By Lena Masri

SOHAG, Egypt (Reuters) – Nesma Ghanem is hoping for a fourth child even though her doctor says her body can’t handle a pregnancy at the moment. She has three daughters and would like them to have a brother.

“In the future he could support his father and the girls,” said Ghanem, 27, who lives in a village in Sohag, Eygypt, an area with one of the country’s highest fertility rates.

The family depends on her husband’s income from a local cafe. “If I have a son people, here in the village can say that he will carry on his father’s name,” she said.

As Egypt’s population heads towards 100 million, the government is trying to change the minds of people like Ghanem. “Two Is Enough” is the government’s first family-planning campaign aiming to challenge traditions of large families in rural Egypt. But Ghanem’s wish to have a son shows how hard that could be.

“The main challenge is that we’re trying to change a way of thinking,” said Randa Fares, coordinator of the campaign at the Social Solidarity Ministry. “To change a way of thinking is difficult.”

Egypt’s population is growing by 2.6 million a year, a high rate for a country where water and jobs are scarce and schools and hospitals overcrowded. President Abdel Fattah al-Sisi says the two biggest threats to Egypt are terrorism and population growth.

An Egyptian family prepare traditional sweets at their house in the province of Fayoum, southwest of Cairo, Egypt February 19, 2019. Picture taken February 19, 2019. REUTERS/Hayam Adel

“We are faced with scarcity in water resources … scarcity in jobs, job creation, and we need to really control this population growth so that people can feel the benefits of development,” Minister of Social Solidarity Ghada Wali told Reuters.

Decades ago, Egypt had a family-planning program, supported by the United States. The fertility rate fell from 5.6 children per woman in 1976 to 3.0 in 2008 while the use of contraceptives went up from 18.8 percent to 60.3 percent. Large amounts of contraceptives were made available and advertisements increased demand for birth control.

Support for family planning from the Egyptian government and large sums from donors helped make the program successful, said Duff Gillespie, who directed USAID’s population office from 1986 to 1993.

But Egypt was relying on donor support and when that assistance went away, family planning was neglected. By 2014 the fertility rate had gone up to 3.5. The United States is supporting family planning in Egypt again, providing more than $19 million for a five-year project ending in 2022 and $4 million for a smaller private sector project ending in 2020.

Those amounts are significantly lower than the $371 million the United States spent on family planning in Egypt between 1976 and 2008.

“Two Is Enough” is mainly financed by Egyptian money, with the Social Solidarity Ministry spending 75 million Egyptian pounds ($4.27 million) and the U.N. providing 10 million pounds, according to the ministry.

The two-year campaign targets more than 1.1 million poor families with up to three children. The Social Solidarity Ministry, with local NGOs, has trained volunteers to make home visits and encourage people to have fewer children.

Mothers are invited to seminars with preachers who say that Islam allows family planning, and doctors who answer questions. Billboards and TV ads promote smaller families. The government aims to reduce the current fertility rate of 3.5 to 2.4 by 2030.

At a session teaching volunteers how to speak to mothers and fathers about family planning in a village in Giza, Asmaa Mohammad, a 25-year-old volunteer, told Reuters she would rather have three children than two.

“Since I was a child I knew I wanted three children,” said Mohammad who is unmarried and doesn’t have children yet.

Deeply rooted traditions and lack of education explain why many Egyptians have big families. Al-Azhar, Egypt’s top Sunni Muslim authority, endorses family planning, but not all Egyptians agree.

Some view children as a future source of support. Others who only have girls keep having more until they get a boy who can carry on the family name.

During a visit from a campaign volunteer, Ghanem said her wish to have a boy was not the main reason she wasn’t using contraceptives. She stopped using an IUD after suffering from bleeding.

About one in three Egyptian women stop using contraceptives within a year, often due to misinformation about the side effects or lack of information about alternatives, according to the United Nations Population Fund.

Nearly 13 percent of married women of reproductive age in Egypt want to use contraceptives but are unable to, according to official data from 2014.

Now the government has renovated clinics, added staff and provided more free contraceptives. Under “Two is Enough” the goal is to have 70 new clinics up and running in March.

But when Reuters visited a clinic in Sohag last month, there were no contraceptives left. Nema Mahmoud, who had traveled from her village, was told to come back the next day.

Sohag, one of Egypt’s poorest governorates, also has one of the highest fertility rates at 4.3. The National Population Council said contraceptive use in Sohag is the lowest among six governorates surveyed.

For years Mahmoud, 33, didn’t use contraceptives consistently even though she wanted a small family. Her mother-in-law kept her from traveling to the city to get contraceptives when the local clinic was out, she said.

It was only after her mother-in-law died that she started using contraceptives properly. By then Mahmoud had three children and three miscarriages.

Since January, the government has limited cash assistance to poor families to two children instead of three in an attempt to push them to have fewer kids. Mahmoud will receive less cash every month. Her husband works only a few days a month, making 45 Egyptian pounds ($2.60) a day, she said.

Mahmoud and her neighbor Sanaa Mohammad, a 38-year-old mother of three, said the change should apply to new families, not women like them who already benefit from the program and have more than two children.

“It’s not fair to give someone something and then take it away,” said Mohammad.

The government sees the population boom as a threat to its economic reform plans. Every year, 800,000 young Egyptians enter the labor market, where unemployment is officially 10 percent.

In Egypt, population growth is around half the economic growth rate, but it should be no more than a third – otherwise it will be difficult to invest in social programs and improve living standards, said Magued Osman, chief executive of Baseera, the Egyptian Center for Public Opinion Research.

Analysts say Egypt should target people before they have children and sex education should be available in schools.

“Two Is Enough is good, but by itself it will not do the job,” said Abla Abdel Latif, executive director of the Egyptian Center for Economic Studies.

Wafaa Mohammad Amin, 36, a mother of four who works on “Two Is Enough”, got married at 17 and had her first child a year later. Two of her children were malnourished because she didn’t know how to breastfeed properly. She had to postpone her education and couldn’t work for years.

“There are many things I know now that I wish I had known back then,” she said. “I don’t want others to go through what I went through.”

(Reporting and writing by Lena Masri; Editing by Giles Elgood)