Poverty and social protection

labor market by 1998. This pressure further increased in 2006 as the majority of this cohort began entering the labor market. six years later, the pressure eased with youth having settled into the labor market. However, there would be unanticipated consequences to fertility, as it was around this time that Egypt’s TFR began to rise again (see chapter 1). According to Egypt’s EDHs series, in 2008, Egypt’s TFR was at 3.0 births per woman, and it rose to 3.5 births per woman by 2014.

At the same time, with the implementation of the new population policy and wider use of contraceptives, TFR began to decline, but it stabilized at 3.1 births per woman by 2018 (ERF and CAPMAs 2018). In fact, the Egypt labor Market Panel survey (ElMPs) of 2018 stated that 62.6 percent of married women ages 15-49 years take action to prevent pregnancy (Krafft, Assaad, and Keo 2019), up from 58.5 percent in the 2014 EDHs (MOHP, El-Zanaty and Associates, and ICF International 2015).

A demographic echo had begun in 2012, when youth started forming families and having children of their own. The echo was noted that year with the population peak between 0 and 4 years, which grew to be 5–9 years in 2018, putting additional pressure on the education system. Toward the end of this decade, these children will reach working age, placing immense pressure on the labor market (Krafft and Kettle 2019). such labor market challenges can be best resolved when demographic changes work in the market’s favor. There is a window of opportunity that Egypt must take advantage of. The current eased demographic pressure—with the largest group of youth having aged and the echo cohort still at school—is the chance Egypt needs to resolve the structural challenges of its labor market.

POVERTY AND SOCIAL PROTECTION

Poverty and lack of social protection contribute to increased fertility. About 3.2 percent of Egyptians live below the level of the international poverty line of Us$1.90 (2011 PPP Us$) per day; only 4.1 percent of Egyptians are considered multidimensionally poor, which reflects Egypt’s strong performance relative to other countries on dimensions such as consumption, schooling, and access to basic utilities. On the other hand, the share of the poor when measured using national poverty lines (Us$3.80 per day) rose from 25.2 percent in 2010 to 32.5 percent in 2017/18 (World Bank 2020). It is estimated to have declined to 29.7 percent in 2019/20 (CAPMAs 2020), which is still high.

In 2014, among the lowest two wealth quintiles, the fertility rate was 3.6 children per woman, higher than the national average of 3.5; the age at marriage was the lowest among all wealth quintiles (18.9 years and 19.6 years, respectively); and contraceptive use was lower than the national average (55.9 and 55.7 percent, respectively) (MOHP, El-Zanaty and Associates, and ICF International 2015). Different social reasons may explain these trends. Poorest families consider children as a source of income, and having more children guarantees more income to the families (which could also lead to high rates of school dropouts) and a source of safety nets for parents in old age.

The poorest population is concentrated in Upper Egypt, especially in rural areas, where there is limited coverage of health units, which translates into lack of access to family planning services and products, particularly female

service providers. The poverty rate in rural Upper Egypt was 51.94 percent, according to the Household Income, Expenditure, and Consumption survey (HIECs) for 2017/18 (Economic Research Forum and CAPMAs 2021). With the limited income, families are faced with the burden of paying the direct and indirect expenses for FP services, if available; and with the high level of illiteracy, mass communication campaign messages may not be as effective. such regions are where social protection programs come in (box 4.1).

Box 4.1

Tackling fertility-related issues through cash transfer programs

social protection programs—that is, cash transfer programs—can have an influence on fertility, although the evidence is mixed. global evidence shows either that cash transfers have no impact on fertility or that they support reductions in fertility or changes in factors that can help reduce fertility over time (UnICEF 2017). Cash transfer programs are widely used to alleviate poverty and help families meet their basic needs. They are typically designed to increase support incrementally with the aim of reducing poverty and economic and social risks and promoting resilience. They may, therefore, influence fertility through several tracks. For example, grant-related income could foster economic independence and increase access to health services, job prospects, and education for girls and women, creating incentives and opportunities for lower pregnancy rates. some have argued that cash transfer programs could have a negative impact because they may motivate families to have larger families to access larger cash transfers (stecklov et al. 2007). The argument suggests that cash transfers may encourage families to keep having children to remain in the program or to get benefits for each child. This is why many countries put a cap on the number of children that can be supported through such a program (Palermo 2016).

Cash transfers could help increase income, thereby reducing fertility in the longer term. Further, they can increase demand and ease access to health care and FP services, which can have both short- and long-term effects on fertility, especially given that in many countries women’s lack of access to such services limits their ability to make reproductive choices (stecklov et al. 2007). This effect is especially relevant for Egypt, where approximately 16 percent of births in 2014 were not wanted (Baseera, nPC, and UnFPA 2017). Moreover, cash transfers may also improve girls’ access to education, which in the longer term can result in women having fewer children over their lifetime through delayed marriages and better access to information and services related to FP (UnICEF 2017). This longer-term effect occurs because some cash transfer programs are conditional upon ensuring that children of families enrolled in the program attend school regularly.

Egypt has launched several programs to tackle fertility-related issues that are focused on gender, social protection, or other aspects. The national cash transfer system, the “Takaful and Karama” program (TKP), launched in 2015, was initially designed to support families with up to three children under the Takaful conditional cash transfer subprogram.a In 2018, the government revised the cap to make it two children only, to support FP efforts. This subprogram targets households with children under 18 years of age and provides them with income support that is tied to improvement in specific behaviors related to education and health care. It was carefully designed to serve as a “nudge” to influence behavioral changes among Egypt’s poorest groups.

Finally, the Ministry of social solidarity has adopted an integrated family development strategy including a life-cycle approach to provide childcare services in the first 1,000 days and equal education opportunities. It has also launched behavioral change programs targeting TKP beneficiaries called “Waaei” (meaning awareness) and “Mawaddah” (meaning cordiality), which use rural leaders and social workers to advocate 12 key messages, including combating female circumcision, encouraging FP and girls’ education, and discouraging early marriage in addition to educating young people about marriage and the value of family through counseling services.