Injectable contraception in islamic and arab populations: Does Indonesia offer a path for Egypt ?

Indonesia is the world's most populous Muslim-majority nation and Egypt has its largest Arab population. Both countries have similar overall and any modern-method contraceptive prevalence rates (61% and 58%), as well as levels of unmet need (12-13% in 2007-08). However, fertility has declined further in Indonesia than Egypt (2.6 and 3.0 births per woman, respectively). Both countries established clinic-oriented national family planning programs in the mid-1960s, but state policies have led to skewed method choice and a narrowed range of providers, and each program has recently hit trouble. Indonesia has the world's highest injectable use rate (32%); almost everyone is current with their injections, with most users relying on local midwives. These trends may increase as Indonesia has shifted attention and resources from family planning. The Egyptian program has poorer informed choice, higher discontinuation rates, and heavier reliance on public sector sources increasingly undermined by ongoing political turmoil. The IUD remains by far the most widely used method (36%), but 7% of women now use injectables, more than in other Arab states and possibly soon usurping pills as the second most common method. We draw on various data sources, including multiple DHS survey rounds, to examine these developments further. With certain caveats, the Indonesian experience offers lessons for increasing injectable use in Egypt and accelerating its path toward replacement fertility. Increasing injectable use can help meet demands on the fragile state health system, make use of Egypt's underdeveloped community-based channels, and may serve as a catalyst for other Arab states.