, yet they were not using contraception.
The program is funded by USAID, and run by a consortium of U.S. organizations specializing in reproductive health issues. Like all USAID projects, Tahseen is being conducted in close cooperation with the Egyptian government and its primary goal is to bring birthrates in Egypt down from over 3.4 to 2.1 children per family, at which point Egypt's population growth will plateau. Egypt's 70 million people live on just 5 percent of the land. Population growth, at over 2 percent a year, is one of the country's most urgent problems.
By next year the program will be in seven Egyptian governorates. The program will most likely end when USAID funds dry up.
"We're shifting our emphases to reflect changes in U.S. foreign policy," said Ken Ellis, the director of USAID Egypt.
Reproductive health programs are being phased out at U.S. Agency for International Development, in response to pressure for more emphasis on abstinence-only for contraception education and the Bush administration's reinstatement of the so-called Global Gag Rule, a policy lifted by President Bill Clinton.
It bars U.S. family planning assistance to any foreign health care agency that uses funds from any source to perform abortions, provide counseling and referral for abortion or lobby to make abortion legal or more available in their country. The agencies may perform abortions only when there is a threat to the woman's life or the pregnancy is the result of rape or incest.
The director of the Tahseen Program, Damianos Odeh, is quick to point out that his project does not endorse abortion. "Abortion is not what we do," said Odeh, who spent 25 years with the World Bank before taking charge of Tahseen. "We consider abortion a failure of family planning. If we did good family planning there would be no need for abortion."
The governor of Minya is a supporter of Tahseen in Egypt, and has begun making family planning a part of his stump speech to constituents. Project organizers have enlisted the support of religious leaders, Muslim sheikhs and Coptic priests, influential voices in this religious culture.
"Girls who are about to be married come to me and they know nothing about sexual intercourse and fertilization," said Fam, the physician running the Minya clinic. "They don't know how the sexual relationship occurs, or that there's pleasure and satisfaction in it, or how she becomes pregnant and how she prevents pregnancy."
He said he didn't discuss such issues before Tahseen because he hadn't been trained in how to approach such culturally sensitive issues and because he simply wasn't aware of the need.
Charles Levinson is a freelance writer based in Cairo, Egypt. His work has appeared in the Boston Globe, the San Francisco Chronicle, and the Christian Science Monitor.
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