restricted access 1. Is There an Islamic IUD? Exploring the Acceptability of a Hormone-Releasing Intrauterine Device in Egypt
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PART I Preventing and Terminating Pregnancy 15 1 Is There an Islamic IUD? Exploring the Acceptability of a HormoneReleasing Intrauterine Device in Egypt Ahmed Ragaa Abdel-Hameed Ragab The intrauterine device (IUD) is one of the most effective contraceptive methods currently available. A small device inserted into the uterus by a trained health-care provider, the copper-T IUD can provide contraceptive benefit for up to twelve years. The effectiveness of the method owes much to the fact that there is little required of the user, and thus, unlike many other contraceptive methods, user error does not figure into calculations of its effectiveness. The copper-T IUD is extremely safe, and there are few contraindications to its use. Side effects and complications associated with the IUD include changes in bleeding patterns, device expulsion, and, rarely, uterine perforation . Once known as coils or loops, the newer generation IUDs are more effective and have fewer complications than their predecessors. However, in many contexts, the IUD is prohibitively expensive, and misinformation about this modality among both providers and potential users abounds. As a result, global IUD use is very uneven. G. Dean and E. Schwarz (2011) report that in parts of Asia more than 50 percent of contraceptive users have adopted IUDs, compared to between 6 percent and 27 percent in Europe and only 5 percent in the United States. In this global context, Egypt’s level of IUD use is comparatively high. The results from the 2008 Egyptian Demographic and Health Survey (EDHS) indicate that 60 percent of currently married women in Egypt are using contraception, and the IUD is the most widely used method; 60 percent of contraceptive users rely on an IUD. This is the result of significant government expenditure to subsidize IUDs and promote IUD use as part of Egypt’s extensive family planning program. Yet despite the Egyptian government’s efforts, misinformation and myths about IUDs are common, particularly outside of the urban centers in the north of the country. The copper-T IUD’s most common side effect—changes in bleeding 16   Abortion Pills, Test Tube Babies, and Sex Toys patterns—has significant cultural implications in Egypt. The majority of the population is Muslim, and Islamic religious authorities teach that women cannot pray, fast, or engage in sexual intercourse when menstruating. As a result, many Muslim women request removal of their IUD before Ramadan, the month of fasting in the Islamic calendar. Drawing on an extensive literature review and a series of in-depth interviews with six Egyptian health service providers and university professors who are experienced in IUD research, provision, and insertion, this chapter provides an overview of the history of the IUD in Egypt and reviews the debates over acceptability and permissibility. The chapter discusses common myths and misperceptions about IUDs, as well as cultural norms around negotiating contraceptive use within couples. The chapter then turns to a discussion of the Mirena®, a hormone-releasing IUD that was introduced recently to Egyptian women. The Mirena significantly reduces the heavy menstrual bleeding and intermenstrual spotting characteristic of inert IUDs, suggesting that it could become the contraceptive method of choice for many Egyptian women. Yet while the Mirena is available in the private sector, this new reproductive health technology is not offered by government clinics. In the private sector, physicians providing the Mirena report that they are linking its provision to costly, invasive, and unnecessary procedures. These two factors have significantly limited uptake of the method in Egypt. A Brief History of the IUD in Egypt Egyptian interest in methods of fertility control has been traced back to the time of the Pharaohs. Archeologists have found written contraceptive recipes dated from fifteen to eighteen centuries before the birth of Christ, in the Petri Papyrus of 1850 BC and the Ebers Papyrus of 1550 BC. Muslim conquerors of Egypt not only allowed but encouraged family planning. A sermon delivered by Amr Bin A’as, a companion of the Prophet and the first governor of Egypt, warned his listeners that a large family was one of the four causes of a decline in living standards. Amr’s exhortation assumed that his subjects knew how to keep family size within reasonable limits (Hefnawi 1982). The concept of IUDs may have first arisen from the practice of putting stones in the uteruses of camels in order to prevent pregnancies during long journeys. This suggests a history of cultural resonance that may have shaped interest in the IUD in the modern Egyptian...


Subject Headings

  • Human reproductive technology -- Middle East.
  • Human reproductive technology -- Africa, North.
  • Birth control -- Middle East.
  • Birth control -- Africa, North.
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