When we speak of the right to natural birth in Egypt, it quickly becomes clear that it is not a right equally available to all. Rather, it resembles a privilege shaped by multiple intersecting factors such as class, geographic location, economic capacity, and social identity. Women in rural areas face conditions that differ fundamentally from those of women in urban centers; and women in Greater Cairo do not live within the same contexts as women in remote governorates. Even within each governorate, conditions vary according to inflation levels, rising prices, and the ability to obtain essential nutritional supplements and vitamins for pregnancy alongside the uneven impacts of climate change from one area to another.

Customs and traditions play a pivotal role in shaping women’s reproductive experiences. Extended families often intervene in women’s choices, while women’s pain and complaints are dismissed as “exaggeration” or “spoiling.” Ultimately, decision-making remains in the hands of male family members particularly the husband’s family within a deeply entrenched patriarchal structure.
This inequality is clearly reflected in the distribution of caesarean and natural births. While caesarean rates rise sharply in urban centers and private hospitals where they constitute more than 63% of total births in Egypt in 2022 (one of the highest rates globally, compared to the international recommendation of 10–15%) some villages still maintain natural birth (i.e., vaginal birth), often attended by traditional birth attendants “midwife”, either due to the absence of adequately equipped health facilities or because caesarean deliveries have become prohibitively expensive.

Within this context, women’s choices are directly shaped by geography, socio-economic status, and the degree of climate-related stress. Maternal mortality in Egypt remains around 37 deaths per 100,000 live births (2020), with higher rates in rural areas and Upper Egypt compared to urban regions. In this way, it may appear that some women “choose” natural birth in remote areas; yet this “choice” often does not stem from genuine autonomy, but from the absence of even the most basic life-saving medical services if complications arise.

If we add to this picture the realities faced by women with disabilities and refugee women, the contours of compounded marginalization become even clearer. Women with disabilities encounter intensified barriers in accessing antenatal care and safe childbirth beginning with physical inaccessibility and the lack of appropriate accommodations in hospitals, extending to stigmatizing attitudes that expose them to discrimination by medical staff themselves, and culminating in weak health policies that fail to address their specific needs. In Egypt, studies indicate that women with disabilities have significantly lower access to reproductive health services than other women, and are more vulnerable to medical neglect or to decisions imposed on their bodies without full, informed consent.

Refugee women whether from Sudan, Syria, or elsewhere face additional challenges linked to economic precarity and limited legal protection, which often push them toward unsafe deliveries under harsh living conditions. A report by the UN High Commissioner for Refugees notes that refugee women in Egypt face serious difficulties in covering childbirth costs; in some private hospitals, the cost of a caesarean delivery can equal several months of a household’s income, leading many to resort to less safe alternatives. This is compounded by exposure to discriminatory or racist practices in certain health facilities, which deepens isolation and increases risks to their lives and the lives of their children.

In these situations, the right to natural birth or even the right to a safe birth in the first place becomes an unattainable privilege. Here, class, geography, disability, and refugee status intersect to determine which women can access basic rights, and which women are excluded from even the minimum forms of protection and care.

Toward Reproductive Justice: Recommendations to Secure the Right to Natural Birth
After examining the economic, climatic, and social factors reshaping the reality of natural birth in Egypt, the state must place women at the center of public-health interventions not treating them as instruments for demographic objectives related to controlling fertility rates, but recognizing them as rights-holders with entitlements to bodily, reproductive, and sexual health. It becomes necessary to move toward practical recommendations that guarantee this right as part of gender justice.

To ensure that natural birth becomes a real right for all women, we recommend the following:

1. Guarantee natural birth as a genuine and safe option
Consistent with Article 12 of the International Covenant on Economic, Social and Cultural Rights (ICESCR), which affirms the right of every person to the highest attainable standard of health, the state should develop health infrastructure in both public and private hospitals and train medical staff in safe, modern practices that support natural birth.

2. Provide integrated nutrition and comprehensive healthcare for pregnant women
In line with Article 12 of the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), which calls for ensuring “adequate nutrition during pregnancy and lactation,” the state should commit to providing subsidized essential vitamins and nutritional supplements in order to protect women’s health and newborn outcomes and to reduce the economic burden on families.

3. Strengthen oversight of private medical institutions
Drawing on General Comment No. 22 of the Committee on Economic, Social and Cultural Rights, which underscores non-discrimination in access to sexual and reproductive health services, the state should establish effective oversight mechanisms to ensure that private hospitals reduce unnecessary caesarean births and protect women from financial exploitation.

4. Protect the most marginalized women
In accordance with CEDAW’s non-discrimination principles, tailored policies should address the realities of women in rural areas, women with disabilities, and refugee women guaranteeing their access to safe healthcare that is free or low-cost, including antenatal, childbirth, and postnatal care.

5. Enable meaningful participation by civil society
In the spirit of the International Conference on Population and Development (ICPD, Cairo 1994), which emphasized the role of local communities in advancing reproductive health, the state should allow civil society organizations to play their role in raising awareness among women and medical personnel and in providing psychosocial support without restriction or undue interference.

6. Confront discrimination and gender-based violence within medical settings
Consistent with Article 12 of CEDAW, which obliges states to ensure healthcare free from discrimination, reproductive health policies should include mandatory training for doctors and health workers on gender-sensitive care, and should end violent, coercive, or humiliating practices against women during pregnancy and childbirth.

Ensuring a safe natural birth is not merely a health issue it is a matter of social justice and human rights. Unless the economic, discriminatory, and climate-related barriers that constrain women’s choices are removed, natural birth will remain a privilege for some rather than a guaranteed right for all women.