Buying safety: the economics of reproductive risk and abortion in Egypt.

This article examines the economics of abortion safety in Egypt. Under Egyptian law induced abortion is restricted to cases in which two physicians certify that the pregnancy presents a danger to the health or life of the mother. Despite this legal restriction, the available data indicate that abortion is quite widely practiced. Multifaceted strands of legal, religious, economic, and health care policy influence both discourse about and access to abortion in Egypt. Interviews with 18 Egyptian women who sought to terminate their pregnancies revealed a wide range of abortion methods that varied in both safety and cost. Three levels of safety were identified: (1) indigenous (wasfa baladi) methods were potentially the least safe; (2) biomedical abortions at clandestine clinics appeared safer than indigenous methods, but were not without risk: and (3) biomedical abortions administered by private gynecologists, were the most safe. Safety is expensive. Wealthy women can literally buy safety, while poor women's lack of financial resources put their lives at great risk.

A community study of gynecological and related morbidities in rural Egypt.

This study assesses the prevalence of gynecological and related morbidity conditions in a rural Egyptian community. A medical examination was conducted on a sample of 509 ever-married, nonpregnant women. For gynecological morbidities, genital prolapse was diagnosed in 56 percent, reproductive tract infections in 52 percent, and abnormal cervical cell changes in 11 percent of the women. For related morbidities, anemia was present in 63 percent of the women, followed by obesity (43 percent), hypertension (18 percent), and urinary tract infection (14 percent). Regression analysis of risk factors demonstrated the contribution of social conditions and medical factors to these diseases. Reproductive tract infections were shown to occur more frequently with uterovaginal prolapse, IUD use, presence of husband (regular sexual activity), and unhygienic behavior. Genital prolapse increased with age and number of deliveries. Age, recent pregnancy, education, socioeconomic class, and workload showed significant associations with related morbidity conditions. This evidence challenges national health programs to go beyond safe motherhood, child survival, and family planning in its services to women, and to consider the social context of health as well.

PIP: The prevalence of gynecological and related morbidity in a rural Egyptian community was assessed as part of the Program of Research and Technical Consultation in Family Resources. Child Survival, and Reproductive Health. A medical examination was conducted on a sample of 509 ever-married, nonpregnant women from November 1989 to July 1990. A logistic regression using Generalized Linear Interactive Modeling was performed for each type of morbidity. For gynecological morbidities, genital prolapse was diagnosed in 56%, reproductive tract infections in 52%, and abnormal cervical cell changes in 11% of the women. For related morbidities, anemia was present in 63% of the women, followed by obesity (43%), hypertension (19%), and urinary tract infection (14%). Most of the women were suffering from at least 1 morbidity, with only 3% free of all the morbidity conditions considered. Gynecological morbidity, together with urinary tract infection and syphilis, showed that 35% of the women had 1 morbidity, 34% had 2, and 17% had 3 or more morbidities. Regression analysis of risk factors demonstrated that social conditions and medical factors contributed to these diseases. Reproductive tract infections occurred more frequently with uterovaginal prolapse, IUD use, presence of husband (regular sexual activity), and unhygienic behavior. Genital prolapse increased with age and number of deliveries. Age, recent pregnancy, education, socioeconomic class, and workload revealed significant associations with related morbidity conditions. The risk of anemia was significantly related to age and to a pregnancy within the previous 2 years. With every increase of 1 year of age, the risk of hypertension increased by 9%. For every increase of 1 year of age, the risk of obesity increased by 7%. Women with the highest level of education had a 3 times greater risk of urinary tract infection than did uneducated women, while women of low-middle socioeconomic status had almost 4 times the risk of women in the lowest class.

Concepts and measures of reproductive morbidity.

This paper presents a conceptual and methodological framework developed by an interdisciplinary group of researchers to diagnose reproductive morbidity at the community level. The paper also presents a determinants structure that delineates the health and social factors hypothesized to influence reproductive morbidity. The high prevalence of reproductive-morbidity conditions revealed by implementation of the study framework in two villages of Giza in Egypt is reported. Based on this research experience and the process of presenting its results to the larger professional community, the paper discusses policy implications of the study in terms of reproductive-health services, education and training programs and research efforts for measurement of reproductive ill-health at a community setting.

PIP: An interdisciplinary group of researchers developed a conceptual and methodological framework to determine the extent of the problem of reproductive morbidity at the community level in Middle Eastern society and then, in turn, to improve reproductive health conditions in women. It conducted an exploratory study in a family planning clinic in Cairo, Egypt; a medical workshop on clarification of the symptomatology of reproductive morbidity; and a focus group in a village in Giza, Egypt, to ensure that the reproductive morbidity questions of interview questionnaires were appropriate and complete. The group tested the accuracy of the questionnaires in 2 villages in rural Giza (509 women). Field workers went to the women's homes to administer the questionnaire on characteristics of the household during the first visit. During the second visit, they administered the questionnaire on reproductive morbidity, and then the social researcher went with the women to the health center so the women could undergo a gynecological examination. 50% of the women had reproductive tract infections, especially vaginitis. 56% had prolapse, and prevalence increased significantly with age. 63% had anemia, especially 14-19 year olds (76%). Just 24 women (5%) had no reproductive morbidity. About 50% had at least 3 reproductive conditions. The leading problems reported by the women were vaginal discharge (77%), dysmenorrhea (71%), perceived delay in conception (48%), stress incontinence (37%), and pain during intercourse (36%). Feeling of heaviness below, probably indicating prolapse, was the only symptom which increased with age (p = .03). 41% had been pregnant in the last 2 years. 77% delivered at home. Leading conditions during pregnancy were headache (59%) and discharge (45%), and those after delivery were fever and discharge/inflammation (30% for both). The interdisciplinary group proposed 3 mechanisms which are of utmost importance to policy: conducting similar research in other communities, expansion of reproductive health services at the community level, and implementing changes in the education and training programs of health professionals and social scientists.

Family planning and maternal health care in Egypt.

PIP: The Government of Egypt is introducing policies to reduce the mortality of women of reproductive age. However, family planning and maternal-child health care programs are unlikely to have the desired impact without corresponding improvements in the status of Egyptian women. Women's status in the areas of education, health, poverty, employment, the family, government, and the community is a crucial determinant of their willingness and ability to accept a smaller family size ideal and become contraceptive users. At present, only 6% of Egyptian women are a part of the work force and 60% are illiterate. In a society in which women are valued on the basis of the number of children they produce for their husbands, those practice birth control risk abandonment and isolation. The powerlessness and insecurity that lead Egyptian women to have an average of at least 5 children impeded national development and thus delay creation of the socioeconomic conditions that could liberate women from their domestic role. Equal opportunities in education and employment would represent a first step toward improving women's status by giving them a source of income and increased independence. Also needed are modifications in archaic marriage, divorce, and custody laws.^ieng