Dr. Fathia Marsafawi, director of family planning for Egypt's Health Ministry, used to have one assistant, but he died last year. Now she has no staff. She would like to hire someone experienced from the provinces to replace him, she said, but Cairo is so crowded that no one from the provinces can find an apartment here.
During her 12 years in office, Marsafawi has had to settle for little victories -- paint for rural clinics, the purchase of a few trucks, the donation of some chairs for her office, a few slightly positive statistics -- while she watched the rate of population growth increase by 40 percent.
"Family planning in our country," she said by way of explanation, "is a very sensitive issue."
The story of Egypt's failure to come to terms with population growth is at the core of this nation's most burdensome realities: widening poverty, bureaucratic sloth, political and religious ferment. It is a problem rooted in what many foreigners regard as economic illusions among the nation's educated elite and a deep-seated cultural failure throughout the population to relate cause and effect.
In the last three years, President Hosni Mubarak has attempted to overcome the apathy engendered by his predecessors and make population control a top government priority. But thus far the inertia of his own bureaucracy and the beliefs of his society have defied his hopes for progress almost completely.
In January 1985, Mubarak formed a new National Family Planning Council. It replaced the Population and Family Planning Board, which had earlier replaced the Supreme Council for Population and Family Planning as the central institution concerned with guiding population policy.
Mubarak is chairman of the board of the new council, which was supposed to meet quarterly. Eleven months later, the board has never met.
Few Egyptians have noticed. Such opposition politicians as address the issue tend to oppose family planning if only because Mubarak says he supports it. The people on the street see the problem as something for God or the government to deal with -- without, it is hoped, asking anything of them.
Zahma -- crowding -- is a common epithet in slum alleys overflowing with sewage, on highways bumper-to-bumper for mile after mile, and in apartments where people sleep in shifts. In some parts of Cairo there are more than 600 persons per acre. Manhattan, by comparison, averages a little over 100. Yet large families are still a source of fierce pride here. The average Egyptian woman has more than five children.
Yet for most of the last three decades Egypt proved a country not only unable but unwilling to help itself.
Egypt has all but abdicated responsibility for funding population programs to foreign donors, spending less than $3 million a year of its own money on the effort and not even using all the funds that others give it.
In 1978, the World Bank lent Egypt $25 million on concessional terms for family planning. So far, only $16 million has been spent and according to officials here the remaining $9 million may be taken away at the end of the year because Egypt cannot decide what to do with it.
The United States since 1977 has spent $61 million on family planning and related activities in Egypt.
The results, as revealed by the litany of statistics compiled with much of this funding, are inconsequential.
From 1972 to 1982, according to a U.S. Agency for International Development assessment, Egypt was "the only country in the world where the rate of population growth has increased by over 40 percent."
The growth rate has since leveled off at 2.7. But the population of this grimly crowded country -- 49 million people on habitable land the size of the Netherlands -- is likely to double in the next 26 years.
Forty-three percent of the population is younger than 15 and 200,000 people a year are reaching reproductive age. About 70 percent of the women over 10 are illiterate. Their legal rights are limited and their best bet for pleasing and keeping their husbands is to bear them sons. At present they bear 150,000 babies a month.
To work on population control in Egypt, said Lenni Kangas, director of USAID's population office, "you've got to have the mentality of a cancer surgeon. You've just got to keep operating despite the odds."
Dr. Maher Mahran, charged with administering the new National Family Planning Council, admits that many people concerned with the issue "are depressed. They say it's a waste of time. We hear that every day."
Some means of birth control are simply ruled out here. "We have no abortion because of law, and no sterilization because of religion," Mahran said.
Contraception is the only means available, with reluctant and limited approval from some Islamic religious leaders.
Statistics compiled by the family planning council and USAID indicate that in all of Egypt, slightly more than 30 percent of the women of childbearing age use some form of birth control. But as Mahran and other experts note, most of these women are mothers who already have from three to six children.
About half the users take the pill. But many of these women reportedly do so only after intercourse, or miss several days and try to make up by taking several pills -- rather than taking them daily as required to be effective.
Condoms are widely distributed at minimal or no cost, but not so widely used, according to several experts.
There are many anecdotal accounts of the cheap birth control pills being fed to chickens to fatten them, condoms being sold to children as balloons, intrauterine devices being smuggled to countries where they can be sold at a profit.
"All these things are true," said Mahran, though how extensive such problems are has not been established.
In rural areas, where population growth is highest and use of contraception lowest, people simply see no reason not to have babies. Children who work in the fields often earn more than their keep. Small hands, for instance, are thought to be the best for picking cotton.
Girls marry young and begin to have children as a matter of tradition and status. While extramarital sex and unwed mothers appear to be very rare, child brides are not.
Despite legal strictures, one western expert in Cairo said, Egypt is a "society that supports child labor, and it's a society that supports childbearing by children."
Mahran cites statistics suggesting that in rural Egypt as many as 40 percent of the women get married before they are 16.
Mubarak is the first Egyptian president even to talk about confronting such problems head-on. He has largely put aside programs based on the theory that population growth could be accommodated simply by speeding up development and reclaiming land from the desert.
The central Population Development Program begun along these lines in 1973 was finally killed this year after studies showed population growth increasing where the program was in effect and decreasing where it was not.
But efforts to apply new methods and techniques have faltered in a morass of bureaucratic competition.
Partly as a result of such opposition, USAID has given extensive funding to private organizations to distribute contraceptive devices.
The most successful of these has been Family of the Future, which uses modern advertising and marketing techniques to promote birth control and sell subsidized contraceptives through private vendors.
"More people buy their contraceptives from the private sector now than from the Ministry of Health network," Kangas said.
In a broad sense, population experts have begun to conclude that little short of a relentless drive to change some of the society's most basic views and the government's most fundamental policies will have the drastic impact on population growth that they say is necessary to avert disaster.
To some extent the sheer crowding of urban areas has begun to limit birthrates. Marriages often are postponed for years because a couple can find no home of their own. Sometimes husbands and wives live apart even after their marriage.
At the same time, the frustrations of urban life, the underemployment of youth and the seething universities consistently raise concerns about possible social and political explosions that could rock the government and the region.
So to keep the masses happy, the government imports $8 million worth of food a day and heavily subsidizes its sale. The United States contributes over a million tons of wheat a year. In effect, some population experts contend, U.S. policy undermines with one hand what it promotes with the other by helping Egypt to reduce the cost of big families. Bread costs less than 2 a loaf.
"This is the only place in the world where it's cheaper to wipe the table with a loaf of the bread than a napkin," one critic of the food subsidies remarked, blaming them for Egypt's reluctance to address its population problems.