In addition to being critical for the health of women and their families, family planning can accelerate a country’s progress towards reducing poverty and achieving development. It is even more pertinent in a politically unstable region with rapid population growth, which the Middle East and North Africa have been experiencing.
A growing number of women are using contraception as family planning services expand in the Arab region. Prevalence of contraceptive methods, however, differs between countries and not all of the need has been satisfied.
Contraceptive prevalence in Lebanon is among the highest in the region, calculated at 53.7% as of 2009, with its highest at 62.7% in 2000 and lowest at 53% in 1971, Index Mundi stated.
“There is a high demand for contraceptive pills and other means of birth control, such as condoms. In general, people are aware of contraceptive methods, especially in urban centres. Those who do not use any method usually plan to have children,” said pharmacist Samar Baltagy.
“My pharmacy is in a poor and popular area but the sales of contraceptives are very high. Women from all classes are using contraceptive means. Some years back, uneducated women from conservative background refrained from resorting to birth control means but today people are more aware of the need for family planning in general,” Baltagy said, adding that “at the starting cost of 3,000 Lebanese pounds ($2) a pack, contraceptive pills are accessible to all.”
Wide varieties of contraceptive resources are available in pharmacies in Lebanon and can be purchased over the counter without a prescription.
In a conservative society such as Jordan, the use of contraceptives is no longer looked at as a taboo but more of a way of life, said Ghadeer Hourani, a pharmacist with 11 years’ experience working at one of Jordan’s largest pharmacy chains.
“Ten years ago, people felt embarrassed to ask for a set of condoms or pills but today it is becoming more open and people can just pick any method they need and pay for it. The price range for contraceptive pills is $10-$15 and they can be found in any pharmacy across Jordan,” Hourani said.
Contraceptives’ prevalence in Jordan is influenced by religion, level of education and social background. The Sisterhood is Global Institute (SIGI), an independent, non-governmental organisation, established in 1998 by a group of Jordanian women, said approximately 62% of women in Jordan aged 15-49 use one of the various types of contraception.
In Egypt, contraceptives are mostly prevalent in big cities and almost totally disregarded in religious and conservative rural areas.
“Imams in the countryside preach against family planning, claiming it contradicts the Islamic religion. There is also the belief that some contraceptives cause cancer and destroy women’s fertility. This causes a lot of women to stay away from contraceptives,” said Soaad Abdel Meguid, the head of the Family Planning Section at the Egyptian Ministry of Health.
Nonetheless, the number of Egyptian women using contraceptives increased from 11.8 million in 2016 to 13 million in 2017. In 2016 and 2017, the government allocated $7.3 million and $14.1 million, respectively, to subsidise birth control pills that are available almost for free at the Health Ministry’s clinics and at a very low price in pharmacies.
“This encourages a lot of people to use them and reflects the government’s readiness to go to any length to curb the population growth,” said Deputy Health Minister Tariq Diab.
Egypt’s population is growing at a rate of 2% annually. It reached 104 million in 2017 and is projected to top 150 million by 2050.
In Tunisia, contraceptives are generally affordable and easily accessible. Women receive birth control, subsidised by the state at local hospitals, and condoms are available there for free.
A 2015 UN report stated that contraceptive prevalence in Tunisia was 64.4%, one of the highest rates in the region, while unmet need stood at 10.5%.
The country’s progressive outlook on reproductive rights goes back to modern Tunisia’s founding under President Habib Bourguiba, who introduced landmark reforms for women’s rights and reproductive health. Also crucial to this legacy was Tunisian doctor Tewhida ben Sheikh, one of the first female physicians in the Arab world and a strong advocate of access to contraception and abortion, which was legalised in 1973.
In March, the Tunisian Association of Free Pharmacists announced that all contraceptive pills were out of stock. The shortage, the association said, was due to the Central Pharmacy’s outstanding debts to foreign suppliers, some of whom threatened to cut off supply of vital medicines.
Birth control is largely rejected by the tribal and conservative Iraqi society, which shuns the idea of limiting childbirth. “It is very difficult to implement birth control policies that go against the mentality of the people, but we hope to be able to act on the issue in the longer term with the help of awareness campaigns,” said Ministry of Planning spokesman Abdul Zahra al-Hindawi.
“However, many modern couples are satisfied with two or three children, which is a good sign for the future.”
Contraceptive pills are available in most pharmacies across Iraq. Newly wed couples often seek to delay starting a family until they become more comfortable financially, said Uhud, a pharmacist who asked to be identified by her first name.