This fact sheet reports on a study in Egypt to test the hypothesis that smaller family size may lead to more equitable childrearing practices between girls and boys.

Egypt

Disparities exist between the way girls and boys are raised in Egypt. Because they typically rank lower than boys in family hierarchies, girls often receive less food and medical care. In addition, girls are overburdened by household chores, care of younger children and care of elderly family members. Researchers have hypothesized that smaller family size may lead to more equitable childrearing practices: When parents have fewer children, they may be more attentive to the survival and well-being of all their children. Therefore, girls may be more highly valued and less subject to discrimination.

Research Findings

Study participants included 644 women who were clients at clinics run by the Ministry of Health and Population, the Health Insurance Organization, the Egyptian Family Planning Association and the Curative Organization. Women in the study were of childbearing age and had at least two children (one boy and one girl).

• The majority of the women had used contraception at some point in their lives -- only 8 percent were never-users -- and 80 percent were currently using a method. The intrauterine device (IUD) was the most popular. Women in small families (three or fewer children) were more likely to have begun using contraception after the birth of their first or second child than were women in large families (four or more children).

• Sex of living children influenced contraceptive use. Women were more likely to use modern contraceptive methods when they had boys or both boys and girls than when they had only girls.

• More than 70 percent of women said they preferred a balanced mix of boys and girls in the family.

• Women were equally likely to breastfeed boys and girls, although more-educated women (those with a secondary education or above) were less likely to breastfeed. The average duration of breastfeeding was longer for boys than girls in all families. The proportion of mothers who stopped breastfeeding because they became pregnant, used a contraceptive or wanted to work was greater among mothers of girls. Boys typically received a greater share of milk, eggs and chicken than did girls. Preferential treatment was greater for boys in large families compared with small families, irrespective of the mother's educational level.

• There were some differences between health care for boys and girls. Less-educated mothers in both small and large families took their sons to private physicians for medical care more often than they took their daughters. When children enrolled in school were covered by health insurance, the gap lessened. Less-educated women in larger families were less likely to take their daughters with fever to a doctor; the average number of doctor visits was 1.6 for boys versus 0.9 for girls.

• Girls were most likely to be enrolled in school if their mothers were more-educated and their families were small.

• Girls typically performed indoor household tasks, such as washing and ironing, while boys performed outdoor chores, such as shopping. Girls in small, educated families had fewer household chores than girls in large, less-educated families. In large, low-literate families, girls were involved in household chores even during the time they should have been in school.

• The practice of female circumcision was more prevalent among larger families and families with less maternal education. In small educated families, 24 percent of women said they will have their daughters circumcised, compared with 87 percent of low-literate families. Among those who have or plan to have their daughters circumcised, their reasons were tradition, religion, decreasing daughters' sexual desire, and hygiene. Women who opposed circumcision said they "did not believe in it" or were afraid of complications. Regardless of family size, circumcision was more likely to be performed by a physician among educated families and by a nurse, midwife or daya in less-educated families.

Recommendations

• Policy-makers should promote education for girls.

• Public and private entities should extend health insurance coverage to all families in order to narrow the gender gap in health treatment among poorer families.

• Since gender equity is more probable in small families, health providers and policy-makers should promote family planning as a means to encourage gender equity.

Study Details

This study was conducted with the support of the National Population Council's Research Management Unit and technical assistance from the Women's Studies Project (WSP) at Family Health International (FHI). The principal investigators were Dr. Seham Ragheb and Dr. Wafaa Guirgis of the Faculty of Nursing at Alexandria University. The WSP was funded through a Cooperative Agreement to the U.S. Agency for International Development. Dr. Cynthia Wazak of FHI served as technical monitor for this study.