No to circumcision : The road to effective social marketing campaigns in Egypt

To inform the design and scale up of initiatives that can drive a change in attitudes and behaviors toward FGM/C abandonment, there is a rising need to understand the perspectives of individuals who are exposed to social marketing campaigns (SMCs), which are a key intervention to promote the abandonment of the practice. This working paper presents the findings of a study that sought to understand how, where, and why SMCs for FGM/C abandonment are working, and with what impact, to inform design and scale-up of campaigns that can foster new perspectives, expectations, and behaviors

No to circumcision’: The road to effective social marketing campaigns in Egypt [Arabic]

This study sought to understand how, where, and why social marketing campaigns (SMCs) supporting abandonment of female genital mutilation/cutting (FGM/C) are working, and with what impact, to inform design and scale-up of campaigns that can foster new perspectives, expectations, and behaviors

Ending the medicalization of female genital mutilation/cutting in Egypt

This policy brief examines the extent of medicalization of female genital mutilation/cutting (FGM/C) in Egypt, the characteristics of girls who were cut by medical personnel, factors that may have contributed to increased medicalization, and potential interventions that could influence both physicians and the public to completely abandon the practice. The data show that younger cohorts of women, those from higher wealth quintiles, higher levels of education, and living in urban regions are more likely to have been cut by medical personnel. More importantly, the analysis shows that despite medicalization being more common among young women with the above-mentioned characteristics, it is in fact prevalent among all groups of young women and in all regions of Egypt. In order to end the practice of FGM/C, interventions must aim to stop physicians from performing FGM/C, while correspondingly aiming to decrease the demand of the public for FGM/C. Additionally, interventions must address underlying cultural and religious norms that perpetuate the practice of FGM/C. The brief includes specific recommendations to address these factors

Ending the medicalization of female genital mutilation/cutting in Egypt [Arabic]

[In Arabic] This policy brief examines the extent of medicalization of female genital mutilation/cutting (FGM/C) in Egypt, the characteristics of girls who were cut by medical personnel, factors that may have contributed to increased medicalization, and potential interventions that could influence both physicians and the public to completely abandon the practice. The data show that younger cohorts of women, those from higher wealth quintiles, higher levels of education, and living in urban regions are more likely to have been cut by medical personnel. More importantly, the analysis shows that despite medicalization being more common among young women with the above-mentioned characteristics, it is in fact prevalent among all groups of young women and in all regions of Egypt. In order to end the practice of FGM/C, interventions must aim to stop physicians from performing FGM/C, while correspondingly aiming to decrease the demand of the public for FGM/C. Additionally, interventions must address underlying cultural and religious norms that perpetuate the practice of FGM/C. The brief includes specific recommendations to address these factors

Follow up and comparative assessment of IgG, IgA, and neutralizing antibody responses to SARS-CoV-2 between mRNA-vaccinated naïve and unvaccinated naturally infected individuals over 10 months

BackgroundEvidence on the effectiveness of vaccination-induced immunity compared to SARS-CoV-2 natural immunity is warranted to inform vaccination recommendations. AimIn this study, we aimed to conduct a comparative assessment of antibody responses between vaccinated naïve (VN) and unvaccinated naturally infected individuals (NI) over 10 Months. MethodThe study comprised fully-vaccinated naïve individuals (VN; n = 596) who had no history of SARS-CoV-2 infection, and received two doses of either BNT162b2 or mRNA-1273, and naturally infected individuals who had a documented history of SARS-CoV-2 infection and no vaccination record (NI cohort; n = 218). We measured the levels of neutralizing total antibodies (NtAbs), anti-S-RBD IgG, and anti-S1 IgA titers among VN and NI up to ∼10 months from administration of the first dose, and up to ∼7 months from SARS-CoV-2 infection, respectively. To explore the relationship between the antibody responses and time, Spearman's correlation coefficient was computed. Furthermore, correlations between the levels of NtAbs/anti-S-RBD IgG and NtAbs/anti-S1 IgA were examined through pairwise correlation analysis. ResultsUp to six months, VN individuals had a significantly higher NtAb and anti-S-RBD IgG antibody responses compared to NI individuals. At the 7th month, there was a significant decline in antibody responses among VN individuals, but not NI individuals, with a minimum decrease of 3.7-fold (p < 0.001). Among VN individuals, anti-S1 IgA levels began to decrease significantly (1.4-fold; p = 0.007) after two months, and both NtAb and S-RBD IgG levels began to decline significantly (NtAb: 2.0-fold; p = 0.042, S-RBD IgG: 2.4-fold; p = 0.035) after three months. After 10 months, the most significant decline among VN individuals was observed for S-RBD-IgG (30.0-fold; P < 0.001), followed by NtAb (15.7-fold; P < 0.001) and S-IgA (3.7-fold; P < 0.001) (most stable). Moreover, after 5 months, there was no significant difference in the IgA response between the two groups. ConclusionThese findings have important implications for policymakers in the development of vaccination strategies, particularly in the consideration of booster doses to sustain long-lasting protection against COVID-19.This work was made possible by WHO grant number COVID-19-22-43 and grant number UREP28-173-3-057 from the Qatar National Research Fund (a member of Qatar Foundation). The statements made herein are solely the responsibility of the authors

The Impact of the Syrian Influx on Egyptian Migrant Workers in Jordan

Over the past forty years, the situation of the Egyptian labor market has not improved and remains to be the principal factor determining labor migration. In the past decade, creation of job opportunities has lagged behind labor force growth, which has led many to resort to migrating. According to the Egyptian Population Census (2017), Saudi Arabia and Jordan are the main countries of destination for Egyptian migrants. This report tackles the current situation of Egyptian labor migration in one of its major Arab destinations, Jordan. The Syrian crisis in 2011 has generated millions of refugees with Jordan being among the major countries hosting them. Among these refugees are hundreds of thousands of workers who have necessarily affected the Jordanian labor market and may have affected the demand for Egyptian migrant workers. In addition to the demand, the terms and conditions of Egyptian workers employment may have been affected by the excess labor supply, the low wages and long working hours accepted by refugee workers out of necessity. The overall objective of this study is to understand the impact of the regional political environment in terms of the large Syrian influx to Jordan on Egyptian Migrant workers in Jordan. The findings of the study indicate the importance of the economic factors in shaping migration decision and the centrality of migration networks in sustaining migration streams from Egypt to Jordan. The primary drivers for migration are low wages and lack of opportunities in Egypt. The preference for Jordan is that it is considered a close familiar country that offers financially rewarding job prospects and is less costly to migrate to in comparison to other countries in the region. There are bilateral agreements that regulate the migration process between Egypt and Jordan. However, the reliance of migrants on migration networks makes the recruitment process largely informal. This leaves room for brokers and intermediaries to overcharge potential migrants who are not always aware of the procedures. A key concern is, also, the increased cost of work permits that pushes more Egyptian migrants to violate the regulations and turn towards irregularity of their migration status. The study concludes that Egyptian migrant workers in Jordan, who are predominately semi and low skilled workers, face many challenges. The study specifically highlighted the difficult working conditions and the inadequate housing. According to the survey with Egyptian migrants, the presence of Syrians had some negative impact on their chances of finding jobs in Jordan. However, on the other hand, the interviews revealed that the jobs taken by the two groups are different. Moreover, although according to secondary data, the flow of Egyptian workers to Jordan has been decreasing since 2 2016, the interviewed returnees did not attribute their return to Egypt to the presence of Syrian refugees in Jordan. They rather associated it to wanting to reunite with their families, to the limited opportunities and increased living expenses in Jordan and to their intention of retirement and decreasing their exposure to further health risks. Many of the returnees have also indicated their aspiration of returning to Jordan once more, if the opportunity arises, as it still offers better financial opportunities. The study concludes with a set of recommendations for the two governments as well as for civil society organizations in the two countries with the ultimate hope of improving the migration experience of Egyptian migrants in Jordan and enabling the two countries to reap the benefits of migration. The study calls for further quantitative and qualitative research particularly with regard to the actual number of Egyptian migrant workers as well as the role of intermediaries and brokers in the migration process

Health care providers’ and mothers’ perceptions about the medicalization of female genital mutilation or cutting in Egypt: A cross-sectional qualitative study

Background: Female genital mutilation/cutting (FGM/C) is a traditional harmful practice that has been prevalent in Egypt for many years. The medicalization of FGM/C has been increasing significantly in Egypt making it the country with the highest rate of medicalization. In this qualitative study, we explored the drivers and motives behind why healthcare professionals perform FGM/C and why mothers rely on them to perform the practice on their daughters. Methods: The study drew on a “mystery client” approach, coupled with in-depth interviews (IDIs) and focus group discussions (FGDs) with health care providers (i.e. physicians and nurses) and mothers. It was conducted in three geographic areas in Egypt: Cairo, Assiut and Al Gharbeya. Results: Study findings suggest that parents who seek medicalized cutting often do so to minimize health risks while conforming to social expectations. Thus, the factors that support FGM/C overlap with the factors that support medicalization. For many mothers and healthcare providers, adherence to community customs and traditions was the most important motive to practice FGM/C. Also, the social construction of girls’ well-being and bodily beauty makes FGM/C a perceived necessity which lays the ground for stigmatization against uncut girls. Finally, the language around FGM/C is being reframed by many healthcare providers as a cosmetic surgery. Such reframing may be one way for providers to overcome the law against FGM/C and market the operation to the clients. Conclusion: These contradictions and contestations highlighted in this study among mothers and healthcare providers suggest that legal, moral and social norms that underpin FGM/C practice are not harmonized and would thus lead to a further rise in the medicalization of FGM/C. This also highlights the critical role that health providers can play in efforts to drive the abandonment of FGM/C in Egypt

Drivers and consequences of child marriage in a context of protracted displacement: a qualitative study among Syrian refugees in Egypt

BACKGROUND: Child marriage is a human rights violation disproportionately impacting girls in low- and middle-income countries. In the Middle East region, conflict and displacement have prompted concerns that families are increasingly resorting to child marriage to cope with economic insecurity and fears from sexual violence. This study set out to examine child marriage among Syrian refugees residing in Egypt with the aim of understanding drivers of child marriage in this context of displacement as well as how child marriage affects refugee girls’ wellbeing. METHODS: This analysis draws from 15 focus group discussions (FGD) conducted with married and unmarried girls, as well as parents of adolescent girls in three governorates in Egypt. FGDs included a participatory ranking exercise and photo-elicitation. Additionally, we conducted 29 in-depth interviews with girls and mothers, as well as 28 key informant interviews with health providers, community leaders, and humanitarian actors. The data was thematically analyzed using a combination of inductive and deductive coding. RESULTS: A prevalent phenomenon in pre-war Syria, child marriage has been sustained after the influx of Syrian refugees into Egypt by pre-existing cultural traditions and gender norms that prioritize the role of girls as wives and mothers. However, displacement into Egypt engendered different responses. For some families, displacement-specific challenges such as disruptions to girls’ education, protection concerns, and livelihood insecurity were found to exacerbate girls’ vulnerability to child marriage. For others, however, displacement into urban areas in Egypt may have contributed to the erosion of social norms that favored child marriage, leading to marriage postponement. Among girls who were married early, we identified a range of negative health and social consequences, including lack of family planning use, disruption to schooling and curtailment of girls’ mobility as well as challenges with marriage and birth registration which accentuated their vulnerability. CONCLUSION: Efforts to address child marriage among Syrian refugees must acknowledge the different ways in which displacement can influence child marriage attitudes and practices and should capitalize on positive changes that have the potential to catalyze social norm change. Moreover, targeted, focused and contextualized interventions should not only focus on preventing child marriage but also on mitigating its impacts