Prepared by : Ghada Elhady Associate Professor of Public Health, Preventive and Social Medicine- Cairo University- Egypt

1. IMPACT OF C VID-19 PANDEMIC
ON FAMILY PLANNING
Ghada Wahby Elhady
Assistant Professor of Public Health and Community Medicine
Faculty of Medicine, Cairo University

2. OUTLINE:
➢ Background:
➢ Public Health Importance of Family
Planning (FP)
➢ Impact of COVID-19 pandemic on FP:
A. Adverse impact on:
- Supply of service
- Demand for service
- Fertility preferences
B. Positive impact
➢ Conclusion
➢ Recommendations:
A. At policy level
B. At programmatic level
C. At facility operational level

3. On 30 January 2020
COVID-19: A Public Health Emergency
BACKGROUND:
Egypt was among the five countries reporting
the highest number of cases in Africa.
Response to COVID 19 across countries had been
similar:
• Setting up of Pandemic Task forces,
• Lockdown of cities and settlements, Closure of
Schools, Markets and Businesses
• Travel Bans and Social distancing
• Personal Hygiene and Community Hygiene
• Testing
• Isolation and Quarantines,
• Search for drugs and vaccine

4. • The pandemic affected all countries; especially
the low and middle income countries (LMIC);
including Egypt
• And all sectors; especially the Health Sector
leading to affection of all essential health care
services
• While prompt response was initiated for different
areas of the health sector by governments, there
an argument on whether reproductive health and
family planning (FP) has received appropriate
response during the pandemic.
COVID-19: A Public Health Emergency
BACKGROUND:

5. CONCEPT:
Family planning allows individuals
and couples to anticipate and attain
their desired number of children
and the spacing and timing of
their births. It is achieved through
use of contraceptive methods and
the treatment of involuntary
infertility (WHO, 2000).
Family Planning Program (FPP) in Egypt:
BACKGROUND: Population
102,750,000
CAPMAS, Dec 2021

6. 2020
TFR
CBR
24.8
BACKGROUND:
Family Planning Program (FPP) in Egypt: Where were we BEFORE COVID-
19?
Sources: EDHS 1988, 1992, 1995, 2000, 2005, 2008 and 2014 and ELMPS 2018 , 2020
NPCS
Fertility Trends:
- Total Fertility Rate (TFR)
- Crude Birth Rate (CBR)
- Age-Specific Fertility Rates
(ASFR)

7. 2020
TFR
CBR
24.8
BACKGROUND:
Family Planning Program (FPP) in Egypt: Where were we BEFORE COVID-
19?
Sources: EDHS 1988, 1992, 1995, 2000, 2005, 2008 and 2014 and ELMPS 2018 , 2020
NPCS
Fertility Trends:
- Total Fertility Rate (TFR)
- Crude Birth Rate (CBR)
- Age-Specific Fertility Rates

8. BACKGROUND:
Family Planning Program (FPP) in Egypt: Where were we BEFORE COVID-
19?
https://www.cairn-int.info/article-E_POPSOC_551_0001--why-has-fertility-been-increasing-in.htm
DHS
Fertility Trends:
- Total Fertility Rate (TFR)
- Crude Birth Rate (CBR)
- Age-Specific Fertility Rates

9. BACKGROUND:
Family Planning Program (FPP) in Egypt: Where were we BEFORE COVID-
19?
https://www.cairn-int.info/article-E_POPSOC_551_0001--why-has-fertility-been-increasing-in.htm
EDHS
Fertility Trends:
- Total Fertility Rate (TFR)
- Crude Birth Rate (CBR)
- Age-Specific Fertility Rates
(ASFR)

10. BACKGROUND:
Family Planning Program (FPP) in Egypt: Why fertility was on the rise 2008-2014?
63.3
9.9 7
59.9
16.7
11.9
51.5
27.4
14.5
IUD OCs Injectables
EDHS 2005 EDHS 2008 EDHS 2014
10 9
13
2005 2008 2014
Unmet Needs for FP
32
26
30
2005 2008 2014
Method Discontinuation Rtae
Method-Mix profile
Contraceptive Use Rate
Why fertility was on the
rise 2008-2014?
- Contraceptive Use Rate
- Method-Mix profile
- Discontinuation Rate
- Unmet Needs for FP
- Exposure to FP message
- Poverty Rate
- Child Morbidity
- Fertility Preferences
- Youth bulge in the 80s

11. BACKGROUND:
Family Planning Program (FPP) in Egypt: Where were we BEFORE COVID-19?
Why fertility was on the
rise 2008-2014?
- Contraceptive Use Rate
- Method-Mix profile
- Discontinuation Rate
- Unmet Needs for FP
- Exposure to FP message
- Poverty Rate
- Child Morbidity
- Fertility Preferences
- Youth bulge in the 80s

12. BACKGROUND:
Family Planning Program (FPP) in Egypt: Where were we BEFORE COVID-19?
Why fertility was on the
rise 2008-2014?
- Contraceptive Use Rate
- Method-Mix profile
- Discontinuation Rate
- Unmet Needs for FP
- Exposure to FP message
- Poverty Rate
- Child Morbidity
- Fertility Preferences
- Youth bulge in the 80s
2.3 2.4
2.8 3
2005 2008 2014 2020
Fertility Preferences in Egypt
NPC
EDHS

13. 2020
TFR
CBR
24.8
BACKGROUND:
Family Planning Program (FPP) in Egypt: Where were we BEFORE COVID-19?
Sources: EDHS 1988, 1992, 1995, 2000, 2005, 2008 and 2014 and ELMPS 2018 , 2020
Why fertility was on the
rise 2008-2014?
- Contraceptive Use Rate
- Method-Mix profile
- Discontinuation Rate
- Unmet Needs for FP
- Exposure to FP message
- Poverty Rate
- Child Morbidity
- Fertility Preferences
- Youth bulge in the 80s

14. 2020
TFR
CBR
24.8
BACKGROUND:
Family Planning Program (FPP) in Egypt: Where were we BEFORE COVID-19?
Sources: EDHS 1988, 1992, 1995, 2000, 2005, 2008 and 2014 and ELMPS 2018 , 2020
NPCS
Why fertility declined
2014 - 2019?
- Contraceptive Use Rate
(CUR) ??
- Little decline in the rate of
marriage since 2014
In spite of:
- Poverty Rate

15. BACKGROUND:
Family Planning Program (FPP) in Egypt:
Where were we before COVID-19?
CHALLENGES: related to the lack of SUSTAINABILITY elements for FP services:
I. FINANCIAL: External donations*
II. POLITICAL: Support does exist. However, turnover of the population
sector/council leadership and affiliations
III. INSTITUTIONAL: Training, supervision, technology of FP methods (especially
the long-term effective)
IV. DEMAND: Keeping the client choice

16. PUBLIC HEALTH IMPORTANCE OF FP

17. Public Health Importance:
Impact on Economy and Sustainable Development:
FP is essential for provision of employment , education and social services opportunities (SDGs 1, 2,
and 3). Lack of Proper FP services is threatening to Egypt’s inhabitants’ development especially in
the context of a faltering economy
Severity:
Unintended pregnancy and improper births spacing also linked to increased maternal morbidity and
mortality, as well as rising numbers of unsafe abortions.
Adolescent girls are particularly vulnerable to the health consequences of pregnancy and delivery, as
early childbearing can have negative effects on girls’ healthy development into adulthood and on
their educational and employment prospects.
Seriousness: Because It affects maternal and child health outcomes

18. Public Health Importance:
Magnitude:
▪ Among the 1.9 billion Women of Reproductive Age group (15-49 years) worldwide, 270 million have
UNFP.
▪ The proportion of the need for family planning satisfied by modern methods, SDG indicator 3.7.1, has
stagnated globally at around 77% from 2015 to 2020 but increased from 55% to 58% in the Africa region.
Use of contraception advances the human right of people to determine the number and spacing of their
children.
▪ Overpopulation are among Egypt’s most pressing health and development challenges. According to the
(CAPMAS), Egypt is home to 102 million individuals, making it the most populous country in the Middle
East and North Africa. At present, a new baby is born in Egypt roughly every 13.9 seconds (new enterers
to labor market), according to CAPMAS estimates.
Trend:
Fertility is increasing 2008 to 2014 and among all social and geographical groups. After 2014, TFR
decreased, yet, fertility preferences increased but this needs to be well evaluated to address high fertility
motives if found. As well, UNFP IS increasing (EDHAS 2014)

19. IMPACT OF COVID-19 ON FP
A) ADVERSE IMPACT
B) POSITIVE IMPACT

20. ADVERSE IMPACT
IMPACT OF COVID-19 ON FP:
Source: Global Financing Facility (GFF), Country Brief India: Preserve Essential Health Services during the COVID-19 Pandemic

21. ADVERSE IMPACT
IMPACT OF COVID-19 ON FP:
Source: Global Financing Facility (GFF), Country Brief India: Preserve Essential Health Services during the COVID-19 Pandemic

22. IMPACT OF COVID-19 ON FP
FERTILITY PREFERENCES
High Income Countries Low and Middle Income Countries
Examples:
Canada, USA
Examples:
Some countries in
Eastern Europe, Africa,
Asia

23. 2.3 2.4
2.8 3
2005 2008 2014 2020
Fertility Preferences
NPC
EDHS
IMPACT OF COVID-19 ON FP
EGYTP

24. POSITIVE IMPACT
IMPACT OF COVID-19 ON FP:
Awareness via MEDIA
Mobile Teams and
community-based
HCW brought services
closer to communities,
reaching women
where they live.
Increased demand on long-term FP methods e.g. IUD
Increased
DONATIONS for
Reproductive
Health and FP
IPC Training of
1000s HCPs
to overcome
fears
Counselling via Telehealth
saved energy and improved
demand for counselling

25. CONCLUSION

26. CONCLUSION
FPP evaluation and improvement is essential for achieving Egypt’s
SDGs.
Egypt already had challenges to the FPP before COVID-19 pandemic
due to lack of SUSTAINABILITY elements for FP services; namely:
Financial, Political, Institutional, and Demand.
Most probably, those challenges were aggravated by the COVID-19
pandemic.

27. RECOMMENDATIONS

28. Policy Level:
Aim at lowering High Fertility Motives and
improve Fertility Preferences
1. Achieve women economic empowerment
e.g. employment opportunities
2. Improve women educational level
3. Increase awareness about FP
4. Children labor ban laws
5. Improve child health
RECOMMENDATIONS
Programmatic Level:
Aim at Improving FP Method-Mix to reduce DR, UNFP
and failure rates:
1. Accurate data collection strategies
2. Improve FP method manufacturing technology to
make long-acting effective and safe FP methods
such as IUD available
3. Public-Private Partnership
4. Working to attract physician
5. Benefit from the FP nurse role and low TOR
6. Reduce turn over of NPC leadership
Operational H. Facility Level:
Aim at capacity building of HCPs through proper training in:
1. Contraceptives technical aspects and IUD insertion and
removal
2. Proper FP counselling
3. Upgraded SOP
4. Effective (Focused) supervision and OJT
5. Moral motivation
6. Effective MIS and Monitoring and Evaluation
7. Benefit from the nurse role esp. in remote areas
SOP: stander of practice. OJT: on-the-job-training

29. THANK
YOU

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