At home and with no medical help, Dalal Nagi delivered her eldest son two months premature in this town in Upper Egypt.
Despite the complications, the boy is now school-aged, and on a recent afternoon was happily peeping over the counter at a juice shop in a dusty, working-class market.
Mrs. Nagi's second son was born on time, in a hospital. The toddler trails his older brother, sipping his tamarind juice from a straw stuck in a little plastic bag.
Like many women here in southern Egypt, known for its poverty, Nagi credits television for helping make her second delivery smoother. "I didn't know anything about doctors. But there are some TV programs that give us advice," she says, her hair and shoulders draped in a red scarf.
In a country where poverty and its associated health risks have long clung to daily life, women such as Nagi are bright examples of a remarkable improvement, one that may offer lessons for other developing nations. Thanks to the political will to make child healthcare a priority, education via the airwaves, investment in health clinics, and training of doctors, Egypt's infant (under age 1) and child (under age 5) and maternal mortality rates have dropped significantly in the past decade.
In 1990, Egypt's child-mortality rate was 104 deaths per 1,000 children. By 2005, that number had fallen 68 percent, according to UNICEF's 2007 State of the World's Children report released in December. Only the Czech Republic reported greater drop – 69 percent – from 13 deaths per 1,000 in 1990 to four in 2005, in the UNICEF report.
Egypt's infant-mortality rate dropped from 76 deaths per 1,000 in 1990 to 28 by 2005, says UNICEF. A report by John Snow International, a consultanting group focused on healthcare, found a 59-percent drop in maternal mortality from 1992 to 2000 in Upper Egypt and a 52 percent fall nationwide.
The turnaround began in 1992 with Egypt's first survey of maternal mortality. The government joined with the US Agency for International Development and USAID contractor John Snow to start a project focusing on women and children's health in Upper Egypt.
In 1994, momentum to reduce the health risks for mothers and children grew. Egypt hosted the International Conference on Population and Development. That helped reinforce the campaign to lower fertility rates and improve the health of mothers and children through education and improvements in facilities and treatments. Egyptian officials came out of the 1994 conference "saying, 'we are going to do something.' [Egypt's President Hosni] Mubarak was going to make bringing down the population [growth rate] one of his personal goals," says Patrick Crump, the country director here for Save the Children, an international aid group that runs mother and child healthcare programs. Mr. Crump notes that the proliferation of televisions in Egypt since the 1990s has also been a boon to getting public service health messages out to even the remotest of areas.
The joint Egyptian Health Ministry and USAID project in Upper Egypt focused on educating women about taking care of their health when they are pregnant, by going to see a doctor during pregnancy, and having a trained medical professional with them during delivery. It also focused on improving training of doctors and nurses in basic clinical protocols as well as in prenatal and postnatal care. Save the Children, which issued a report Tuesday on worldwide infant and maternal health using previously released data from the UN and other sources, began a project in 2003 in 30 villages in Upper Egypt in pre- and postnatal care, facility improvements, as well as training local women who then give courses in their areas to other women, in Minya in particular.
Contraceptive use in Egypt has risen by about 1.5 percent a year since 1990, reaching 60 percent of the population in 2003, according to the UN World Contraceptive Use reports for 2003 and 2005. Many Egyptians say it is against Islam to use contraceptives because children are considered blessings given by God. But Crump says that spacing out births for the health of the mother has gained traction as some religious leaders promote passages in the Koran that support the idea.
As horse-drawn carts whiz past on the dirt road through the market and merchants hock cheap children's clothing and glazed sweets, Desoki Abdel Aziz peers through the slit between her black head scarf and the black niqab veil that covers her face.
"In the past the women were not educated, so they didn't know about the hospital. They were treating themselves naturally, but now the young people are more educated so they know it's cleaner to give birth at the hospital," says Aziz, who uses her father's name, as her daughter wriggled in a stroller.
But in absolute terms Egypt still has a long way to go to improve the health of infants, children, and pregnant mothers. For example, its current 33 deaths per 1,000 children under age 5 compares with seven deaths per 1,000 children in the US, on par with Cuba, Estonia, and Poland, according to UNICEF.
Upper Egypt is dotted by small rural villages where there are long traditions of giving birth using midwives in the home. "I didn't go to the hospital [to deliver my children] but I heard about meetings at the hospital for mothers," says Merva, who only gave her first name, while holding her young daughter's hand. "I went to a small house. Most births are in the home. If [the birth] is normal why should I go to the hospital?"
Hossam Mamdon has one more year left in medical school in Minya and hopes to work in a hospital or clinic in the area. Education of mothers is key, he says. "Diarrhea is something the programs have helped very much.... In the past it was a killing disease but now it's considered mild," he says.