1. U.S. SUPPORT OF EGYPTIAN DEVELOPMENT & FAMILY PLANNING: 1954-1988
HIST 311: The United States and the Middle East
November 18, 2013
2. International Development as National Security:
The United States has a reputation of getting itself involved at all corners of the globe. It
is the U.S.'s military intervention that gets the bulk of the attention and admittedly funding, but
the effort that America has directed towards international development should not be
overlooked. While the United States' humanitarian work through the Peace Corp and USAID get
the bulk of attention, the United States' military also plays a substantial role in providing
humanitarian aid.1 This extensive effort not entirely selfless, but rather an extension of their own
interests in creating a more stable world order. The instability of developing nations is
considered vital to the United States' foreign policy for two reasons. Firstly, severe poverty is
often the root of regional conflicts that have the potential to fuel global issues. Secondly, a stable
nation is necessary to allow the United States to promote its democratic ideal. Therefore, the
stability of other nations is important to U.S. interests both in terms of impacts on global stability
and in terms of its ability to spread its principles.
Despite the efforts that the United States has extended towards humanitarian relief,
leading economist Jeffery Sachs argues that the U.S. has not done nearly enough towards solving
the true cause of global instability: severe poverty. His severe criticism of the ratio of spending
on military efforts compared to humanitarian efforts likely overlooks the role that the military
has played in humanitarian efforts; however, he brings attention to the extent to which extreme
poverty contributes to severe regional instability. Therefore extreme poverty should not be
overlooked. He argues that without directly addressing poverty the United States will never
achieve any level of peace.2 This view emphasizes the idea that ridding the world of poverty will
decrease costs that developed countries face as a result of severe instability impacting global
1 Chris Seiple, The U.S. Military/NGO Relationship in Humanitarian Interventions,,1996, 11–12.
2 Jeffrey Sachs,The End of Poverty: the Economic Possibilities for Our Time (New York: Penguin Books, 2005),
3. stability. While this point of view places emphasis on decreasing world poverty, it is important to
realize that the drive behind it is not a moral one. Rather, the goal in decreasing world poverty is
seen as being directly linked to creating stability for the rest of the world. Economists such as
Sachs place stress on the role of factors such as GDP per capita to measure the development of a
country, believing that the importance in investing in development efforts is related to the role
that poverty plays in creating conflict. As USAID explains, "In an interconnected world,
instability anywhere around the world can impact us here at home."3
Not all scholars who focus on development share Sachs's emphasis on economic factors
in order to measure development. Scholars such as Amartya Sen argue that when trying to
understand a country's level of development we should also look at indicators by in terms of their
ability to provide freedom to the people. He states:
Development requires the removal of majority sources of unfreedom: poverty as well as tyranny,poor
economic opportunities as well as systematic social deprivation, neglect of public facilities as well as
intolerance or overactivity of repressive states.4
Sen provides support for the United States' interest in democratization as a champion of
democratization efforts. He emphasizes the role that democracy plays in establishing civil rights
and giving people a voice within their government.5
The value of democracy can be understood to not only improve the life of those within a
country, but also to improve the country's relationship with other democracies. Fareed Zakaria
translates the importance that Sen places on the freedoms of individuals within a country in order
to establish why it plays an important role within the context of democracy and the international
sphere. He supports the democratic peace theory, in which it is believed that democracies will
3 “What We Do,” USAID, accessed November 15, 2013, http://www.usaid.gov/what-we-do.
4 Amartya Kumar Sen, Development as freedom (New Delhi; Oxford: Oxford University Press, 2000), Kindle
5 Ibid, "Importance of Democracy".
4. not fight with other democracies, but points out that all democracies are not created the same. He
argues that the democratic peace theory holds, not solely because of the involvement of the
people within democratic decision making, but also the similar goals of liberal democracies. He
points out that not all countries that are considered democracies truly include representation of
the people through fair and unbiased elections, meaning that in some democracies the people's
views are not accurately represented within their government. Consequently democratic peace
theory would not hold, because you can no longer rely on the rationality of the people to prevent
the likelihood of becoming involved in conflict.6 Through this perspective the promotion of
democracy is not only of interest to the United States based on principles, but also as a matter of
It is evident that the United States has taken advice from scholars at all ends of this
spectrum when building their program for international development within the U.S. Foreign
Assistance Act of 1961.
United States development cooperation policy should emphasize five principal goals : (1) the alleviation of the
worst physical manifestations of poverty among the world’s poor majority; (2) the promotion of conditions
enabling developing countries to achieve self-sustaining economic growth with equitable distribution of
benefits; (3) the encouragement of development processes in which individual civil and economic rights are
respected and enhanced; (4) the integration of the developing countries into an open and equitable international
economic system; (5) the promotion of good governance through combating corruption and improving
transparency and accountability.7
This act was passed under the influence of President John F. Kennedy who sought to combine
multiple international aid organizations into one central agency in order to create a unified
central mission. It was this act that established United States Agency for International
Development (USAID) an organization that has played a leading role in development efforts
6 Fareed Zakaria, “The Rise of Illiberal Democracy,” Foreign Affairs 76, no. 6 (December 11, 1997): 22–43.
7 “U.S. Foreign Assistance Act of 1961,” Council on Foreign Relations,18, accessed October 25, 2013,
5. A clear understanding of development theory from leading scholars who have significant
influence over policy makers provides a context for understanding the basis of the United States'
international development goals. It becomes evident that the United States can see high stakes
within the development of other countries due to the role that a country's development plays in
its stability within the international sphere. As such, the United States sees progress in various
measures of development in foreign countries as an important part of its foreign policy goals.
U.S. Aid to Egypt:
While American rhetoric focuses on general reasons for aiding development throughout
the world, Egypt provides us with a key example of a country where the United States has
attempted to use development to meet an additional goal: political influence. The success of
attaining this goal through development is dependent on two main factors: the desire of the
government for aid and their inability to turn elsewhere. When a country is unable to turn
elsewhere the two countries often develop a special relationship of sorts where both parties can
be dependent on each other for political reasons; however, a special relationship with Egypt did
not emerge. The history of U.S. foreign aid to Egypt is a story of conflict and of two parties
attempting to achieve their own goals through the other. The United States sought to gain
influence in the Middle East through special favors from the Egyptian government. As a USAID
study put it, "[The goal was] to moderate [the] behavior of the Egyptian government along lines
which are at least not inimical to United States interest."8 Meanwhile Egypt wanted to gain
funding for various programs while still maintaining political autonomy. This meant that Egypt
was not against turning elsewhere for funding.
8 William J. Burns, Economic Aid and American Policy Toward Egypt, 1955-1981 (Albany: State University of New
York Press, 1985), 2.
6. Early Attempts to Gain Influence
This dynamic of the United States seeking political influence in Egypt was especially true
when U.S. aid programs to Egypt began in the 1950's.9 In the post- World War II era tensions
were high between the Soviet Union and the United States as they both struggled to gain
hegemony in the new world order. Egypt became a key game piece in this struggle as both
countries fought to use their relationship with Egypt as a means through which to gain political
influence in the Middle East.10 The U.S. government was put in a difficult position in the early
1950's when the Egyptian government requested an arms deal. On one hand, it saw Egypt as
playing a critical role within their Cold War political game within the Middle East. On the other
hand, Britain was struggling with Egypt over the Suez Canal and the United States had to
consider how aiding Egypt in such a time would affect their relationship with Britain during a
sensitive period while Britain lost power as the United States gained it. Attempting to balance
this, the United States decided to protect its relationship with Britain by postponing agreeing to
an arms deal with Egypt.11 After the Suez Crisis calmed down in 1954, the United States offered
Egypt a military aid package that was attached to some political stipulations, hoping to gain the
political influence that they had wanted all along. To the U.S.'s surprise the Egyptian government
accepted an arms package from the Czech government the following year instead of accepting
the aid package that the U.S. had offered.12 This was seen as the first of many missed
opportunities for the United States in Egypt.13
9 Ibid., 1.
10 Ibid, xiii-xiv.
11 Ibid., 8–14.
12 Ibid., 16–18.
13 Ibid., 35.
7. In 1955 the United States tried to make up for its mistake with the arms deal by offering
to sponsor the High Aswan Dam Project.14 Nasser saw this project as an opportunity to take
advantage of one of Egypt's only natural resources: the Nile River. He hoped that by gaining
control of the Nile River he could prove that a country that had been behind in terms of social
and economic development was capable of sustaining itself and maintaining independence from
both the United States and the Soviet Union15. Secretary of State Foster Dulles hoped that by
offering to sponsor the dam the United States would be able to convince Egypt to not further
align itself with the Soviet Bloc.16 Attached to the offer were a number of requirements including
exclusion of the Soviet Bloc from bidding on construction of the dam and requirements for the
Egyptian government to invest in the dam as well.17 The United States had not learned its lesson
earlier in the year: Egypt had another option for funding. One that attached a lot less strings to its
money. By June of 1956 it was clear that Egypt had no intentions of making political
concessions in exchange for funding of the dam, leading Dulles to withdraw the offer a month
later.18 This immediate withdraw was the beginning of a negative relationship between Egypt
and the United States. Egypt would receive no funding from the U.S. in 1957.19
14 Ibid., 36–37.
15 Howard J. Dooley, “Nasser and DeGaulle: Heroes in Search of a Role,” The History Teacher 4, no. 2 (January 1,
1971): 49–50, doi:10.2307/491395.
16 Burns, Economic Aid and American Policy Toward Egypt, 1955-1981,36–37.
17 Ibid., 55.
18 Ibid., 85–96.
19 Ibid., 108.
8. The Modern U.S.-Egyptian Aid Relationship
Still hoping to gain influence in the Middle East through allying itself with Egypt, the
United States hoped to patch up the relationship that had been damaged with the sudden
withdraw of the Aswan Dam offer. At the end of 1958 the Eisenhower administration offered an
olive branch by proposing reintroducing food aid programs.20 This offer resulted in the Egyptian
government agreeing to implement long term development projects that would rely heavily on
U.S. funding. The programs would emphasize economic projects focused on modernization.21
These programs that were developed in the late 1950's provided a catalyst for future U.S. foreign
assistance programs to Egypt.22
When Kennedy took office in 1961, he hoped to move away from the staunch bipolarity
of Eisenhower's administration by acting favorably towards non aligned nations by appointing
ambassadors who were familiar with the region, depoliticizing aid, and recognized how
conditions attached to aid could contribute to third world countries acting against U.S. interests.
These changes in policy benefited Egyptian development programs during Kennedy's
presidency.23 In 1962 the United States further expanded its food aid program.24 The Kennedy
administration was disappointed that despite attempts to exert control through a "short leash",
Egypt was unwilling to bend to the will of the American government.25 If anything the "short
leash" had made the Egyptian government more skeptical of the U.S. government. These years
set the tone for the modern economic aid relationship between the United States and Egypt.
20 Ibid., 112.
21 Ibid., 119.
22 Ibid., 132.
23 Ethan Nadelmann, “Setting the Stage: American Policy Toward the Middle East, 1961 - 1966,” International
Journal of Middle East Studies 14, no. 4 (November 1, 1982): 438.
24 Burns, Economic Aid and American Policy Toward Egypt, 1955-1981,134.
25 Ibid., 172.
9. While the Kennedy administration had been viewed favorably by most of the Arab world,
his predecessor Lyndon B. Johnson was viewed by the Arab world as a friend of Israel and a
successor of Eisenhower's policies. Despite the fact that Johnson initially continued the policies
of the Kennedy administration, Arab perceptions of the new administration resulted in a decrease
in Nasser's willingness to work in accordance with U.S. goals.26 Due to the fact that Egypt had
refused to act in accordance with American goals the Johnson administration had begun a
gradual suspension of food aid in 1965.27 The United States beginning to suspend aid that had
been introduced just years previously was reason enough for the Egyptian government to be
skeptical of American intentions. U.S. support of Israel, an Egyptian enemy, without the same
type of political concessions that it had required of Egypt only served to feed the doubts of
Nasser and other Arab leaders who felt the need to turn towards the Soviet Union.28 It seemed
that while the United States had learned something from the past, that suddenly withdrawing aid
to Egypt would severely hurt U.S.-Egyptian relations, it underestimated the toll that enforcing its
"short leash" would have. Consequently, the Johnson administration began to hope that a
strengthened Israel would pressure Arab states such as Egypt back to the negotiation table to
seek a peace treaty in the region after the Six Days War, where the United States would hope to
influence Egyptian decisions through offering to reactivate aid.29
After Nasser's death in 1970 the United States once again hoped that money could talk
and Egypt would be willing to base its political decisions on U.S. influence under Sadat's rule.30
In the early years of Sadat's rule, Secretary of State Henry Kissinger was pleasantly surprised by
26 Nadelmann, “Setting the Stage,” 446.
27 Fawaz Gerges, “The 1967 Arab-Israeli War: U.S. Actions and Arab Perceptions,” in The Middle East and the
United States:A Historical and Political Reassessment, ed. Lesch David W. (Boulder, Colorado: Westview Press,
28 Ibid., 165–170.
29 Burns, Economic Aid and American Policy Toward Egypt, 1955-1981,167.
30 Ibid., 174–175.
10. how willing Sadat was to discuss strategy and make concessions that were favorable to the
Israeli government in 1973 while trying to reach a peace agreement to end the October War.31
This attitude seems to have been upheld throughout Sadat's presidency as he also complied and
signed the Camp David Accord in 1978.32 This is likely closely tied with his believe that the
military should be used strategically to advance its political position and therefore be
methodological with its decisions.33 While Egypt still wasn't necessarily ready to begin
completely basing its decisions on the will of the American government, it was clear that Sadat
was willing to make major compromises in order to secure economic aid from the United States.
Sadat had begun promising his country that the compromises were necessary, because the money
received from the U.S. government. It was during Sadat's rule that the modern relationship
between the United States and Egypt that is heavily based on the economic assistance that the
U.S. provides was developed.34
While the reintroduction of aid to Egypt in the late 1950's marked the beginning of a new
era of economic relations between the two countries, the United States' goals remained the same.
They still hoped to be able to gain influence over Egypt's foreign policy decisions through their
aid; however, one lesson seemed to have been learned after the previous era. Attaching
conditions to the aid too early would be futile. Despite attempting to attached strict conditions to
the economic aid, the United States learned that completely withdrawing the aid could have
disastrous implications35. In retrospect it is evident that Egypt never had any intentions of
answering to the United States even with the billions of dollars in economic aid that it was
31 Adel Safty, “Sadat’s Negotiations with the United States and Israel: From Sinai to Camp David,” American
Journal of Economicsand Sociology 50, no. 3 (July 1, 1991): 287–289.
32 Burns, Economic Aid and American Policy Toward Egypt, 1955-1981,192.
33 Moshe Shemesh, “The Origins of Sadat’s Strategic Volte-face: (Marking 30 Years Since Sadat’s Historic Visit to
Israel, November 1977),” Israel Studies 13, no. 2 (July 1, 2008): 44.
34 Burns, Economic Aid and American Policy Toward Egypt, 1955-1981,198–199.
35 Ibid., 205.
11. receiving. At the time hope remained strong within the United States and each change in ruler
was seen as a new opportunity for the United States to gain this influence. This desire to gain
influence through the delivery of non-military aid to Egypt resulted in the establishment of a
broad range of development programs. These programs unlike earlier food aid problems were
established with the intentions of improved quality of life for Egyptians and not merely provide
them with food.
The Needfor Family Planning in Egypt:
Population growth in Egypt was steady for well over a century before any efforts to
introduce population control policies were made. Scholars cite that the origins of this population
growth can likely be linked to Muhammad Ali Pasha's rule during which Egypt became a stable
oasis within Ottoman rule.36 Muhammad Ali Pasha introduced a range of policies such as
conscription, education reforms, tax reforms, and agricultural reforms inspired by those of
Europe that allowed Egypt to develop as a stable country relatively early for the region.
Additionally, Muhammad Ali Pasha introduced a number of campaigns to promote the health of
the population. This stability and increased standard of health meant that it was easier for
individuals and families to establish themselves and raise large families. These large families
were seen as contributing to the strength of the country, because up until the middle of the 19th
century a large population was seen as a source of strength due to the implications of an
increased output of production37. However, during the course of the 19th century Egypt's
population skyrocketed, going from just under 2.5 million to over 11 million, presenting Egypt
36 Kamran AsdarAli, Planning the Family in Egypt: New Bodies, New Selves, 1st ed, Modern Middle East Series
no. 21 (Austin,TX: University of Texas Press, 2002), 24.
37 Muhammad Ali Pasha ruled Egypt from 1805-1848 as an agent of the Ottoman Empire.
12. the challenge of providing for the needs of this increased population.38 It was the changes that
occurred during this era that created the need for family planning in Egypt.
Early Family Planning in Egypt:
The earliest efforts to introduce family planning as a means of population control were
led by the Egyptian government in the 1950's.39 These efforts began with the establishment of
the National Commission for Population in 1953, which included the foundation of 8
government run health clinics. In this early stage one of the primary objectives was field study.
By 1958 the program had expanded, was placed under the authority of the Ministry of Social
Affairs and became known as the Egyptian Association for Population Studies. During this
introduction of family planning to Egypt resources were limited and only available through a few
private associations and government units. The introduction of family planning resources
included both infertility treatments and contraceptives; however, in order to gain access a woman
must demonstrate her medical or economic need for assistance along with the support of her
husband. While these services were becoming available the lack of advertising limited the
demographic to which they were available.40
The following decade the Egyptian government acknowledged the extent to which the
population growth was a threat to the stability of Egypt. In 1962 President Nasser expressed
formal support of the foundation of a national family planning program, supporting the views of
Egyptian policy makers. Within the next couple of years the family planning program began its
tradition from being focused on field study to being focused on providing services. This
38 Justin A. McCarthy, “Nineteenth-Century Egyptian Population,” Middle Eastern Studies 12, no. 3 (October 1,
39 Ali, Planning the Family in Egypt, 31.
40 Mary Taylor Hassouna,“Assessment of Family Planning Service Delivery in Egypt,” Studies in Family Planning
11, no. 5 (May 1, 1980): 159, doi:10.2307/1965758.
13. expanded the ability of the government to provide contraceptive services with the introduction of
the of both oral contraceptives and IUDs in 1964. The same year, utilizing the new access to
these products, the Joint Committee for Family Planning was founded to help volunteer groups
with research, communicate with communities, and provide services to said communities.41
During the second half of the 1960's Nasser's endorsement of family planning efforts in
Egypt began to take full effect within Egypt. The Supreme National Council for Family Planning
was established in 1965 in order to addressed this raised interest in the effects of population on
development. Under this program there was a heavy reliance on health clinics to provide access
to contraceptives and information regarding them.42 This council was formed to bring together
the Ministries of Health, Social Welfare, Higher Education, National Guidance, Religion,
National Planning, Local Administration, and State in response to the clear lack of organization
that was present within the efforts during the past decade and a half. In 1966 the Executive
Family Planning Board was founded in order to address the need to coordinate the involvement
of the many ministries that were to participate in the Supreme Council on Family Planning's
efforts, though in practice the Ministry of Health headed these projects. By this point national
family planning efforts had expanded substantially, from only 8 centers in 1952 to 1,991 in
Despite the nationwide effort to increase access to family planning tools, a study showed
that a decade later only 7.4% of eligible women were utilizing the services and 30-60%
discontinued use.44 With so little involvement in the government led family planning efforts the
Central Agency for Public Mobilization and Statistics was concerned when the population of
42 Ali, Planning the Family in Egypt, 31.
43 Hassouna,“Assessment of Family Planning Service Delivery in Egypt,” 160.
14. Egypt reached 37 million in 1975, a population that suggested a 2.2 annual population growth.45
Reflecting on these statistics General Aksar stated:
The time has come to call things by their right name; we need birth control not family planning. The
programs of family planning which have been applied to date have affirmed their deficiencies and their
lack of seriousness,and the need for more comprehensive and dynamic approaches is inescapable.46
Even those who were skeptical about how successful a family planning campaign could be in
creating an impact in the short term shared General Aksar's sentiment. Ignoring the need for
population control would be futile.
Family Planning as International Development:
The final outcomes of a country such as the United States' international development plan
is clear: support the creation of conditions that will promote stability within a country and by
extension enhance the state's ability to act as a stable player in the international sphere. These
goals are seen as being achieved through the improvement of the economic health and freedoms
of individuals within a country. Even these narrowed goals are broad and lack a concrete plan for
improvement. This means that it is crucial to develop a means by which to achieve these sub-
goals. There are many facets through which this can be achieved such as education, agricultural
development, or the introduction of industrial production. One method that is often overlooked,
despite its proven ability to improve living conditions is family planning. Family planning can be
used as a tool to both improve the economic situation of a country and expand the freedoms of
the people. This means that family planning is a tool that can be used to achieve both of the
United States' main development goals.
45 “Egypt,” Studiesin Family Planning 6, no. 8 (August 1, 1975): 305, doi:10.2307/1964987.
46 Ibid., 306.
15. Minimizing the fertility rate of foreign countries through the use of family planning
campaigns can significantly improve the internal economic situation of a country. While large
families in agrarian societies increased output and therefore increased economic output,
translating to larger families being wealthier, the global trend of industrialization has made that
correlation mute: large families that once provided economic benefit have become economic
burdens. World Bank data tells us that there is a linear negative correlation between the net
fertility rate (fertility minus mortality) and GDP per capita.47 With industrialization and a
growing importance of service based economies in the modern world the availability of
education to individuals has growing importance on the economic wellbeing of a family. As such
it is seen that the more human capital a family is able to invest in its children's education the
higher the family's economic growth.48 As such, decreasing a country's fertility rate can improve
the economic success of a country both on a national level and an individual level. By increasing
GDP per capita through this method we are able to satisfy the goals of scholars from both Sachs's
and Sen's schools of thought. Not only do we decrease the level of poverty and therefore the
conflict and instability that is created by this, but due to an improved economic situation for
families we are expanding their independent freedoms. The ability of family planning to achieve
these things through its influence on the GDP per capita is no doubt why we see population
control specifically listed as a means for achieving the goals of development within the U.S.
Foreign Assistance Act of 196149 After all, a country's population outgrowing its economy could
lead to a failed state, whose lack of stability would pose a security concern to the United States.
47 Robert J. Barro, “Economic Growth in a Cross Section of Countries,” The Quarterly Journal of Economics 106,
no. 2 (May 1, 1991): 424, doi:10.2307/2937943.
48 Ibid., 422.
49 “U.S. Foreign Assistance Act of 1961,” 22.
16. This is particularly applicable to countries such as Egypt due to their geopolitical position during
the Cold War. A weak Egypt could be easier for the Soviet Union to gain influence of.
Addressing the fertility rate of a country through an information and service driven
family planning campaign takes further steps towards meeting Sen's goal of development as
freedom. When giving families the opportunity to access contraceptives and information that
empowers them to effectively use it to control the size of their family you are taking a large step
towards promoting individual choice and therefore freedom within their personal life. As an
extension of this, because of how connected it is to the life of women it works to directly address
the USAID goal of, "Elevating the role of women and girls."50 Further, as Zakaria alluded to, a
state in which individual choices and liberties are emphasized are more likely to develop into a
liberal democracy.51 This means that through one ground level program we can begin
introducing the societal values necessary for creating a liberal democracy.
Despite not being nearly as widely discussed as food aid and other development efforts,
family planning can play a critical role within a development plan. While it presents unique
complications due to the necessity of the compliance of individuals the potential benefit is huge.
In fact, it is this very complication that is responsible for the level of success that it can have. By
incorporating the people and influencing them to make decisions on their own you stimulate
lasting change that will translate into other facets of life as the way that people think as a whole
shifts. This is why it should be no surprise that family planning was a component of USAID's
program in Egypt, where a central goal was modernization, because modernization requires a
shift in the mentality of the people.52
50 “What We Do.”
51 Zakaria, “The Rise of Illiberal Democracy.”
52 Burns, Economic Aid and American Policy Toward Egypt, 1955-1981,199.
17. The U.S. Becomes Involved in Egyptian Family Planning
As Sadat's Egypt had become more compliant with U.S. goals after 1976, the United
States expanded its aid programs to Egypt throughout the 1970's. One of the many new programs
that the United States invested in during this period was a bilateral family planning program in
1977. In developing this program the United States pledged $87 million to family planning
efforts alone, making it by far the largest financial contributor to family planning programs
within Egypt.53 The United States used the influence that it gained with its funding to push the
importance of fertility control within the country.54 While the UNFPA, World Bank, and a few
other European aid organizations also provided funding to the Egyptian Family planning
campaign, the United States was responsible for approximately 75% of the funding. The U.S.
hoped that it could use the basis of its funding to influence the Egyptian government to more
directly target the Egyptian people with its family planning programming in order to address the
low participation rate.55
The United States seems to have been successful in this endeavor and has continued to
maintain a significant level of influence over family planning in Egypt through its financial
influence. With the end of the current funding contract in sight, Mubarak held a conference to
bring to the forefront of the Egyptian people's attention the importance of a family planning
We cannot ignore the fact that the current rate of increase in population will hinder our efforts to achieve
development, will dissipate our hopes for changing the quality of life of every Egyptian and confine our
ambitions to preventing the deterioration and aggravation of our situation.We will not accept this.56
53 Ali, Planning the Family in Egypt, 32.
54 Ibid., 31.
55 Kamran AsdarAli, “Faulty Deployments: Persuading Women and Constructing Choice in Egypt,” Comparative
Studiesin Society and History 44, no. 2 (April 1, 2002): 373.
56 “President Hosni Mubarak on Egypt’s Population,” Population and Development Review 34, no. 3 (September 1,
18. In 1983 the initial funding contract came to an end. The United States utilized its position
as the leading funder to further influence the family planning program in Egypt. The Egyptian
government agreed to American terms for family planning programming and funding was
continued with the United States pledging an additional $102 million between the years 1983-
1988.57 With this increased influence USAID recommended the establishment of the National
Population Council in 1985. Through this new council a new National Population Plan (NPP)
was also developed.58 The NPP focused on the free choice for individuals to control their family
size, grassroots involvement, the empowerment of women and mass education regarding family
planning.59 By this point it was clear that the United States played an integral role in determining
the path of family planning within Egypt. So it is no surprise that when despite the many efforts
that had been made earlier by the Egyptian government there was still a need for further
organization the United States was able to exercise significant influence.
The Evolution of the Egyptian Family Planning Campaign After 1985:
In 1985 the family planning program in Egypt was widely seen as weak, despite
significant efforts to expand family planning earlier within the decade. By 1984 the Future of the
Family, a semi-private organization that was a recipient of USAID funding, was able to use
modern marketing in order to expand the use of contraceptive usage to 30%, an impressive
increase from the 7.4% in 1976. Despite this increase the popularity, the program was still
considered low and in need of improvement.60 This need for improvement is due to the lack of
perceived stability in the program and the need for future development in order to establish that
57 Ali, Planning the Family in Egypt, 32.
58 Ali, “Faulty Deployments,” 373.
59 Ali, Planning the Family in Egypt, 33.
60 Muhammad Faour, “Fertility Policy and Family Planning in the Arab Countries,” Studies in Family Planning 20,
no. 5 (September 1, 1989): 256, doi:10.2307/1966762.
19. the program will be sustainable.61 Some of the main obstacles that programs faced as a result of
the country's 55% illiteracy rate were misinformation regarding proper use of contraceptives and
an exaggerated fear of the side effects of contraceptives.62 This necessitated further work to
refine the program to achieve the desired outcomes of a family planning program.
During the 1980's a USAID-sponsored report revealed that women tended to misuse oral
contraceptives and often based the way that they used the birth control on their own personal
understanding of how it worked and not in accordance with how they had been instructed by
family planning programs. Women were notorious for discontinuing during brief periods for
which they were not sexually active.63 Hoping to minimize the impact non-compliant birth
control users NGOs under USAID influence pushed for implementing methods other than oral
contraceptive. Consequently the availability of the IUD significantly increased in the late
1980s.64 The hope was that this would be more effective in implementing the family planning
goals as it was much less reliant on the women's ideas and behaviors than oral contraceptives as
it could not be removed by the user without health risks, forcing a reliance on interaction with
their healthcare provider and was effective for up to 8 years.65
Paired with the increased availability of the provider dependent IUD during the late
1980's an increased emphasis was placed on the importance of the interactions with the woman
and the provider to appease the American emphasis on developing programs that will empower
women. When a woman began use of the IUD they were also signed up for follow up
appointments, through these follow up appointments the healthcare provider could check to
ensure that the IUD was properly in place and also provide counseling on the IUD. It was
61 Karen F. A. Fox, “Social Marketing of Oral Rehydration Therapy and Contraceptives in Egypt,” Studies in Family
Planning 19, no. 2 (March 1, 1988): 106, doi:10.2307/1966494.
62 Faour, “Fertility Policy and Family Planning in the Arab Countries,” 256–257.
63 Ali, Planning the Family in Egypt, 34.
64 Ali, “Faulty Deployments,” 374.
65 Ibid., 34.
20. important to work towards making the woman more comfortable with this new form of
contraceptive.66 This was established to addres the developing understanding that, "while mass
media campaigns, subsidized prices, and social marketing are important, face-to-face personal
communication is crucial for effectively delivering the family planning message."67 Counseling
wasn't just reserved for women who were utilizing the IUD. It was believed that if they patient
trusted her care provider she was more likely to be compliant in oral contraceptive use as well.
Through USAID sponsored training programs doctors were instructed to work towards building
a bond with their patients that would develop trust between the patient and care giver.68
In order to develop a woman's understanding of the importance of this relationship as
well, Egypt launched a number of media campaigns. These campaigns did a number of things.
For one they began depicting families of smaller size in an attempt to begin reshaping the
Egyptian idea of what a family looked like. Perhaps more important though was the emphasis on
only trusting family planning specialists as a source of information regarding their contraceptive
use. Additionally, these campaigns focused on the fact that the directions that they received were
personalized and therefore should only be applied to them. These programs began developing in
this fashion due to US pressure to increase the correctly educate women on the products that they
were using69 These campaigns no doubt hoped not only to encourage women to also seek a better
relationship with their healthcare provider, but also to avoid women taking advice from each
other regarding how contraceptives should be used.
Despite the increased emphasis on communicating with patients and developing a
trusting relationship with the women that they treated, doctors were still seeing a large number of
66 Ali, Planning the Family in Egypt, 34.
67 Ali, “Faulty Deployments,” 378.
69 Ibid., 375-376.
21. women quit the use of oral contraceptives and IUDs alike. In response to this injectables and
Norplant were introduced through heavy funding of USAID. These new contraceptive methods
were primarily marketed towards women who were extremely poor and lived in rural areas. The
introduction of Norplant to the family planning programming was met by a lot of criticism by
American, but USAID went to great lengths to stress that it expanded the choice of the
consumers. While it is true that introducing two new methods of contraception doubled the
number of options that Egyptian women had in preventing pregnancies, it is important to
understand that these new methods created an increased reliance on healthcare providers, which
in effect took away decision making power from the women once they decided to begin a
contraceptive regiment and consequently failed to actually fulfill the American push for
empowering women and their families, but still worked to convince America that Egypt was
working to develop a program that would fulfill the objectives that they sought in a family
This was the path that family planning took within Egypt. Efforts began well before the
United States became involved when the National Commission for Population was founded in
1953. What initially was developed as a research-based program developed over time to become
a service based program. This service based program evolved until the service included not only
providing various forms of contraceptives to women and focusing primarily on fertility control,
but also on the premise that a relationship needed to be formed between a woman and her doctor
in order to allow a woman to make an informed decision and ensure an effective family planning
70 Ibid., 375.
22. The Success of Family Planning in Egypt:
The Family Planning efforts that took place in Egypt are widely considered to be a
success as only a portion of a wider USAID public health program within the country. U.S.
Ambassador to Egypt Margaret Scobey bragged about the overall success of the Egyptian public
health program, saying that "the success in Egypt during the past 50 years has been dramatic
more than any other country in the world."71 This view is no doubt at least in part held due to the
incredible success that the Egyptian family planning campaign has had.
In 1986 the United Nations expressed the goal of reducing the population growth rate in
Egypt to 1.3 % by the year 2000.72 At the time Egypt's population growth rate was at 2.35%.
While the United Nation's complete goal was not reached, by 2000 the population growth rate
was down to 1.58%, a significant decrease within the span of 24 years.73 President Hosni
Mubarak reflected this point of view. He praised the family planning program, claiming that
without it the population of Egypt could have easily risen to be 18 million above what it was;
however, it was clear that while he appreciated the success, he still saw a need for further efforts
to tackle the issue when he stated, "True, we have managed to reduce the population increase
rate from 2.8 per cent in 1980s to 1.9 per cent at present. However, this has not resulted in the
necessary and due balance between population and resources and there persists the question:
71 “Egypt Has One of the Most SuccessfulHealth Programs, says USAID Report,” Daily News Egypt,May 12,
72 Faour, “Fertility Policy and Family Planning in the Arab Countries,” 256.
73 “Egypt, Arab Rep.,” The World Bank:Working for a World Free of Poverty, 2013,
74 “President Hosni Mubarak on Egypt’s Population,”585.
75According to the World Bank, Egypt's population increase rate in 2008 when Mubarak made that speech was in
fact 1.69% and not 1.9%. “Egypt, Arab Rep.”
23. The Importance to the United States
It is interesting and should be noted that America seemed much more confident in the
success of the family planning program. This sheds some light on the distance that the United
States had from what was actually happening within Egypt. Or perhaps what it really sheds light
on was the interests that the United States had within the development of a family planning
program within Egypt. It is nice to believe that the foreign aid that the American government
provides is part of a good samaritan effort, unfortunately this is rarely the case.
The United States has been using economic aid to Egypt as a tool for political gains as
long as the relationship has existed. The program for joint American and Egyptian efforts to
tackle the population increase rate in Egypt coincided with Sadat's agreements to end fighting
within Israel. Expanding the types of aid offered to Egypt strengthened the relationship between
Egypt and the United States, which the U.S. no doubt hoped would buy it greater influence over
foreign policy decisions. It is because of the vast amounts of money that the United States has
invested within modernization projects among other things that has allowed it to trump Egypt as
a foreign aid success.
By investing specifically in family planning the United States was able to boast about a
wide range of achievements it was reaching. In addressing the population growth problem it was
able to make an economic impact through a means other than just education or industrialization.
And in doing so it was able to tackle a critical cause of instability, which would create a more
stable country to interact with. Additionally, by investing in family planning the United States
was providing an example of what it was doing to meet it's expanding human rights rhetoric.
Western led family planning campaigns are always used to emphasize what the United States is
doing to empower women in developing countries. The exact reality on the ground has remained
24. unimportant to the United States. The population increase rate has decreased. The average family
size is smaller. To the United States Egypt is a victory, an oasis of success in the Middle East,
the only Muslim country in which its influence has led to a successful family planning campaign.
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