Growing Old in Egypt: The Supply and Demand of Care for Older Persons

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This number is expected to rise to This large proportion of women in the reproductive ages means that the number of annual births is likely to increase, to 1. Figure Projected Population Growth in Egypt, Around eight in ten married women in Egypt want no additional children or want to delay the next birth for at least two years.

Data from the Egypt Demographic and Health Survey DHS in suggest that the percentage of Egyptian women of reproductive age who want to limit family size or have no more children but are not using contraception is 16 percent. This is a sizable number of women and represents the target group that family planning programs are trying to reach. The gap between stated preference and actual behavior is a measure of what demographers label the "unmet need for contraception," which refers to the behavior of women who want no more children or want to delay their next pregnancy but do not use contraception.

Demographers categorize unmet need in two types: a need for birth spacing and for limiting family size. As shown in Figure 3, the unmet need for contraception is especially high in rural Upper Egypt, where nearly a quarter of women of reproductive age say they want no additional children or want to delay the next birth for at least two years but are nonetheless not using contraception. Enabling women to achieve their reproductive preferences will increase their age at the first birth, increase the spacing between their births, reduce the number of unintended pregnancies, reduce fertility rates, and decrease the rate of population growth.

These changes in turn will yield benefits for individual women and their families and for the country as a whole. Reductions in fertility can reduce the risk of mortality and morbidity associated with childbirth, a risk magnified by many successive pregnancies. Maternal mortality in Egypt is high. In a national survey reported a maternal mortality rate of maternal deaths per , live births compared to rates of 6 per , in Canada and 12 per , in the United States.

Maternal mortality and morbidity can also be reduced by enabling women to delay first births until age 20 or later and to space births at least two years apart. Women are more likely to die or suffer serious injury during pregnancy or childbirth when pregnancies occur before age 20 or occur very close together. Reducing the incidence of unintended pregnancy will reduce the number of unsafe abortions, which may follow such pregnancies, and in so doing reduce the maternal morbidity and mortality associated with these abortions.

Abortion in Egypt is illegal except when medically necessary. The findings suggest that approximately 28, women seek postabortion treatment in Egypt in public-sector hospitals each month. Lower fertility produces healthier children. Closely spaced children less than two years apart , children with many siblings, and children born either to younger or older mothers are all more common at higher levels of fertility and all face higher mortality risks.

Allowing women more control over their fertility can enhance their choices in settings where educational and economic opportunities are expanding. For example, the major reason behind the high dropout rate among Egyptian schoolgirls is economic. Moreover, if the family's economic circumstances are so difficult that only some children can be educated, girls--older girls in particular--are likely to be withdrawn from school first so that they can help care for younger siblings.

A recent study in Alexandria examined the relationship between family size, the level of education of the father, and gender equity in child care. It showed that 52 percent of girls from large, less literate families spent time caring for younger siblings, compared with only 15 percent for girls from smaller, low-literacy families and only 5 percent for girls from smaller, more literate families.

Recent efforts have aimed to provide basic education to deprived groups through establishing Single Class Schools. The focus is on primary school dropouts to enable them to achieve literacy. Women who have many children are less able to take advantage of these educational opportunities. Reducing the proportion of school-age children in the population reduces the burden on schools.

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Population Growth in Egypt - A Continuing Policy Challenge

Reducing child dependency also allows families and nations to invest more in education, improving the quality of the future labor force. A recent projection estimated that there would be 3. Achieving the fertility-reduction goal of the Egyptian government, i. The projections comparing continued fertility decline with the situation if such decline does not take place estimate that by per capita income would be 18 percent higher than it would be if fertility remained at its current level.

A reduced rate of population growth would provide the opportunity to provide such public services as piped water and sanitation to a greater number of households.

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In , 17 percent of households in the country and 44 percent in rural Upper Egypt did not have access to piped water. Population trends will also have a significant impact on the amount of water available per person in the future. The aforementioned projections show that, at the current level of fertility, the annual amount of water available per person would be reduced to nearly half of today's levels by falling from cubic meters per person per year today to by However, the available amount would drop only to cubic meters if reduced fertility is achieved, which would allow each person to consume extra cubic meters, or 18 percent more water per year.

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The standard yearly requirement for water consumption per person is 1, cubic meters. The results of efforts in the past two decades to increase the amount of cultivated land lagged behind population growth. If fertility remains at its current level, however, the per capita share of cultivated land will also remain at today's level. The projects designed to increase the area of land on which the Egyptian population lives from 5. However, this relief will not be available in the short term. Another way in which lower fertility can promote socioeconomic development is by reducing the proportion of dependent children in the population.

At present, children under age 15 constitute 24 percent of the total population of Egypt. Reducing fertility to replacement level by will reduce this percentage to 21 percent. On the other hand, continuing at the present fertility level will raise the proportion of children to 30 percent of the total population in A lower ratio of children to adults will reduce the current dependency ratio that is, the proportion of children under 15 and older people over 60 compared with the number of population in the age group from 0.

With fewer children, families will have more disposable income to save or invest. This constitutes a "demographic bonus," which may help to spur economic growth, create jobs, and in turn reduce unemployment. In , the unemployment rates were The "demographic bonus" is not automatic but depends on appropriate policy in other areas. Savings must be spent wisely. The decreases in fertility that have occurred in Egypt since attest to the success of family planning and related efforts to improve the education of women.

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Egypt's family planning program has led to sharp increases in the use of a variety of contraceptive methods, including intrauterine devices, birth control pills, and condoms. A major contributor to this achievement has been the comprehensive support from the U. Operations research and other studies sponsored by USAID have played a major role in shaping program operations and interventions. To achieve the government's goal of reducing fertility to replacement level by , it will be necessary to increase contraceptive prevalence to 70 percent. However, meeting current total demand for contraception which equals the Program efforts will face a challenge in reaching an additional 3.

Operations research and data such as those collected by the DHS have shed light on the reasons why, in spite of not wanting to have another child soon , a number of Egyptian couples are not practicing contraception. Egypt has an extremely young population. According to the census, 46 percent of the population was 20 years of age or younger, up from Nearly By , It also means that population growth will be highest in the poorest regions of Egypt.

The number of women of childbearing age will continue to increase before it gets smaller. This means that the family planning program will need to serve a larger number of people.

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Even if contraceptive prevalence rates and fertility preferences don't change, a greater number of women will be wanting to practice contraception, and the number with unmet need will be larger as well. Even in regions where fertility is relatively low, access to contraception is still important because it can help reduce unwanted pregnancies and the unsafe abortions that sometimes follow them. As noted above, unintended pregnancy is still prevalent in many parts of Egypt especially those where fertility rates are relatively low , and there are many unsafe abortions.

The Population Council study mentioned above found that less than 3 percent of the postabortion patients in public-sector hospitals were counseled about family planning. It is clear that repeated abortion causes a heavy burden on the health and well-being of Egyptian women. This finding also suggests that scarce medical resources are being used to treat a condition that could be avoided through provision of family planning services. Current population projections assume that fertility will drop--that is, that family planning programs will continue to increase the use of contraception.

Therefore, if family planning programs do not continue their success, the projections will not be met and the actual population size in the future will be greater than expected. Family planning programs have enjoyed widespread success and popularity in Egypt. However, the continued levels of unmet need for contraception in several areas of Egypt and the increase in the number of women reaching childbearing age indicate that the work of family planning is not finished.

Current trends suggest that Egyptian family planning programs need to strengthen efforts to meet unmet need and to provide more explicit links between contraceptive services and postabortion counseling to reduce unintended pregnancies and the need for abortion. These conditions include cancer, dementia, increase in the number of falls, obesity, and diabetes.

Population Growth in Egypt - A Continuing Policy Challenge | RAND

Cancer Due to the increasing aging population, the number of cancer cases is expected to increase to 17 million by and 27 million by The organization also projects a significant proportion of the million will be in less developed countries. This is attributed to the fact that Baby Boomers are living longer, remaining active, and possibly on medications that could lead to falls.

Almost , hip fractures occurred in , a figure that is expected to double by the year Our health care system also needs to prepare for new technology especially because of the higher cost by increasing training of health care workers and examining how technology will impact hospital infrastructure. An important challenge is implementation of new approaches in health care delivery to address the changing health status of this aging population. With chronic conditions on the rise in this population, their health care becomes more complex.

Focusing on a single disease rather than comorbidity can result in insufficient focus on other present medical conditions. There also needs to be a focus on providing preventive care versus reactive care.

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Strategies may include a more comprehensive care plan before discharge, a system to help identify patients who require follow-up, and implementation of a program to help monitor patients. Garza received her doctor of pharmacy degree from the University of Texas at Austin. She is currently working as the director of the Life Sciences Library at RxWiki, where she continues to build her practice on the fundamental belief that providing patients with medication information and medical knowledge contributes significantly to the quality of care they receive and improves quality of life and health outcomes.

Her work focuses on educating patients and providing them with the resources needed to navigate the overwhelming and complex health system. References Suzman R, Beard J. Global health and aging: preface. National Institute on Aging website.

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