Cultural and Gender Drivers of Fertility in Egypt’s Frontier Communities

Background Egypt’s National Population Council (NPC) leads the country’s population policies and strategies. To inform its work, NPC undertakes research in governorates showing alarming fertility indicators in the 2021 Egypt Family Health Survey (EFHS). Matrouh Governorate, a frontier area with high fertility, low contraceptive prevalence, widespread child marriage, and large family size, was selected for investigation. This study explored barriers and enablers underlying local fertility practices and their sociocultural determinants. Methods A qualitative study was conducted through nine focus group discussions (FGDs) with married women, married men, mothers-in-law, and community leaders across Matrouh Governorate, complemented by a desk review of secondary sources. Data were analyzed thematically to identify perceptions and practices related to age at first pregnancy, birth spacing, and preferred family size. Results Fertility practices in Matrouh are shaped by entrenched cultural values, gender hierarchies, and misconceptions about modern contraceptive methods. Early marriage remains prevalent, particularly among Bedouin families, driven by social expectations and economic motives. Myths about contraceptive side effects, including infertility and harm to lactation, deter use. Birth spacing is idealized but rarely practiced due to male dominance and son preference. Despite awareness of health risks, women have limited agency in fertility decisions. Conclusion Deeply rooted gender norms, patriarchal decision-making, and misinformation sustain high fertility in Matrouh despite awareness of modern family planning (FP) benefits. Addressing these barriers requires gender-transformative, culturally grounded interventions that engage men, mothers-in-law, and religious leaders.