POPULATION REFERENCE BUREAU POPULATION TRENDS AND CHALLENGES IN THE MIDDLE EAST AND NORTH AFRICA he people of the Middle East and North Figure 1 Africa (MENA)* have long played an inte- Ratio of Population Size in 2000 to Population gral, if sometimes volatile, role in the his- T Size in 1950, by Major World Regions tory of human civilization. MENA is one of the cradles of civilization and of urban culture. Three 3.7 3.6 of the world’s major religions originated in the region—Judaism, Christianity, and Islam. Univer- 3.2 sities existed in MENA long before they did in 2.6 Europe. In modern times, MENA’s politics, reli- gion, and economics have been inextricably tied 1.8 in ways that affect the globe. The region’s vast 1.3 petroleum supply—two-thirds of the world’s known oil reserves—is a major reason for the world’s interest. But the influence of MENA extends beyond its rich oil fields. It occupies a MENA Sub-Saharan Latin Asia North Europe strategically important geographic position Africa America America between Asia, Africa, and Europe. It has often SOURCE: United Nations, World Population Prospects: The 2000 Revision been caught in a tug-of-war of land and influence (New York: United Nations, 2001). that affects the entire world. Today, MENA’s rapid population growth exacerbates the challenges that this region faces as developed regions. The introduction of modern it enters the third millennium. For hundreds of medical services and public health interventions, years, the population of MENA fluctuated around such as antibiotics, immunization, and sanitation, 30 million, reaching 60 million early in the 20th caused death rates to drop rapidly in the develop- century. Only in the second half of 20th century ing world after 1950, while the decline in birth did population growth in the region gain momen- rates lagged behind, resulting in high rates of natu- tum. The total population increased from around ral increase (the surplus of births over deaths). 100 million in 1950 to around 380 million in The declines in mortality that occurred in the 2000—an addition of 280 million people in 50 past 50 years in the developing world mostly ben- years. During this period the population of the efited infants and young children. In MENA, MENA region increased 3.7 times, more than any infant mortality (infants dying before their first other major world region (see Figure 1). This overview of population trends and chal- Population Change lenges in the MENA region is the first in MENA experienced the highest rate of population a series of policy briefs from the Population growth of any region in the world over the past Reference Bureau that analyze population, envi- century. MENA’s annual population growth ronment, reproductive health, and development reached a peak of 3 percent around 1980, while linkages within the framework of the Cairo the growth rate for world as a whole reached its Programme of Action and the cultural contexts peak of 2 percent annually more than a decade ear- of population groups in the region. Future lier.1 Improvements in human survival, particularly briefs on MENA will cover specific population- during the second half of the 20th century, led to related topics or country case studies. rapid population growth in MENA and other less * Countries and territories included in the Middle East and North Africa region as defined here are listed in the table on page 4. birthdays) dropped from close to 200 deaths per higher than that of Latin America and East Asia 1,000 live births in the early 1950s to fewer than (see Figure 2). 50 deaths per 1,000 live births at the turn of the While the “demographic transition,” the shift 21st century. Despite this sharp decline and the from high to low mortality and from high to low fact that infant mortality rates in some oil-rich fertility, is well under way throughout the region, Persian Gulf states are quite low (Kuwait’s infant individual countries are at different stages (see mortality is as low as the average for Europe), the Figure 3). On average, fertility in MENA declined regional infant mortality rate in MENA remains from 7 children per woman around 1960 to 3.6 children in 2001. The total fertility rate (average number of births per woman) is less than 3 in Figure 2 Bahrain, Iran, Lebanon, Tunisia, and Turkey, and Decline in Infant Mortality is more than 5 in Iraq, Oman, Palestinian Number of deaths under age 1 per 1,000 live births Territory, Saudi Arabia, and Yemen (see Table 1 250 Yemen on pages 4 and 5). Even though the decline in fertility rates is 200 expected to continue in the MENA region, the Morocco population will continue to grow rapidly for sev- eral decades. In a number of countries, each gen- 150 Saudi Arabia eration of young people enters childbearing years in greater numbers than the previous generation, 100 so as a whole they will produce a larger number of Venezuela births. This phenomenon is referred to as “popula- Malaysia 50 tion momentum.” The population of the region is increasing at 2 percent per year, the second high- est rate in the world after sub-Saharan Africa. 0 1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 Nearly 7 million people are added each year, and MENA’s population is expected to nearly double SOURCE: United Nations, World Population Prospects: The 2000 Revision (New York: United Nations, 2001). in the next 50 years (see Figure 4). Demographic Consequences and Figure 3 Challenges Total Fertility Rates Regardless of the level of economic development or national income, MENA governments are Average number of births per woman increasingly challenged to provide the basic needs Yemen 8 for a growing numbers of citizens—adequate housing, sanitation, health care, education, and 7 Saudi Arabia jobs—and to combat poverty, narrow the gap between rich and poor, and generally improve the 6 Turkey Morocco standard of living. In addition, the region’s scarce water resources need to be managed in the face of 5 growing demand. Egypt Its young population gives unprecedented 4 momentum to MENA’s population growth. One- third of MENA’s population is under age 15. 3 Over the next 15 years these children and adoles- cents will reach their childbearing years and enter 2 1950-55 1960-65 1970-75 1980-85 1990-95 2000-05 the job market. In most MENA countries, the number of women of childbearing age (15 to 49 SOURCE: United Nations, World Population Prospects: The 2000 Revision (New years) will at least double in the next 30 years. York: United Nations, 2001). Providing quality reproductive health services to a 2 PRB MENA Policy Brief 2001 growing number of women is a challenge and is Commitment to political stability, investment key to slowing population growth. in health and human resources, and sound eco- As MENA’s total population increases, so does nomic policies can turn the population challenges of its elderly population and with it a health bur- MENA to “demographic bonuses.” A demograph- den that has important implications for the cost ic bonus may occur, for example, when a large and configuration of health systems. For example, young population is healthy, educated, trained, and the elderly population of Egypt (60 years and ready to be absorbed in a market economy and to older) is expected to grow from 4.3 million in contribute to the national economy. Unfortunately, 2000 to 23.7 million in 2050. Saudi Arabia’s MENA countries are currently more likely to expe- elderly population is expected to grow from 1 mil- rience “brain drain,” as large flows of educated peo- lion in 2000 to 7.7 million in 2050. MENA’s working-age population is growing Figure 5 very rapidly as huge cohorts of children reach adulthood. In 1996, for example, there were five Age and Sex Profiles of Jordan and Saudi Arabia in Mid-1990s Jordanians under 15 years of age poised to enter the labor market for every Jordanian age 45 to 60 nearing retirement age. For Saudi nationals, this Jordan, Nationals 1996 ratio was 8-to-1 in 1996 (see Figure 5). 80+ 75-79 The region’s economic dependency—the 70-74 Males Females ratio of the economically inactive to economically 65-69 active population—is the highest in the world. 60-64 55-59 Because of its young age structure and low level 50-54 of female labor force participation, the propor- 45-49 40-44 tion of the population that is economically 35-39 active is lower in MENA than in all other 30-34 regions. According to the International Labour 25-29 20-24 Organization (ILO), the only countries with a 15-19 dependency ratio of two or higher (an average of 10-14 5-9 two or more persons not economically active per 0-4 one economically active person) are found in the 20 16 12 8 4 048121620 MENA region.2 Percent Figure 4 Saudi Arabia, Nationals 1996 Ratio of Projected Population Size in 80+ 75-79 2050 to Population Size in 2001 70-74 Males Females 4.0 65-69 60-64 3.4 55-59 50-54 2.9 45-49 40-44 2.3 35-39 1.9 30-34 1.7 1.6 1.5 25-29 20-24 15-19 10-14 5-9 0-4 n 20 16 12 8 4 048121620 Percent Egypt Saudi MENA Algeria Jordan rabia Turkey Yeme A Palestine* SOURCE: United Nations Economic & Social Commission for Western Asia * Palestine includes the Arab populations of the West Bank and Gaza.