1 – Among the world’s fastest growth rates since 1950

26Like other regions, the rate of population growth in the geopolitical entity comprising North Africa, the Arabian Peninsula and the Middle East increased slightly from the early 1950s (2.6% per year) until around 1980-84 (2.9%) [22] as the result of declining mortality and a consistently high birth rate. Though the growth rate equalled that of sub-Saharan Africa from 1975 to 1985 (almost 3%, Figure 2), it then began to drop sharply due to declining fertility in many countries. The growth rate thus fell from 2.9% in 1980-84 to 2.3% in 1990-94 and to 1.9% in the early 2000s (Appendix Table A.3). Population growth in the region is still very high however, and well above that of other developing regions, except for sub-Saharan Africa.

Figure 2

Population growth rates from 1950 to 2005 in five major regions and in all developing countries (%)

Population growth rates from 1950 to 2005 in five major regions and in all developing countries (%)

27The rate at which population growth is slowing down varies from one country to another. Figure 3, based on the most recent United Nations data (2005), compares pre-transition growth rates of 1970-74 with those of 2000-04 for each of the 20 countries. At one extreme we find two countries, Yemen and Palestine, whose very high population growth rates (3.2 and 3.5% per year respectively), have even increased slightly since the 1970s. At the other extreme, in six or seven countries – Kuwait (which began very high), Algeria, Iran, Bahrain, Lebanon and Tunisia – the growth rate has decreased by almost 50%. Between these two extremes, the growth rates in Iraq [23], Saudi Arabia, Syria and Egypt are declining more slowly. The same applies to Qatar and Israel, which began from much lower growth rates in 1970-74. All in all, there is no clear relationship between the rates of decline and the starting level in 1970-74.

Figure 3

Change in population growth rates from 1970-74 to 2000-04 in the 20 countries of the region (%)

Change in population growth rates from 1970-74 to 2000-04 in the 20 countries of the region (%)

28In sum, disparities in the rate of population growth in the region are much larger today than in the past: thirty years ago, most countries had annual growth rates of between 2.4 and 3.5%, while today they range between around 1.2% (Tunisia, Lebanon, Iran) and more than 3.2% (Yemen, Palestine). Out of the twenty countries, twelve have fallen below the 2% threshold, while only three are below 1.5%.

29Though the growth rate is indeed slowing down, absolute population growth, and hence demographic pressure on essential goods and services (education, housing, food, employment, etc.) is still very strong. The region’s population has quadrupled since 1950 (see Appendix Table A.2), more than doubled since 1970 and increased by 35% since 1990. The multiplier coefficients [24] of the population in certain countries since 1970, over a period of 35 years, are as follows:

30These very high figures are the consequence of recent fertility history, but also, in certain cases, of international migration (refugees, workers). And this population growth is set to continue over the coming decades.

2 – Prospects up to 2040

31The population projections established by national statistical institutes cover different periods and are obtained using different methods, so they are not easy to use for comparative purposes. For this reason, we have based our analysis on the United Nations projections [25], which are more consistent in methodological terms, though they no doubt gloss over certain national particularities. Revised every two years, the 2004 projections incorporate the most recent changes, in fertility especially, whose future trends are a key component of all prospective studies.

32Though recent and updated, the 2004 projections must be seen as one possible future among many, liable to be revised upward or downward over the coming years in line with changing patterns of fertility and, in certain cases, migration. A simple comparison of the two sets of United Nations projections for seven major countries of the region, spaced just four years apart (in 2000 and 2004), illustrates the degree of uncertainty of projections at national level for the horizons 2025 and 2040 (Table 4). For three countries – Turkey, but above all Egypt and Iraq – the projected populations in 2025 and 2040 have been revised substantially upwards, while for four others, including Iran and Saudi Arabia, the opposite is the case. But the diverging trends tend to balance each other out and the total population of these seven countries remains practically unchanged (almost 446 million in 2025, around 510 million in 2040).

Table 4

Comparison of population projections (in millions) for 2025 and 2040 established by the United Nations in 2000 and 2004 for 7 major countries

Country Population in 2005 Population in 2025 Population in 2040 2000 projection 2004 projection Difference (%) 2000 projection 2004 projection Difference (%) Algeria Egypt Morocco Saudi Arabia Iran Iraq Turkey 32.8 74.0 31.5 24.6 69.5 28.8 73.2 42.7 94.8 42.0 40.5 99.3 40.3 86.6 42.9 101.0 40.3 37.2 89.0 44.7 90.6 + 0.5 + 6.5 – 4.1 – 8.2 – 10.4 + 11.0 + 4.6 48.5 107.4 47.8 52.7 113.5 48.4 95.1 47.5 117.8 44.8 45.3 98.0 56.7 98.7 – 2.1 + 9.7 – 6.3 – 14.0 – 13.7 + 17.2 + 3.8 Total 334.4 446.2 445.7 – 0.1 513.4 508.8 – 0.9 Sources: United Nations (2001); United Nations (2005); medium scenario.

Comparison of population projections (in millions) for 2025 and 2040 established by the United Nations in 2000 and 2004 for 7 major countries

33Appendix Table A.2 shows the population change since 1950 by country and sub-region and the prospects for 2010, 2025 and 2040. Though growth is expected to slow down, it will remain high in most countries (between 1.5% and 2.5% per year), leading to rapid population growth over the next 35 years. Under the United Nations medium scenario (2005), the population of the whole region (Figure 4) will increase from 421 million inhabitants in 2005 to 575 million by 2025 (+37%), then to 667 million in 2040 (+58%). All in all, the region is set to reach 800 to 900 million inhabitants by the end of the twenty-first century, with a doubling of its population over a period of 80 to 90 years. By 2040, the Arab world (17 countries) will have population growth (69%) which is double that of Turkey, Iran and Israel taken together (38%) (Table 5). In 35 years, the region will very probably have a population twice as large that of the 17 major countries of southern and western Europe (Figure 4).

Figure 4

Population change since 1950 and projections up to 2040 for the whole region, the three sub-regions and southern and western Europe

Population change since 1950 and projections up to 2040 for the whole region, the three sub-regions and southern and western Europe

Table 5

Population (millions) and growth (%) in the sub-regions from 2005 to 2040

Sub-regions Population Growth (%) from 2005 to 2040 1990 2005 2025 2040 North Africa (5) Arabian Peninsula (7) Middle East (8) 118.2 35.3 158.0 154.3 56.8 210.3 204.2 90.8 279.9 231.9 115.8 319.4 + 50.3 + 103.9 + 51.9 Arab countries (17) Non-Arab countries (3) 193.0 118.5 272.0 149.4 386.6 188.3 460.5 206.6 + 69.3 + 38.3 Total (20) 311.5 421.4 574.9 667.1 + 58.3 N.B.: Figures in brackets indicate the number of countries per sub-region. Source: Appendix Table A.2.

Population (millions) and growth (%) in the sub-regions from 2005 to 2040

34At sub-regional level (Table 5, Figure 4), the populations of North Africa and the Middle East will grow at a similar pace up to 2040 (by around 50%), but at only half the speed of the Arabian Peninsula (104%) which, driven by Saudi Arabia and Yemen, will double its population in just 35 years due to a slower decline in fertility than elsewhere.

35The populations of all the countries will rise over the next 35 years. The overall increase will be large, though the situation will vary from one country to another. According to the United Nations prospects by country, growth rates will be very rapid in certain countries, such as Yemen, Saudi Arabia, Iraq [26] and especially Palestine, leading to a doubling of population size in 35 years, and much more contained in others (Algeria, Morocco, Lebanon, Israel). By 2040, three countries will have close to 100 million inhabitants (Egypt, Iran and Turkey), four will verge on 45 million (Algeria, Morocco, Saudi Arabia and Yemen), and five will have 8 to 10 million (Libya, United Arab Emirates, Israel, Jordan and Palestine).

36Under these scenarios, which are practically inevitable despite a certain margin of error, it is not difficult to imagine the scale of human pressure – already posing severe problems in the region today – on ecosystems (oceans, coastal regions and in some cases forests), on land and on a resource as fundamental as water.

37We will now examine the two components which, excluding migration, underlie population growth in all geographical entities, namely the birth and death rates [27], whose respective variations over time determine what is commonly known as the transition model.

1 – Age at marriage has increased, sometimes dramatically

45Only thirty years ago, the age at first marriage of women in the region was still young (Appendix Table A.4), ranging between 18 and 21 years in most countries. Only in Lebanon, Israel and Tunisia was it around 23. Very often, half of all women were already married by age 17 or 18. The situation at the end of the 1990s was altogether different. Excepting Yemen, mean ages at first marriage ranged from 22 (Oman, Palestine, Saudi Arabia, Iraq and Turkey) to around 27 or over (Algeria, Tunisia, Egypt, Libya and Qatar). In many countries they have increased by between 4 and 6 years over a period of 20-25 years. Only in Palestine, where this age was already higher in 1975, has there been no marked change.

46These changes in the timing of women’s marriages have been very rapid in the three Maghreb countries (Figure 7). The increase in women’s age at marriage began in Tunisia in the 1960s, and ten years later in Algeria and Morocco. Today, mean age at first marriage among women in Algeria and Tunisia currently stands close to 30 years at the national level, one of the highest in the world. A slower pattern of change is observed for Iran (Figure 7), which in broad outline is also that for Iraq, Jordan and Turkey and probably also for Saudi Arabia and Oman.

Figure 7

Mean age at first marriage of women in the three Maghreb countries and Iran, 1960-2000

Mean age at first marriage of women in the three Maghreb countries and Iran, 1960-2000

47Ages at first marriage among men, which were already relatively late in the 1970s (commonly around 25), have also risen, though on the whole more slowly. They now stand at around 27 or 28 in a majority of countries (Appendix Table A.4). As is the case for women, these ages are highest (30 or above) in Algeria, Libya and Tunisia. They are lowest (around 25) in Turkey, Saudi Arabia, Iran and Palestine.

2 – A much narrower age difference between spouses

48The faster increase in the age at marriage of women has led to a clear reduction in the differences in mean ages between spouses, particularly since the 1980s. From traditionally high levels – 5 to 7 years depending on the country – they have fallen to around 3 years in a majority of cases (Appendix Table A.4). Egypt and Yemen are the only countries where the age difference between spouses is still over 5.5 years.

49Figure 8 clearly illustrates the large differences between countries in age at marriage, for both women and men, which contrasts with the relative uniformity that prevailed in the 1950s and 1960s. It also shows that at the aggregate level the age difference between spouses is not, or only loosely, related to women’s age at marriage [30].

Figure 8

Mean ages at first marriage of men and women, c.1998 (18 countries)

Mean ages at first marriage of men and women, c.1998 (18 countries)

3 – The extension of single life: an end to universal marriage?

50This represents a major and novel change for women in particular. The general shift is away from a female life cycle dedicated to marriage and childbearing from the end of adolescence, to a cycle that begins with a more or less extended period of single life, as was already partly the case for men. Though this extended period of single living for men and women has become general throughout the region (except in Yemen), it is particularly the case in North Africa (Appendix Table A.5). At ages 20-24, for example, 60% of women in Morocco and 80% in Tunisia are still single. In Algeria, which is an extreme example in this respect, the proportions of never-married women are currently 83% at ages 20-24, 58% at 25-29, 34% at 30-34, and 17% at 35-39.

51This constitutes an unprecedented change in the marriage regime, and is probably related to the longer time spent in education and to cultural changes, but also to the economic crisis (unemployment among young people) and to the housing shortage. This extended single life is often lived out within the family sphere, in contexts characterized sometimes by low economic activity among women, as is the case in Algeria, but always by a strong social control over the lives and sexuality of young people, particularly women.

52Getting married remains the predominant social norm throughout the region, for women as well as for men. In the 1970s, as in the 1990s, permanent celibacy [31] affected barely 1% to 5% of the female population of the countries [32] (Appendix Table A.4.). In other words, practically all the women in these oldest cohorts (aged 40-49) have been married, in many cases at an early age, as mentioned earlier. In all probability, however, the near future will see the end of universal marriage and the appearance, as in other continents, of a “structural” never-married population. On the basis of the current proportions of women (and men) still single at ages 30-39 – ages at which getting married becomes more difficult – it is reasonable to predict a substantial increase in the proportion never marrying in the years 2000-10, particularly in the Maghreb countries.

4 – Polygyny in decline

53Polygny is authorized under Muslim marriage law [33]. Historically it has been practised in all Islamic societies [34], and it remains authorized by all the states in the region, with the exception of Tunisia since 1956 and Turkey since 1926 [35]. But polygyny has never been nearly as common here as in West or Central Africa, where it may concern up to 40% of women (Tabutin and Schoumaker, 2004). It has never been a dominant marriage system in the region, and is showing clear signs of decline. The proportion of women in polygnyous unions now stands at only 3-5% in North Africa (Tunisia excluded), Palestine, Iran and Syria (Appendix Table A.4); substantially higher levels (around 9%) are confined to the countries of the Arabian Peninsula.

5 – Family endogamy persists

54Kin marriage (between blood relations), and in particular cousin preference marriage (between maternal or paternal first cousins), has long been a distinctive feature of the alliance system in the Arab and Islamic world. In traditional society, endogamous marriage provided a guarantee for securing assets, notably land and family structures [36]. It was practised widely (Fargues, 1989).

55Contrary to what might be expected in a region that has experienced urbanization and become exposed to external influences, and where education is on the increase, kin marriage remains valued and widespread. In a majority of the ten countries included in Table 6 [37], around 40% of all marriages are between kin members, with Turkey (23%) at one extreme, and Kuwait (53%), Saudi Arabia (58%) and Palestine (66%) at the other. First cousin marriage is universally encouraged.

Table 6

Distribution of marriages by kinship ties between spouses in selected countries (%)

Country Survey date First cousins Other kin Not related Total Algeria Saudi Arabia Egypt Iran Jordan Kuwait Palestine Tunisia Turkey Yemen 1970 1986 2002 1987 1991 1995 2000 1991 2002 1987 1995 1995 1993 1997 23 27 22 36 31 35 32 25 26 30 30 28 15 34 9 11 11 22 7 4 6 4 17 23 36 12 8 6 68 62 67 42 62 61 62 71 57 47 34 60 77 60 100 100 100 100 100 100 100 100 100 100 100 100 100 100 Sources: Country survey reports.

Distribution of marriages by kinship ties between spouses in selected countries (%)

56Though endogamy has declined locally, in Tunisia for example (Ben Salem and Locoh, 2001), it has maintained its position in Egypt and in Algeria (Table 6). It remains a key element of marriage systems in the region, even “if it has changed its meaning, form and direction in the new generations, by expanding to include a wider family circle” (Ouadah-Bedidi, 2004, p. 431).

57Nevertheless, in six of the ten countries in Table 6, around two in three marriages are between individuals who are not related. The situation is not one of complete freedom of marital choice for young men and women, but families now play a less important role.

6 – Divorce and remarriage

58In the past, the fact that traditional Muslim law [38] enabled men to divorce through unilateral repudiation of their wives led to high levels of marital dissolution. Indeed, Fargues (1986) suggests that it even acted as a regulator for a marriage market based, as we have seen, on generalized marriage [39]. In addition, divorce was frequently the response to a sterile or sub-fecund union [40].

59As is the case in other world regions, divorce and remarriage are among the least well-documented demographic phenomena, due to the lack of data for both earlier and contemporary periods [41]. The few recent studies have on the whole concluded in favour of a definite decline in divorce in the Arab societies, even though levels remain non-negligible. The divorce rate per 100 marriages [42] in Algeria is believed to have dropped from 38% in 1900 to 13% in the 1960s; in Egypt from 32% in 1941-45 to 14% in 1996-2000 (Fargues, 2002); in Tunisia it remained stable, at around 15%, from the 1960s to the 1980s. In the 1970s, according to the WFS surveys, the probability of divorce after 30 years of marriage was 14% in Egypt, 24% in Morocco, and only 6% in Syria. In Algeria, it dropped from 40% (1970 survey) to 19% (1992 survey). If the data from these few countries are reliable, we are indeed witnessing a relative stabilization of marriage. Divorce, on the other hand, appears to occur as early as ever and would seem to be spreading to all groups in society [43].

60As in other regions of the world, remarriage is less frequent among women than among men, and takes place after a slightly longer interval. In Algeria, twice as many men remarry after a divorce than women (Ouadah-Bedidi, 2004). In Iran, the frequency of female remarriage may even have fallen between 1977 and 1991 (Ladier-Fouladi, 2003).

7 – Sub-national geographical and social disparities

61These nuptiality transitions vary in pace and form between countries but also between different living environments and social groups within countries. As in other parts of the world, changes do not affect the entire population of a country to the same degree. We will take as an example the median age of women at first marriage by place of residence (urban or rural area) and educational level, in the five countries that have recently conducted a DHS survey (Table 7).

Table 7

Median age at first marriage of women^(a) by residence and educational level in five countries (years)

Country Survey date Residence Level of education Total Urban Rural Illiterate Primary Secondary or above Egypt Jordan Morocco Turkey Yemen 2000 2002 2003 1998 1997 21.7 22.5 24.0 20.5 16.2 18.3 21.9 20.9 19.9 16.0 17.3 20.4 20.4 18.0 15.8 18.4 20.6 23.8 19.8 18.2 22.8 23.5 27.7 23.8 24.8 19.9 22.4 22.7 20.3 16.2 (a) Age at which 50% of women aged 30-34 years in the survey were already married. Sources: Country reports from the latest DHS surveys.

Median age at first marriage of women^(a) by residence and educational level in five countries (years)

62An urban-rural contrast in median age at first marriage [44] is observed everywhere but to varying degrees depending on the country. The differences between median ages are still negligible in Yemen where half of women were already married at age 16, small in Jordan and in Turkey, and large (around three years) in Morocco and Egypt. The educational level of women is shown – a classic result – to have an enormous influence on their age at first marriage. Between illiterate women and those with a primary education, the increase is already perceptible (including in Yemen), and those with a secondary education or above marry at a much later age, ranging from 23 years in Egypt to nearly 28 years in Morocco.

63The same pattern is observed for other components of nuptiality. The period of single life is much longer in the cities, notably the largest ones, and of course among highly educated men and women, for whom permanent celibacy is likely to become a real prospect in the near future. Polygyny seems to be more present in rural than in urban areas, and among the least educated groups. This also appears to be the case for family endogamy which, though universally present, is tending to decline, in Algeria at least, as the educational level of men and women rises. Similarly, divorce is often more frequent in the cities than in rural areas (Libya, Algeria).

64These combined factors mean that several nuptiality regimes co-exist today in the same country, with different models by social group, living environment and region. This is scarcely surprising insofar as modernity, cultural openness, the relations between men and women, the effects of economic crisis and of development all vary from one sub-population to another, in North Africa and the Middle East, as elsewhere in the world. These diverse and, in some cases, rapid changes in marriage patterns have an appreciable influence on fertility levels and trends in these countries.

1 – Decline everywhere but at different paces

66Comparison of the total fertility rates of all 20 countries in 1970-74 and in 2000-04 (Figure 9) [45] clearly shows the decline to be general but extremely uneven. In ten or so countries, with very different socio-economic profiles – from Tunisia and Algeria to Jordan, Kuwait and Qatar – the number of children per woman has fallen from between 6 and 8 in the 1970s to between 2 and 3 at present. Six of these countries are in the final stages of their fertility transition, with close to 2.1 children per woman: they are Algeria, Tunisia, Morocco, Iran, Lebanon and Turkey, which have fallen below Israel, the country where fertility was by far the lowest thirty years ago. At the other extreme, Yemen, Iraq and Palestine still have levels of between 5 and 6 children per woman. There has been a marked increase in heterogeneity within the region.

Figure 9

Total fertility rates (TFR) from 1970-74 to 2000-04 in the 20 countries (number of children per woman)

Total fertility rates (TFR) from 1970-74 to 2000-04 in the 20 countries (number of children per woman)

67We can illustrate the diversity and specificity of the transition histories using some well-documented individual cases.

2 – Five examples of fertility transition since 1960

68Our examples are five countries (Figure 10) for which suitable time-series are available and that represent the diversity of fertility changes in the region. In all these countries (Algeria, Egypt, Iran, Jordan and Tunisia), total fertility stood at very high levels of between 7 and 8 children per woman in the early 1960s, with virtually no deliberate birth control. Tunisia [46] and Egypt were the first countries to see a decrease in fertility, starting with the introduction of family planning programmes in the late 1960s. But the fertility histories of the two countries diverged after 1974. In Tunisia, fertility continued to fall steadily down to its present level of 2.1 children per woman, whereas in Egypt it followed a more erratic, slower, and ultimately less certain course: a slight upturn following military demobilization after the 1973 war with Israel, a renewed decline between 1980 and 1990, followed by virtual stagnation at around 3.5 children per woman [47]. In the remaining three countries, on the other hand, fertility gave few signs of change before the late 1970s. In Algeria, it was not until 1981 and especially 1986, after the official launch of a family planning programme, that a rapid decline was observed. In Iran, an abrupt downward movement began in 1984, after the establishment of the Islamic Republic in 1979, against a background of severe economic crisis and five years before the birth control programme was restarted. Finally, in Jordan, the mid-1980s saw the onset of a transition that was more gradual than in the other two countries, consistent with that observed in many others.

Figure 10

Total fertility rate from 1960 to 2000 in five countries (mean number of children per woman)

Total fertility rate from 1960 to 2000 in five countries (mean number of children per woman)

3 – Substantial and contrasting changes in the timing of births

69These changes in the intensity of fertility were accompanied by major changes in its timing. To illustrate this point, we can examine two other countries, Morocco and Turkey, where total fertility has also fallen from 6 to 2.5 children per woman, or by 58%, over thirty or so years. Figure 11 presents the trends in age-specific rates over this period and shows that fertility decreases markedly at all ages but at differing paces. The sharpest decline occurs at below 25 years in Morocco (strong increase in the proportion single at these ages), and at over 35 years in Turkey (widespread use of terminal contraception) [48]. By around 2000, for an equivalent number of children in both countries, this yields differing tempos of fertility and an appreciably lower mean age at childbearing in Turkey (26.6 years) than in Morocco (29.1 years).

Figure 11

Age-specific fertility rates in Morocco and Turkey between the 1970s and 2000s (‰)

Age-specific fertility rates in Morocco and Turkey between the 1970s and 2000s (‰)

70Figure 11 shows clearly that the fertility transition follows diverse paths in North Africa and the Middle East, as in the rest of the world. So as we have seen, overall fertility depends partly on changes in age at marriage [49], and these changes have been substantial in some countries. We will now move on to look at marital fertility.

4 – Marital fertility remains relatively high

71Table 8 compares the total and marital fertility rates in ten countries in the 1990s. Trends in marital fertility are determined primarily by practices for spacing or stopping births.

Table 8

Total and marital^(a) fertility rates for selected countries in the 1990s (number of children per woman)

Country Survey date Total fertility Marital fertility Algeria Saudi Arabia Bahrain Egypt United Arab Emirates Jordan Morocco Tunisia Turkey Yemen 2002 1987 1989 1995 1989 1997 1995 1995 1998 1997 2.2 6.5 4.2 3.7 5.9 4.5 3.4 2.6 2.6 6.7 6.0 7.8 6.0 5.1 7.2 6.2 5.2 6.1 3.1 8.0 (a) The total fertility rate is the number of children a woman would have during her lifetime if she were to experience the fertility rates of the period at each age. The marital fertility rate is the number of children a woman would have if she remained married from 15 to 49 and experienced the average marital fertility at every age. We have calculated it by summing the published marriage duration-specific fertility rates. Sources: National survey reports (Appendix Table A.1).

Total and marital^(a) fertility rates for selected countries in the 1990s (number of children per woman)

72Marital fertility remains relatively high in the region. Excluding Turkey (3.1 children) and probably Israel, a woman who marries at age 15 and stays married until age 50 has around 6 children (from 5.1 in Egypt to 8.0 in Yemen and Saudi Arabia). In a country like Algeria, where overall fertility is now very low (2.2 children), marital fertility still stands at 6 children (Oudah-Bedidi, 2004). But it has fallen considerably, from 11 children in 1970 to 8.3 in 1992 and then to 6.0, as a result of increased contraceptive practice among married couples.

5 – Declining demand for children: towards a new family model?

73In every country of the region, the demand for children remains strong and the image of the family highly valued, but the number of children wanted is declining almost everywhere. The indicators available in the nine countries for which we have information all point in the same general direction. For example, the ideal family size has been falling for 15 years among married women aged 15-49, along a negative gradient from the oldest to the youngest cohorts. The proportion of married women aged 30-34 years who report not wanting any more children is on the increase [50]. This is also observed among women who already have three children. Growing numbers of couples are thus prepared to limit the number of their children, notably in the cities and among the higher social groups.

74The indicator of demand for children varies between countries. Among married women aged 25-34 years, the ideal number of children ranges from 2.5 in Turkey to 4.4 in Palestine and 4.6 in Yemen (Appendix Table A.7). Ideal family size is close to observed fertility levels (TFR) in Jordan, Turkey and Morocco, markedly higher in Algeria (by almost one child), and substantially lower in the two high fertility countries (Yemen and Palestine).

75The indicators of nuptiality, examined earlier, and fertility all suggest that profound changes in the traditionally dominant family model are under way in the region. Overall, there is a shift from the large family model to that of the smaller nuclear unit, doubtless partly in response to the difficult living conditions in many countries (for employment, housing, cost of living, etc.), but also because of the environment (urbanization) and cultural change. At the national level, the model is not (yet) that of two children per couple, since reproductive norms and behaviour still vary substantially, even within countries.

6 – Social and spatial diversification of reproductive patterns in the different countries

76In the history of every society, the fertility transition at the national level occurs in stages. Fertility decline does not begin at exactly the same time across all the regions or social groups in a country, nor does it proceed at the same pace. There are always social groups (or regions) that are ahead of others, culturally more open to progress or that adapt more easily to the effects of crisis. In other words, we observe first an increased diversification of life (or survival) strategies – which include fertility – followed by a gradual convergence of behaviour. As elsewhere, fertility transitions in the region are driven by urban living, access to education and the social group. To illustrate this, Table 9 presents the differences between actual and ideal fertility according to the place of residence and educational level of women, and the two extreme regions in five countries currently in different stages of the transition.

Table 9

Total fertility rates and mean ideal number of children^(a) by women’s residence and educational level, and for the extreme regions of the country (five countries)

Country Index Residence Level of education Extreme regions Total Urban Rural Illiterate Primary Secondary or above Minimum Maximum Egypt (2000) Jordan (2002) Morocco (2003) Turkey (1998) Yemen (1997) TFR Ideal number TFR Ideal number TFR Ideal number TFR Ideal number TFR Ideal number 3.1 2.7 3.5 4.2 2.1 2.7 2.4 2.4 5.0 4.1 3.9 3.1 4.2 4.5 3.0 3.3 3.1 2.6 7.0 4.6 4.1 3.3 3.7 4.8 3.0 3.3 3.9 2.9 6.9 4.6 3.8 3.0 3.8 4.4 2.3 2.7 2.4 2.4 4.7 4.0 3.2 2.6 3.7 4.1 1.8 2.4 1.6 2.1 3.1 3.7 2.9 2.6 3.5 4.1 1.8 2.5 2.0 2.3 5.8 4.4 4.7 3.5 4.0 4.6 3.1 3.4 4.2 3.1 6.6 4.7 3.5 2.9 3.7 4.2 2.5 2.9 2.6 2.5 6.5 4.5 (a) Reported by married women aged 15-49. Sources: Country reports from the latest DHS surveys.

Total fertility rates and mean ideal number of children^(a) by women’s residence and educational level, and for the extreme regions of the country (five countries)

77Urban and rural areas are everywhere quite distinct as regards both actual and ideal numbers of children. Urban fertility levels are appreciably lower in all the countries, even in Yemen where the transition has only just started [51], but on the whole these urban-rural differences decreased substantially during the 1990s. Likewise, the desired number of children is consistently lower in the cities. These contrasts between urban and rural areas have varied over time, like those observed between social groups and educational levels. The case of Algeria (Table 10) provides an example. From a low level in the 1970s with universally high fertility, the disparities widened in the 1980s when changes in norms and behaviour began to spread across the cities. They then narrowed again in the 1990s due to the rapid “diffusion” of these same changes in the rural areas.

Table 10

Total fertility rate in Algeria, 1970-2002, by residence (number of children per woman)

Year of survey Urban (1) Rural (2) Total Ratio (2)/(1) 1970 1986 1992 1998 2002 7.3 4.5 3.6 2.4 2.0 8.5 7.1 5.3 3.0 2.5 8.1 6.3 4.4 2.7 2.2 1.16 1.58 1.47 1.25 1.25 Sources: Survey reports (see Appendix Table A.1.).

Total fertility rate in Algeria, 1970-2002, by residence (number of children per woman)

78Fertility in some capitals or major cities now stands at particularly low levels. In cities like Algiers, Rabat, Casablanca and Istanbul, the fertility transition is complete, with slightly fewer than two children per woman. In these contexts, demand for children is low, marriage is late for both men and women, and contraception is widely practised.

79Similarly, the education of women has an increasingly important role in the region, as elsewhere in the world. Except in Jordan [52], receiving a primary education is enough in itself to modify behaviour appreciably; and this effect is greatly accentuated by access to secondary or higher education (Table 9). The largest inequalities associated with access to education are observed in Turkey and Morocco. As we have seen for age at marriage – and as we shall see for contraception and breastfeeding – education considerably modifies the role of the intermediate fertility variables.

80Similarly, the countries still exhibit marked regional diversity, with differences in fertility ranging from 0.5 to 2.2 children per woman between the extreme regions of the five countries (Table 9). These differences remain particularly large in Turkey (western region/eastern region), in Morocco (Grand Casablanca/Tangiers-Tetouan), and in Egypt (Urban Governorates/Upper Egypt).

81All in all, the comparative social and spatial homogeneity observed during the 1970s and 1980s clearly belongs to the past, even if the countries are at different stages of transition.

7 – Human development and infant mortality: loose correlates of fertility

82Contrary to what is observed at the world level or in other regions of the world, such as sub-Saharan Africa (Tabutin and Schoumaker, 2004), in North Africa and the Middle East no close relationship was discernible around 2002 between fertility and the human development index (HDI) [53], nor between fertility and infant mortality (Figures 12 and 13) [54].

Figure 12

Relationship between the total fertility rate and the human development index in 19 countries, c. 2002

Relationship between the total fertility rate and the human development index in 19 countries, c. 2002

Figure 13

Relationship between the total fertility rate and infant mortality in 20 countries, c. 2002

Relationship between the total fertility rate and infant mortality in 20 countries, c. 2002

83The correlations are statistically significant (R² = 0.29 for HDI, R² = 0.24 for infant mortality), but the points are widely dispersed. For example, at an identical level of human development (HDI around 0.73), fertility values range from 2.0 children in Tunisia to 4.1 in Saudi Arabia and even to 5.6 in Palestine. Conversely, for the same fertility level (around 3 children), the human development index ranges from 0.62 in Morocco to 0.91 in Israel. The same is true for infant mortality: Tunisia with 2.0 children, Saudi Arabia with 4.1 children and Palestine with 5.6 children are at a low level (around 22‰); at 3 children or thereabouts, mortality ranges from 5‰ in Israel to 40‰ in Egypt. All in all, in many countries of the region, notably in the Middle East and Arabian Peninsula, current fertility is substantially higher than it would be elsewhere for the same level of development and health. The absence of a clear relationship also confirms the distinctiveness of national histories and the diversity of the paths followed by the fertility transition.

1 – Post-partum sexual abstinence and breastfeeding: few significant changes

87Post-partum sexual abstinence and breastfeeding are two of the variables that can influence the duration of post-partum sterility following a birth.

88Post-partum abstinence is traditionally short in the Arabo-Muslim world [58], where reference is often made to a norm of 40 days [59]. To judge from the results for the last 30 years, it remains close to this duration, with a median value of 1.7 to 1.9 months in the latest DHS surveys (Appendix Table A.8). It has changed little over time; it is simply a little shorter in the cities and among educated and younger couples [60].

89Breastfeeding [61] continues to be widely practised in the region and generally for fairly long periods, with median durations of 11 or 12 months in Palestine, Turkey and Libya, between 13 and 15 months in Algeria, Morocco, Jordan and Tunisia, and even 18 months in Egypt and Yemen (Appendix Table A.8). On the whole, no major changes have occurred in the last fifteen years. This cross-country variability is nevertheless accompanied by substantial diversification in norms and practices within countries. In Egypt (DHS 2000), for example, the very long breastfeeding durations of the national average are being maintained in the cities as well as in rural areas, and vary little with the educational level or residence of the mother. In Turkey (DHS 1998), on the other hand, the practices are more differentiated between places of residence and social groups, although overall breastfeeding duration remains at around 12 months. The changes in behaviour for certain groups are clearer still in Morocco. Relatively weak at the start of the 1980s (1979-80 survey), the urban-rural differentials have grown considerably since then. In 2003 the median duration of breastfeeding was only 11 months in urban areas versus 16 in the countryside; it even fell to 9 and 8 months among women with the most education and of the highest social group, versus 16 months among those who were illiterate and in the poorest group. This quite radical break with tradition seems to have been less abrupt in Tunisia (Ayad and Jemai, 2001). No significant differences in breastfeeding between boys and girls are observed anywhere.

2 – Rapid and diversified progress of modern contraception

90The situation in the region is not at all comparable with that of the early 1980s when – excepting Tunisia, Egypt and Israel – modern contraceptive use was particularly low, with prevalence among married women ranging between 4% and 10% in most countries. Considerable progress has been made, especially since 1985, with wide variations between sub-regions and between countries however. Contraceptive prevalence by country (any method, modern methods) is presented in Appendix Table A.8. Figure 14 illustrates the variability in contraceptive use across the region and its relationship with fertility.

91Today, knowledge of contraceptive methods is widespread in the region. If the results from the latest surveys can be relied upon, between 90% and 98% of married women in most countries report knowing at least one modern method [62]. Contraceptive practice now depends essentially on the demand from couples and on the availability of services (geographical or cultural accessibility, cost and quality).

92Around the year 2000 [63], modern contraceptive prevalence among married women aged 15-49 was over 40% in 9 countries of the region, between 20% and 40% in 9 others, and remained at particularly low levels only in Yemen (10%) and Oman (18%). The three Maghreb countries, and Egypt, Israel and Iran, stand out especially, with current prevalence levels of around 55% (Figure 14). By contrast, with the exception of Kuwait, levels in the countries of the Arabian Peninsula are clearly lagging behind (around 30% in 1996).

Figure 14

Relationship between the total fertility rate and modern contraceptive prevalence among married women (age 15-49), c. 2000

Relationship between the total fertility rate and modern contraceptive prevalence among married women (age 15-49), c. 2000

93The three Maghreb countries, Iran and, to a lesser degree, Lebanon have experienced a contraceptive revolution that has surprised by its speed. Such a rapid change could not have been imagined barely 20 years ago. In Morocco, for example, modern contraceptive prevalence has climbed from 19% to 55% in 22 years, and in Algeria from 22% to 52% in 20 years.

94Overall, and consistent with what is observed in other regions, a strong inverse relationship exists between modern contraceptive practice and total fertility (Figure 14), with a coefficient of determination of 0.73. The phenomenon is especially clear in the extreme situations, somewhat less so in the intermediate countries: thus a contraceptive prevalence of around 30% gives fertility ranging from 3 to 6 children per woman. The relationship with marital fertility, which we have not presented due to too few data, would have been even stronger.

95As in other regions of the world, contraceptive use has spread – and continues to do so – from cities to rural areas, and from the most educated and affluent couples to the most disadvantaged couples. The fact that not all countries are yet at the same level results in clear differences between geographical and social groups by country. In the most advanced countries in terms of family planning provision (the examples of Egypt and Morocco in Table 11), social and geographical disparities are now relatively small, though educated and urban women still have a slight advantage. The disparities are much larger in countries where contraceptive use is at intermediate levels (Turkey and Jordan in Table 11). And they are enormous in Yemen, where policy on contraception is in its very early stages.

Table 11

Proportion of married women (15-49) using a modern contraceptive method, by residence and educational level (%)

Country Residence Level of education Total Urban Rural Illiterate Primary Secondary or above Egypt (2000) Jordan (2002) Morocco (2003) Turkey (1998) Yemen (1997) 59 43 56 41 21 50 36 53 31 6 50 33 54 28 8 55 36 57 39 17 59 43 56 53 31 53 41 55 38 10 Sources: Country reports from the latest DHS surveys.

Proportion of married women (15-49) using a modern contraceptive method, by residence and educational level (%)

96The modern methods of contraception used for birth spacing or birth stopping vary markedly between countries [64]. The pill is still the most widely used method in Morocco and Algeria where it has been adopted respectively by 73% and 90% of users of modern methods, whereas the IUD has become by far the most popular in Egypt, Tunisia, Palestine and Jordan, with between 55% and 65% of users. On the whole, the condom remains unpopular, except in Turkey (22%). Female sterilization, which for long was viewed negatively and seldom used, is on the increase in countries such as Morocco, Jordan and Turkey where between 5% and 10% of married women say they use a modern method; it has even become the second method in Tunisia, after the IUD. The traditional methods reported are mainly withdrawal and periodic abstinence and in some cases prolonged breastfeeding [65].

97But to what extent can the substantial reductions in total fertility described earlier be attributed to the increased age at marriage of women and to what extent to the adoption of contraception among married couples?

3 – The respective roles of contraception and nuptiality in the fertility declines

98We will confine our analysis to the three Maghreb countries – Morocco, Algeria and Tunisia – which have experienced the greatest changes in both nuptiality and contraception over the last thirty years. Indeed, these changes have at times even been described as marital and contraceptive revolutions. Here we will merely summarize the results of three recent studies [66] on Morocco (Bakass, 2003), Algeria (Ouadah-Bedidi, 2004), and Tunisia (Ayad and Jemai, 2001). The methodology they use is the Bongaarts model. This model breaks down the fertility-reducing effects of three main variables: the duration of post-partum sterility (closely related to length of breastfeeding), the postponement of marriage, and the spread of contraceptive use [67]. More specifically, it is used to “explain” the difference between a total fertility observed at a given time (5 children per woman, for example) and a hypothetical maximum or theoretical fertility (estimated by J. Bongaarts at an average of 15.3 children).

99Table 12 ranks the three main fertility-reducing factors for each country in the 1970s, 1980s and 1990s. During the 1970s, the reduction in fertility (relative to the theoretical maximum) was due primarily to post-partum sterility, but the effect of nuptiality was already perceptible whereas that of contraception was weak [68]. The latter began to develop in the three countries from the mid-1980s and increased its contribution to fertility reduction in the 1990s, as did nuptiality, through a large rise in women’s age at marriage (see Section VII). In the future, the effect of contraception is likely to increase further and that of nuptiality to stagnate, given the already late ages at marriage. Finally, the effect of breastfeeding (which has hardly altered over 25 years) will be determined by the intensity of changes in behaviour.

Table 12

The three main factors in fertility reduction (ranked by order of importance) in the Maghreb in the 1970s, 1980s and 1990s

Country c. 1975 c. 1986 c. 2000 Algeria 1. breastfeeding 2. nuptiality 3. contraception (negligible) 1. contraception 2. nuptiality and breastfeeding 1. contraception 2. nuptiality and breastfeeding Morocco 1. breastfeeding 2. nuptiality 3. contraception (weak) 1. contraception 2. breastfeeding 3. nuptiality 1. contraception 2. nuptiality 3. breastfeeding Tunisia 1. breastfeeding 2. contraception and nuptiality 1. contraception 2. nuptiality and breastfeeding 1. contraception 2. nuptiality 3. breastfeeding Sources: Summary of results from Bakass (2003) on Morocco, from Ouadah-Bedidi (2004) on Algeria and of Ayad and Jemai (2001) on Tunisia.

The three main factors in fertility reduction (ranked by order of importance) in the Maghreb in the 1970s, 1980s and 1990s

100All in all, over the last 30 years as a whole, the increase in women’s age at marriage and the growth of contraception have contributed almost equally, but not at the same time, to the rapid fall in fertility.

4 – Abortion

101Except in the two countries where it is legal – in Turkey since 1983 and in Tunisia since 1973 [69] – induced abortion is largely a taboo subject about which little is known and that receives little attention in the official surveys of the countries in the region [70]. Abortion is not mentioned explicitly in either the Koran or the Sunna (the Tradition), and the four great schools of jurisprudence [71] in Sunni Islam have adopted more or less restrictive positions on the question, ranging from absolute prohibition (the Hanbalite school in Saudi Arabia, for example) to toleration or authorization, notably when the mother’s health or life is at stake (the Malikite school in the Maghreb countries) [72].

102Consequently, there is little research on the subject, and given the lack of data, abortion is usually not considered as an intermediate variable of fertility. Some figures can nonetheless be given. An earlier study on induced abortion in 21 developing countries (Johnston and Hill, 1996) found that abortion was clearly present in Morocco, Egypt and Jordan, as well as in Yemen, but that its impact on fertility was much smaller than in Latin America or Southeast Asia. Turkey [73] alone stood out clearly. Abortion appears to have been long practised here and on a fairly large scale (United Nations, 2002); in the latest DHS survey of 1998, 27% of ever-married Turkish women reported having had at least one abortion, notably after age 35 and a second child; 15% of pregnancies in the last five years were terminated, a slightly lower figure than in the 1993 survey. The proportions in Morocco are far lower, yet even so, according to the 1995 DHS survey (Bakass and Fazouane, 2004), 2.3% of recent pregnancies (3.6% in cities, 1.6% in the countryside) were reported as terminated by induced abortion, especially – as in Turkey – after age 35 (6.4%). In Iran, in cities such as Shiraz (Ladier-Fouladi, 2003), abortion is practised unofficially, mainly when the mother’s life is in danger. In Tunisia, abortions are believed to have numbered around 20,000 annually in the 1990s, despite the intensive family planning programme (Ayad and Jemai, 2001).

103These few data on the frequency of abortion, commonly under-estimated in the world, show the emergence and possibly growing importance of the problem in the region.

1 – Constant but uneven progress since 1950

106Having stood at barely 44 years in the 1950s, life expectancy (or mean length of life) in the region as a whole is now close to 70 years [75], with average annual gains over the period 1950-54 to 2000-04 of about 0.52 years, close to those in Southeast Asia, but slightly less than in East Asia where the annual gain is 0.59 years (gains calculated from Table 13).

Table 13

Changes in life expectancy since 1950, maternal mortality and HIV prevalence c. 2000, by sub-region

Sub-region Life expectancy (years) Maternal mortality rate in 2000(a) HIV prevalence (%) end 2003(b) 1950-1954 1970-1974 1990-1994 2000-2004 North Africa Arabian Peninsula Middle East Whole region 42.8 36.5 45.2 43.5 53.0 48.5 57.2 54.8 65.7 65.1 66.0 65.8 70.3 68.3 68.8 69.3 120 29(c) 100 102(c) Ý0.1 Ý0.1 Ý0.1 Ý0.1 Sub-Saharan Africa East Asia Southeast Asia Latin America 37.4 42.9 41.0 52.0 45.3 64.2 52.0 60.5 48.2 69.2 63.8 67.9 45.9 72.6 67.2 71.3 870 60 260 170 7.5 0.1 0.6 0.6 (a) Number of maternal deaths per 100,000 live births. (b) Men and women aged 15-49. The HIV prevalence rate measures the proportion of HIV-infected persons, whether or not they have AIDS. (c) Mean calculated without Yemen, where maternal mortality is very high (570 per 100,000 births) compared with the other countries of the region. Sources: Appendix Tables A.9 and A.10. The sub-regional averages are national averages weighted by the mid-period population totals.

Changes in life expectancy since 1950, maternal mortality and HIV prevalence c. 2000, by sub-region

107Progress has been particularly rapid in the Arabian Peninsula, where the annual gain is 0.64 years, though it started from a lower level, with life expectancy of barely 33 years in Yemen (52% of the sub-region’s population) in the early 1950s. The gains accelerated markedly in this sub-region between 1965 and 1985 (Figure 15).

108Today, the region has finally closed much of the gap relative to Latin America and East Asia, though it still trails them by 2 to 3 years of life expectancy (Figure 15). It has a large lead over South Asia. In the three sub-regions, life expectancy is gradually converging towards 70 years, a figure already reached in North Africa according to these United Nations estimates.

Figure 15

Change in life expectancy by sub-region between 1950-54 and 2000-04

Change in life expectancy by sub-region between 1950-54 and 2000-04

109As in the health development of the other world regions, the speed of progress, generally rapid, has varied between countries [76], though of course they did not all start from the same position. The geographical inequalities were already present in the 1950s (Appendix Table A.9). In a few countries (Yemen, Saudi Arabia, Oman) life expectancy was below 40 years, in most it was between 42 and 46 years, while it already stood at around 56 years in Lebanon and 65 years in Israel. Figure 16 illustrates the change in life expectancy in the 20 countries between 1970-74 and 2000-04, the period in which progress was fastest and most diverse. It was particularly impressive – with mean length of life increasing by between 25% and 45% over 30 years – in the five countries of North Africa, and in Jordan and Iran, but also, if these UN data can be relied upon, in Palestine and in Yemen. In Israel and Lebanon, which started out from higher levels, progress was slower. The inequalities between countries remain today. At one extreme are Iraq, the only country where life expectancy has fallen by 3 years since 1980-1984 due to the various wars, and Yemen where it is barely 60 years; at the opposite extreme are a few countries at very advanced stages of their health transition and where life expectancies are close to those in western industrialized countries: Israel (about 80 years), United Arab Emirates (78 years) and Kuwait (77 years)

Figure 16

Change in life expectancy levels by sub-region between 1970-74 and 2000-04 in the 20 countries

Change in life expectancy levels by sub-region between 1970-74 and 2000-04 in the 20 countries

2 – The epidemiological transitions underpinning mortality decline

110Although lack of space and adequate data prevent a full illustration here, it is obvious that this passage from life expectancies of around 50 years in 1970 to close to 70 years today corresponds to a profound transformation in morbidity and cause-of-death patterns and in the age pattern of mortality. The infectious and parasitic diseases that predominated initially, particularly among children, have gradually given way to chronic and degenerative diseases and to accidents; disease and mortality risks have shifted to increasingly older ages. In simplified form, this is the classic model of the epidemiological transition.

111The age pattern of mortality can be illustrated using the example of Tunisia (Waltisperger et al., 2001). With the implementation of ambitious social and health policies from the 1960s, male life expectancy rose over a period of 26 years (between 1969 and 1995) from 52.3 to 69.6 years (a total gain of 17.3 years), and female life expectancy from 52.3 to 73.7 years (a total gain of 21.4 years, greater than that for men). Nearly 62% of the improvement for males, and 58% of that for females, stems from the reduction in under-five mortality, and above all in infant mortality [77]. The next largest improvement, though far smaller, is after age 60. The obvious effect of this is to gradually push back the age structure of mortality and to change considerably the causes of morbidity and mortality, with consequences for health policies, both preventive and curative, that are already affecting most countries in the region.

3 – Sex inequalities: a return to normal?

112Mortality decline is invariably accompanied by a change in sex differentials. A situation in which male and female life spans are roughly equal gives way to one in which women live longer than men, although the size of this difference varies between cultures and regions [78]. Excess female mortality, common at younger ages (we will return to this point) and in the childbearing ages, gradually diminishes and eventually disappears [79].

113Table 14 presents the trends in these male-female inequalities since 1960 in four countries of the region (Algeria, Egypt, Tunisia and Iran) for which we possess relatively reliable time-series for life expectancy by sex. Up to the early 1970s, when life expectancies stood at around 52 years, the differences between men and women were small. They were almost non-existent in Algeria and Tunisia, and of barely one year to the advantage of women in Egypt, while in Iran, it was men who lived longer than women [80]. From the early 1980s, the female advantage gradually became more pronounced, although the pace of this change varied. It proceeded smoothly in Tunisia and Egypt, where the sex differential currently stands at 4 years; it was much slower in Algeria, where women’s average life expectancy of 75 years is only 2 years more than men’s, and it was slower still in Iran, despite the war with Iraq (1980-88) during which a majority of the 200,000 or so victims (civilians and soldiers) were young males aged 16-30 (Ladier-Fouladi, 2003).

Table 14

Life expectancy at birth by sex in Algeria, Egypt, Tunisia and Iran, since 1960 (years)

Country Year Men (1) Women (2) Overall Difference (2)-(1) Algeria 1965 1970 1979 1981 1983 1985 1987 1995 2004 51.1 52.6 55.1 58.0 61.6 62.6 64.9 66.1 73.8 51.2 52.8 56.3 59.6 63.3 64.2 66.5 68.2 75.8 51.1 52.7 56.0 58.8 62.4 63.6 65.5 67.3 74.8 0.1 0.2 1.2 1.6 1.7 1.6 1.6 2.1 2.0 Egypt 1958-1962 1965 1975-1977 1988 2003 48.3 49.3 53.2 62.2 67.5 49.3 50.1 55.9 64.3 71.9 48.8 49.7 54.6 63.3 69.7 1.0 0.8 2.7 2.1 4.4 Tunisia 1968-1969 1973-1977 1980-1981 1984 1995 53.1 58.7 65.1 65.9 69.5 53.0 60.4 67.3 68.9 73.7 53.0 59.5 66.1 67.4 71.5 – 0.1 1.7 2.2 3.0 4.2 Iran 1974 1986 1991 1996 57.1 58.5 62.4 66.8 56.5 59.2 63.2 69.4 56.8 58.9 62.8 68.1 – 0.6 0.7 0.8 2.6 Sources: For the three countries of North Africa, Tabutin (1991), updated from national statistical agencies; for Iran, Ladier-Fouladi (2003).

Life expectancy at birth by sex in Algeria, Egypt, Tunisia and Iran, since 1960 (years)

114The sex differences in life expectancy since 1960 are nevertheless smaller in these four countries than in other world regions. For example, for a life expectancy of 65 years, the female advantage was 4.3 years in Latin America and 7 years in East Asia (United Nations, 1988) but only 2 years in South Asia, another region where women have been, and still are, subject to severe discrimination.

115In the past these small differences were due to concentrations of excess female mortality at certain ages. Until the mid-1970s, Algerian women, for example (Tabutin, 1991), experienced a large excess mortality beginning at age 6 or 7 months and lasting up to age 35; the same pattern prevailed, though with less intensity, in Tunisia. This excess female mortality – related to the status of women in society and to the risks of childbearing – subsequently declined and eventually disappeared at almost all ages (the exception being the ages of 1-4 years, to which we shall return). At present, women’s life expectancy advantage in countries like Algeria and Iran is substantially smaller than that observed in much of the world.

116In sum, the health and mortality transitions in the region have followed the classic pattern and benefited women more than men (the life expectancy differentials are increasing), but not always to the same extent as elsewhere.

4 – Maternal mortality

117Maternal deaths in the 20 countries of the region numbered roughly 15,300 in 2000, representing 3% of the world total of maternal deaths (for 6.5% of the world population) [81]. But in this region as elsewhere, national estimates of maternal mortality, that WHO defines as the death of a woman while pregnant or within 42 days of delivery, must be treated with considerable caution. In the absence of cause-of-death statistics these are usually indirect estimates, based on various possible definitions and calculation methods [82], and should be taken simply as orders of magnitude [83]. The data by country are given in Appendix Table A.10, and the sub-regional estimates in Table 13.

118For the region as a whole, the average maternal mortality rate is around 1 death per 1,000 births (Table 13). This is far better than in sub-Saharan Africa (1 death for 115 births), but better also than in Southeast Asia or even in Latin America (1 death per 590 births). Nevertheless, for women in the region, the risk of dying during their reproductive life is around one in 100 – compared with one in 4,000 in the industrialized countries – making maternal mortality a major public health issue (WHO, 2003).

119The phenomenon is characterized by great geographical diversity. On average, maternal mortality is particularly low in the countries of the Arabian Peninsula (29 deaths per 100,000 births), if Yemen, where it is the highest (570 deaths) of the region, is excluded from the calculation. It is between three and four times higher in the Middle East and North Africa (Table 13). At one extreme are the countries where maternal mortality is practically “under control” (Israel, Qatar, Kuwait, with 17 deaths per 100,000 births, comparable with European levels); at the other are Syria, Lebanon, Iraq, Algeria and Morocco, where it still ranges between 140 and 250 deaths per 100,000 births. Intermediate levels prevail in the three large countries: Egypt, Iran and Turkey.

120Although maternal mortality seems to have declined locally over the last ten years, vast progress remains to be made. Such progress depends both on the supply of health care (quality and quantity of services) and on demand from the population for pregnancy monitoring, safe delivery conditions and post-natal care. We will examine these questions in the next section.

5 – The threat of AIDS

121Compared with other world regions, HIV prevalence (percentage of people aged 15-49 infected with HIV) is low in North Africa and the Middle East (Table 13). The average prevalence calculated for the 20 countries [84] is only around 0.1%, the same as in East Asia but substantially lower than in Southeast Asia (0.6%), Latin America (0.6%) and above all sub-Saharan Africa (7.5% in late 2003) [85]. According to United Nations estimates, national prevalence currently ranges from under 0.1% to 0.3% in Libya (Appendix Table A.10). Many public health specialists are concerned about the pandemic however [86], since there are many signs that sexually transmitted diseases, HIV/AIDS in particular, are increasing rapidly in the region, in certain countries at least. For example, we estimate that the number of infected persons in the region rose from around 60,000 in late 2001 to nearly 100,000 in late 2003 [87]. Some countries are particularly badly affected. Algeria, where the number of HIV infected people is thought to have increased from 6,800 to 9,100 over these two years, Libya (from 7,000 to 10,000), Iran (from 18,000 to 31,000), and some of the Gulf states such as Kuwait, Oman and Qatar. Israel, Egypt and Lebanon are all confronted by the same problem. Indeed, some commentators see HIV/AIDS as the third most important cause of morbidity affecting the adult population in the poorest countries of the region.

122These figures must be treated with great caution, however, since most of the countries as yet possess no adequate surveillance system, notably for high-risk groups, and conduct little research in this field. Few have made it a clear priority for action. Only Tunisia, Iran, Morocco and Yemen have initiated clear national strategies for awareness [88] and action (Jenkins and Robalino, 2003).

123Yet national and foreign health experts all agree on the need to act while prevalence levels are low, especially since conditions in many countries favour the development of the pandemic: large-scale migration, increased injecting drug use (in Iran, for example), high levels of poverty and unemployment (particularly among young people) more or less everywhere, plus localized conflict and violence.

1 – Substantial progress since 1960

126Infant mortality rates in the 1950s (Table 15) were still extremely high throughout the developing regions, with little difference between them. Excluding South America, already ahead in this respect, infant mortality ranged from 168‰ to 192‰ (regional averages). If these estimates for the past can be relied upon, the Arabo-Muslim world, and the Arabian Peninsula in particular (219‰), even presented a slight excess mortality compared with the other regions.

Table 15

Infant mortality by sub-region, 1952-2002

Sub-region Infant mortality rate (‰) Change (%) 1952 1972 1992 2002 1952-1972 1972-1992 1992-2002 North Africa Arabian Peninsula Middle East Whole region 189 219 192 192 130 135 113 121 58 49 52 54 36 38 42 39 – 31 – 38 – 41 – 37 – 55 – 64 – 54 – 55 – 38 – 22 – 19 28 Sub-Saharan Africa East Asia Southeast Asia South Asia Latin America 177 181 168 187 126 134 56 108 131 84 109 44 54 84 39 101 32 40 69 26 – 24 – 69 – 36 – 30 – 33 – 19 – 21 – 50 – 36 – 54 – 7 – 27 – 26 – 18 – 33 Source: Appendix Table A.9, United Nations (2005).

Infant mortality by sub-region, 1952-2002

127The situation quickly began to change, but the pace of the change varied (Figure 17). Infant mortality in East Asia (including China) fell sharply from the 1960s before stabilizing at around 40‰ from 1980. Progress was much slower in South Asia, while it was fairly steady and rapid in the three sub-regions of interest here, especially in the Arabian Peninsula between 1970 and 1990 (excluding Yemen).

Figure 17

Infant mortality between 1950-54 and 2000-04, by sub-region

Infant mortality between 1950-54 and 2000-04, by sub-region

128Today, with infant mortality at around 39‰, the level in the region as a whole (20 countries) is the same as in Southeast Asia, but higher than in East Asia (32‰) and Latin America (26‰). The six Gulf states (19‰) alone stand out as exceptions to the general rule.

129These aggregate-level changes conceal the diversity in progress and in mortality levels by country, illustrated by Figure 18 that compares national infant mortality in 1970-74 and 2000-04. On the one hand, Israel, the most developed country, where infant mortality is only 5-6‰ (close to European levels); on the other, Yemen, the poorest country, where it is around 70‰. In Palestine, despite high fertility, economic hardship and the conflict with Israel, immense progress has been made in reducing infant mortality (currently around 20‰), with an effective health care system funded mainly by outside sources (oil producing countries, the Palestinian diaspora, international organizations). After three wars and a protracted embargo, Iraq is the only country where no progress has been registered, and infant mortality is at the same high levels as in the late 1960s (94‰ in 2000-04). Over this 30-year period, infant mortality fell in most of the other countries by 70-90%, the pace of improvement being unrelated to initial levels (in 1970-74). Turkey has not caught up with Morocco, Algeria, Egypt and Iran, and mortality here still exceeds 40‰ at the national level [91].

Figure 18

Infant mortality in the 20 countries of the region, between 1970-74 and 2000-04

Infant mortality in the 20 countries of the region, between 1970-74 and 2000-04

130Beyond these overall changes, strong spatial and social differentials in infant and child mortality are observed in every country, frequently varying by a factor of 3 or 4 between regions, places of residence, or social groups. We return to this point later.

2 – Marked changes in the age pattern of under-five mortality

131In historical mortality transitions, the progress achieved does not benefit all ages equally. The same is true for under-five mortality, which by convention is broken down into neonatal mortality (under one month), post-neonatal mortality (between one and twelve months), and child mortality (between one and five years). A reduction has been achieved in each of these components, but at different paces and following different chronologies.

132By way of illustration we will take the example of Egypt between 1965 and 1998 (Figure 19). The history of under-five mortality there is consistent with the classic pattern. The gradual control (preventive and curative) of infectious and parasitic diseases had its greatest effect on mortality between 1 and 5 years, which plummeted from 119‰ in 1967 to 11‰ in 1998. Progress was also achieved against mortality between 1 and 12 months, though on a smaller scale (from 83‰ to 21‰). Meanwhile, neonatal mortality, more closely dependent on the mother and on the conditions of pregnancy and delivery (low birth weight, congenital malformations, etc.), declined later and more slowly.

Figure 19

Neonatal, post-neonatal, and child mortality in Egypt, 1967-98

Neonatal, post-neonatal, and child mortality in Egypt, 1967-98

133The contrasting pace of these declines results in a radical and rapid transformation of the age patterns of mortality in the first years of life in most countries of the region. The gradual concentration of mortality risks in the first weeks or months of life has implications for action and policy in the areas of infant and child health, given that that reductions in mortality are more difficult and expensive to achieve at these early ages.

3 – Excess female child mortality: an ever-present problem

134In the 1970s and 1980s, North Africa and the Middle East, in common with the other world regions, experienced excess female child mortality at ages 1-5 that was particularly high and early, often beginning at the age of 2 or 3 months. In other words, when female children emerged from the period of endogenous risks and entered the ages of morbidity and mortality from infectious and parasitic diseases, they rapidly lost their initial biological advantage and became more at risk than male children (Tabutin and Willems, 1995; Tabutin and Gourbin, 1997). With the decline in mortality at early ages, notably through the greater control of infectious diseases, this excess mortality of female children has almost or entirely disappeared from many countries of the world and been replaced by a general excess mortality of male children. Often this has occurred when life expectancies approach 65 years [92].

135The countries of the region have not followed this pattern. At present, with life expectancies around or above 70 years, and with relatively low infant and child mortality (regional average under-five probability of dying: 30‰), excess female mortality at ages 1-5 is still observed at significant levels in virtually all the countries of the region. According to Table 16, which gives the probabilities of dying (both sexes) at these ages and the sex ratios of the probabilities for 10 countries, this excess mortality ranges between 10% and 30% depending on the country, and there is no link with the mortality level. This has been a constant feature since 1970 in Algeria, Morocco, Egypt and Tunisia (Table 16), despite impressive mortality and fertility declines and substantial improvements in social welfare, education and health care.

Table 16

Excess mortality of female children (1-5 years) in selected countries, 1970-2000

Country and date Probability of dying (‰) between 1 and 5 years (both sexes)(a) Ratio (%) of male probability to female probability Algeria 1970 1981 1985 1992 1996-1998(b) 83 31 20 6 8 92 92 87 70 93 Egypt 1988 1992 1995 2000 42 31 25 16 82 70 77 91 Morocco 1979 1987 1992 2003 52 31 22 10 73 98 88 83 Tunisia 1969 1980 1996 66 29 8 85 93 79 Libya 1995 6 84 Lebanon 2000 7 70 Bahrain 1988 4 80 Jordan 2000 5 100 Yemen 1997 32 84 Turkey 1992 1998 13 12 90 78 (a) Probability of dying between the first and fifth birthdays. (b) Averages calculated from the three official life tables based on civil registration (ONS, 2005). Sources: Tabutin and Gourbin (1997) updated from most recent surveys.

Excess mortality of female children (1-5 years) in selected countries, 1970-2000

136The factors and mechanisms that account for the persistence of this historical excess female child mortality, usually attributed to differential behaviour by families and communities in the care and attention given to children, deserve special attention throughout the region.

4 – Spatial inequalities in healthcare

137To illustrate the health situation of the region and shed light on geographical inequalities in under-five mortality, we will examine three important practices for the health of mother and child: antenatal care, assistance at delivery, and vaccination. We will then make a few remarks about malnutrition, relatively prevalent in the region.

138Based on the most recent data, Appendix Table A.11 presents for each of the 20 countries the probabilities of dying at ages 0-1 month, 0-1 year, and 0-5 years, the proportion of births occurring without antenatal care, the proportion of children receiving the full set of vaccinations (BCG, DPT, polio and measles), and the proportion of children suffering from chronic malnutrition (moderate and severe). Table 17 gives all these indicators as sub-regional averages, from which Yemen and Iraq have been excluded because of their particularly poor health situation compared with the other countries.

Table 17

Mortality under one year and under five years, antenatal care, delivery conditions, vaccination and child malnutrition, by sub-region, c. 2000

Sub-region Probability of dying (‰) % of births without antenatal care % of deliveries unattended by skilled health personnel % of children fully vaccinated % of children with chronic malnutrition(a) Below one year 0-5 years North Africa (5) Arabian Peninsula (6) Middle East (7) Total (18) Yemen and Iraq (2) 32 16 26 25 85 39 20 32 30 105 25 6 18 16 45 20 4 9 11 54 88 88 82 86 42 17 17 14 16 37 (a)Under age five in most of the surveys. Source and definitions of indicators: Appendix Table A.11. The sub-regional figures are non-weighted averages of national results. Yemen and Iraq are presented separately because of their particularly poor health situation compared with the rest of the region. Figures in brackets indicate the number of countries per sub-region.

Mortality under one year and under five years, antenatal care, delivery conditions, vaccination and child malnutrition, by sub-region, c. 2000

139Taken as a whole, the region is still far from achieving full coverage in antenatal care. Among mothers in 18 countries (Table 17), 16% on average, or more than one in six, give birth without any form of antenatal care. Above all, enormous disparities, reflecting health policies, are observed between sub-regions and between countries – sometimes neighbouring ones – within sub-regions. The proportion receiving no antenatal care rises from just 6% in the Arabian Peninsula to 18% in the Middle East and 25% in North Africa. By far the highest coverage is found in the small Gulf states, plus Jordan and Tunisia [93] (between 92% and 98% of pregnancies, Appendix Table A.11), followed by Palestine, Lebanon, and Saudi Arabia (around 90%). By contrast, in four countries, among the largest by population size, coverage is seriously deficient: Syria, Turkey and Morocco (around 66%) and most of all Egypt, where barely one in two pregnancies receive antenatal care. That proportion is only one in three in Yemen.

140Equally large geographical inequalities are observed for medical assistance at delivery (Appendix Table A.11, Table 17). The situations range from what can be described as near excellent in the United Arab Emirates, Israel and Jordan (where 96% to 99% of deliveries are attended by skilled health personnel), through relatively good (around 90%) in Algeria, Tunisia, Iran, Palestine, Lebanon and Turkey, to seriously deficient in Iraq and Syria (between 70% and 80%) and especially, once again, in Egypt and Morocco (between 60% and 70%). As for Yemen, only 22% of births are attended by skilled personnel, a level between those of Ethiopia and Rwanda, two of the most disadvantaged countries in sub-Saharan Africa (Tabutin and Schoumaker, 2004).

141Although imperfect, a certain relationship exists between these two indicators of pregnancy monitoring and medical assistance at birth, and the level of neonatal mortality. The countries that rank lowest in this respect, Egypt, Morocco and Turkey (the latter for antenatal care at least), plus Yemen of course, are those where neonatal mortality is the highest in the region (Appendix Table A.11).

142Vaccination coverage, while not total, is relatively high in the region, with 86% of children on average receiving the full set of basic vaccinations (versus 45% in sub-Saharan Africa) circa 2000 (BCG, DPT, polio and measles). Coverage levels generally range between 82% in Syria and 92% in Egypt (which stands out on this variable) or 95% in Iran. Three countries lag badly behind: Yemen (24%, a figure among the lowest in the world) and Iraq (61%) but also Turkey where, in 1998, fewer than one in two children were fully vaccinated [94]. There are no instances of significant sex differences. Nor is any relationship observed between vaccination levels (fairly uniform) and levels of child mortality [95].

143As a result of poor living conditions, low incomes and poverty experienced by a proportion of the population, child malnutrition remains a major problem in the region, with nearly 16% of children (regional average, Table 17), or more than one in six, suffering from chronic malnutrition (all degrees) and nearly one in thirteen from severe malnutrition [96]. The situation in the region is far better than in South Asia (44% of children malnourished) or in sub-Saharan Africa (38%), but behind Latin America and East Asia. Malnutrition is rife everywhere, in North Africa (between 12 and 19% of children depending on the country), in the Middle East (although it appears to be lowest in Jordan and Palestine, at close to 8%) as well as in some wealthy countries of the Arabian Peninsula (notably Kuwait and Saudi Arabia). The level of child malnutrition in Yemen (52%) is comparable to that in the worst affected countries of sub-Saharan Africa (Ethiopia, Madagascar, Zambia and Nigeria).

144All these national-level indicators obviously conceal numerous disparities within countries.

5 – Strong social and spatial inequalities within the countries

145However different their political and economic histories, all the countries of the region – as elsewhere – present major social and regional inequalities in child health and mortality. Without dwelling here on this complex question, of key importance for public health policy, we look at the example of Morocco, a country with close to 32 million inhabitants today, where the demographic transition is proceeding quite rapidly and where, in common with other countries, social and regional inequalities are large [97]. Table 18 presents the variability of child mortality and health indicators by living environment, mother’s level of education, and living standard of the household.

Table 18

Under-five mortality, conditions of delivery, vaccination and malnutrition, Morocco, c. 2003, by mother’s residence, educational level and household living standard

Under-five mortality(a) (‰) Childbirths with antenatal care (%) Births attended by skilled health personnel (%) Vaccinated children aged 12-23 months (complete vaccination) (%) Malnourished children(b) (%) Relative weight of each group (%) Place of residence Urban Rural 38 69 85 48 85 40 94 84 13 24 60 40 Level of education None Primary Secondary or above 63 42 27 55 79 93 49 77 95 86 92 96 23 14 10 50 20 30 Living standard quintile First (poorest) Second Third Fourth Fifth (richest) 78 65 47 37 26 39 56 71 87 93 30 50 70 86 95 81 85 91 95 97 29 20 16 11 10 18 19 20 21 22 Total 55 68 63 89 18 100 (a) Probability of dying between birth and age five. (b) Height-for-age index as measure of chronic malnutrition (moderate and severe) in children under five. Source: DHS survey report, 2003.

Under-five mortality, conditions of delivery, vaccination and malnutrition, Morocco, c. 2003, by mother’s residence, educational level and household living standard

146As elsewhere, urban populations in Morocco are much more privileged than those living in rural areas, though their situation is far from perfect. Under-five mortality in rural areas is practically double the level in the cities, while antenatal care and medical assistance in delivery are half as frequent, and chronic malnutrition, already present in the cities (13% of children), is twice as common [98]. Only on the vaccination variable are the differences reasonably small [99].

147In Morocco, as elsewhere, education and living standards have a considerable influence on health practices and behaviour (Table 18). Under-five mortality varies by a factor of over two with educational level, and by a factor of three with living standards. The mothers’ level of education introduces sharp contrasts in behaviour and practices, ranging from low use of medical services for pregnancy and delivery (one in two children) among illiterate women, to almost total coverage among the most educated women, although 10% of the latter’s children suffer chronic malnutrition (moderate and severe) [100]. The inequalities are further increased by differences in the standard of living. Overall, all the indicators improve from one income quintile to the next (Table 18). The situation of the poorest 20%, like that of the next lowest quintile, is particularly alarming. Excepting vaccination, between half and two thirds (depending on quintile) of women or children have no contact with the modern health system; nearly one in ten children suffer from severe chronic malnutrition, nearly one in seven from moderate malnutrition (figures not presented here). Poverty – material and cultural – clearly remains a key factor in child health.

1 – Growing heterogeneity between sub-regions and countries

150The age-sex structures of the populations of the sub-regions and countries are quite diverse. The structures for North Africa and the Middle East are very similar, reflecting the relative proximity of fertility transitions at the sub-regional level, but that of the Arabian Peninsula by contrast is considerably younger, due to the young populations of Yemen and Saudi Arabia. It is also characterized by a large sex imbalance, with 23% more men than women, the result of immigration by foreign male workers. The heterogeneity of age-sex structures between countries is of course much greater (see Appendix Table A.12). In Israel, for example, the proportion aged 60 or over already exceeds 13%, whereas in many countries it is around 6%, and even close to 3% in the Gulf states. Young people under 15 account for nearly half the population in Yemen and Palestine, but barely a quarter in the United Arab Emirates. And the sex ratios vary from 96 men for 100 women in Lebanon to over 200 (twice as many men as women) in the United Arab Emirates! This heterogeneity in age and sex structures results not just from the diversity of fertility histories but also from international migration, particularly in the Gulf States (see below).

151We will now take a closer look at the changes in the age pyramids between 1950 and 2000 and the projections to 2020 in four countries (Yemen, Egypt, Tunisia, Iran) with differing experiences of fertility transition (Figure 20). In 1950, none of these countries was yet engaged in the fertility transition, nor had they experienced large-scale migration: consequently they had very similar age and sex structures. By 2000 the situations were much more diversified, and they will become more so in the years ahead. The case of Yemen is typical of a country where fertility has undergone little or no change. Its population in 2000 is very young, younger in fact than in 1950, because mortality reduction has concerned mainly children. Between now and 2020, population ageing will occur, though on a moderate scale. As we have seen, the fertility decline in Egypt began quite early but has been rather erratic and generally fairly slow, and fertility currently stands at around 3.5 children per woman. This change is reflected in the age structure of the population in 2000: the base of the pyramid has narrowed but children aged 0-4 are still as numerous as those aged 5-9. The base of the pyramid will continue to narrow until 2020, at a relatively moderate pace. By contrast, the changes in Tunisia and Iran are much larger and this trend is set to continue. Fertility decline in Tunisia has been far more consistent than in Egypt, and the total fertility rate (2.0 children per woman) is now considerably lower. This is reflected in a marked narrowing of the base of the pyramid: in 2000, there are 15% fewer children aged 0-4 than aged 5-9, who in turn are less numerous than those aged 10-14. The ageing of the pyramid will continue fairly steadily in the years ahead, and the under-15s, who made up 30% of the population in 2000, will be no more than 20% or so in 2020. Finally, the case of Iran illustrates the changes to the age structure associated with a late but very rapid fall in fertility from 1985. From 2000, we see a marked narrowing of the pyramid’s base, with almost 30% fewer children aged 0-4 than aged 5-9. Contrary to the situation in Tunisia, the coming decades will see major changes in the age structure, with large fluctuations in the number of births and in the size of the other age groups.

Figure 20

Population pyramids in 1950, 2000 and 2020 in 4 countries

Population pyramids in 1950, 2000 and 2020 in 4 countries

2 – The effects of a rapid fertility decline: the example of Iran

152We can illustrate the effects on age structure of a sharp decline in fertility by observing the fluctuations in the numbers of school-age children (aged 6-11 and 12-17) in Iran between 1980 and 2050 (Figure 21).

Figure 21

Populations aged 6-11 and 12-17 in Iran, 1980-2050

Populations aged 6-11 and 12-17 in Iran, 1980-2050

153Between the 1980s and 1995, the number of 6-11 year-olds increased rapidly from just over 6 million to 11 million (annual growth of 3.6%); the number of 12-17 year-olds followed a similar course at a few years’ interval. After this first peak, the school-age population started to contract as the number of births declined in the 1990s. The number of 6-11 year-olds drops back to just under 7 million in 2010; the 12-17 year-olds are expected to reach this figure in 2015. Despite the fall in fertility, births will increase again after 2005 or thereabouts, as large numbers of women reach the ages of highest fertility. This will lead to a renewed increase in the number of 6-11 year-olds after 2010 and of 12-17 year-olds shortly afterwards. From 2025-2030 they will start to decline, though their numbers will continue to oscillate for several decades. As can be seen, Iran will face extreme fluctuations in the age structure of its population, affecting the organization of the educational system, for example. This will also be the case, albeit to a lesser degree, in other countries where fertility has fallen sharply over a short period (Algeria, Libya, etc.). What we have shown for the school ages will apply equally to the ages of entry into the labour force (18-25 year-olds) or of union formation (20-30 year-olds), and hence to the problems of employment and housing.

3 – Dependency ratios and demographic dividends

154Another short-term consequence of the fertility declines is (or will be) a more or less rapid fall in dependency ratios [101] in the countries of the region. We will again take the four countries in Figure 20 and examine the change in their dependency ratios between 1950 and 2050 (Figure 22). In Tunisia and Iran, the countries furthest advanced in the fertility transition, the dependency ratios are currently very low, around 50%. In other words, in these countries, working-age individuals are twice as numerous as young people under 15 and persons aged 65 and over. The change has been particularly rapid in Iran, as a logical result of the abrupt decline in fertility since the mid-1980s. The ratio fell from 87% in 1995 to 50% in 2005, and will probably reach 42% in 2010. In Egypt, the change has occurred more slowly, and the dependency ratio stands at about 60%. Yemen, in the very early stages of transition, still has as many young and elderly people as adults aged 15-64.

Figure 22

Dependency ratios (%) in four countries, 1950-2050

Dependency ratios (%) in four countries, 1950-2050

155The fall in dependency ratios indicates a reduction in the demographic pressure that young people exert on the working-age populations (in particular by reducing the investments needed for their health and education), which has potentially important social and economic implications. In a favourable economic environment it may be possible to “reap” what are sometimes termed the “demographic dividends” associated with these changes in population age structures, in the form of more rapid economic growth and human development. Clearly, this depends on a great many other economic and political factors (Bloom, Canning and Sevilla, 2003). Will the countries of the region be able to capitalize on the short- and medium-term benefits of these structural changes?

4 – Atypical pyramids: the effect of migration

156Though fertility is generally the main factor, at least initially, behind changes in age structures, migratory movements also exert a strong influence in some countries of the region. This is the case for the oil-producing countries of the Arabian Peninsula with large populations of migrants (see section XIV). The type of imbalance encountered in the demographic structures of these countries is well illustrated by the age pyramid of Bahrain in 2004 (Figure 23), which distinguishes between Bahrain nationals and foreign nationals (nearly 40% of the total population). For the Bahrain nationals the population pyramid is of a fairly classic shape, with a slight narrowing of the base indicating a fall in fertility, but the structure of the total population is very different. The population presents a distinct “bulge” at the working ages (20-55 years), associated with the presence of foreign workers, men being heavily over-represented at these ages (160 men for 100 women). The sex ratio, which stands at 102 men for 100 women among Bahrain nationals, reaches 227 for foreigners and 136 for the total population. Atypical structures like these are observed in all the Gulf countries, with more or less extreme situations depending on the size of the migrant communities.

Figure 23

Age and sex structure by nationality of the resident population of Bahrain in 2001

Age and sex structure by nationality of the resident population of Bahrain in 2001

1 – Disparate levels and trends

158The region is far from homogeneous however. As with other variables, urbanization levels and trends differ significantly between sub-regions and between countries. By the early 1950s, levels ranged from less than 5% in Oman to nearly 80% in Qatar (Figure 24). Excluding these two countries, they ranged from 6% in Yemen to 66% in Israel, with a majority of countries reporting urbanization levels of 20-40%. Fifty years later, percentages ranged from 25% in Yemen to 96% in Kuwait, with 8 countries over 80% (versus a single one in 1950), and 18 of the 20 countries above 50%.

Figure 24

Urbanization level (%) in 1950 and 2000 in the 20 countries of the region

Urbanization level (%) in 1950 and 2000 in the 20 countries of the region

159The changes have been especially pronounced in the Arabian Peninsula (Table 20). Back in the 1950s, its urbanization level was very low, and comparable to that of sub-Saharan Africa in the same period. Today, nearly two-thirds of its population lives in towns and cities [103]. In 1950, the urbanization level was already above 50% in four countries: Kuwait, Bahrain, Qatar, and United Arab Emirates. But the current rapid trend is largely fuelled by the sub-region’s largest country: Saudi Arabia. Its level of urbanization has increased from 17% to 86% in 50 years, with an urban population that has been multiplied by 33, from 560,000 inhabitants to more than 18 million. This country alone accounts for 60% of the sub-region’s urban growth. The urban population today exceeds 75% in all six Gulf countries. Yemen is the clear exception, with barely 25% of urban dwellers. This trend in the Gulf countries, sometimes referred to as oil-driven urbanization, is partly due to the influx of foreign labour from neighbouring countries and Asia. We return to this point later.

160North Africa has experienced far slower urbanization, and is the most sluggish of the three sub-regions. The proportion of urban dwellers has edged up from 28% in 1950 to just over 50%, making North Africa the least urbanized of the three sub-regions. This relative lag is largely due to the slowdown of urbanization in Egypt: from being the region’s most urbanized country in 1950 with a level of 32%, it has fallen well behind the others at 42%. Conversely, Libya, one of the least urbanized countries in 1950 at 18%, now leads the group with 85%. Algeria, Morocco, and Tunisia have registered fairly similar trends, with the percentage of urban dwellers rising from between 20 and 30% to about 60% in 50 years. All in all, North Africa’s situation is far more diversified today than half a century ago.

161Urbanization has also advanced at varying speeds in the Middle East. Overall, the pace has been quicker than in North Africa, but slower than in the Arabian Peninsula. Israel, already the most urbanized country in 1950 (66%), now has 91% of its population living in urban areas. Lebanon went from 33% to 87% in 50 years, whereas Syria, from a comparable starting point in 1950, has only now crossed the 50% mark. Iran, Iraq, Jordan, Palestine, and Turkey post levels of between 64% and 79%, around 30-40 percentage points more than in 1950.

2 – The emergence of mega-cities

162In parallel with the growth of the urban population, the past fifty years have seen an increase in the number of large and very large cities. In 2000, the region had 31 cities of over one million inhabitants (including 14 capitals), compared with only three a half-century earlier (Alexandria, Cairo, and Tehran). There are now four cities with more than 5 million inhabitants: Cairo, Tehran, Baghdad, and Istanbul. According to the United Nations urbanization prospects (2004), Riyadh is expected to join the group by 2015. The region’s most populous metropolis, Cairo, has over 10 million inhabitants, and could reach 13 million by 2015 (Table 21). Such large cities are centres of innovation and of social and economic progress. Most of them, however, also face severe problems in such areas as employment, pollution, access to drinking water, and housing (Grenon and Batisse, 1988).

Table 21

Change in population of main cities in selected countries of the region, 1950-2000, and prospects for 2015

Cities Country Population (in thousands) Mean annual growth rate (%) % of country’s total population in 2000 % of country’s urban population in 2000 1950 1975 2000 2015 1950-1975 1975-2000 Algiers Baghdad Beirut Casablanca Damascus Istanbul Cairo Riyadh Sanaa Tehran Tel Aviv Tripoli Algeria Iraq Lebanon Morocco Syria Turkey Egypt Saudi Arabia Yemen Iran Israel Libya 469 579 335 625 367 967 2,436 111 46 1,041 418 106 1,507 2,814 1,500 1,793 1,122 3,600 6,437 710 141 4,273 1,206 611 2,761 5,200 1,639 3,344 2,105 8,744 10,398 4,519 1,264 6,979 2,752 1,877 3,260 7,390 2,174 4,579 2,849 11,302 13,123 7,155 2,658 8,457 3,542 2,497 4.7 6.3 6.0 4.2 4.5 5.3 3.9 7.4 4.5 5.6 4.2 7.0 2.4 2.5 0.4 2.5 2.5 3.5 1.9 7.4 8.8 2.0 3.3 4.5 9 21 48 11 13 13 15 21 7 11 45 35 16 31 56 21 25 20 37 24 29 16 49 42 Source: United Nations (2004c).

Change in population of main cities in selected countries of the region, 1950-2000, and prospects for 2015

163In some countries, these large cities concentrate a sizeable share of the total population (Table 21). Nearly half of the Lebanese population lives in Beirut, 45% of Israelis reside in Tel-Aviv, and one-third of the Libyan population lives in Tripoli. The three cities also concentrate between 42% and 56% of the urban population – the sign of an unquestionable “macrocephalia” in these countries. The urban system is more balanced in other countries such as Morocco, Algeria, Turkey, and Iran. Casablanca, for example, accounted for only 21% of Morocco’s urban population and 11% of its total population in 2000. Morocco has six other cities of more than 500,000 inhabitants (Rabat, Fez, Marrakech, Agadir, Tangiers, and Meknes), plus 13 other cities with a population of between 100,000 and 500,000. Another example is Iran, with 56 agglomerations of more than 100,000 inhabitants in addition to Tehran, including five exceeding one million inhabitants.

3 – Slower urban growth

164By and large, the phase of strong population growth (in relative terms) in large cities is over. Of the 12 cities listed in table 21, 10 registered substantially slower growth between 1975 and 2000 than between 1950 and 1975. For example, Tehran, whose population grew an average 5.6% a year between 1950 and 1975, expanded by “only” 2% a year between 1975 and 2000 and, according to United Nations forecasts, is set to grow at an annual pace of 1.3% until 2015. The only exceptions among these 12 cities are Riyadh and Sanaa. Riyadh has continued to expand by more than 7% a year, its population thus doubling in less than 10 years. For Sanaa, growth has accelerated from 4.5% to 8.8%, due partly to the return of Yemenis from Saudi Arabia during the Gulf War (1990-91).

165This slower growth of large cities reflects a broader pattern of slower urbanization, due to the decline in natural growth and in migration growth. In all 20 countries except Yemen, urban growth rates in 2000-05 are considerably lower than in the 1970s: they have fallen from 3-5% in most countries in 1970-75 [104] to around 2% in 2000-05. However, the slowdown in large cities is, on average, sharper than in urban areas as a whole. The large cities’ share of total urban population has therefore decreased substantially in many countries. Algiers concentrated 23% of Algeria’s urban population in 1975, compared with only 16% in 2000; roughly 16% of Iran’s urban population now lives in Tehran, down from 28% in 1975. In some other countries, by contrast, the share of the urban population living in the largest city has remained relatively stable (Cairo, Tripoli, Istanbul, Damascus); in a few others – Sanaa, Riyadh, Tel Aviv – it has increased.

1 – Intensive and sharply polarized migration flows

167Generally speaking, the North Africa-Arabian Peninsula-Middle East region is characterized by intensive migration. Around 2000, it comprised 22 million international migrants. In other words, nearly 6% of the region’s entire population consisted of persons born outside their country of residence. This proportion – far higher than those observed in other developing regions [106] – reflects several factors including the appeal of the Gulf countries for Arab and Asian workers, significant immigration to Israel, and flows of refugees, chiefly Palestinian. In about 2000, international migrants accounted for over 10% of the population in eleven of the region’s twenty countries, and for over 30% in seven (Qatar, Kuwait, United Arab Emirates, Bahrain, Israel, Jordan, and Palestine). Far from being homogeneous, however, the region also includes countries with heavy emigration, such as Morocco, Algeria, and Turkey. The sub-regional and inter-country disparities in the proportions of migrants are therefore extremely large (Appendix Table A.13). The proportion ranges from under 1% in North Africa, a source of heavy emigration, to 6% in the Middle East and 20% in the Arabian Peninsula – and this figure rises to 31% if we exclude Yemen from the sub-region. Inter-country differences are even wider, with the proportion of migrants as low as 0.1% in Morocco and as high as 70% in Qatar.

168Net migration rates in the late 1990s (Appendix Table A.13) broadly confirm this contrast between strongly attractive immigration countries on the one hand and emigration countries on the other. The annual migration balances are negative in North Africa except for Libya (–2.1‰ for Morocco, –1.3‰ for Algeria); the Middle East comprises high-immigration countries (9.6‰ in Israel) and emigration countries (–1.4‰ in Iran, –1.8% in Lebanon); the Gulf countries, apart from Oman, registered positive net migration in the 1995-2000 period, with rates as high as 40‰ for the United Arab Emirates [107].

169This wide variety of country situations has been shaped by a number of factors including sometimes turbulent political histories, armed conflicts, and major economic changes. In sum, the nature and causes of these migration flows are highly diverse, and migration takes multiple forms – temporary or permanent, spontaneous or forced, legal or clandestine, and so on. Without elaborating on migration flows, which are complex and not always well documented, we will focus on four key elements of the region’s migration dynamics: (1) migration to the Gulf oil economies, (2) settlement migration in Israel, (3) displacements of the Palestinian population and its present distribution, and (4) migration flows to western countries from the countries of the region [108].

2 – Migration to the Gulf: a slowdown in the 1990s

170As noted earlier, the countries of the Arabian Peninsula – particularly the six members of the Gulf Cooperation Council [109], harbour a large migrant population. Between them, they had nearly 10 million foreign-born residents in about 2000, i.e. approximately one-third of their total population, and almost half of the region’s total migrants.

171This migrant population, largely composed of temporary workers of Asian and Arab origin, has expanded considerably in the past 30-40 years (Figure 25). Already under way in the 1930s and 40s with the fledgling oil industry, the influx of foreign labour in the Gulf countries began to accelerate substantially in 1973-74 with the increase in oil revenues and in industrial and infrastructure investment in these countries (Seccombe and Lawless, 1986; United Nations, 2003). Saudi Arabia, which hosted only 300,000 migrants in 1970, now has more than 5 million. In the United Arab Emirates, the data show a rise from 60,000 migrants in 1970 to 2 million in 2000 (Figure 25 and Appendix Table A.13). These six Gulf countries have seen their migrant population expand tenfold since 1970, and fortyfold since 1960!

Figure 25

Change in migrant stock in 6 Gulf States, 1960-2000

Change in migrant stock in 6 Gulf States, 1960-2000

172The increase in the migrant population, in absolute and relative terms, slowed considerably in the 1990s however. In five of the six countries (Bahrain being the exception), the growth in migrant stock was significantly smaller in the 1990s than in the 1980s. In Saudi Arabia, for example, the annual average increase in migrant numbers slowed from about 240,000 in the 1980s to about 100,000 in the 1990s. Kuwait actually lost a large share of its population, with 450,000 fewer migrants in 2000 than in 1990. There are several reasons for these slowdowns. Iraq’s invasion of Kuwait in 1990 and the ensuing war substantially affected migration in the region, particularly in Kuwait. Some 250,000 Jordanians, mostly of Palestinian origin, and about 160,000 Egyptians are believed to have left Kuwait after the conflict (United Nations, 2003). The Gulf War also impacted the migrant population of other countries: according to some estimates, several hundred thousand Yemenis left Saudi Arabia in the early 1990s (United Nations, 2003; Stevenson, 1993). Another contributing factor is the Gulf countries’ stricter migration policies, aimed at reducing their dependence on foreign labour: one example is the “Saudization” policy [110].

173The geographic origin of migrants in these countries has also shifted significantly in the past three to four decades, with a growing share of workers now coming from South and Southeast Asia (Humphrey, 1993; Kapiszewski, 2001). Admittedly, substantial numbers of Asian workers were already present in several countries in the 1970s [111], sometimes even forming the largest expatriate group. At the time, however, workers of Arab origin (for example, Egyptians, Jordanians, Palestinians, and Yemenis) were by far the largest group in Saudi Arabia (91%) and Kuwait (80%), representing 72% of the total expatriate population in the Gulf countries in 1975 (Kapiszewski, 2001). But by 1996, migrants of Arab origin accounted for only 31% of all foreigners. Asians had become the largest contingent of foreign workers in the six countries, their share ranging from 57% in Kuwait to 86% in Oman. In the late 1990s, India, Pakistan, Bangladesh, and Sri Lanka were the main countries of origin of Asian workers. Regional conflicts naturally played a role in these shifts in the composition of the migrant population. One of the main effects of the Gulf War, as noted above, was the massive departure from Kuwait and Saudi Arabia of Jordanian, Egyptian, and Yemeni workers. Among the other factors that have helped to stimulate immigration by Asian workers are their more “controllable” behaviour – they are less politicized and less inclined to protest than Arab populations – and their shorter stays (Humphrey, 1993; Russell, 1992).

3 – Israel: populated by migration

174Israel also displays an atypical pattern of migration dynamics. The country’s migrant population (persons born abroad) in 2000 was estimated at about 2.25 million, or 37% of its total population of 6 million (United Nations, 2005). This figure puts Israel in second place in the region, well behind Saudi Arabia (more than 5 million migrants), but ahead of the United Arab Emirates and Jordan (slightly under 2 million each), Palestine (1.7 million), and Turkey (1.5 million).

175Israel’s population growth since its creation in 1948 has relied largely on voluntary migration of Jewish populations from very diverse origins, including the former Soviet Union, Europe, North America, North Africa, and Ethiopia. Between 1948 and 2003, Israel took in nearly 3 million immigrants (Berthomière, 2003; Central Bureau of Statistics, 2004) [112] who arrived in several major waves (Figure 26). From 1948 to 1951, a total of almost 700,000 migrants came to settle in Israel, doubling its population in three years. By 1952, arrivals decreased sharply, then fluctuated at about 30,000 per year until 1989, with some higher peaks recorded during the period [113]. The fall of the Communist bloc triggered a second large immigration wave, mostly from the ex-USSR, with the arrival of nearly 200,000 immigrants in 1990 and just under 180,000 in 1991 (Central Bureau of Statistics, 2004). Entries then fell, stabilized at around 70,000 a year until 2000, and declined yet again to only 20,000 in 2003 [114].

Figure 26

Number of permanent immigrants to Israel, 1948-2003

Number of permanent immigrants to Israel, 1948-2003

176These figures concern permanent immigrants [115] and do not include arrivals of temporary workers, previously infrequent but on the increase since the early 1990s. Turks, Chinese, Thais, Romanians, and others have been hired to meet growing labour demand, particularly in the construction industry, and to replace Palestinian workers, whose access to the Israeli labour market has been sharply curbed since the early 1990s (Kemp and Raijman, 2004; McMurray, 1999).

4 – Palestinians: the world’s largest refugee population

177The Palestinians’ migration history and their present distribution in the world are also intimately linked to the region’s political situation and Israeli history. Since the creation of Israel in 1948 and the Israeli-Arab conflict, Palestinians have moved massively to neighbouring countries, mainly Jordan, Syria, and Lebanon. They have also relocated to the oil-producing Gulf countries, most notably after 1967 and the Six-Day War (Stanton Russell, 1992; Humphrey, 1993) [116]. After the Oslo Accords of 1993, return migration took place, with members of the diaspora settling in the West Bank and Gaza Strip, but the phenomenon has remained limited (Hammer, 2005, estimates their total number at around 100,000).

178Because of these conflicts and the resulting migration flows, most of the population of Palestinian origin now lives outside Palestine (Courbage 1995, 2005). Table 22 gives estimates of the world distribution of the population of Palestinian origin. Out of a total estimated at more than 9 million, just over 3.5 million live in the Gaza Strip, the West Bank, and East Jerusalem. The great majority of the remainder live in neighbouring Arab countries (2.7 million in Jordan, about 420,000 in Syria, and 400,000 in Lebanon) and Israel (1 million, or slightly over 15% of the country’s population [117]). About 460,000 Palestinians reportedly live in the Gulf countries (of whom 300,000 in Saudi Arabia), and 650,000 elsewhere in the world (other Arab countries, U.S., Europe, etc.). At the end of 2002, nearly half the Palestinian population had refugee status: approximately 4 million Palestinians are registered with UNRWA [118] (1.5 million in Palestine and 2.5 million in Jordan, Syria, and Lebanon), and a further 350,000 under HCR status (mainly in Saudi Arabia and Egypt), making this the world’s largest refugee population. Almost one-third of UNRWA refugees live in 59 camps in Palestine, Jordan, Syria, and Lebanon, where living conditions are often deplorable (FAFO, 2005; Rabah et al., 2005).

Table 22

Estimated Palestinian population by place of residence and refugee status, ca. end-2002

Place of residence Total number (end-2002) Refugees registered with UNRWA (end-2002) UNRWA refugees living in camps (end-2002) Gaza Strip West Bank of which: East Jerusalem Total Palestine 1 299,000 2 261,000 246,000 3 560,000 893,000 639,000 1 532,000 474,000 172,000 646,000 Jordan Israel (except East Jerusalem) Syria Lebanon Saudi Arabia United States Egypt Kuwait Other Gulf countries Other Arab countries (Iraq, Libya, etc.) Rest of the World Total outside Palestine 2 716,000 1 038,000 423,000 403,000 301,000 232,000 60,000 38,000 121,000 118,000 295,000 5 745,000 1 698,000 406,000 389,000 2 493,000 297,000 121,000 219,000 637,000 Total 9 305,000 4 025,000 1 283,000 Sources: Figures for Palestinian occupied territories (Gaza Strip and West Bank) for 2002 are pro jections prepared from the 1997 census by the Palestinian Central Bureau of Statistics. They are published in the Palestine Statistical Yearbook, no. 4, Table 3.2.5 (Palestinian Central Bureau of Statistics, 2003). Estimates of East Jerusalem population from Jerusalem Statistical Yearbook, no. 6, Table 5.6 (Pales tinian Central Bureau of Statistics, 2004). Estimates of Palestinian population outside occupied territories and East Jerusalem from Palestine Statistical Yearbook, no. 4, Table 3.2.5 (Palestinian Central Bureau of Statistics, 2003). Statistics on refugees by country are published by UNRWA. We have used values for 2002 for com parison with total Palestinian population. More recent statistics are available on the UNRWA web site ((www. un. org/ unrwa). The Palestinian refugee population under HCR status is not grouped with UNRWA refugees, but is included in the total population.

Estimated Palestinian population by place of residence and refugee status, ca. end-2002

179As Courbage (1995) underscored a few years ago, the future of Palestine’s population will depend on many factors that are hard to predict, notably the scope of return migration by diaspora Palestinians.

5 – Migration to Western countries: Europe the prime destination

180For many years, North Africa and the Middle East have been a major source of emigrants to Western countries, particularly those of Europe. In the 1960s and 1970s, migration from North Africa and Turkey was arranged to meet labour demand in European countries, most notably France, Germany, Belgium, and the Netherlands (see, for example, IOM, 2002, for migration from Morocco). Labour migration slowed significantly after the oil crisis, from 1973-74 onward, but migration for family reunion and clandestine entries continued to drive flows to Europe. Migration of refugees – Iranians and Iraqis especially – also contributed to departures from the region toward the West [119]. As a result of these migration flows, several Western countries now have very large populations of North African and Middle Eastern origin.

181Table 23 shows the migrant population from North Africa, the Arabian Peninsula, and the Middle East in eight Western countries – Germany, Australia, Belgium, Canada, U.S., France, Netherlands, Sweden – circa 2000 [120]. These eight countries alone harbour nearly 6.5 million migrants from the sub-regions studied. By comparison, fewer than 2 million migrants from sub-Saharan Africa are recorded in the eight countries, despite the fact that sub-Saharan Africa has 300 million more inhabitants. Most of the migrants come from the Middle East (about 4.2 million, of whom more than 2 million in Germany) and North Africa (about 2.1 million, of whom 1.3 million in France). By contrast, there are very few migrants from the Arabian Peninsula.

Table 23

Migrants from North Africa, Arabian Peninsula, and Middle East in 8 Western countries, ca. 2000

Region of origin Receiving country Germany Australia Belgium Canada United States France Netherlands Sweden 2002 2001 2004 2001 2003 1999 2003 2001 North Africa Arabian Peninsula Middle East Total number of migrants from the 20 countries 139,000 4,100 2,181,300 2,324,400 39,500 7,200 161,400 208,100 164,700 500 94,300 259,500 82,800 30,200 231,500 344,500 153,000 43,000 864,000 1,060,000 1,317,900 2,400 240,100 1,560,400 184,600 3,900 266,100 454,600 13,900 200 177,600 191,700 Total number of migrants in the receiving country 7,335,600 4,105,700 1,185,500 5,647,100 33,471,000 4,308,500 1,714,200 1,028,000 Proportion of migrants from the 20 countries among total migrants in the receiving country 32% 5% 22% 6% 3% 36% 27% 19% Main countries of origin for migrants from the 20 countries of the region (number of migrants in brackets) Turkey (1,912,000) Lebanon (71,300) Morocco (134,200) Iran (75,000) Iran (315,000) Algeria (576,000) Turkey (190,500) Iraq (55,700) Notes: Origin is defined by place of birth except for Germany, where, owing to lack of data, origin is defined by nationality. Statistics for France refer to foreign-born aliens. Figures exclude migration of native French persons born abroad, particularly persons repatriated from Algeria and former French protectorates. Including native French persons born in North Africa, the total number of migrants from this sub-region in France is about 2.3 million. Data on number of U.S. residents from the Arabian Peninsula are not published for certain countries of this sub-region. The estimate shown in this table was obtained by subtracting migrants from countries other than those of the Arabian Peninsula from the total number of Asian migrants. Due to a lack of data, migrants from Azerbaijan, Cyprus and Georgia are included with those from the Arabian Peninsula. Sources: Data for Germany, Australia, Canada, the Netherlands, Sweden, and the U.S. are obtained from a compilation of data from National Statistical Institutes prepared by the Migration Information Source project of the Migration Policy Institute ((www. migrationinformation. org). For Belgium, we were given unpublished data by the National Statistical Institute. Data for France are taken from the 1999 census. They are available on the website of the Institut national d’études démographiques (www. ined. fr).

Migrants from North Africa, Arabian Peninsula, and Middle East in 8 Western countries, ca. 2000

182About three-quarters of them are recorded in the five European countries listed in Table 23, whereas the total population of the five countries is about one-half that of the U.S., Canada, and Australia combined. The figures clearly show Europe’s dominant role as a host region for these migrants. This is mainly due to historical ties (including the colonial past), earlier migration policies, and – of course – geographic proximity. Migrant populations from the sub-regions examined also account for a very large share of total migrants in European countries. For example, they represent almost one-third of the total in France (36%) and Germany (32%), 27% in the Netherlands, and about 20% in Sweden and Belgium, compared with only 3 to 6% in the other countries. The migrants’ origin by sub-region also varies widely between countries: North Africans form the largest group in France and Belgium; migrants from the Middle East are in the majority in all the other countries (up to more than 90% in Germany and Sweden).

183Migration to several Western countries is continuing or intensifying across all categories: labour migration, refugee migration, family reunion, and so on. By way of illustration, let us briefly examine migration from the three Maghreb countries (Morocco, Algeria, Tunisia) to France in the period 1994-2002 (Table 24). During this period, France [121] recorded over 300,000 immigrants from the three countries, with a particularly sharp acceleration in the late 1990s. The annual number of immigrants rose from 20,000 in the 1990s to over 60,000 in 2002, or about 30% of total entries into France that year. Immigrant flows from North Africa are around twice as large as those from sub-Saharan Africa.

Table 24

Legal long-term immigration by year of admission to legal residence in France, for the 3 Maghreb countries, and by region for rest of world, 1994-2002

Nationality 1994 1995 1996 1997 1998 1999 2000 2001 2002 Maghreb Morocco Algeria Tunisia Sub-Saharan Africa Europe Asia Americas Other 23,029 9,267 10,911 2,851 11,316 61,216 13,123 9,797 1,082 18,431 7,453 8,564 2,414 9,852 55,680 11,177 9,216 1,824 18,746 7,669 8,469 2,608 10,179 54,212 11,447 9,352 2,050 27,286 10,957 12,412 3,917 18,652 54,232 14,972 10,256 2,033 36,138 16,243 14,523 5,372 27,880 59,322 19,668 11,255 1,616 33,553 16,496 12,103 4,954 19,776 61,195 17,759 11,498 1,339 40,953 21,507 12,760 6,686 22,427 61,912 21,001 12,776 1,359 51,526 24,986 18,555 7,985 26,325 64,010 25,234 14,083 1,516 63,107 26,177 27,936 8,994 30,245 67,022 29,027 14,682 1,624 Total 119,563 106,180 105,986 127,431 155,879 145,120 160,428 182,694 205,707 Sources: Tables published by X. Thierry (2004) and INED publications on statistics for immigration flows into France (1994-2002), available on the INED website (www. ined. fr).

Legal long-term immigration by year of admission to legal residence in France, for the 3 Maghreb countries, and by region for rest of world, 1994-2002

1 – Extensive adult illiteracy, particularly among women

186Despite tremendous progress in most countries in the past thirty years, adult illiteracy remains very widespread throughout the region. With 32% of illiterates (Table 25), or nearly one in three adults, the region outranks South and West Asia (45%) and sub-Saharan Sahara (40%), but lags far behind Latin America (11%) and East Asia (13%). Apart from East Asia, the region under study is also the one with the greatest inequalities between men and women: nearly one adult woman out of two, versus less than one man in four, can neither read nor write. In terms of sub-regions (Appendix Table A.15), the Middle East (25% of illiterates) is in a better position, with slightly less gender inequality than the Arabian Peninsula (34%, including Yemen), and – even more so – North Africa (42%).

187An examination of results by country (Figure 27) naturally reveals wider disparities, which are simply due to the history of access to education in each country since 1960 or 1970. At one end, we find Israel, the small wealthy countries of the Gulf, but also countries as diverse as Palestine, Lebanon, Turkey and Jordan, where the illiteracy rate is no greater than 5-20% and gender inequalities are the smallest in the region. At the other extreme, we find Iraq and Yemen, but also Morocco and Egypt, where approximately one in two adults can neither read nor write, and where gender inequalities are very large.

Figure 27

Male and female literacy rates in the 20 countries, 2000 (%)

Male and female literacy rates in the 20 countries, 2000 (%)

188The fight against illiteracy and gender inequality is far from over in the region, particularly in the Arab countries. We will now look at primary school enrolment, which is a more accurate reflection of recent policies and plays a key role for the future.

2 – A diverse pattern of school enrolment in the region

189Overall, more than eight in ten children of primary school age were enrolled in school in 2000, with boys more likely to be attending than girls (Table 25). The figure is slightly higher than in South and West Asia (81%) and distinctly lower than in Latin America (97%) or East Asia (93%). In sub-regional average terms (Appendix Table A.15), North Africa (91%) is now sending more of its children to school than the Middle East (84%) and far more than the Arabian Peninsula (65%). Apart from Morocco, the North African countries are making up for the lag that developed in the 1960s, 1970s, and 1980s – particularly in female education – by implementing dynamic education policies. The lag is still reflected in a sizeable adult illiteracy rate, which should, however, decline fairly quickly.

190According to these recent UNESCO data (2003), only two countries have achieved primary school enrolment for all children: Israel and Tunisia (Figure 28), though six others post a very high enrolment ratio (93-98%): Algeria, Egypt, Bahrain, Iraq [124], Jordan, and Syria [125]. Despite progress in recent years, Iran and Morocco are far behind. Their national school-enrolment ratios of 75% are a long way from the hoped-for results, most notably in rural areas [126]. Saudi Arabia appears to be lingering at 58% [127], below Yemen.

Figure 28

Net primary school enrolment ratios by sex in 17 countries, 2000 (%)

Net primary school enrolment ratios by sex in 17 countries, 2000 (%)

191Gender inequalities in primary school enrolment have narrowed dramatically with the development of access to education, and are generally quite modest (Figure 28). But Morocco, Saudi Arabia, Iraq, and, above all, Yemen still have a long way to go.

3 – Relationships with fertility and infant mortality: looser than elsewhere

192In international analyses (covering the whole world, all Southern countries or a single large region), the relationships observed at a point in time between fertility or child mortality and educational attainment are traditionally negative and fairly robust: generally speaking, the higher the educational attainment of a country’s population, the lower its fertility and mortality. How well did the region fit this pattern in 2000?

193Calculated for all 20 countries, the correlation between female fertility (TFR) and female literacy is indeed negative, but not very high: the coefficient of determination (R²) is a modest 0.23 (Figure 29) [128]. This is well below the level often observed (R² of about 0.60), including in sub-Saharan Africa (R² of 0.45, see Tabutin and Schoumaker, 2004). In other words, at the aggregate level, the influence of women’s education on fertility is not as great in the region studied as in others. Figure 29 perfectly illustrates the diversity of situations: for example, at a female literacy level of 60% or so, fertility rates range from 2 children per woman (Tunisia) to more than 4 (Saudi Arabia); conversely, a fertility rate of about 3 children is reached with literacy rates ranging from 36% (Morocco) to over 80% (Qatar and Israel). Palestine’s profile is exceptional in world terms, with a fertility rate of nearly 6 children per woman and almost 85% female literacy [129].

Figure 29

Relationship between fertility and literacy of adult women in the 20 countries, 2000

Relationship between fertility and literacy of adult women in the 20 countries, 2000

194The correlation between infant mortality (Figure 30) and the female literacy rate, negative of course, is far higher and consistent with the classic pattern (R² = 0.68) [130], although not perfectly linear. When computed with the male literacy rate, the value drops to 0.43. This demonstrates the prevailing role of female education, even in aggregate analyses such as ours [131]. Without speaking of Iraq and Yemen, which register very high infant mortality, Turkey stands apart for its excess mortality: with 77% of women able to read and write, infant mortality could be twice as low.

Figure 30

Relationship between infant mortality and literacy of adult women in the 20 countries, 2000

Relationship between infant mortality and literacy of adult women in the 20 countries, 2000