Reproductive Inequality and the Stalled Fertility Transition in Egypt: Multilevel Evidence from the Demographic and Health Survey

Despite ongoing investments in family planning initiatives and significant improvements in female education, fertility decline in Egypt has shown clear signs of stagnation. This study examines reproductive inequality from a biostatistical perspective by modelling high fertility rates and modern contraceptive use within a hierarchical population framework. Using nationally representative data from 9,722 ever-married women aged 15-49 from the 2014 Egypt Demographic and Health Survey, multilevel logistic regression models were applied to measure both individual-level associations and variability across different contexts in reproductive outcomes. Higher educational attainment was linked to notably lower odds of high fertility and a greater likelihood of using modern contraception. Nonetheless, these effects were influenced by socioeconomic and life-course factors. Cross-level interaction analyses revealed a significant amplification of the educational impact among women in higher wealth quintiles (OR ≈ 12.4) and older age groups (OR ≈ 3.0). Random-effects estimates showed that a considerable proportion of variation in reproductive outcomes remained attributable to community-level factors, even after adjusting for individual characteristics. Results suggest that the stagnation of fertility decline in Egypt reflects reproductive inequality within hierarchical social structures. This study highlights the importance of multilevel inference to capture conditional effects and contextual heterogeneity in population health research.