By Shaimaa Tantawy
Last month, the official spokesperson for Egypt’s Ministry of Health and Population issued a formal statement announcing the introduction of new standards for the medical sector to promote natural birth and reduce caesarean births, which the Ministry described as “medically unjustified.” The statement outlined a package of mandatory regulatory measures applicable to all medical facilities, aimed at reducing caesarean-section rates which according to the Deputy Minister of Health, based on data from the 2021 Egypt Demographic and Health Survey surpassed an alarming 72% of total births in Egypt last year.
This medically unjustified surge reveals a crisis far deeper than a mere “clinical choice.” It exposes the pathways through which healthcare institutions engage with women’s overall health on the one hand, and their sexual and reproductive health on the other. This statistic raises numerous urgent questions: How are decisions made when women’s lives and health are at stake? Are women transparently informed and meaningfully supported to understand all available options? Do women make autonomous decisions regarding their own bodies, their health, and the health of their children or are these rights over women’s reproductive bodies systematically constrained by male family authority on one side and male-dominated state institutions on the other? Do physicians approach these decisions purely from a medical perspective, or do financial incentives and time–cost calculations shape decision-making given that caesarean births can be scheduled more predictably and may yield higher financial returns relative to time, compared to natural births?
This disregard for women’s health and for their physical and psychological recovery raises broader questions about the right to natural birth as an essential and integral component of the right to health, and about how this issue intersects with escalating economic pressures and climate crises that are fundamentally reshaping daily life.
A Suspended Right: Natural Birth Between Policy Decisions and Lived Reality
While discussing natural birth as a right may appear self-evident for women, the most pressing question remains: Which women actually possess the freedom to make informed and voluntary choices? And what meaning does this “right” hold if it is presented in the form of mandatory procedures, without providing the tools and mechanisms that ensure implementation on the ground and make it a realistic, accessible option for all?
Natural birth cannot be discussed in isolation from the adequacy of medical infrastructure and facilities, nor from the existence of healthcare institutions that genuinely recognize the importance of women’s reproductive health and recovery. This also requires trained medical personnel who operate from principles of care and wellbeing rather than profit-and-loss calculations or the minimization of women’s pain and complaints as exaggeration. The right to natural birth is intrinsically linked to dismantling gender stereotypes about women’s capacity to endure, and to recognizing that women’s health conditions today have fundamentally changed from what they once were. These transformations include escalating economic pressures, the impacts of climate change and rising temperatures, and, finally, the scarcity of healthy, balanced nutrition that provides mothers and fetuses with essential nutrients all within a context of limited or ineffective governmental support.
Nevertheless, women are expected to choose natural birth, while private hospitals impose a contradictory reality predicated on increasing caesarean births as more profitable and less demanding for physicians. In the absence of serious oversight mechanisms, the question persists: How will the state ensure that the “procedural package” announced by the Ministry of Health translates into actual implementation? Do women in rural areas or in more structurally vulnerable governorates possess the same access to safe natural birth as urban women who can afford higher-quality healthcare?
In this sense, the right to natural birth becomes a conditional and circumscribed right indeed, closer to a privilege accessible to some rather than a fundamental guarantee for all women.
From Inflation to Desertification: How Women’s Health and Their Right to Natural Birth Are Being Reshaped
Economic and social pressures intersect with climate change to render pregnancy and childbirth an increasingly harsh experience for women, fundamentally reshaping their relationship with the right to natural birth.
At the economic level, women and their families bear exorbitant costs throughout pregnancy to secure adequate nutrition, dietary supplements, and vitamins, amid the absence of supportive governmental policies that provide these basic necessities equitably and accessibly. Official data indicate that approximately 29.7% of Egyptians live below the poverty line (CAPMAS, 2023), meaning that a substantial segment of pregnant women lack the means to afford the food or medication necessary to maintain their health and that of their fetuses consequently losing the capacity to physically prepare their bodies for a safe natural birth.
The state is presumed to provide tools and mechanisms that support women in improving their health before and during pregnancy, through the provision of essential vitamins and nutritional support for both mother and fetus. However, women are left to confront an inflated pharmaceutical and food market that compels them to expend substantial sums throughout pregnancy merely to maintain the health conditions that enable natural birth. The critical question thus arises: How will the state provide a comprehensive health program for pregnant women one that includes subsidized nutritional supplements and fortified vitamins during pregnancy and lactation thereby supporting natural birth? Can the state prioritize women and their reproductive health with the same level of commitment demonstrated in the provision of contraception within population policies?
At the environmental level, manifestations of climate change including desertification and the contraction of green spaces have significantly contributed to rising temperatures and worsening heat stress. This, in turn, restricts pregnant women’s options to engage in even the most basic forms of physical activity, such as walking an activity often considered supportive of physical readiness for childbirth. However, the absence of women-friendly public spaces denies them this possibility, while streets remain unsafe due to gender-based violence. Thus, even simple daily movement becomes an additional risk rather than a means of care and health.
Women in the labour market face a compounded burden of paid work and unpaid domestic labour, as workplaces generally do not adopt gender-responsive policies, particularly regarding pregnant women. This renders the experience of working during pregnancy insufficiently protected by labour laws and workplace policies. Additionally, many women work in deteriorating governmental facilities that lack adequate infrastructure to cope with rising temperatures and intensifying climate impacts, while others engage in informal or daily wage labour for meagre compensation within unprotected work environments further compounded by severe climatic conditions.
Meanwhile, women who do not participate in the public labour market are not spared the burden of exhausting domestic work under deteriorating climatic and economic conditions often within private domains where compounded forms of violence and discrimination are practiced against them.
In all cases, it becomes evident that what is termed the “right to natural birth” is a conditional and constrained right, governed by economic, climatic, and cultural systems that do not center women’s health and wellbeing as a core priority. As these economic and climate challenges intensify, their impact remains most severe on the most vulnerable women from women in provinces and rural areas, to women with disabilities and refugee women who find themselves facing compounded adversity within a reality that neither recognizes their choices nor provides the minimum standard of safe care. This raises a critical question: What impact does discrimination produce when it intersects with deficiencies in healthcare services?
Further details to follow in the forthcoming installment…
