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The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends and Emerging Issues
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The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends and Emerging Issues

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  • 1. !! 2!
  • 2. Table of ContentsPreface .......................................................................................................................................................... 2Table of Figures............................................................................................................................................. 4Acronyms and Abbreviations ........................................................................................................................ 6Executive Summary....................................................................................................................................... 81. Introduction ........................................................................................................................................ 112. Methodological note........................................................................................................................... 12A. Bridging discrepancies in definitions................................................................................................... 143. Demographic trends ........................................................................................................................... 154. Poverty trends..................................................................................................................................... 305. Health trends ...................................................................................................................................... 376. HIV and AIDS trends............................................................................................................................ 557. Education trends ................................................................................................................................. 63B. Mind the gap: the school to work transition and the informal economy........................................... 758. Livelihoods and economic participation trends.................................................................................. 799. Migration trends ................................................................................................................................. 9110. Political and civic engagement trends ............................................................................................ 9811. Child protection trends ................................................................................................................. 10212. Conflict and emergency ................................................................................................................ 113C. Youth and adolescents in post conflict situations............................................................................. 12013. Conclusions ................................................................................................................................... 121Annex I: Recommendations for improving understanding of MENA youth ............................................. 123Annex II: Introduction to Core and Extended Indicator Lists.................................................................... 126Annex III: Core Indicator List ..................................................................................................................... 129Annex IV: Extended Indicator List ............................................................................................................. 133Annex V: Major household surveys in MENA countries .......................................................................... 152Annex VI: Institutional definitions of MENA ............................................................................................. 153Annex VII: Bibliography............................................................................................................................. 155Annex VIII: Glossary .................................................................................................................................. 166 3
  • 3. Table of FiguresFigure 1 MENA population under 25 years of age...................................................................................... 16Figure 2 Total Fertility Rate, 1989 & 2009. ................................................................................................. 17Figure 3 Adolescent Fertility Rates. ............................................................................................................ 18Figure 4 Youth Fertility Rate. ...................................................................................................................... 19Figure 5 Ratio of change in adolescent and youth fertility rates................................................................ 20Figure 6 Probability of death as a percentage (ages 10 24, 1996 2006). ................................................... 22Figure 7 Probability of death as a percentage (ages 10 19, 1996 2006). ................................................... 23Figure 8 Probability of death as a percentage (ages 15 24, 1996 2006). ................................................... 24Figure 9 Percentage of total population living in absolute poverty (less than $1.25 per day)................... 31Figure 10 Percentage of the total population living in relative poverty (less than $2 per day) ................. 32Figure 11 Per annum percentage change in absolute and relative poverty rates...................................... 32Figure 12 Youth working poverty rate, ages 15 24, 2005........................................................................... 35Figure 13 Minimum legal age of marriage.................................................................................................. 41Figure 14 Percentage of women age 20 24 married before age 18. .......................................................... 42Figure 15 Percentage of students (age 13 15) currently smoking cigarettes............................................. 46Figure 16 Percentage of students (ages 13 15) who are obese. ................................................................ 48Figure 17 Proportion of population below the minimum level of dietary energy consumption by subregion. ......................................................................................................................................................... 49Figure 18 Percentage of students (ages 13 15) experiencing food insecurity. .......................................... 50Figure 19 Primary causes of death and disability, men ages 15 29............................................................ 51Figure 20 Primary causes of death and disability, women ages 15 29 ...................................................... 52Figure 21 Percentage of students aged 13 15 who felt lonely most or all of the time during the preceding12 months. .................................................................................................................................................. 53Figure 22 HIV prevalence by gender........................................................................................................... 61Figure 23 Gross Enrollment Ratio, secondary school. ................................................................................ 66Figure 24 Youth literacy rate by gender ..................................................................................................... 68Figure 25 Regional youth unemployment rates ......................................................................................... 82Figure 26 Youth labor force participation rates.......................................................................................... 82Figure 27 Country specific labor force participation rates ......................................................................... 86Figure 28 Youth unemployment rates, by gender ...................................................................................... 89Figure 29 Net migration (thousands).......................................................................................................... 94Figure 30 Net migration per 1,000 population ........................................................................................... 95Figure 31 Percentage of youth reporting "that they are likely to move away from the city or area wherethey currently live. ...................................................................................................................................... 97Figure 32 Percentage of students (ages 13 15) physically attacked in the past year............................... 105Figure 33 Percent of females reporting Female Genital Mutilation/Cutting............................................ 108Figure 34 Total Population of Concern by UNHCR Regions, 2008 ............................................................ 115Figure 35 Population of Concern by MENA country of asylum ................................................................ 116Figure 36 Demographic data coverage for Population of Concern .......................................................... 117Figure 37 Net refugee flow by country of asylum .................................................................................... 118 4
  • 4. Table of TablesTable 1 Percent of regional populations living in absolute vs. relative poverty………………………………………30Table 2 Change in absolute poverty rate as a percentage of change in relative poverty rate…………………33Table 3: Regional fertility rates and maternal mortality rates……………………………………………………………….43Table 4 Reported HIV cases……………………………………………………………………………………………………………………57Table 5 Young women with comprehensive, correct HIV knowledge in MENA countries……………………….58Table 6 Distribution of Migrants from Select MENA Countries………………………………………………………………93Table 7 Youth specific organizations in MENA……………………………………………………………………………………..100Table 8 Birth registration rates, 2000 2007………………………………………………………………………………………….103Table 9 Child Discipline and Domestic Violence……………………………………………………………………………………104Table 10 Prohibition of Corporal Punishment in MENA Countries………………………………………………………..107Table 11: Children in Detention in Available MENA Countries……………………………………………………………..110Table of DiagramsDiagram 1 Sample population pyramid in society experiencing a “Youth Bulge”……………………………………26Diagram 2 Population pyramid of MENA region and world…………………………………………………………………..27Diagram 3 2007 adult HIV prevalence estimates. ………………………………………………………………………………….57Diagram 4 Sub regional dependency ratios, 1950 2050………………………………………………………………………..85Diagram 5 Share of unemployed youth in total unemployed and age transition in LFPR…………………….87Please note that figures and tables in the report were created by the authors with data from the sourcecited. Diagrams are figures from other publications which are reproduced in the Review. Both thepublication and the original source of the data are cited whenever possible. When data for a countrywere not available, that country was omitted from the figure. 5
  • 5. Acronyms and AbbreviationsCEDAW Convention on the Elimination of all Forms of Discrimination against WomenCSEE & CIS Central and South eastern Europe (non EU) & Commonwealth of Independent States (ILO region)CRC Convention of the Rights of the ChildDALY Disability adjusted Life YearDevInfo a database, formerly known as ChildInfo, with UN Development Group endorsementEA East Asia (ILO region)EAP East Asia and the Pacific (World Bank region)ECA Europe and Central Asia (World Bank region)EMRO Eastern Mediterranean Regional Office, WHOESCWA United Nations Economic and Social Commission for Western AsiaDEEU Developed economies and European Union (ILO region)GCC Gulf Cooperation Council: Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, & UAEGER Gross Enrollment RatioHDI Human Development IndexHIV and AIDS Human Immunodeficiency Virus and Acquired Immunodeficiency SyndromeICT Information and Communication TechnologyIDP Internally Displaced PersonsILO International Labour OrganizationFGM/C Female genital mutilation/cuttingLABORSTA an International Labour Office database on labor statisticsLAC Latin America & Caribbean (World Bank region, ILO region)LAS League of Arab StatesLFPR Labor Force Participation RateMDG Millennium Development GoalMENA Middle East and North AfricaMENARO Middle East and North Africa Regional Office, UNICEFMICS Multiple Indicator Cluster SurveyMICS4 4th Round of the Multiple Indicator Cluster SurveyNER Net Enrollment RatioNGO Non governmental organizationoPt occupied Palestinian territoryPSER Primary School Enrollment RatioPAPFAM Pan Arab Project for Family HealthSA South Asia (World Bank region, ILO region)SEA&P South east Asia and the PacificSSA Sub Saharan Africa (World Bank region, ILO region)SSER Secondary School Enrollment Ratio 6
  • 6. TFR Total Fertility RateTIMMS Trends in International Mathematics and Science StudyUAE United Arab EmiratesUNAIDS Joint United Nations Programme on HIV/AIDSUNDESA United Nations Department of Economic and Social AffairsUNDP United Nations Development ProgrammeUNESCO United Nations Educational, Scientific and Cultural OrganizationUNFPA United Nations Population FundUNHCR United Nations High Commissioner for RefugeesUNICEF United Nations Children’s FundUNODC United Nations Office on Drugs and CrimeWB The World BankWDI World Development Indicators, published by the World BankWHO World Health OrganizationWPAY United Nations World Programme of Action for Youth to the Year 2000 and Beyond 7
  • 7. Executive SummaryThe Middle East and North Africa (MENA) region is experiencing an unprecedented boom in thenumbers of young people. All countries in the region have a youth population (here defined as ages 1024) comprising 22 to 36 percent of the total population; proportions unlikely to change in the nearfuture. The growing numbers of youth (projected at 121 million for the region in 2009) presents anexciting window of opportunity for the countries of the region to capitalize on this abundance of youngpeople and to translate it into human, material and economic gains. To convert this potential asset intotangible social development gains, countries have to ensure that the policy environment enables youngpeople to realize their full potential and capacities. To be effective, the diverse needs of young peoplehave to be addressed by a range of public and private agencies and institutions, each with a distinctivecontribution to make to youth well being. UNICEF thus presents this Review of key domains forassessing the quality of life for young people across the 20 countries in the UNICEF MENA region andproposes core and extended youth indicator lists for the region.The Review focuses primarily on a regional overview of trends and issues, and is not a detailed analysisof country data nor a study of intra regional comparisons. For each of ten key domains (demography,poverty, health, HIV and AIDS, education, economic participation, migration, civic engagement, childprotection, and conflict and emergency), the Review highlights trends and assesses the state of data andindicators for each one. A summary follows.Both relative and absolute poverty rates for the general population in MENA compare favorably to otherglobal regions, although youth specific poverty estimates are not generally available. Great disparitiespersist within the region. The World Bank estimates that 3.6 percent of the MENA region’s populationlived in absolute poverty in 2005, defined as less than $1.25 per day, whereas 16.9 percent lived inrelative poverty (<$2 per day). ILO estimates of regional youth working poverty rates indicate thatalmost 40 percent of MENA’s employed youth were living on less than $2 a day in 2005.Regional estimates suggest that the primary causes of death and disability for MENA’s youth are injuries,especially road traffic accidents, mental health and maternal health conditions. As in other domains,data on health are incomplete. Data on young peoples’ sexual and reproductive health are limited inmost cases to fertility data. Estimates of HIV prevalence in MENA countries remain low compared toother global regions and cases are concentrated in high risk groups. Child marriage remains common inmany countries in the region. Tobacco use is an emerging threat to young people’s health in the region,while data on use of other substances are largely absent. Malnutrition persists in some areas; obesity isa rising concern.In recent decades, MENA has seen enormous gains in access to formal education. Many countries areapproaching or have achieved full enrollment in basic education. Secondary and tertiary education ratesare on a par with other countries at comparable levels of development. Nevertheless, enrollment ratesfor girls lag behind those for boys in half of the countries in the region, while enrollment rates for bothsexes are low in several of the region’s poorer countries. Education quality is uneven and represents a 8
  • 8. continuing challenge. An effective transition from school to decent employment remains an unrealizedgoal for many youth. Although young people in MENA comprise approximately one third of the workingage population, they account for almost 50 per cent of the region’s total unemployment. The ILOestimated youth unemployment in the region at 22 percent in 2007. Many MENA youth and parentsprefer public sector employment. As private sector growth has not kept pace with the rapid expansionof the labor force, informal jobs are often the only choice. Young women face additional barriers toobtaining decent employment.Migration in MENA is generally of three types: rural to urban (domestic), intra regional (within MENA),and inter regional (outside MENA). Due to gaps in data, it is difficult to estimate the percentage offoreign workers who are adolescents or youths or the flow of young migrants within the region. Ingeneral cultural norms create a barrier for women wanting to migrate, as do the lack of economicopportunities available to women generally. In 2008, there were an estimated six million refugees, IDPs,asylum seekers and stateless persons in the UNHCR region.Available data indicate that civic and political participation among MENA youth remains limited, thoughthe spread of Information and Communication Technologies (ICT) is allowing youth to engage in theircommunities in non traditional ways.Data on child protection trends point to important shortfalls in safeguarding young people across theregion. Exposure to violence is widespread. Female genital mutilation/cutting (FGM/C) remains commonin four countries. Legal systems are poorly adapted to the unique needs of juvenile offenders. Nearly sixmillion orphans live in the region, while efforts to enumerate the number of street children have failedto produce an estimate of this sizable and vulnerable population.Several countries in the MENA region currently experience precarious security conditions. Adolescentsand young people, in addition to suffering the effects of conflict and emergency, are also potentialagents for positive change. Engaging young people in the dialogue of peace may help protect statesagainst instability.While the population trends mentioned above have resulted in increased attention towards the role ofyouth in MENA society, data collection efforts have not kept pace with this new found interest. Arecurring theme in the Review is the critical need for complete and timely data for youth in all countriesof the region. Data collection efforts must strive for complete inclusion of the youth population,including vulnerable populations. Results disaggregated by five year age group, sex and other relevantcharacteristics, such as socio economic status, highlight disparities and allow users to tailor measures tosub groups of interest. A central, publically accessible database of current and historic youth data, ifestablished and supported, could expedite dissemination and promote evidence based youth policy andprogramming.Much of the data currently available on youth consist of objective measures and fail to capture a holisticpicture of contemporary youth experiences in the region. New indicators are needed to describeimportant constructs, such as identity and job quality. Data producers also have to advocate for thecollection of information in sensitive and illegal areas, such as substance abuse and extra marital 9
  • 9. sexuality, in order to understand the situation of youth and to create policies to promote a successfultransition to adulthood. UNICEF’s upcoming round of the household survey, MICS4, presents an excitingopportunity to gain insight into the youth experience.In the years ahead, it will be critical for the MENA countries to continue to improve their systems formonitoring all aspects of the experience of adolescents and youth in the region, so that countries canbetter understand young peoples capabilities and needs, and in turn maximize the promise offered bythe next generation. UNICEF is poised to take a leadership role in this effort. 10
  • 10. 1. IntroductionYoung people must be endowed with the knowledge, skills and capacities necessary to assume theirroles as adults. Investment in the adolescents and youth of today is the foundation of future prosperity.The Middle East and North Africa (MENA) region has the ability to shape the future by investing in itsyouth. Despite significant challenges, the burgeoning young population has the capacity to propel theregion forward and to deliver on the promise of a greater tomorrow. With more than half of the region’speople under the age of 25, MENA has the opportunity to strengthen its economies, empower itscitizens, and guarantee the fundamental rights of all within its borders. Leaders throughout the regionseek development that can be facilitated by investing in the utility of the region’s young people. The firststep on this path is to create an enabling and supportive environment for adolescents and youth torealize their potential.Increased attention to the needs of young people is a common theme across many countries in theregion. The renewed efforts of many countries to meaningfully address young people’s needs haverevealed the paucity of data on MENA’s youth and adolescents. Decision makers must be empowered tocreate policies and programs that are efficient and effective by drawing on reliable information. Thesituation of the region’s young people lacks comprehensive analysis, and therefore requires novelapproaches to assessing adolescents’ and youths’ assets and vulnerabilities.This Desk Review, commissioned by the UNICEF MENA Regional Office, takes a close look at thesituation of adolescents and youth age 10 to 24 in the MENA region with a view to informing such acomprehensive approach. In assessing the status of key aspects of young peoples’ lives in MENA, theReview analyzes what is known about adolescents and youth in the region, and also outlinesfundamental gaps in current knowledge. As such, it seeks to highlight both the knowns and theunknowns: the situation today, and what planners will need to know in the future. By closing the gaps,decision makers in MENA can create more effective and efficient policy, enabling them to deliver on thepromise of young people. 11
  • 11. 2. Methodological noteThe Review focuses primarily on a regional overview of trends and issues, and is not intended to analyzecountry data nor to make intra regional comparisons. Some country specific information is raised inorder to highlight or illustrate a particular trend or issue. For a detailed list of references reviewed forthis exercise, please refer to Annex VII.Defining age scopeThe Review uses the following age definitions: Children: 0 17 years; Adolescents: 10 19 years; YoungPeople: 10 24 years; and/or Youth: 15 24 years.A major constraint of existing data sources is incomplete coverage across the full age span of youngpeople, 10 24 years old. Many excellent data sources include only children or youth, for example, ordefine youth as 15 29 year olds. In order to fully understand the situation of young people in MENA,data must be obtained for the entire population of young people. Please see the Bridging Discrepanciesin Definitions section for more information.Defining the MENA regionThe MENA region is defined for this report using the UNICEF regional definition: Algeria, Bahrain,Djibouti, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, occupied Palestinian territory (oPt),Oman, Qatar, Saudi Arabia, Syria, Sudan, Tunisia, UAE, and Yemen. Other agencies define the MENAregion differently or use different terminology to refer to the region (e.g., Eastern Mediterranean, ArabStates, Western Asia, or simply Middle East or North Africa separately). Annex VI provides a list ofmajor international agencies and their regional definitions of MENA or the closest equivalent. Forconsistency, the Review refers to the MENA region, using this term exclusively. When citing a sourcewith a different regional definition, differences in regional groupings are highlighted. Any lack ofregional convergences due to interagency differences in defining MENA is properly identified in the text.The lack of convergence among international agencies in defining the geographical bounds of the MENAregion contributes to the data gaps for young people in the region. When agencies provide regionalaverages for MENA, these figures may only approximate the true value for UNICEF’s MENA region whenthe data collector has used a different list of countries in its regional definition. Furthermore, regionaldata collection efforts led by other agencies may result in a partial list of national figures for UNICEF’sMENA region when an alternative list of countries in the region is used.Defining adolescent and youth indicatorsThe Review examined the Youth Development Index (YDI). Spearheaded by UNDESA, it represents theonly intra agency effort to define common youth indicators. Furthermore, it reviewed the indicatorsused and data available from other sources, including the MDGs, UNICEF MENARO’s 2006 List ofIndicators on Adolescents, ChildInfo, the World Youth Report, World Development Indicators, the GlobalSchool based Student Health Survey, Global Youth Tobacco Survey and others. 12
  • 12. Annexes III and IV list the proposed indicators and describe the intended uses of each. These lists werecreated through a process of expert consultation with leaders at both Harvard School of Public Healthand the UNICEF MENA Regional Office. A list of indicators drafted for an earlier version of the deskreview served as an additional source.Desk Review processThe Review is organized by domain, taking in turn each of the major areas affecting youth. For eachdomain, the Review summarizes the status of youth in the region, the status of data on youth in theregion and recommendations for improving current knowledge.The Review was initiated with a study of secondary data sets and analyses produced by UNICEF, UNagencies, World Bank, League of Arab States, international research institutions and others. Materialsreviewed include regional and global reports on young people, as well as general reports involvingyoung people in the region and globally (see Annex VII). Since the Review focuses on regional datarather than country specific data, individual country MICS or DHS surveys were not individuallyreviewed, although data sources were referred to throughout the process. Where regional data werenot available through international databases because regional selection was incompatible (as was thecase with ILO, UNESCO), global and regional reports generating regional comparisons were consulted.Organization of Desk Review reportThe Review contains an overview of the current status of data on adolescents and youth in MENA andan assessment of current trends and issues facing young people in MENA today. The latter also includesrecommendations on ways to close the existing knowledge gaps and improve data collection andanalysis on young people in the region. The annexes provide supporting documentation and additionalinformation, including a set of core indicators that provide a snapshot of the situation for youth in eachMENA country. 13
  • 13. A. Bridging discrepancies in definitionsDisparities in age group classifications by different organizations complicate comparative analysis, andreduce the utility of data that is available. For example, the WHO disaggregates age into threecategories: 0 14, 15 29, or simply 15 64, with no disaggregation for adolescents, youth or young people.UNICEF, on the other hand, works with children (below 18 years of age), though occasionally furtherdisaggregates into smaller categories, including youth and adolescents. UNDESA, the publisher of therecent World Youth Report 2007, presented data conforming to the UN definition of youth as thoseaged between 15 and 24, but further disaggregated this category into two age groups: 15 19 and 20 24to capture differences between younger and older youths. The ILO’s international database presents itslabor statistics in the same manner. UNHCR defines youth as individuals aged 5 to 17. The World Bank’sWorld Development Report 2007 broadened the definition of youth to include all ages between 12 and24. Private organizations, such as Gallup Inc. and the World Values Survey each have their owndefinition of youth. Additionally, for some topic areas, surveys of students are the best current source ofdata, and surveys poll students whose age range does not align with other organizations. The GlobalSchool based Student Health Survey, for example, polls primarily students who are 13 to 15.Compounding these inconsistencies are varying definitions between countries, some of which havelinked the ‘legal age of majority’ typically 18 years with the definition of youth.1 As a result, somereports are inconsistent across countries, such as the WHO’s Surveillance of Chronic Disease Risk FactorReport, which reports obesity data for different age groups depending on the country.For data to be most useful to national and international bodies alike, it should be disaggregated andclassified according to the established definitions set forth by the United Nations, and in somecircumstances, in smaller component age groups. Not only will this classification yield a more detailedpicture of the phenomenon of interest, but will allow for ease of comparison with other organizationsand situations, better informing the policy and program development process.See also Annex VI for more information on institutional definitions of the MENA region.1 United Nations Children’s Fund, Young People in the East Asia and Pacific Region: Indicator and Data Issues,UNICEF, East Asia and the Pacific Regional Office, 2007.
  • 14. 3. Demographic trendsBoth national and international estimates indicate that more than half of the total population in theMENA region is under the age of 25. While the age distributions of the populations of countries in theregion vary widely, it is estimated that the under 25 population in MENA region constitutesapproximately 53 percent of the total population; the second highest proportion in the world after subSaharan Africa (63 percent).2 Adolescents and youth each constitute over 20 percent of the totalpopulation, comprising 20 percent and 21 percent of the region’s 396 million people respectively, asdepicted in Figure 1. The demographic shift currently underway has serious social and economicimplications for individual countries and the region as a whole. At present, it is estimated that there areapproximately 121 million young people in MENA. That figure is expected to grow to around 133 millionby 2015; an increase of 12 million young people in six years.3 Over the same period, however, the totalMENA population is expected to increase by approximately 109 million, as the current large cohort ofyouth and adolescents passes age 25. As a result, the youth and adolescent component of thepopulation will fall from its current level of 31 percent to approximately 26 percent of the total.Similarly, the proportion of the total regional population comprised of young people will fall from itscurrent level of 53 percent to 45 percent by 2025. As today’s young people make the transition fromyouth and adolescents to adulthood, this wave of new adults will place new demands on socialresources and infrastructure. The public and private sectors of today’s MENA region have to rapidlyevolve to fulfill this demand if they are to fully harness the potential of current and future generations.2 United States Census Bureau International Database, http://www.census.gov/ipc/www/idb/, accessed 17September 2009.3 United Nations Population Division, World Population Prospects: The 2008 Revision Population Database,http://esa.un.org/unpp/, accessed 17 September 2009.
  • 15. Figure 1 MENA population under 25 years of age. 0 9 10 14 22% 15 19 19 24 25 + 47.20% 10.10% 10.30% 10.30%Source: UN Population Division 2009 estimatesFertility in MENAAs with estimates of the population distributions of countries in MENA, fertility rates vary widelythroughout the region (Figure 2). A country’s Total Fertility Rate (TFR) is the average number of childrena woman would be expected to bear throughout her lifetime if she experienced the currently observedage specific fertility rates until the end of her reproductive life. Some countries in MENA exhibit TFRsmuch lower than the global average (2.56), such as Algeria (1.79), Iran (1.71), Lebanon (1.85) and Tunisia(1.72). Others, however, exhibit very high TFRs, such as Oman (5.53), Sudan (4.48) and Yemen (5).4,5When countries exhibit a TFR above replacement level, usually around 2.1, their population willincrease, while if it is below, the size of the population will decrease in size in the longer term. Asdisplayed in Figure 2, most countries in the region exhibit TFRs in excess of replacement level,contributing to the projected population increase described above. As such, the high proportion ofyoung people in MENA countries’ total populations today are primarily the result of high TFRs in thepast. While other considerations such as life expectancy, migration and the trend in TFR both before andafter the birth of this cohort of young people contribute to the population distribution, past high TFRs, inconjunction with TFR reductions since then, has resulted in today’s high young person to populationratio. It is for this reason, in addition to trends in migration and life expectancy at birth, that thecontinued decline in the TFR of many MENA countries will result in a lower proportion of young peoplein MENA in the future. In 2007, the Population Reference Bureau estimated that the overall share of4 United States Census Bureau International Database, http://www.census.gov/ipc/www/idb/, accessed 17September 2009.5 Gaza’s TFR is one of the highest in the region at 5.03; however the West Bank’s is 3.22. Therefore, the weightedaverage TFR of the oPt is 3.92 based on 2009 estimates. 16
  • 16. youth in MENA will drop to 17 percent by 2025, from its current level of approximately 21 percent.6Those countries with a lower TFR are likely to see this change the soonest, as the current youth andadolescent bulge moves into adulthood, while those with a higher TFR may expect a later transition.Figure 2 Total Fertility Rate, 1989 & 2009. 7 6 5 4 3 1989 2 2009 1 0 Morocco Djibouti Egypt Bahrain Lebanon Sudan World Average Qatar Algeria Gaza Iran Iraq Libya Syria West Bank Jordan Kuwait Oman Saudi Arabia UAE Yemen Tunisia MENA RegionSource: US Census Bureau International Database.Adolescent (15 19) Fertility in MENAOver the past 30 years, the adolescent fertility rate has fallen in all but two countries in the MENAregion; Egypt, where it has increased by 26 births per 1,000 adolescent women, and oPt, where it hasincreased by 5 births per 1,000 adolescent women (Figure 3). In all other countries in the MENA region,the adolescent fertility rate has fallen by at least 90 births per 1,000 woman; a significant reduction fromprevious levels. In 1970 75, only six countries with available data exhibited an adolescent fertility ratelower than the world average of 71 births per 1,000 women aged 15 19, while 11 had adolescentfertility rates higher than the world average. For the period 2000 2005, however, only three countrieshad an adolescent fertility rate greater than the world average of 55 births per 1,000 women aged 1519: the oPt (60), Syria (58), and Yemen (83). Due to the marked reduction in adolescent fertility over thepast 30 years by all countries except two of those with data between 1970 and 1975, the region’saverage adolescent fertility rate is now significantly below the global average. Of countries in the MENAregion, Algeria (6), Libya (7) and Tunisia (8) currently report the lowest adolescent fertility rates.6 Population Reference Bureau. Youth in the Middle East and North Africa: Demographic Opportunity or Challenge?PRB, Washington DC, April, 2007. 17
  • 17. Figure 3 Adolescent Fertility Rates.Source: UN Population Division, World Fertility Patterns 2007.Youth (20 24) fertility in MENAYouth fertility in the region has also shown a marked decline (Figure 4). In the period 1970 1975, onlyEgypt (157), Lebanon (184) and Qatar (169) were below the global average youth fertility rate of 231births per 1,000 women aged 20 24. The remaining 14 countries for which data are available displayedage specific fertility rates higher than the global average, most notably Bahrain (411) and Oman (409).Since the early seventies, the fertility rate for the 20 24 age group has fallen dramatically in all MENAcountries except Egypt (increasing by 25 births per 1,000 women aged 20 24) and the oPt (where it hasdecreased by 9 births per 1,000 women aged 20 24; a relatively small decrease). All but three countrieshave fertility rates in the 20 24 age group lower than the world average in 2000 2006 of 159 births per1,000 women: the oPt (233), Syria (165), and Yemen (245). 18
  • 18. Figure 4 Youth Fertility Rate. 450 400 Births per 1,000 Women aged 15-24 350 300 250 200 1970-1975 2000-2005 150 100 50 0 Egypt Morocco Tunisia WORLD Lebanon Sudan Yemen oPt Oman Algeria Jordan Kuwait Qatar Iraq Libya Syria Bahrain Djibouti Iran UAE Saudi ArabiaSource: UN Population Division, World Fertility Patterns 2007.Adolescent (15 29) versus youth (20 24) fertility ratesMost countries in the region now have fertility rates for age groups 15 19 and 20 24 below the worldaverage. While the absolute age specific fertility rates may have both decreased, this change has notbeen proportional. Figure 5 displays the ratio of reductions in the age specific fertility rates of both agegroups. Countries with a value greater than one have decreased their adolescent (15 19) fertility ratefaster than their youth (20 24) fertility rate, while those with a value of less than one have decreasedtheir youth fertility rate faster than their adolescent fertility rate. In the case of Egypt, the changerepresents the ratio of increasing age specific fertility rates. In Egypt, the adolescent fertility rate hasincreased at only 14 percent the rate of the youth fertility rate. Data from the oPt are not displayed, asthe adolescent fertility rate has increased in the Territory, while the youth rate has decreased. 19
  • 19. Figure 5 Ratio of change in adolescent and youth fertility rates.Source: UN Population Division, World Fertility Patterns 2007.As presented in Figure 5, the youth fertility rate has fallen faster than the adolescent fertility rate in allcountries available for comparison except for Lebanon and Syria, where the adolescent rate has fallenfaster. As such, the percentage reduction in age specific fertility has been greater in the age group 20 24than amongst the 15 19 year olds. While the percentage reduction has generally been greater amongthose ages 20 24, the adolescent fertility rate has been falling in all countries in the MENA region overtime. In MENA today, the 20 24 age group contribute more births to the Total Fertility Rate than doesthe 15 19 age group but greater percentage reductions since the early 1970s have been seen amongthose aged 20 24.Mortality in MENAYoung people as a group face different health challenges to young children and older people. On thewhole, young people in the MENA region experience lower rates of death from communicable and 20
  • 20. chronic diseases than do those of the older generation.7 Young people generally, and young menspecifically, face a higher burden of disease from accidents, injuries and mental health issues.8 Youngwomen in the region face the additional risk of maternal health complications. Taken together, thesefour realms contribute roughly 66 percent of women’s total burden of disease in the MENA region, andapproximately 71 percent of men’s. The burden of disease will be discussed further in Section 5 – Healthtrends.Young peopleSince 1996, the death rates for young people have declined in most countries (Figure 6). In the decade1996 2006, only three countries experienced an increased probability of dying between ages 10 24: Iraq(increasing 6 percent), Qatar (increasing 0.15 percent), and Sudan (increasing 0.31 percent). In Iraq andSudan, this increase may be explained by new and continuing conflict. In 2006, Djibouti (3 percent), Iraq(8 percent), Sudan (3 percent) and Yemen (2 percent) witnessed the highest probability of death in thisage group. In contrast, Bahrain (0.74 percent), Kuwait (0.64 percent) and the United Arab Emirates (0.55percent) exhibited the lowest probability of death, all below 0.75 percent. Of all countries in the MENAregion, Iran has seen the greatest reduction in the period 1996 2006, falling 1.35 percent from 2.57percent in 1996 to 1.22 percent in 2006. While the general trend in the probability of death for youngpeople in the region is decreasing, the three exceptions of Iraq, Qatar and Sudan require particularattention.7 World Health Organization, The Global Burden of Disease, 2004 Update, WHO, Geneva, 2008. World Bank MENAregion (16 countries)8 Ibid. 21
  • 21. Figure 6 Probability of death as a percentage (ages 10 24, 1996 2006). 9.00 8.00 7.00 6.00 5.00 4.00 1996 3.00 2006 2.00 Change 1996-2006 1.00 0.00 -1.00 -2.00 Djibouti Lebanon Sudan Tunisia Jordan Libya Morocco Qatar Syria UAE Egypt Yemen Algeria Bahrain Iran Iraq Kuwait Oman Saudi ArabiaSource: WHOSIS Database. Accessed at: http://apps.who.int/whosis/database/life_tables/life_tables.cfm.AdolescentsSimilar to young people generally, the probability of dying between ages 10 19 has generally fallenacross MENA (Figure 7). In 2006, the probability of dying was highest in Djibouti (1.58 percent), Iraq(2.86 percent), Sudan (1.7 percent) and Yemen (1.39 percent). For Iraq and Sudan, this risk of death is anincrease of 1.85 percent and 0.09 percent from 1996 levels, respectively. While still one of the highest inthe region, Djibouti’s probability of death for adolescents marks a reduction of 0.39 percent. However, 22
  • 22. while still around the regional average, the probability of death for adolescents in Qatar increased by0.01 percent from 1996 to 2006, to 0.59 percent.Figure 7 Probability of death as a percentage (ages 10 19, 1996 2006). 3.00 2.00 1996 1.00 2006 Change 1996-2006 0.00 -1.00 Morocco Tunisia Djibouti Iran Lebanon Sudan Yemen Jordan Algeria QatarSource: WHOSIS Database. Accessed at: http://apps.who.int/whosis/database/life_tables/life_tables.cfm.In contrast, Bahrain (0.39 percent), Kuwait (0.36 percent), Oman (0.44 percent), and the United ArabEmirates (0.29 percent) experienced the lowest probability of death for adolescents in 2006; all under0.5 percent. Bahrain, Kuwait and the United Arab Emirates also displayed the lowest regional rates inMENA in 1996; however Qatar previously had a lower probability of death than Oman (0.58 percent and0.77 percent respectively). The greatest reduction in adolescent probability of death was again Iran,falling from 1.36 percent to 0.66 percent, a reduction of 0.7 percent.YouthFour countries in the region displayed an increase in the probability of death for youth between 1996and 2006, while the remaining 15 countries for which data were available displayed a reduction (Figure8). Bahrain and Qatar witnessed increases of 0.01 percent and 0.22 percent, resulting in probabilities ofdeath between the ages of 15 24 of 0.63 percent and 0.91 percent respectively. The increase in youthmortality in Iraq may be attributable to conflict, resulting in an increase of 5.33 percent in Iraq to a 2006level of 6.85 percent, and an increase of 0.02 percent in Sudan to a 2006 level of 6.85 percent. 23
  • 23. Figure 8 Probability of death as a percentage (ages 15 24, 1996 2006). 8.00 7.00 6.00 5.00 4.00 3.00 1996 2.00 2006 Change 1996-2006 1.00 0.00 -1.00 -2.00 Tunisia Sudan Morocco Djibouti Iran Lebanon Yemen Jordan Algeria QatarSource: WHOSIS Database. Accessed at: http://apps.who.int/whosis/database/life_tables/life_tables.cfm.Four countries in the region exhibited a probability of mortality between ages 15 24 of less than 0.75percent: Bahrain (0.63 percent), Kuwait (0.49 percent), Oman (0.73 percent), and UAE (0.47 percent).Similar to the adolescent probability of mortality, Bahrain, Kuwait and UAE also had the lowest youthmortality probability in 1996 (0.62 percent, 0.95 percent and 0.86 percent, respectively); however Qatar(0.69 percent) previously displayed a lower adolescent mortality probability than Oman (1.23 percent).While Qatar had one of the lowest mortality risks in the region for this age group in 1996, both theadolescent and youth age groups experienced an increase in the probability of death between 1996 and2006, whereas Oman experienced a decrease in both age groups.MENA’s demographic shift and the potential window of opportunityWhile MENA’s total population will continue to grow in the medium term future, the averagepopulation growth rate peaked in the latter half of the 1980s at approximately 3 percent per year, andhas declined to approximately 2 percent per year since.9 In comparison, the global growth rate peakedin the mid 1960s at 2 percent per year, and currently rests at 1.2 percent per year. As noted earlier in9 Population Reference Bureau. Youth in the Middle East and North Africa: Demographic Opportunity or Challenge?PRB, Washington DC, April, 2007. 24
  • 24. this section, the size of a population depends on three factors: the fertility rate, the mortality rate, andnet migration. Estimates of these three factors conclude that MENA’s population will continue to growin the medium term due to birth rates above replacement level and increasing life expectancies in themajority of countries. While there will be a greater flow of migrants leaving MENA than entering10, thisnegative factor will not offset growth due to fertility and delayed mortality. Should fertility decrease toreplacement level or below, the region will still experience growth, as the large cohort of children andyoung people move into their reproductive years and have children of their own. Though this cohort willbe having fewer children per person than the current adult population, growth will continue due to thelarger size of the population of reproductive age.Declining fertility in the region will result in a ‘youth bulge’, in which the proportion of the populationcomprised of adolescents and youth peaks and then declines. The hypothetical population pyramiddepicted in Diagram 1 displays this phenomenon, as the proportion of the population aged 10 19 islarger than any other 10 year age bracket older or younger. Diagram 2 displays a population pyramidcomparing the MENA region and the global average population distribution. The global populationdistribution displays this youth bulge, where the proportion of people in the 10 14 age bracket is largerthan any before or after it. As MENA’s fertility rate declines, the number of children born in each newcohort will decline as a percentage of the total population. As the ‘youth bulge’ cohort reachesadolescents and youth, countries in the region have the opportunity to harness the potential of ageneration equipped with the human and social capital to propel the region forward, or miss theopportunity and face substantial economic, social and political challenges as this large generationreaches adulthood.10 United States Census Bureau International Database, http://www.census.gov/ipc/www/idb/, accessed 17September 2009. 25
  • 25. Diagram 1 Sample Population Pyramid in Society Experiencing a “Youth Bulge”.Source: United Nations Programme on Ageing. Available at: www.un.org/ageing/popageing_demo1.html. 26
  • 26. Diagram 2 Population Pyramid of MENA Region and WorldThe creation of a large cohort of young people marks the opportunity for countries and the region as awhole to transform the cohort’s skills and knowledge into growth. As they move through adolescenceand into adulthood, the cohort becomes part of the working age population. The country or region’ssuccess in forming appropriate policy and planning for the needs of adolescents and youth willdetermine whether the youth bulge will have a positive or negative effect on the society in the future.The working age population is comprised of all those aged 15 65, and represents the country or region’spotential supply of labor. As the youth bulge moves into this age category, there is the potential totranslate this window of opportunity into a ‘demographic dividend’.11 This increase in the proportion ofthe population who are of working age decreases the dependency rate; the ratio of the working agepopulation to the sum of those aged less than 15 and over 65. By utilizing the working age population indecent and productive work, countries translate their human capital resources into economic growth. Afall in the dependency ratio, if planned and managed effectively, can lead to increased productivity, aswell as higher incomes, savings and investment, as seen in the case of the ‘East Asian Tigers’. Increasingproductivity and incomes can be transformed into benefits for the young and elderly also, either directlythrough families, or indirectly through higher government revenues channeled into programs. Thedemographic dividend has the potential to significantly boost the sensitive economies of individualcountries, and the region as a whole. Should the youth bulge not be adequately planned for andsufficient investments made, countries face the risk of higher general and youth specificunemployment, reduced productivity, stymied investment and stunted economic growth. Asinvestments in social infrastructure must be planned in advance, the MENA region now faces the11 Bloom, David E., Canning D and Sevilla, J., The Demographic Dividend: A New Perspective on the EconomicConsequences of Population Change, Population Matters Monograph MR 1274, RAND, Santa Monica, 2003. 27
  • 27. opportunity, or potential challenge, of investing in the human and social capital of its youth to propelthe region forward.The 2007 Economic and Social Council for Western Asia (UNESCWA) and the League of Arab States (LAS)recently noted that the demographic window of opportunity for economic growth is the 30 to 40 yearperiod when countries experience a low dependency rate due to the youth bulge moving through theworking ages. Following this period of potentially significant economic growth, the dependency ratioagain increases, as the large cohort moves out of the working age band and retires, once morebecoming primarily dependents. UN ESCWA and LAS estimated that in the MENA region, thedemographic window of opportunity opened in 1995, and is expected to close around 2045 throughoutthe region. Never has there been a more important time to invest in MENA’s young people to developand harness their knowledge, talents and potential for building the region’s future.Several factors are fundamental to ensuring that the demographic dividend is realized. Foremost amongthem is the creation of an education system that equips students with the knowledge and skills they willneed in their future careers. Simply providing places in primary, secondary and tertiary education isnecessary, but not enough. Countries must ensure that school curricula improve the quality of educationby focusing on critical thinking skills, and effectively linking education to the needs of the labor market.Additionally, education systems must furnish their students with the vision and skills to become leadersthemselves, through developing entrepreneurial ability and fostering opportunity.Second, governments must become employment enablers and not constrainers. By creating an enablingenvironment for the private sector, governments can encourage job creation and opportunities foryoung people entering the workforce. By motivating industry to provide productive, decent work, policymakers can ensure that the rights of workers are upheld while promoting a dynamic economy thatresponds to the needs of its customers and community. Growing productive economies create jobopportunities, reducing both the unemployment rate and the demand on resources it creates, allowingindividuals to claim income with dignity.Third, countries must invest in their social capital, particularly in the areas of health and pensionsystems. Healthcare should not merely respond to disease and disability after it has occurred; healthpolicy should seek to prevent, as well as cure the burden of disease. Primary prevention is aninexpensive component of a health system, not only compared with expenditure required for treatment,but also in terms of maintaining a healthy and productive workforce free of infirmity. Health systemsshould strive to be efficient, cost effective and accessible, providing the care that is required whentreatment becomes necessary. Similarly, in the longer term, governments must ensure that when thecurrent youth bulge reaches retirement, they are able to lead full and fruitful lives withoutcompromising the opportunities for the rest of the population. Policies must allow for individuals tocontribute to their own retirement while working, and also support solvent and economically soundpension systems to ensure that burdens of aged care are shared across the population.Fourth, countries must endeavor to equip the next and current generations with the civic skillsnecessary to become the leaders of tomorrow. Policies encouraging community engagement and female 28
  • 28. and youth empowerment advance the ideal of an inclusive society, promoting shared ideals and socialbonds. Efforts to deepen intergenerational relations and community belonging enhance social cohesionand the development of a just society, consolidating communities’ willingness to contribute to their owndevelopment.Through such measures, countries in the MENA region can strengthen their ability to fully benefit fromthe valuable demographic opportunity before them. By investing in the social and human capital of itspopulation, and especially its adolescents and youth, the MENA region stands to reap the demographicdividend. Should the region’s countries fail to adequately plan and respond to this window ofopportunity, they stand not only to miss out on the potential benefits of the demographic dividend, butalso to bear the burden of high unemployment and low economic growth, and a future which will leavethem unequipped to provide for the needs of their aging populations.Recommendations Collect data on both internal and international migration among youth and ensure that non national youth populations are included in national surveys. Improve existing data on child marriage by stratifying between those who were married before 18 and those who were married before 15. Standardize age categories across agencies collecting data in the region. 29
  • 29. 4. Poverty trends General poverty issues facing MENA Poverty data are available for eight of the 20 countries in the MENA region. Both relative and absolute poverty rates in MENA compare favorably to other global regions. While some countries, such as Djibouti and Yemen, drive regional poverty estimates upward, MENA as a whole fares better than any other global region (Table 1). Table 1 Percent of regional populations living in absolute vs. relative poverty. Percentage in Absolute Poverty (<$1.25 per day) Percentage in Relative Poverty (<$2 per day) Percentage PercentageRegion 1990 2005 Change 1990 2005 Change change change EAP 56.00% 18.00% -38.00% -67.86% 80.00% 39.60% -40.40% -50.50% ECA 3.90% 4.10% 0.20% 5.13% 10.60% 9.30% -1.30% -12.30% LAC 10.00% 7.90% -2.10% -21.00% 20.40% 16.90% -3.50% -17.20%MENA 4.30% 3.60% -0.70% -16.28% 19.70% 16.90% -2.80% -14.20% SA 51.70% 40.40% -11.30% -21.86% 82.70% 73.90% -8.80% -10.60% SSA 57.80% 51.20% -6.60% -11.42% 76.10% 72.90% -3.20% -4.20%World 42.30% 25.70% -16.60% -39.24% 63.70% 47.30% -16.40% -25.70% Source: Ravallion, M., Chen, S., "The developing world is poorer than we thought, but no less successful in the fight against poverty", World Bank 2008. According to a 2008 World Bank report, 3.6 percent of the MENA region’s population lived in absolute poverty in 2005, defined as less than $1.25 per day ($1 per day at 1990 levels). Since 1990, the share of the total population subject to absolute poverty has fallen 0.7 percent; a reduction of approximately 16 percent from 1990 levels of 4.3 percent. This reduction has been larger than the reductions experienced in some other regions over the same time period; Sub Saharan Africa experienced a reduction of 11 percent and Europe and Central Asia actually saw the share of people living in absolute poverty increase 5.1 percent. The region, however, experienced slower progress than East Asia and the Pacific (68 percent reduction), Latin America and the Caribbean (21 percent reduction), and South Asia (22 percent reduction). In 2005, 26 percent of the global population lived in absolute poverty, indicating that the MENA region is far ahead of the global absolute poverty prevalence, but is unlikely to meet the first MDG of halving the proportion of people living in absolute poverty by 2015 unless there is a marked improvement in poverty reduction rates. The estimates presented above are based on official country data from a minority of states in the region, raising concerns that projections and estimates may not be accurate for the region as a whole. Although absolute poverty rates in the MENA region are relatively low, a far greater proportion of the population lives on less than $2 per day (adjusted from 1990 levels). For MENA as a whole, 17 percent of 30
  • 30. the population lives below this benchmark, a reduction of 14 percent since 1990. Comparing percentagereduction figures for absolute and relative poverty reductions show that MENA states have reduced theproportion of their population living on less than $1.25 per day faster than the proportion living on lessthan $2 per day. While decreases in both rates are positive, disparities between reduction rates raisethe concern that the absolute poor are merely shifting from one state of poverty to another, and notexperiencing meaningful increases in incomes. While this is less of a concern in MENA than in any otherglobal region, individual countries in MENA should be aware of the total income distribution of theirpopulation to ensure that economic gains are spread throughout society.Available poverty data for eight countries in the region display heterogeneity in both levels of absoluteand relative poverty rates themselves, and states’ success in assisting their poor out of poverty (Figures9 and 10). While some countries in the region report relatively low absolute and relative poverty rates,such as Iran (absolute poverty: 1.45 percent, relative poverty: 3.45 percent) and Jordan (absolutepoverty: 0.38 percent, relative poverty: 8.02 percent), others such as Djibouti (absolute poverty: 18.84percent, relative poverty: 41.17 percent) and Yemen (absolute poverty: 17.53 percent, relative poverty:46.56 percent) display very high rates, driving up the regional average. Similarly, per annum changes inabsolute and relative poverty rates have been mixed in MENA (Figure 11), with Djibouti and Yemendisplaying large increases in both absolute and relative poverty rates (Yemen: 0.66 percent & 1.46percent, Djibouti: 1.97 percent & 3.49 percent increases per annum, respectively), while Morocco andTunisia have experienced significant decreases (Morocco: 0.53 percent & 1.31 percent, Tunisia: 0.79percent & 1.51 percent decreases per annum, respectively.Figure 9 Percentage of total population living in absolute poverty (less than $1.25 per day) 20% 18% 16% 14% 12% 10% 8% 1995-1998 6% 2000-2006 4% 2% 0%Source: Ravallion, M., Chen, S., "The developing world is poorer than we thought, but no less successful in the fight againstpoverty", World Bank 2008. 31
  • 31. Figure 10 Percentage of the total population living in relative poverty (less than $2 per day) 50.00% 45.00% 40.00% 35.00% 30.00% 25.00% 20.00% 1995-1998 15.00% 2000-2005 10.00% 5.00% 0.00%Source: Ravallion, M., Chen, S., "The developing world is poorer than we thought, but no less successful in the fight againstpoverty", World Bank 2008.Figure 11 Per annum percentage change in absolute and relative poverty rates 4% 3% 2% 1% Less than $1.25 per day 0% Less than $2 per day -1% -2% Egypt Morocco Tunisia Djibouti Yemen Jordan Algeria IranSource: Calculated from statistics presented in Ravallion, M., Chen, S., "The developing world is poorer than we thought, butno less successful in the fight against poverty", World Bank 2008. 32
  • 32. Table 2 presents the change in absolute poverty as a percentage of the change in relative poverty forcountries where data were available. The distribution of poverty rate change has differed betweencountries in the region, with only Jordan reducing absolute poverty at a faster per annum rate thanrelative poverty, though the absolute difference is small due to Jordan’s low baseline rate for the periodof analysis. Change in absolute poverty rates in the four other countries for which data are availableoccurred at approximately half the rate of relative poverty. In Morocco and Tunisia, these changes werea decrease; in Djibouti and Yemen, the relative poverty rate increased at twice the rate of absolutepoverty. In Egypt, absolute poverty fell at only 6 percent the rate of relative poverty. Proportionalcomparisons were not possible for Algeria and Iran, because absolute poverty rates increased, whilerelative poverty rates decreased.Table 2 Change in absolute poverty rate as a percentage of change in relative poverty rate 1990 2005 Djibouti 56.4% Egypt 6.0% Jordan 418.5% Morocco 40.8% Tunisia 51.9% Yemen 45.4%Source: Calculated from statistics presented in Ravallion, M., Chen, S., "The developing world is poorer than we thought, butno less successful in the fight against poverty", World Bank 2008.Significant barriers exist to accessing reliable, recent data on poverty levels and trends in MENA. Inmany cases, poverty information is not collected regularly, while in other cases, data are collected buteither not shared, or made available to only a limited audience. As such, poverty data analysis in MENAis stifled by a lack of both data collection and data dissemination.12 Reliable population wide data isavailable only for eight countries in the region, and is not available for any of the GCC states.Youth specific poverty in MENAInternationally, adolescents and youth are typically overlooked in poverty data collection and povertyreduction strategies.13 Even in cases where national data are collected, findings are not disaggregated byage to allow for reliable adolescent and youth specific estimates. In comparison to adults, young peopleoften experience a “dynamic”, acute form of poverty, while adults face more chronic, long termeconomic difficulties. As young people complete their education and move to the labor market, they12 The World Bank. Sustaining Gains in Poverty Reduction and Human Development in the Middle East and North Africa, The World Bank, Washington DC, 2006.13 International Labor Office, Global Employment Trends for Youth, ILO, Geneva, 2006. 33
  • 33. find employment that generally helps lift them from the poverty cycle. Extrapolation of adolescent andyouth poverty rates from national poverty figures is therefore an imprecise measure, as young peoplemake the transition from the economic circumstance of their families to their own. Data collection andanalysis strategies that overlook this factor risk presenting an unrealistic and inaccurate picture of thepoverty situation of young people in MENA.In addition to the paucity of population wide poverty data for the vast majority of countries in theMENA region, there is a particular dearth of adolescent and youth specific poverty information,rendering regional aggregation and comparison problematic. Although limited data from the 2007World Youth Report reveals estimated youth poverty rates for seven countries in the region, these datasuffer two shortcomings. First, youth poverty estimates are presented in terms of absolute numbers,rather than proportions. These numbers are not the result of poverty survey data, but are the nationalpercentage of the population living in poverty multiplied by the number of youths in the population atthat time. These estimates therefore assume that the youth specific poverty rate is identical to thepopulation wide poverty rate. As such, the data do not lend themselves to calculation of a youth specificpoverty rate, but indicate the number of youth living in poverty if they experience poverty ratesidentical to the population average.Second, estimates are not presented for adolescent poverty rates or levels. This may be due to twofactors: 1) poverty data are not disaggregated at the time of collection to allow for adolescent specificcalculations, due to methodological restrictions; and 2) while a number of agencies work withadolescents, there is no dedicated global or regional publication dedicated to adolescents, such as theWorld Youth Report. Estimates and analysis of adolescent issues therefore do not have a “referencepublication”, where adolescent specific data would be presented.Both of these considerations limit the validity and reliability of adolescent and youth poverty estimatesin MENA. The prima facie lack of available poverty data, and the scarcity of national adolescent andyouth specific poverty estimates complicate calculation of accurate regional levels and trends. Wherehousehold surveys are conducted, it is still difficult to disaggregate the data collected at the householdlevel. Household members are not questioned individually about their income, making any form of datadisaggregation virtually impossible.14 To arrive at accurate estimates of adolescent and youth specificpoverty rates, novel methods must be designed and implemented to ensure reliability and validity.Three conclusions can be drawn from the available poverty data for eight countries in the region(Figures 9 & 10): 1) national poverty rates differ markedly across MENA, reflective of the diversity ofdevelopment between states in the region. While a large percentage of Djibouti and Yemen’spopulations live on less than $2 per day, the other five countries with available data display much lowerrates of poverty; 2) the percentage of people in absolute poverty (living on less than $1.25 per day) isnotably low in five of the eight countries, ranging from less than half of a percentage point to two and ahalf percent. Absolute poverty in Djibouti and Yemen, however, rest at 19 percent and 18 percent,respectively; and 3) the share of the population surviving on $1.25 to $2 per day far exceeds the14 International Labor Office, Global Employment Trends for Youth, ILO, Geneva, 2006. 34
  • 34. percentage in absolute poverty. This contrast indicates that while absolute poverty rates in MENA arerelatively low, a far higher proportion of national populations are still subject to very low incomesthroughout the region.It is important to note that key international institutions providing poverty reduction support havelaunched initiatives to make poverty reduction policy in low income countries more effective. The WorldBank and the International Monetary Fund have launched the Poverty Reduction Strategy (PRS)Initiative, in which countries seeking debt relief must demonstrate through Poverty Reduction StrategyPapers (PRSPs) how savings will contribute to poverty reduction. However, a 2006 review of 55 PSRPfound that “young people are under represented, despite their large share of the populations of poorcountries.”15 As one of the largest segments of MENA’s population, with distinct needs andexpectations, national poverty reduction strategies must take into account the unique circumstances ofyouth and adolescents in order to design effective poverty reduction initiatives.Youth working in povertyOf related concern to poverty rates themselves, the ILO has recently calculated the regional share of theworking youth population who do not earn enough to lift themselves out of poverty (Figure 12). Such asituation is concerning, as it suggests that many young people who find work still do not earn enough tomeet their basic needs. Youth working poor are therefore all of those aged 15 to 24 who work but whodo not receive enough to surpass the $1.25 or $2 a day poverty thresholds through decent andproductive work. The youth working poor are more likely to be employed in the informal economy,earning low wages with little job security or benefits.16Figure 12 Youth working poverty rate, ages 15 24, 2005. South Asia SSA South East Asia and Pacific East Asia LAC Youth US$2 per day working poverty rate Cent/East Europe and CIS Youth US$1 per day working World poverty rate MENA 0 20 40 60 80 100 PercentageSource: Global Employment Trends for Youth. ILO, 2006.15 UNFPA. Putting Young People into National Poverty Reduction Strategies: A guide to statistics on young people inpoverty. UNFPA, New York, 2008.16 International Labor Office, Global Employment Trends for Youth, ILO, Geneva, 2006. 35
  • 35. ILO estimates of regional youth working poverty rates indicate that almost 40 percent of MENA’semployed youth were living on less than $2 a day in 2005. While this is a high percentage, the regionfares better than four of the six other ILO regions. Latin America and the Caribbean has a slightly lowerproportion of working youth living on less than $2 per day (35 percent), but a higher proportion of itsworking youth live in absolute poverty (13 percent, compared to 3 percent in MENA).As MENA approaches 2015, the region’s progress towards achieving MDG 1 has been greater than manyothers. However, to narrow the gap further, and to meet states’ commitments made in 2000, theseefforts must be sustained and intensified for adolescents and youth in MENA.Recommendations: Adolescent and youth specific poverty data must be collected, both in order to review young person specific levels and trends and also to allow comparison between young peoples’ experience of poverty with those of other age groups. Data collection methodologies should expand to include measures of deprivation, in areas such as shelter, food and nutrition, sanitation, water, and other key areas. These non income poverty indicators exist in other areas, but have not been collected within the MENA region. Future surveys of young people should also include subjective indicators exploring motivations for delayed marriage and family formation, as no data currently exist on this phenomenon, limiting policy makers ability to reduce barriers to these rites of passage to adulthood. 36
  • 36. 5. Health trendsPromoting health is an essential component of strengthening populations’ human security. The right tohealth is a fundamental human right, and MENA states’ commitment to fulfilling the promise of healthprovides a standard against which they may be held accountable. While adolescents and youth are arelatively healthy population, their well being is subject to vulnerability that is different to most otherage groups. Challenges to young peoples’ health in MENA are primarily the result of exposure to riskyhealth behavior. Many young people underestimate their risk of disease, injury and vulnerability to riskfactors such as smoking and obesity. Behavioral patterns expose young people to greater risk fromnutritional, lifestyle, and sexual choices, among others, that amplify their risk of adverse outcomes.17The lack of resonant and accessible preventive and restorative health information available to youngpeople limits their ability to make informed decisions, leading to excess mortality and morbidity in theMENA region.18 Compounding these challenges is the dearth of youth and adolescent specific healthdata, denying decision makers the evidence to guide effective and efficient health policy.To date, global health data collection and analysis has primarily focused on child survival (0 5 or 0 9years), maternal health (15 49 years) and general adult health (15 49 years). Recognition of theimportance of adolescents and youth, as well as the distinctive challenges confronting young peoples’health, has spurred efforts to gather data on these traditionally overlooked populations. Collection ofage specific data empowers policy makers to identify needs and formulate policies that positively affectthe health status of young people in MENA. At present, these data are minimal, outdated,unrepresentative, or entirely unavailable. One exception is a recently published study that analyzedworldwide rates and patterns of mortality between early adolescent and young adulthood. Findings forthe MENA region are discussed later in this section.19This section will examine the available data and identify gaps in information on adolescent and youthhealth trends in MENA. This analysis will include: 1) young people’s sexual and reproductive health(SRH), including sexually transmitted infections (STIs), early marriage, adolescent fertility, andadolescent maternal mortality; 2) substance use and abuse; 3) nutrition; 4) injury and mortality; and 5)mental and psychosocial health. For purposes of highlighting the multi sectoral nature of HIV AND AIDS,it will be discussed independently in Section 6 – HIV AND AIDS trends, despite several references to it inthis section. Adolescent and youth fertility and mortality rates are discussed in Section 3 – Demographictrends though their causes and risk factors are addressed here. While not addressed in this report,occupational health among MENA youth is an area worthy of increased attention in the future. It isimportant to note that youth who earn their living in the informal economy may be at increased risk ofoccupational safety hazards due to the absence of any regulatory authority promoting safe workplacebehavior and policies.17 Roudi Fahimi, F. and Ashford, L. Sexual and Reproductive Health in the Middle East and North Africa: A Guide for Reporters. Population Reference Bureau, 2008.18 UN ESCWA and the League of Arab States. The Millennium Development Goals in the Arab Region 2007: A Youth Lens. 2007.19 Patton G et al., Global patterns of mortality in young people: a systematic analysis of population health data,The Lancet, vol 374, 12 September 2009, p881 92. 37
  • 37. Young people’s sexual and reproductive health (SRH)Adolescence is a time of physical, physiological, and social transition into adulthood. Sexualdevelopment is a natural part of this process, but not all adolescents are exposed to the appropriateinformation and services to help them further understand this transition in their lives.20 Social anddemographic shifts occurring in the MENA region, such as delayed marriage and prolonged schooling,necessitate the provision of accessible sexual and reproductive health information, as young people facea transition very different from that of their parents. Delayed completion of key rites of passage toadulthood, such as marriage and employment, create a gap between adolescence and adulthood. Morethan any other time, it is in this period that young people face increased risk of unintended pregnancyand sexually transmitted infections (STIs).21 Reducing these risks and vulnerabilities requires theformulation and implementation of evidence based policy and programs at the national level.At the policy level, all MENA countries have ratified the CRC, and most have ratified the InternationalCovenant on Economic, Social, and Cultural Rights (ICESCR), as well as participated in the Convention onthe Elimination of all Forms of Discrimination against Women (CEDAW) and Beijing Conferences (originaland the Beijing +5). Participation in these treaties indicates governments’ willingness to meet thecommitments necessary to fulfill young peoples’ right to access SRH information, education andservices. A key study in the field of young people’s SRH in MENA, “Breaking the Silence and SavingLives”, emphasizes the failure of many states to meet their commitments due to community taboos anddisapproval of behaviors such as premarital sexual activity or substance abuse. By not fulfilling theirresponsibilities, states tacitly contribute to the further marginalization and vulnerability of youngpeople.22Little data have been generated on adolescent and youth sexual and reproductive health in MENA. Thefew groundbreaking studies that have been conducted are necessarily limited, due to challenges in datacollection on sensitive topics. Taboos against discussion and analysis of the reproductive health of youngpeople pose a major obstacle to further research on the topic. The lack of services for unmarried youngpeople also contributes to the shortage of data generation, as the majority of data are derived fromoperational research. As such, social taboos and cultural sensitivities have been the primary factorcontributing to the current paucity of data on young people’s sexual and reproductive health.23 Anumber of other factors have exacerbated these shortcomings: In addition to a lack of information available to young people, adolescents’ and youths’ reproductive health needs are not being fully met nor addressed as a consequence of conservative societal mores and taboos; Health services and informational campaigns generally fail to address the needs of young people and target only married young people;20 DeJong, J. and El Khoury, G. ‘Reproductive Health of Arab Young People’, British Medical Journal, 333, October2006, 849 851.21 Population Reference Bureau. Young People’s Sexual and Reproductive Health in the Middle East and NorthAfrica., PRB, Washington DC, 2007.22 Shepard, B. and DeJong, J. Breaking the Silence and Saving Lives: Young People’s Sexual and Reproductive Health in the Arab States and Iran. Harvard School of Public Health, Boston, 2005.23 Ibid. 38
  • 38. Schools do not provide information on young people’s sexual and reproductive health; Young people have not had opportunities to provide feedback on their SRH education and services needs; and Ongoing conflicts in the region increase the vulnerabilities of young people.24As a result of shortages of data collection, analysis and dissemination of accessible information andservices, young people are unprepared to make informed sexual and reproductive health decisions,increasing their risk of unintended pregnancies and STIs, including HIV AND AIDS.25 Contrary tomisconceptions of opponents of sexual and reproductive health education for young people, reviews ofsexual education programs show that sexual education does not promote early sexual activity, but canrather delay initiation and promote safer practices.26Within MENA, sexually transmitted disease surveillance capabilities remain weak; cases are underreported, with relatively few country specific studies on STI incidence among young people. Of thelimited data available on STIs, which are seldom disaggregated by age, findings indicate that STIs aremore common among younger adults (15 29) than those in older age groups. Few studies haveexamined young people’s knowledge of STIs, however available research suggests that correctknowledge about STIs and their transmission is low.27Surveys in a limited number of MENA countries have aimed to collect information on STIs, including HIVAND AIDS. Results indicate that although many young people had heard of HIV AND AIDS, most knewlittle about its transmission or about other STIs. The results also demonstrated that young Tunisianswere better informed than those in Syria and Algeria, indicating the success of different governmentpolicies.28Given the lack of data directly addressing young people’s sexual and reproductive health knowledge inMENA, this review will use the proxy measures of early marriage, adolescent fertility and adolescentmaternal mortality to indicate the extent of health risk and protective factors. Additionally, theseaspects constitute key outcomes of sexual and reproductive knowledge and behaviors, allowing arudimentary evaluation of state performance.Early marriageEarly marriage is closely associated with adolescent fertility, which carries significant maternal andinfant health risks. Early marriage can also lead to other non health related consequences. Women whomarry early are more likely to: 1) become school drop outs and be socially isolated; 2) receive pressurefrom their family and social circle to have children quickly; 3) have less knowledge about family planning24 DeJong, J. and El Khoury, G. ‘Reproductive Health of Arab Young People’, British Medical Journal, 333, October 2006, 849 851.25 Shepard, B. and DeJong, J. Breaking the Silence and Saving Lives: Young People’s Sexual and Reproductive Health in the Arab States and Iran. Harvard School of Public Health, Boston, 2005.26 Population Reference Bureau. Young People’s Sexual and Reproductive Health in the Middle East and North Africa., PRB, Washington DC, 2007.27 Ibid.28 Ibid. 39
  • 39. and SRH in general than their older counterparts; 4) lack decision making power over their own health.All factors combined have greater probability of serious health risks for themselves and their infants.29Although the CRC states that the legal and actual minimum ages of marriage, particularly for girls, arestill very low in several participating countries, “marriage is not considered directly in theCRC…[Nevertheless,] it is clear that the Committee places a great deal of importance in ensuring thatmarriage should not be concluded too early and that the minimum age for marriage should be equal forboys and girls.”30 Within the CRC’s Guidelines for Periodic Reports, participating CRC countries arerequired to “provide relevant information with respect to article 1 of the Convention, including on: …the minimum legal age defined by the national legislation for … marriage.”31 Twenty six participatingworld countries provide unclear or no information about minimum age for marriage – seven of whichare in MENA (Bahrain, Djibouti, Iran, Iraq, Qatar, Syria and UAE). Moreover, Lebanon, Saudi Arabia andSudan do not currently have legal minimum ages of marriage (Figure 13).3229 Roudi Fahimi, F. and Ashford, L. Sexual and Reproductive Health in the Middle East and North Africa: A Guide for Reporters. Population Reference Bureau, Washington, 2008.30 Melchiorre A. At What Age Are School Children Employed, Married and Taken to Court? Second Edition, Right to Education Project, 2005.31 Committee on the Rights of the Child. General Comment No. 4 (2003): Adolescent Health and Development in the Context of the Convention on the Rights of the Child. Thirty third Session, July 2003.32 Melchiorre A. At What Age Are School Children Employed, Married and Taken to Court? Second Edition, Right to Education Project, 2005 40
  • 40. Figure 13 Minimum legal age of marriage. 22 20 Minimum age at marriage 18 16 Male 14 Female 12 10Source: Right to Education Project. Available at: http://www.right to education.org/node/279.While the region has experienced an overall trend toward delayed marriage, there are nonethelesspopulation groups where child marriage and early childbearing remains common (Figure 14). Culturaland traditional values in some countries encourage families to betroth their daughters before age 18.33According to UNICEF data, the region’s highest rates of early marriage occur in Yemen (32 percent) andSudan (34 percent), while Algeria (2 percent) and Djibouti (5 percent) show the lowest rates for MENAcountries with available data.3433 Roudi Fahimi, F. and Ashford, L. Sexual and Reproductive Health in the Middle East and North Africa: A Guide for Reporters. Population Reference Bureau, Washington, 2008.34 United Nations Children’s Fund, State of the World’s Children 2008. UNICEF, New York, December 2007. 41
  • 41. Figure 14 Percentage of women age 20 24 married before age 18. 40% 35% 30% 25% 20% 15% 10% 5% 0%Source: most recent MICS or DHS.Adolescent fertilityWhile adolescent and youth fertility rates are discussed in Section 3 – Demographic trends of thisReview, broad conclusions on fertility are repeated here for ease of use. Estimates of adolescent fertilityrates are consistently collected throughout the world, simplifying country and regional comparisons.Overall fertility rates have declined throughout the world and, in the past decade, 16 MENA countrieshave seen a decline in their total fertility rate. The MENA region as a whole saw the greatest absolutereduction in TFR (1.3), and the second highest percentage change over the time period (26 percent),after the CEE/CIS and Baltic States region (30 percent) (Table 3). Nonetheless, MENA’s total fertility ratewas the second highest in the world in 2000, at 3.7, after Sub Saharan Africa (5.7). The adolescentfertility rate for MENA, however, is the third lowest in the world (39), after East Asia and Pacific (18) andthe CEE/CIS and Baltic States regions (35). MENA is now below the global average adolescent fertilityrate of 50 births per year to every 1,000 girls aged 15 19 but there are sub and intra regionaldisparities.3535 United Nations Children’s Fund, ChildInfo statistics by area, http://www.childinfo.org/statsbyarea.html, accessed17 September 2009. 42
  • 42. Table 3: Regional Fertility Rates and Maternal Mortality Rates Adolescent Maternal Fertility Rate Mortality Rate Region Total Fertility Rate (Annual (maternal (lifetime births per births per deaths per 100 woman at current 1,000 girls) 000 live births) fertility rates) 1990 2000 2000 2005 1990 2005 MENA 5.0 3.7 39 270 210 World 3.2 2.7 50 430 400 South Asia 4.2 3.5 56 650 500 East Asia and Pacific 2.5 2.0 18 220 150 LAC 3.2 2.6 71 180 130 SSA 6.3 5.7 127 940 920 CEE/CIS 2.3 1.6 35 63 46 Developing Countries 3.6 3.0 480 450 Industrialized Countries 1.7 1.6 24 8 8Source: UNICEF Statistics By Area Database (data from 2000 2005), and Maternal Mortality in 2005: Estimates Developed byWHO, UNICEF, UNFPA and World Bank. World Health Organization, 2007.Specific to MENA, adolescent fertility is only reported for births within wedlock, and little data areavailable on non marriage births and young people’s reproductive health in general. High adolescentfertility rates, which are directly associated with early marriage in the region, are accompanied bygreater risks of pregnancy and childbirth complications. In poorer countries, such complications are theleading cause of death for adolescent girls between the ages of 15 and 19, and adolescent girls are twiceas likely as their older female counterparts to die of pregnancy or childbirth related complications. Inaddition to the risks of early childbirth on adolescent mothers, children born to adolescents also havecompromised survival rates, with greater risk of: 1) premature birth; 2) low birth weights; 3) dyingwithin the first month of life; 4) having less access to adequate nutrition or health and educationservices when older; and in general, 5) are more likely to continue the cycle of poverty.3636 Save the Children, Children Having Children: State of the World’s Mothers 2004, Save the Children, 2004. 43
  • 43. In MENA, poorer countries have higher adolescent fertility rates; Yemen (83), the oPt (60), Syria (58),and Sudan (51) have higher rates than countries with higher average incomes (Figure 3). Save theChildren’s Early Motherhood Ranking, which categorizes the fifty most perilous countries where earlymotherhood has the most adverse effects, includes several MENA countries: Morocco and Egypt (tyingat #48 along with Indonesia); Sudan (#41); Iraq (#28); and Yemen (#20).37 This ranking reflects theprobability of mortality and morbidity as a result of adolescent childbirth, reflecting lack of access toservices that are not available to many women in the MENA region.While family planning services have expanded throughout several MENA countries and in some subregions in particular, young married women generally do not use family planning methods until aftertheir first child. Age is also a determinant of family planning use younger married women aged 15 to 19are less likely to use modern contraception than the cohort aged 20 to 24 who are also married. Equally,young married women from these two groups are less likely than other older women to access healthservices that supply modern contraceptives,38 reflective of the lack of access felt by many young womenin the MENA region. Establishment of families is also changing in many parts of the MENA region, giventhe overall delay of marriage as youth stay in school longer. Contraceptive prevalence rates are greaterthan 50 percent in Algeria (61 percent), Bahrain (62 percent), Egypt (59 percent), Iran (74 percent),Jordan (56 percent), Lebanon (58 percent), Morocco (63 percent), Syria (58 percent), and Tunisia (66percent), but remain significantly lower in Djibouti (9 percent) and Sudan (7 percent.)39 Prevalence ratesfor young people are not available.Adolescent maternal mortalityDespite being monitored under the MDG framework, adolescent maternal mortality data are notavailable for the MENA region. Therefore, inferences must be drawn from comparisons of populationwide maternal mortality estimates.As previously mentioned, teen mothers face greater risks of disability and mortality due to childbirthand labor than their older counterparts. For the most part, young women who marry early and becomepregnant quickly tend to be poor and have less access to health services. In Morocco, for example, thepoorest adolescent females are three times more likely than richest adolescent population quartile to bepregnant or already have had a child.40As can be seen in Table 3, maternal mortality rates throughout the world have improved across theboard between 1990 and 2005. The maternal mortality rate (MMR) for MENA has fallen from 270 to 210over the past 15 years, and remains lower than the world average (400).41 Intra regional disparities37 Ibid.38 Population Reference Bureau. Young People’s Sexual and Reproductive Health in the Middle East and North Africa., PRB, Washington DC, 2007.39 UN ESCWA and the League of Arab States. The Millennium Development Goals in the Arab Region 2007: A Youth Lens. 2007.40 Population Reference Bureau. Young People’s Sexual and Reproductive Health in the Middle East and North Africa., PRB, Washington DC, 2007.41 World Health Organization, Maternal Mortality in 2005: Estimates Developed by WHO, UNICEF, UNFPA and World Bank, WHO, Geneva, 2007. 44
  • 44. persist, whereby Algeria (180), Djibouti (650), Sudan (450), Yemen (430), and Morocco (240) havenoticeably higher rates than the rest of the region. Adolescent maternal mortality data collection shouldbe prioritized in these countries, given their poor total maternal mortality rates. Conversely, Egypt hasreduced its MMR from 174 in 1992 to 130 maternal deaths per 100,000 live births in 2005, throughadoption of a national safe motherhood strategy that helped decrease home deliveries while increasingthe percentage of medically assisted deliveries and the utilization of maternal health care and antenatalcare services.42 This initiative should be adapted and replicated in other high maternal mortality MENAstates to spread the potential benefits of the intervention across the region.According to a recent joint report issued by UN ESCWA and the League of Arab States,43 the reduction inmaternal mortality in most of MENA is partially attributable to a decline in adolescent fertility rates,which are due in part to social shifts throughout many parts of the region caused by delayed marriage.These gains should be complemented by education campaigns and increased access to services to spurcontinued reduction in maternal mortality rates in many MENA countries.Substance use and abuseThe issue of substance use and abuse is an emerging public health concern in the MENA region.Geographically, MENA is a key transit area for the drug trade. Socially, it is a region replete withvulnerabilities due to rapid social change, economic challenges and conflict situations; all risk factors fordrug use and abuse, especially among young people. Despite little available research, regional trendanalyses indicate that use among youth and women is rising, with the most common substances usedbeing tobacco, cannabis, sedatives, opiates and stimulants. Injecting drug use, primarily of opiates, isconsidered a new phenomenon in MENA. According to the WHO, there has been a rise in theprevalence of HIV among injecting drug users – from 0.16 per cent in 1999 to 3.26 per cent in 2003. Overthe same time period, HIV transmission rates via injecting drug use increased from 2 percent in 1999 to13 percent in 2003.44Tobacco useThe use of tobacco products in MENA is highly prevalent, and is now considered one of the greatesthealth risk factors facing young people in the region. Concordant with global trends, the majority ofsmokers in MENA start smoking before the age of 25, and the resurgent popularity of the shisha(hookah or water pipe) as a medium for tobacco use should be of concern for the region, due to widelyperceived beliefs that it is less harmful than cigarette smoke. Studies have shown that frequent use of42 The World Bank. The Status and Progress of Women in the Middle East and North Africa, The World Bank, Washington DC, 2007.43 UN ESCWA and the League of Arab States. The Millennium Development Goals in the Arab Region 2007: A YouthLens, 2007.44 WHO/EMRO. The Work of WHO in the Eastern Mediterranean Region: Annual Report of the Regional Director. Dec/Jan 2005. http://www.emro.who.int/rd/AnnualReports/2005/chapter4_print.htm, accessed 17 September 17, 2009. 45
  • 45. shisha is as equally harmful as cigarettes, and “may have a disproportionate effect on young womenwho are otherwise culturally dissuaded from cigarettes.”45Findings from the Global Tobacco School Survey (2002 2008) demonstrate that tobacco prevalenceamong students (ages 13 15) ranged from less than 1 percent (Libya, Iran) to 7 percent (Jordan) for girlsand from 3 percent (Iraq) to 19 percent (Syria) for boys. Earlier data collected by the WHOs GlobalYouth Tobacco Survey in 2001 2002 suggested that rates were much higher, up to 47 percent for malesin Djibouti. Based on these results, it would appear that tobacco control messages are not targetingand/or are not having the necessary impact of limiting young people’s smoking behavior.46 See Figure15 for a comparison of current smoking rates among students.Figure 15 Percentage of students (age 13 15) currently smoking cigarettes. 25% 20% 15% 10% Boys Girls 5% 0% Egypt Morocco Kuwait Iraq Libya Syria Tunisia Bahrain Djibouti Lebanon Oman Sudan Jordan UAE Yemen Qatar Saudi Arabia IranSource: Global Tobacco School Survey 2002 2008.45 The World Bank. Youth – An Undervalued Asset: Towards a New Agenda in the Middle East and North Africa. The World Bank, Washington DC, September 2007.46 WHO/EMRO. Trends in Tobacco Use among School Students in the Eastern Mediterranean Region, World Health Organization. Regional Office for the Eastern Mediterranean, Cairo, 2007. 46
  • 46. Drug useSignificantly less data are available on drug and alcohol use in the region, as drug use and, to a lesserextent, alcohol use are considered taboo topics. Given the vulnerabilities of MENA’s adolescents andyouth, the transition from adolescence to young adulthood is a critical point at which experimentationwith drugs could begin. There is mounting evidence that drug use in the region is becoming a seriousmatter that merits further attention and research. UNODC has been spearheading the few countrystudies that have been conducted to date in MENA, but there are no formal initiatives at the regionallevel. National surveys have been conducted in a few countries, including Egypt, Iran and Lebanon,however the lack of representative data prohibit broad country and region wide generalization anddrawing of inferences.NutritionOn a global level, adolescents and youth face nutritional challenges that are distinct to those of youngerchildren. As in other areas, adolescents and youth are often overlooked in nutritional analyses. Onaverage, 20 percent of total height and 50 percent of adult weight are gained during adolescence,highlighting the necessity of healthy nutrition in these ages for future well being.47 Three generalnutritional characteristics are common in MENA’s adolescent and youth population: Undernutrition; Micronutrient deficiencies: Iron, Vitamin A, iodine, calcium deficiencies; and Overweight and obesity; an emerging trend in the region.48The presence of both under and over nutrition reflects the dual burden of disease in the region. Whilesome segments of the population have very high access to food, others still suffer deprivation due toeconomic circumstance and lack of accessibility. Dual disease burdens are most prominent in countrieswith large income disparities. As a result, those in the highest income groups typically assume a moreWestern nutritional lifestyle, with its associated risks of overweight and obesity, and propensity forother higher risk behaviors such as inactivity. Conversely, those in the lowest income groups lack boththe financial means and in some cases, the physical access, to sufficient high quality foods to meet theirdaily needs, resulting in undernutrition and micronutrient deficiencies, and greater susceptibility toillness.For the region as a whole, young people’s nutritional status broadly fits the pattern of the dual burdenof disease. According to the WHO, there are “high levels of overweight and obesity along with pocketsof under nutrition and micronutrient deficiencies, high consumption of energy dense foods andaggressive marketing of ‘processed’ and ‘fast’ foods and carbonated drinks prevail in some countries. Inothers, moderate to low levels of overweight/obesity co exist with moderate levels of under nutritionand widespread micronutrient deficiencies. Long lasting complex emergencies and humanitarian crises47 WPRO/WHO. Value Adolescents, Invest in the Future. Adolescent Health and Development: A WHO RegionalFramework, 2001 2004. World Health Organization, Regional Office for the Western Pacific, 2001.48 Deslisle, H. et al. Should Adolescents be Specifically Targeted for Nutrition in Developing Countries? To Address which Problems and How? WHO, Geneva, 2001. 47
  • 47. affect a number of countries, where overall poor health and environmental conditions co exist withinadequate institutional capacity and insufficient trained human resources”.49Seven countries in MENA have presented data on obesity rates among children and young people aspart of the WHO CDC Global School Based Student Health Survey (Figure 16). Countries with higherincomes typically have higher rates of obesity. The United Arab Emirates displays the highest obesityrate among school students aged 13 15 of any MENA country. However, Lebanon exhibits a lowerobesity rate than would be expected of a country with similar income levels. Lebanon’s estimatedadolescent obesity rate is the lowest of all countries for which data are available (2.7 percent), followedby Yemen (3.3 percent) and Djibouti (3.5 percent), respectively.Figure 16 Percentage of students (ages 13 15) who are obese. 14.0% 12.0% 10.0% 8.0% Total 6.0% Men Women 4.0% 2.0% 0.0% Djibouti Egypt Jordan Lebanon Libya UAE YemenSource: Global School based Student Health Study.While data for Kuwait was not collected during the Global School Based Student Health Survey, onestudy found an obesity rate of 37 percent in males and 36 percent in females aged 10 13 years.Comparing these estimates with those of the UAE suggests that the studies used different methods toindicate obesity. The Global School Based Student Health Survey defined obesity as weight above the95th global weight percentile, while the Kuwait study used a Body Mass Index of 30 or more ((weight inkilograms)/(height in meters, squared)) to classify children as obese. Disparate definitions may createconfusion in interpreting obesity prevalence statistics, and complicate data comparison and verification.49 WHO/EMRO. The Work of WHO in the Eastern Mediterranean Region: Annual Report of the Regional Director. Dec/Jan 2005. http://www.emro.who.int/rd/AnnualReports/2005/chapter4_print.htm, accessed 17 September 17, 2009. 48
  • 48. Food insecurity and under nutrition rates vary across the region, with inadequate dietary energy intakein the Least Developed Arab Countries (Djibouti, Sudan and Yemen) affecting more than 25 percent ofthe total population (Figure 17). However, this high rate skews the regional average upwards, with theMashreq (3.2 percent), Maghreb (4.7 percent) and GCC (3.4 percent) sub regions all displayingsignificantly lower proportions surviving on less than 1800 calories per day. At the country level, theGlobal School Based Student Health Survey asked participants if they had gone hungry “most or all ofthe time during the past 30 days”. Results indicate a diversity of experiences across the region (Figure18), ranging from 2.7 percent of Lebanese students reporting food insecurity, to 18.7 percent of childrenin Djibouti. The survey also noted gender disparities in adolescent food insecurity, with adolescent boysexperiencing slightly higher rates of food insecurity than girls in all surveyed countries except Djiboutiand Yemen.Figure 17 Proportion of population below the minimum level of dietary energy consumption by sub region. 30% Proportion of population undernourished 25% 20% 15% 1991 1996 10% 2002 5% 0% Mashreq Maghreb GCC Arab LDCs Arab region Developing countries countries countries regions *Data for developing regions refer to the time periods 1990-1992 and 2001-2003.Source: MDGs in the Arab Region, A youth lens, 2007. 49
  • 49. Figure 18 Percentage of students (ages 13 15) experiencing food insecurity. 25% 20% 15% Total 10% Male Female 5% 0%Source: Global School based Student Health Survey.Injury and mortalityA 2000 WHO EMRO regional study on injury and mortality identified the leading causes of death for 1529 year olds for Eastern Mediterranean Region (EMR) medium and low income countries as: 1) roadtraffic injuries; 2) tuberculosis; 3) HIV AND AIDS; 4) interpersonal violence; 5) self inflicted injuries; and6) war injuries. EMR high income countries’ 15 29 year olds are more prone to dying from: 1) roadtraffic injuries; 2) interpersonal violence; 3) self inflicted injuries; 4) poisonings; 5) drowning; and 6) warinjuries.50 Consistent with the general world mortality profile, deaths and disabilities due to road trafficinjuries pose a great burden to young people across the region, accounting for 13 percent of allDisability Adjusted Life Years (DALYs) for men aged 15 29 in the World Bank’s MENA region (Figure 19).By contrast, road traffic injuries account for only 4 percent of young women’s DALYs (Figure 20). Lowerincome countries have a pronounced element of communicable disease in the mortality profile of youngpeople, whereas higher income countries are more prone to mortality due to injury and accidentfollowed by non communicable diseases. Of note is that mortality for this age group due to war injuriesor conflict is equally prevalent and is a reflection of the precarious security situation of some countriesin the MENA region.50 World Health Organization, The Global Burden of Disease, 2004 Update, WHO, Geneva, 2008. The World Bank MENA region (16 countries). 50
  • 50. Figure 19 Primary causes of death and disability, men ages 15 29. Fires 1% Drownings 2% Other causes 28% Poisonings Falls 1% 3% Other Unintentional Intentional Unintentional Injuries injuries Injuries 10% Road traffic 17% 29% accidents 13% Neuropsychiatric conditions 25%Source: Global Burden of Disease 2004. World Bank Eastern Mediterranean Region. 51
  • 51. Figure 20 Primary causes of death and disability, women ages 15 29 . Schizophrenia 6% Panic disorder Other causes 2% 35% Bipolar disorder Neuropsychiatric 6% conditions Other 34% 10% Unintentional injuries 13% Maternal conditions 19% Unipolar depressive disorders 9%Source: Global Burden of Disease 2004. World Bank Eastern Mediterranean Region.While believed to account for a significant proportion of young people’s deaths in MENA, very little dataare available on deaths from suicide. Throughout the world, suicide is among the three leading causesof death among adolescents and youth, while existing WHO EMRO data indicate that the phenomenonis rare in the MENA region.51 However, several factors limit the reliability of this data. Many deathregistration entries do not detail a cause of death. Combined with cultural resistance to suicide due tofamily honor, there is reason to believe that the actual suicide rate is higher than current estimatessuggest.52 Further research and analysis that adequately addresses issues of cultural sensitivity in thedata collection process are required to conclude reliable suicide estimates for countries across theregion.Mental healthMental and psychosocial health has only recently become a global priority, with the majority of previoushealth data relating only to physical conditions. The under measured phenomenon of youth suicide isindicative of the need for more data collection in this area, as both governmental and non governmental51 World Health Organization, The Global Burden of Disease, 2004 Update, WHO, Geneva, 2008. World Bank MENAregion (16 countries).52 Mediterranean Initiative for Child Rights, Towards a New Agenda for Children in the Southern Mediterranean Countries: A Rights Based Analysis. UNICEF, Innocenti Research Centre. 52
  • 52. planners do not have sufficient information to assess the scale of mental and psychosocial health issues,let alone design policies and programs to reduce their burden. Despite the high prevalence of severalrisk factors for suicide in many parts of the MENA region, such as conflict and violence, economicinsecurity, the transition to modernity, and generalized vulnerability, the need for prevention has nottranslated into monitoring and evaluation efforts by data gathering organizations, especially on youngpeople.Few surveys in the MENA region have included indicators of mental and psychosocial health and accessto support. The Global School Based Student Health Survey, discussed previously in this section, askedrespondents questions on a limited number of psychosocial and mental health symptoms, such aswhether the respondent felt lonely most or all of the time during the past year (Figure 21). Youngpeople in participating countries reported relatively high rates of loneliness, indicative of social isolationand a lack of strong, relevant protective networks. While not a valid and reliable measure ofpsychosocial and mental health on its own, the results of the survey indicate an untapped and underresearched area of global priority. Related questions on the number of close friends reported by youngpeople further confirm the need for greater research in these areas, as they are currently unaddressedin data gathering tools, and not a focus of policy makers.Figure 21 Percentage of students aged 13 15 who felt lonely most or all of the time during the preceding 12 months. 25% 20% 15% Total Male 10% Female 5% 0% Djibouti Egypt Jordan Lebanon Morocco Tunisia UAESource: Global School based Student Health Survey, 2005 2008. 53
  • 53. Mental and psychosocial health are inherently difficult concepts to measure. While physical infirmitydisplays obvious symptoms, mental and psychosocial issues are more often undiagnosed, and thereforeunder reported. For this reason, existing indicators have typically assumed the approach of measuringeither risk factors or low correlation symptoms, such as loneliness, or assessed theoretical access tosupport services, such as social workers per 100,000 people. These approaches each have their flaws, asmany risk factors will not develop into cases, and the provision of support structures is usually the resultof government planning. If governments do not have reliable data from which to develop policy, servicesprovided may underestimate the problem. Indicators for the population wide assessment of mental andpsychosocial health either do not exist, or are still in developmental form. Mental and psychosocialindicators and data collection should become a priority for governments and other organizationsworking with young people, to redress the current paucity of valid and reliable data.Recommendations Culturally sensitive data collection methodologies must be developed and applied to gather data on the range of sensitive health topics discussed above, including sexual and reproductive health, substance use and abuse, and death rates from causes subject to social taboo. Data producers should utilize standardized definitions for “overweight”, “obesity” and “underweight” to simplify comparison and allow for complementarity between data sources, reducing the need for duplicate evaluations. Youth and adolescent health data must become a priority area for data users and decision makers, spurring the collection of disaggregated statistics on health risk factors, disease prevalence, and causes of mortality. Mental and psychosocial health indicators should be developed and implemented for population wide estimation. Data producing organizations should incorporate mental and psychosocial health questions in country and regional surveys, to provide baseline estimates to be refined with the further development of indicators. 54
  • 54. 6. HIV and AIDS trendsCurrent estimates of HIV prevalence in MENA countries remain low compared to other global regions.While the proportion of the population living with HIV in most countries remains relatively low, nationalprevalence rates are rising. At present, low awareness of HIV and sexual health, coupled with lowprevalence in most countries except Djibouti and Sudan, contribute to a state of complacency towardsprevention, management and treatment of the disease.53 At an institutional level, this has meantminimal investment in disease surveillance, decreasing the region’s ability to detect changes in incidencerates and stop the disease’s unchecked spread. Low prevalence today does not mean that people inMENA have low risk and vulnerability to infection.54 Indeed, low awareness and risk mitigating behaviorintensify the region’s vulnerability, heightening the potential for a generalized, widespread epidemic.The World Bank has placed states in the MENA region into three categories, reflecting the distinct typesof epidemics currently witnessed: Type 1: Repeated testing, low prevalence, and few “high risk” groups (Egypt, Jordan, Saudi Arabia and Iraq); Type 2: Localized epidemic with greater prevalence and incidence in “high risk” groups (Algeria; Bahrain, Iran, Kuwait, Lebanon, Libya, Morocco, Oman, Yemen, Tunisia, Qatar and UAE). Type 3: Generalized epidemic. The epidemic is not confined to “high risk” groups, and spreads throughout the general population (Djibouti and Sudan).55According to UNAIDS, the HIV and AIDS epidemic in the region is driven by heterosexual transmission,often through paid sex work, and injecting drug use, with these transmission methods accounting forthe majority of new incident cases. Pre existing cases are concentrated in high risk groups, such as sexworkers, men who have sex with men and injecting drug users, who then channel the infection to thelarger population through unprotected sex. UNDP has estimated that more than 5 percent of male drugusers in the MENA region are HIV positive, contributing to the epidemic’s spread.56 Among the mostvulnerable groups today are married women and young people, due to low knowledge and the falseassumptions that husbands remain faithful and young people abstain from premarital sex.5753 Joint United Nations Programme on HIV/AIDS (UNAIDS) and World Health Organization, Middle East and North Africa, AIDS Epidemic Update, Regional Summary. UNAIDS and WHO, 2007.54 The World Bank. Preventing HIV/AIDS in the Middle East and North Africa: A Window of Opportunity to Act. A World Bank Regional Strategy, The World Bank, Washington DC, 2005.55 Jenkins, C. and Robalino, D. HIV/AIDS in the Middle East and North Africa: The Costs of Inaction. The World Bank, Washington DC, 2003.56 Cheemeh, PE, Montoya, ID, Essien, EJ & Ogungbade, GO. ‘HIV/AIDS in the Middle East: a Guide to a ProactiveResponse’, The Journal of the Royal Society for the Promotion of Health, 126(4), 2006, pp. 165 171.57 Roudi Fahimi, F. and Ashford, L. Sexual and Reproductive Health in the Middle East and North Africa: A Guide for Reporters. Population Reference Bureau, 2008. 55
  • 55. From a global perspective, almost half of new infections in 2007 occurred among young people aged 1524, the period during which sexual initiation typically begins. 5.4 million young men and women areliving with HIV today.58 The number of people living with HIV and AIDS in MENA is still relatively low;however prevalence rates in the region are rising over time. Transmission of HIV in MENA ispredominantly through sexual contact, placing young people at higher risk due to higher rates of nonmonogamous sexual relations and higher risk behaviors than their older counterparts. Young peopleare the largest population group at risk of contracting the disease,59 currently accounting for 31 percentof the regional population.60 Therefore, young people constitute an increasing proportion of new HIVcases in MENA, due to higher risk behaviors, greater vulnerability to risk factors, and the increasingshare of the population in the 10 24 age bracket. Despite an overall lack of disease surveillance in MENAcountries, available data indicate that a greater proportion of HIV infections are now occurring amongyounger age groups, with the vast majority of cases reported among the youth and young adultpopulation aged 20 29. For example, in Djibouti, 3.8 percent of recorded HIV cases are found amongthose 15 to 19 years old, while 43.6 percent of infections are recorded among those aged 20 29 yearsof age.61 Please see Table 4 and Diagram 3 for 2007 youth prevalence rate estimates in MENA.58 United Nations Children’s Fund, Joint United Nations Program on HIV/AIDS, World Health Organization,. Children and AIDS: Second Stock Taking Report., UNAIDS, 2008.59 Roudi Fahimi, F. and Ashford, L. Sexual and Reproductive Health in the Middle East and North Africa: A Guide forReporters. Population Reference Bureau, 2008.60 United States Census Bureau International Database, http://www.census.gov/ipc/www/idb/, accessed 17September 2009.61 Shepard, B. and DeJong, J. Breaking the Silence and Saving Lives: Young People’s Sexual and Reproductive Health in the Arab States and Iran. Harvard School of Public Health, Boston, 2005. 56
  • 56. Table 4 Reported HIV cases. Young Adult Adult Women Young Men Adults Adults Women Women (15 24) (15 24) Total, Total, (15+), (15+), (15+), (15+), prevalence, prevalence, Country 2007 2001 2007 2001 2007 2001 2007 2007 MENA 380,000 300,000 350,000 280,000 190,000 150,000 0.3% 0.1% Algeria 21,000 12,000 21,000 12,000 6,000 3,000 0.1% 0.1% Bahrain <1,000 Djibouti 16,000 13,000 15,000 12,000 8,700 7,200 2.1% 0.7% Egypt 9200 5,700 9,000 5,600 2,600 1,500 <0.1% <0.1% Iran 86,000 46,000 85,000 45,000 24,000 12,000 0.1% 0.2% Iraq Jordan <1,000 Kuwait <1,000 Lebanon 3,000 2,200 3,000 2,200 <1,000 <1,000 0.1% 0.1% Libya Morocco 21,000 13,000 21,000 12,000 5,900 3,300 0.1% 0.1% Oman Qatar Saudi Arabia Sudan 320,000 270,000 290,000 250,000 170,000 140,000 1.0% 0.3% Syria Tunisia 3,700 2,200 3,600 2,200 1,000 <0.1% 0.1% Turkey <2,000 UAE YemenSource: UNAIDS 2008 report.Diagram 3 2007 adult HIV prevalence estimates.Source: UNAIDS 2008 report. 57
  • 57. According to UNAIDS, young people in MENA are undergoing substantial socio economic changes,including delayed marriage and increased pre marital sex.62 Despite the assertion that traditional valuesprotect the MENA population from the epidemic, there is increasing evidence that the region’s youngpeople are engaging in higher rates of premarital and unprotected sex, increasing the risk of infection.63Despite this increase of premarital sexuality in the region and the vulnerability of young people to theHIV epidemic, there is very little research and data available on HIV and AIDS related knowledge andbehaviors of 10 24 year olds across the region. Risks associated with low levels of knowledge andawareness of HIV are compounded by very limited access to “voluntary counseling and testing for HIVAND AIDS, or for any other STIs, and to antiretroviral therapies” for those found to have the disease.64While all available research points to an overwhelming lack of preventative knowledge and risk reducingbehavior among young people in MENA (Table 5 – Young women with comprehensive, correct HIVknowledge), little large scale data collection is available to substantiate this hypothesis at thepopulation level. Knowledge, attitude, belief, and practice surveys have been conducted in a limitednumber of countries in the region, however questions regarding sexuality and behaviors were ultimatelynot asked due to cultural resistance. In other cases, such as Iran, while data collection was permitted,publication and dissemination of study findings was prohibited. Social stigma towards those practicinghigh risk behaviors, such as drug use and male to male sexual conduct, severely restrict both efforts toestimate HIV prevalence, especially among population sub groups, and the necessary policy dialogue toinform programming. As such, it is difficult to obtain specific estimates of levels of infection and trendsin the region due to inadequate surveillance and the limitations of surveying youth on behaviors.65Table 5 Young women with comprehensive, correct HIV knowledge in MENA countries Country Prevalence Algeria 13 16% Djibouti 18% Egypt 4% Iraq 3% Jordan 3% Morocco 12% Syria 7% Tunisia 29%Source: Kassak, K., Soubra, R. & Barbir, F. Children, Young People, and HIV/AIDS in the Countries of the MENA Region, UNICEFMENARO, 2009.62 Joint United Nations Programme on HIV/AIDS (UNAIDS) and World Health Organization, Middle East and NorthAfrica, AIDS Epidemic Update, Regional Summary. UNAIDS and WHO, 2007.63 The World Bank. Preventing HIV/AIDS in the Middle East and North Africa: A Window of Opportunity to Act. A World Bank Regional Strategy, The World Bank, Washington DC, 2005.64 Shepard, B. and DeJong, J. Breaking the Silence and Saving Lives: Young People’s Sexual and Reproductive Healthin the Arab States and Iran. Harvard School of Public Health, Boston, 2005.65 Ibid. 58
  • 58. Data on HIV prevalence, knowledge and behavior among adolescents and youth are absent for themajority of states in MENA and therefore for the region as a whole.66 More research and data on thedeterminants of behavior change among adolescents and young people, especially those most at risk,are urgently needed in order to better target HIV prevention efforts. In addition to the unmet need foradolescent and youth data collection, there is a general need throughout the region for improved HIVsurveillance systems and more informed prevention programming that can reach the most vulnerablegroups. Such surveillance systems should not only disaggregate results by age and sex, but also bymarital status, to provide a more comprehensive and accurate perspective of epidemic patterns.As stated by several reports on HIV and AIDS in the region, MENA countries now have an exceptionalwindow of opportunity to curtail the spread of HIV and AIDS in the region while prevalence remains low(see Table 4). By informing young people about preventative measures, strengthening and scaling upsurveillance mechanisms, and creating an enabling environment for those infected to access diseasemanagement and treatment opportunities, the region may potentially avoid the further spread of theepidemic.67,68Adolescent and youth vulnerabilities and risk factors in MENASeveral socioeconomic factors in the MENA region today increase young people’s vulnerability to an HIVepidemic.69,70, 71 Demography: Despite the potential for a “demographic dividend” for the region, the growing proportion of young people in MENA’s total population could give rise to social and economic challenges such as unemployment, social unrest and negative health effects if the dividend is not adequately planned for. These factors would reduce young people’s potential resilience to an HIV epidemic, by decreasing access to education, prevention, management and treatment opportunities. Conflict and Civil Unrest: Extended periods of civil unrest and/or conflicts in Iraq, the occupied Palestinian territory and Sudan have a negative impact on the population in general, and young people in particular. Such effects include the disintegration of families and communities, increasing individual risk taking behavior, an increased number of orphans, and the breakdown66 United Nations Children’s Fund, Joint United Nations Program on HIV/AIDS, World Health Organization, Childrenand AIDS: Second Stock Taking Report., UNAIDS, 2008.67 The World Bank. Preventing HIV/AIDS in the Middle East and North Africa: A Window of Opportunity to Act. A World Bank Regional Strategy, The World Bank, Washington DC, 2005.68 Shepard, B. and DeJong, J. Breaking the Silence and Saving Lives: Young People’s Sexual and Reproductive Health in the Arab States and Iran. Harvard School of Public Health, Boston, 2005.69 The World Bank, Preventing HIV/AIDS in the Middle East and North Africa: A Window of Opportunity to Act. A World Bank Regional Strategy, The World Bank, Washington DC, 2005.70 The Joint United Nations Program on HIV/AIDS, Notes on HIV and AIDS Epidemic in The Middle East And North Africa. UNAIDS Regional Support Team Middle East and North Africa, February 2007.71 Kassak, K., Soubra, R. & Barbir, F. Children, Young People, and HIV/AIDS in the Countries of the MENA Region,UNICEF MENARO, 2009. 59
  • 59. of health, educational and other services. Reductions in social support mechanisms increase the risk of adopting health averse behaviors, and decrease access to traditional resilience factors such as strong personal, familial and social relationships. Refugees and Internally Displaced Persons: MENA has some of the highest numbers of refugees and internally displaced persons (IDPs) in the world. At the end of 2007, the MENA region included approximately 3.5 million IDPs. Additionally, the region housed almost twice as many refugees, exceeding seven million, when over one million people fled from Iraq to neighboring countries.72 In Sudan, it is estimated that there are 6.7 million IDPs and refugees. This refugee population in the sub region comprises over 60 per cent of registered migrants, of whom approximately one quarter are hosted throughout MENA. Large scale population displacement interrupts many social structures and bonds that are preventative factors for HIV incidence. Migration: International and intra regional migration in MENA is occurring for various reasons and consists of diverse segments of the population. Migration does not only involve refugees and internally displaced populations, but also legal migrants and their families, and undocumented and temporary migrants. Influxes of migrants from countries experiencing high HIV prevalence rates increase the potential for the spread of the disease, as a higher proportion of the national population may carry the virus. Youth unemployment and inactivity: Figures for both youth unemployment and inactivity are the highest in the world. While the majority will not, some inactive youth will engage in deviant behavior, such as drug use, increasing the risk of HIV transmission. Gender: Women in general may also face increased vulnerability due to: 1) changing patterns of marriage; 2) high female illiteracy rates in certain countries; 3) limited access to services; and 4) socio cultural practices and unfavorable socio economic conditions, particularly in Djibouti, Sudan, and Yemen. A higher percentage of young women in MENA are infected with HIV than young men. See Figure 22 for HIV prevalence by gender.72 Internal Displacement Monitoring Centre, Internal Displacement in the Middle East, 2007. http://www.internal displacement.org/8025708F004CE90B/(httpRegionPages)/F4C363E496AB88D1802570A6005599C7?OpenDocum ent) Accessed 17 September 2009. 60
  • 60. Figure 22 HIV prevalence by gender. 3.5% 3.0% 2.5% 2.0% Adult Prevalence (15- 49), 2007 1.5% Young Women Prevalence (15- 24), 2007 1.0% Young Men Prevalence (15- 24), 2007 0.5% 0.0%Source: UNAIDS 2008 report.RecommendationsA study previously discussed in this section proposes key research driven recommendations that canfurther guide the planning of collection and analysis of adolescent and youth data. In order to achievethe aforementioned data collection, the study proposed that the agencies that work with adolescentsand youth ensure that: Donors collaborating with national governments and regional bodies expand the range of issues addressed in nationally representative health and development surveys on adolescents and youth; Inter disciplinary research on adolescents and youth be expanded, and include both quantitative and qualitative methods, particularly on social protective and risk factors, and in particular, HIV related knowledge, social norms and behavior; Data are disaggregated by age, sex and, where appropriate, marital status, both in primary research on HIV and AIDS as well as in secondary analysis of existing data sets that include young people; 61
  • 61. Pre existing data sets are made publically available for policy makers, programmers and the general public; and Inter disciplinary research is supported to fill specific knowledge gaps that could include young people’s perceptions of service needs and quality, as well as issues related to correct and comprehensive knowledge about HIV and AIDS, and STI prevention.7373 Shepard, B. and DeJong, J. Breaking the Silence and Saving Lives: Young People’s Sexual and Reproductive Health in the Arab States and Iran. Harvard School of Public Health, Boston, 2005. 62
  • 62. 7. Education trendsEducation was first recognized as a human right in the Universal Declaration of Human Rights adopted in1948, and has since been affirmed in several global human rights treaties, including the UNESCOConvention against Discrimination in Education (1960), the International Covenant on Economic, Socialand Cultural Rights (1966) and the CEDAW (1981). These treaties establish an entitlement to “free,compulsory primary education for all children; an obligation to develop secondary education, supportedby measures to render it accessible to all children; equitable access to higher education; and aresponsibility to provide basic education for individuals who have not completed primary education.”74Additionally, these treaties assert that, apart from didactic learning, the objectives of education are to“promote personal development, strengthen respect for human rights and freedoms, enable individualsto participate effectively in a free society, and promote understanding, friendship and tolerance.”75According to the 1989 United Nations Convention on the Rights of the Child (CRC), the concept of ahuman rights based approach to education is widened to also include the CRC’s four core principles of:1) non discrimination; 2) the best interests of the child; 3) the right to life, survival and development ofthe child to the maximum extent possible; and 4) the right of children to express their views in allmatters affecting them and for their views to be given due weight in accordance with their age andmaturity.76According to the 2006 Follow up to the World Programme of Action for Youth, education is a basichuman right that should also provide the necessary knowledge and skills to boost young people’sinvolvement in the global economy and further improve their livelihoods and well being. MENA mustaddress the educational needs of its young people now in order to safeguard their future livelihoods andpotential contributions to the region’s economic growth, national development and stability.Information in this section that draws on data from the Education for All Global Monitoring Reportsrefers to the UNESCO Arab States regional definition. For a list of countries in this regional definition,please see Annex VI.General education issues facing MENASince the 1970s, MENA has invested more in its public education systems as a share of total GDP thanany other region, and this investment has led to enormous gains in access to formal education. ManyMENA countries currently report full or close to full enrollment in basic education and secondary andtertiary education rates are on par with countries in other regions at comparable levels of74 United Nations Children’s Fund and United Nations Education, Scientific, and Cultural Organization. A Human Rights Based Approach to Education for All, UNICEF and UNESCO, New York and Paris, 2007.75 Ibid.76 Santos Pais, M, ‘The Convention on the Rights of the Child’, Office of the High Commissioner for Human Rights, United Nations Institute for Training and Research, and United Nations Staff College Project, Manual on Human Rights Reporting under Six Major International Human Rights Instruments, United Nations, Geneva, 1997. 63
  • 63. development.77 Gender disparities in secondary and tertiary education have been dramatically reduced.These advances have contributed to the declines in fertility and infant mortality experienced in MENAover the past decades as well as the rapid increases in life expectancy.However, much work remains to be done in the education sector. Despite these high investments, theaverage level of educational attainment remains lower in MENA than in other regions78. High dropoutrates, low average literacy rates, and low percentages of graduates in the sciences and other technicalfields persist.79 Moreover, international testing assessments in some of the MENA countriesdemonstrate limited literacy and quantitative skills, particularly among poorer children. In 2003, theTrends in International Mathematics and Science Study (TIMMS 2003) was conducted and included 26countries, three of which were from MENA. The three MENA countries ranked in the lowest threepositions of the TIMMS Yemen ranked 26, Tunisia 25 and Morocco 24.80These indicators shed light on some of the major problems facing education systems in the region.Increased levels of education have not translated into long term economic growth. Transitioningeffectively from school to decent employment remains a tremendous obstacle for many MENA youth. Atthe root of both of these problems lies the reality that quality of education is sorely lacking in many ofthe region’s schools. This problem will become particularly acute in the years ahead as the youth boomputs unprecedented demands on the education system, both because of the cohort’s large size, andbecause it will require new sets of skills and demand better results. The global marketplace calls for newcompetencies that the current education system is not fully prepared to teach. And to adjust to therealities of globalization, schools must be prepared to transform their curricula even while they diversifytheir funding sources. Given that MENA countries already spend a large share of public resources oneducation, funding for reform is limited; and will therefore require new efficiency. These challengesfacing the education sector mean that despite important advances, MENA has yet to close the educationgap with other regions.Primary and secondary school enrollmentPrimary education has a major impact on MENA youth’s lifelong ability to learn and is a crucialfoundation for future secure livelihoods. Over the past few decades, school enrollment rates have risenconsiderably throughout MENA, and the region is making steady progress towards the goal of universalprimary education by 2015 laid out at 2000’s World Education Forum. Some nations are close; Bahrain,Egypt and Tunisia register near universal primary enrollment. However while others have farther totravel, (Djibouti’s net enrollment ratio is below 40 percent) they are making progress. Between 1999 and2006 there was a 14 percent increase in the number of children entering primary school, and these gains77 The World Bank. The Road Not Traveled: Education Reform in the Middle East and North Africa, The World Bank, Washington DC, 2008.78 The World Bank. Youth – An Undervalued Asset: Towards a New Agenda in the Middle East and North Africa. The World Bank, Washington DC, September 2007.79 The World Bank. The Road Not Traveled: Education Reform in the Middle East and North Africa, The World Bank, Washington DC, 2008.80 Zaalouk, M. Quality Education and Youth Participation: The Case of Social Protection in the Middle East andNorth Africa. Working Paper, 2007. 64
  • 64. were driven by some of the region’s poorest countries.81 Djibouti increased the number of entrants by81 percent while Yemen raised its gross intake rate by more than 35 percent.82 To achieve the goal ofeducation for all, however, MENA countries must accelerate access while retaining students so that theycomplete a full primary cycle. In many countries, students face mutually reinforcing cycles of graderepetition and drop out, which makes it impossible to complete primary school and mean that only asmall proportion of children attend the appropriate class for their age, therefore negatively impactingeducation quality. Breaking the cycle of repetition and drop out will be particularly challenging in theface of the growing number of primary school age children in the region; the cohort is expected to growby 4 million between 2008 and 2015.83Enrollment rates have also risen at the secondary level. In 2006, 28 million students were enrolled insecondary education in the region representing a 24 percent increase since 1999.84 While participationin secondary school improved in most countries with data available, significant differences existbetween countries. For example, Djibouti’s 2006 secondary net enrollment ratio was under 20 percent,while Bahrain, oPt and Qatar registered ratios close to 90 percent.85 The same phenomenon holds truefor the transition rate from primary to secondary school. For the school year ending in 2005, theregional median rate was 92%. Rates reached close to 100 percent, however, in Kuwait, Oman, oPt,Qatar, and the UAE while Algeria, Iran, Iraq, Morocco, Tunisia, and Yemen reported much lowerfigures.86 Another important transition is the one between lower and upper secondary school. Whilelower secondary education is often part of compulsory basic education, upper secondary frequentlyconsists of more specialized instruction. In 2006, the average gross enrollment ratio was much higherfor lower secondary education (81 percent) than for upper (54 percent.)87 Algeria, Libya, Morocco, Syria,and Tunisia register particularly large gaps. It is also important to note that technical and vocationaleducation and training play a large role in secondary education. 12 percent of the region’s secondaryschool students were enrolled in these programs in 2006.88One study found that the low secondary enrollment rates that followed significant increases in primaryenrollment levels in MENA’s less developed countries were mainly attributable to poverty relatedbarriers. Enrollment rates for girls lag behind their male counterparts in half of the countries in the81 United Nations Educational, Scientific, and Cultural Organization, EFA Global Monitoring Report 2008. ArabStates: An Overview, UNESCO, 2008.82 Ibid.83 Ibid.84 Ibid.85 United Nations Department of Economic and Social Affairs, World Youth Report, 2007, United Nations, NewYork, 2007.86 United Nations Educational, Scientific, and Cultural Organization, World Bank EdStats Queryhttp://web.worldbank.org/WBSITE/EXTERNAL/TOPICS/EXTEDUCATION/EXTDATASTATISTICS/EXTEDSTATS/0,,contentMDK:21528247~menuPK:3409442~pagePK:64168445~piPK:64168309~theSitePK:3232764,00.html, accessed 17September 17, 2009.87 , United Nations Educational, Scientific, and Cultural Organization, EFA Global Monitoring Report 2008. ArabStates: An Overview, UNESCO, 2008.88 Ibid. 65
  • 65. region.89 In general, the higher the overall secondary enrollment rate, the more likely more girls will beenrolled than boy. See Figure 23. One cause of low female enrollment rates may be the fulfillment ofstereotypes of women’s roles in MENA, which tend to “include early marriage and early pregnancy, aswell as conservative mindsets prohibiting women from attending schools that are not nearby andexcluding them first in case of financial limitations.”90Overall MENA is now in a position similar to that of East Asia in the early 1980s, with a broad base ofprimary and secondary graduates. Looking to other regions suggests that MENA countries must carefullymanage their investment in education beyond the secondary level. A 2004 World Bank report explainsoutcomes resulting from neglecting secondary education: “East Asia raised mean schooling levels byinvesting in secondary education, reducing dropout rates, and sequencing later investments in highereducation. In contrast, many Latin American countries in the same time period invested heavily in highereducation without ensuring a solid base of secondary school students. The result has been greatereducational and income inequality in Latin America.”91Figure 23 Gross Enrollment Ratio, secondary school. 120 100 80Percent youth 60 Male 40 Female 20 0Source: State of the World’s Children, 2008. Data for Saudi Arabia from World Youth Report 2007.89 United Nations Children’s Fund. The State of the World’s Children, 2009, UNICEF, New York, 2009.90 UN ESCWA and the League of Arab States. The Millennium Development Goals in the Arab Region 2007: A YouthLens. 2007.91 The World Bank. Unlocking the employment potential in the Middle East and North Africa: Toward a new socialcontract, The World Bank, Washington DC, 2004. 66
  • 66. Tertiary educationSince 1995, there has been a significant increase of 31 percent in tertiary enrollment throughout theregion. Nevertheless, overall participation in tertiary education remained relatively low the region’saverage tertiary gross enrollment rate was only 22 percent in 2006.92 Compared to tertiary enrollmentrates in other regions, MENA falls in the middle, though well short of Europe and Central Asia’s rate of51 percent. This overall MENA average again masks the variance in gross enrollment rates amongcountries. For example, Lebanon and Libya each had rates over 50 percent in 2005, while rates inDjibouti and Yemen were below 10 percent.93 It is interesting to note that tertiary enrollment in theMENA region is actually higher among females, particularly in the GCC countries (see Gender andEducation heading).There have been some encouraging trends recently in higher education in MENA. Some countries aregranting universities greater autonomy, allowing them to vary their curricula and develop alternativeprograms for different populations.94 Jordan and Iran are on the vanguard of this effort. Six MENAcountries have also introduced national quality insurance systems in the last six years, evaluating andaccrediting both public and private universities, depending on the country.95 While the effectiveness ofthese systems has not yet been assessed, they are important steps towards raising overall quality andaccountability at the tertiary level.Youth literacyThroughout the world, literacy rates among 15 to 24 year olds tend to be higher than adult literacyrates, a reflection of global trends of increased schooling access and participation. While MENA is almoston par with the global youth literacy average for males and females, it lags behind Central and EasternEurope, East Asia, and Latin America and the Caribbean. In fact, though differences have declined sincethe 1950s, overall illiteracy in MENA remains twice as high as in East Asia and Latin America. Results oninternational tests demonstrate outcomes are close to what would be predicted considering GDP percapita and enrollment rates, however these results fall below those found in fast developing middleincome countries, such as the Republic of Korea and Malaysia.9692 United Nations Educational, Scientific, and Cultural Organization, EFA Global Monitoring Report 2008. ArabStates: An Overview, UNESCO, 2008.93 Ibid.94 The World Bank. The Road Not Traveled: Education Reform in the Middle East and North Africa, The World Bank,Washington DC, 2008.95 Ibid.96 Ibid. 67
  • 67. Figure 24 Youth literacy rate by gender Kuwait Bahrain oPt Jordan Qatar Oman Libya UAE Iran Saudi Arabia Tunisia Syria Females Algeria Males Lebanon Egypt Iraq Sudan Yemen Morocco Djibouti 0 20 40 60 80 100 Percent of literate youthSource: The State of the Worlds Children 2009, UNICEF.Looking at youth literacy data by country, significant progress was achieved in Algeria, Egypt, Kuwait,Morocco and Yemen, where rates increased by 12 to 22 percent between 1985 1994 and 1995 2004.Better still, youth literacy rates in Algeria, Kuwait and Saudi Arabia reached over 90 percent during the1995 2004 period.97 However, great differences remain between countries and within certain regionswithin countries. Literacy rates for males are substantially higher than rates for females in Yemenwhereas in countries such as Kuwait, the UAE, Bahrain, and Qatar demonstrate much greater parity(Figure 24). In addition to differences between countries, the urban rural disparity in female literacypersists, particularly in countries where overall rates are comparatively low.98 Disparities exist withinareas as well; for example nomadic populations tend to be less literate than the overall rural population.Youth without access to formal education and literacy programs, such as migrants and people withdisabilities, are at a particular disadvantage. For example, studies from Egypt show that in urban areas,migrants from the countryside report lower literacy rates than workers born in cities.9997 United Nations Educational, Scientific, and Cultural Organization, EFA Global Monitoring Report 2008. ArabStates: An Overview, UNESCO, 2008.98 The World Bank. MENA Regional Gender Brief,http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/MENAEXT/EXTMNAREGTOPGENDER/0,,contentMDK:20516633~pagePK:34004173~piPK:34003707~theSitePK:493333,00.html, accessed 17 September 2009.99 United Nations Educational, Scientific, and Cultural Organization, EFA Global Monitoring Report 2006. ArabStates: An Overview, UNESCO, 2006. 68
  • 68. Out of school adolescents and youthUNESCO defines out of school children as “children in the official primary school age range who are notenrolled in either primary or secondary school.”100 The World Bank has widened this definition toinclude a subgroup of youth and is defined as individuals between the ages of 6 to 20 who should be incompulsory schooling, but, for one reason or another, are not.101 Children are more likely to be out ofschool if they are from poor households, live in rural areas and/or have a mother with no schooling.Being a girl increases the likelihood of exclusion from school: three out of five primary school agechildren not enrolled in the region in 2005 were girls.102 53 percent of out of school girls had never beenenrolled compared with 39% of out of school boys.103 It is estimated that anywhere from 15 to 20percent of school aged children and adolescents are currently out of school because they: 1) neverattended school in the first place; 2) did not complete primary school; and/or 3) did not attend orcomplete compulsory secondary school.104 Moreover, as children drop out, they become morevulnerable to: 1) continuing the cycle of poverty; 2) being involved in child labor and exploitation; 3)being unemployed; 4) engaging in civic misconduct; and 5) marginalization or isolation by society.105Despite major investments in education, more than 6 million children in the region were out of school in2005. .106 These children fell into several categories. Based on analysis of enrollment data by age,around half had never enrolled and might never do so without new policies and incentives. More than athird might eventually enroll as late entrants, and about 18 percent had enrolled but dropped out.107.Despite a recent decline of over two million out of school children between 1999 and 2006 due toincreases in primary school participation108, projections for 2015 show a two fold increase in out ofschool children to more than 13 million.109 It is estimated that almost half of out of school children inthe region are concentrated in Iraq, Morocco, Saudi Arabia and Yemen.110100 United Nations Educational, Scientific, and Cultural Organization, EFA Global Monitoring Report 2008. ArabStates: An Overview, UNESCO, 2008.101 The World Bank. The Road Not Traveled: Education Reform in the Middle East and North Africa, The WorldBank, Washington DC, 2008.102 United Nations Educational, Scientific, and Cultural Organization, EFA Global Monitoring Report 2008. ArabStates: An Overview, UNESCO, 2008.103 United Nations Educational, Scientific, and Cultural Organization, EFA Global Monitoring Report 2009. ArabStates: An Overview, UNESCO, 2009.104 The World Bank. The Road Not Traveled: Education Reform in the Middle East and North Africa, The WorldBank, Washington DC, 2008.105 Zaalouk, M. Quality Education and Youth Participation: The Case of Social Protection in the Middle East andNorth Africa. Working Paper, 2007.106 United Nations Educational, Scientific, and Cultural Organization, EFA Global Monitoring Report 2008. ArabStates: An Overview, UNESCO, 2008.107 United Nations Educational, Scientific, and Cultural Organization, EFA Global Monitoring Report 2009. ArabStates: An Overview, UNESCO, 2009.108 Ibid.109 The World Bank. The Road Not Traveled: Education Reform in the Middle East and North Africa, The WorldBank, Washington DC, 2008.110 United Nations Educational, Scientific, and Cultural Organization, EFA Global Monitoring Report 2008. ArabStates: An Overview, UNESCO, 2008. 69
  • 69. Gender and educationOverall, MENA has made significant advances in addressing gender disparities in education in the pastfew decades. Female enrollment at all levels of education has increased significantly, and the ratio ofgirls to boys in primary and secondary education was 92 percent in 2004, close to the world average.111However the region as a whole was unable to reach gender parity in gross enrollment ratios for primaryand secondary education by 2005; only Jordan, Qatar, and UAE were at parity at both levels. Genderdisparities are more widespread at levels of education beyond primary. In 2006, there were nearly asmany countries with gender disparities in secondary education enrollment at the expense of boys as atthe expense of girls.112 Enrollment rates in tertiary education have been found to favor women in tenMENA countries,113 “in part resulting from the lack of job opportunities or the negative attitudestowards women working outside the home, which drives women to engage in tertiary education as asecond choice; and in part from the higher grades achieved by female students in the universityadmission exams”.114 However, despite progress, women continue to enroll in “traditional fields ofstudy” which are considered appropriate for girls. In MENA, the median share of females in engineering,manufacturing and construction was 31% in 2006. Women were much better represented in fields suchas education (70 percent) and humanities and the arts (74 percent).115 Furthermore, the problem ofgender stereotyping persists – albeit increasingly in more subtle forms often supported by schoolcurricula.116 To combat this, the presence of female teachers may help increase girls’ access to schools incountries where high gender disparities prevail. Teachers of either sex may discriminate by gender,however, and therefore gender training for teachers is an important tool for diminishing disparities.Female literacy has increased in all MENA countries, some more so than others. Of significant note is thestark contrast between female youth literacy rates and female adult literacy rates, where in a few casesfemale youth rates are almost 30 percent higher than their adult counterparts. For example, femaleyouth literacy in Tunisia in 2004 was 92 percent, whereas the female adult literacy rate was 65 percent;in Saudi Arabia, the rates were 94 percent and 69 percent.117 Despite this progress, illiteracy levels,particularly in North Africa, continue to be one of the most glaring examples of gender disparities ineducation in the MENA region. In North Africa, rates among young females can be twice as high as their111 The World Bank. The Status and Progress of Women in the Middle East and North Africa, The World Bank,Washington DC, 2007.112 United Nations Educational, Scientific, and Cultural Organization, EFA Global Monitoring Report 2009. ArabStates: An Overview, UNESCO, 2009.113 Ibid.114 UN ESCWA and the League of Arab States. The Millennium Development Goals in the Arab Region 2007: A YouthLens. 2007.115 United Nations Educational, Scientific, and Cultural Organization, EFA Global Monitoring Report 2008. ArabStates: An Overview, UNESCO, 2008.116 The World Bank. MENA Regional Gender Brief,http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/MENAEXT/EXTMNAREGTOPGENDER/0,,contentMDK:20516633~pagePK:34004173~piPK:34003707~theSitePK:493333,00.html, accessed 17 September 2009.117 The World Bank. The Status and Progress of Women in the Middle East and North Africa, The World Bank,Washington DC, 2007. 70
  • 70. male counterparts. Given current efforts to increase universal primary education for girls, there is thepotential for female illiteracy rates to fall dramatically in the years ahead.118It is important to remember that narrowing the gender gap in education does not mean that equalitybetween men and women will automatically follow. Enrollment is not the whole story. Sexual violence,insecure school environments, and inadequate sanitation take a toll on girls’ self esteem, participation,and attendance in the MENA region.119Minimum age for completion of compulsory educationAccording to Article 28 of the CRC, participating countries are required to ensure that primary educationis free and compulsory, although a minimum age for completion of compulsory education is notmandated. However, countries are now moving away from the assumption that compulsory schoolingshould only include primary school, and are extending compulsory education past primary schooling.120Despite this move towards extending minimum school leaving ages, there are still many countries thathave not made education compulsory at all or who report unclear information on the matter. In theMENA region specifically, three countries have not made education compulsory (Bahrain, Sudan andYemen) whereas five have not clearly specified information on the matter (Djibouti, Iraq, Oman, Qatarand Saudi Arabia).121Education QualityWhile most of MENA’s countries have exhibited a strong commitment to investing in education andincreasing gender parity, their education systems have yet to demonstrate the quality that otherdeveloping regions have achieved. Median instruction time is one indicator of the inadequate learningenvironment; MENA countries median required hours for the first six years of schooling fall well belowthe 850 to 1000 per year recommended by several international agencies and reports.122 Lack oftextbooks, blackboards, and other resources remains a concern in some of the poorer MENA countries.And old, overcrowded school buildings are also a problem in many areas, particularly those ridden byconflict and natural disaster. For example, more than 2700 schools in Iraq required rehabilitation afterbeing looted, damaged, or burned in 2003.123 These problems are but a few examples of the educationchallenges that combine to prevent MENA youth from achieving their full potential.118 The World Bank. The Road Not Traveled: Education Reform in the Middle East and North Africa, The WorldBank, Washington DC, 2008.119 United Nations Educational, Scientific, and Cultural Organization, EFA Global Monitoring Report 2008. ArabStates: An Overview, UNESCO, 2008.120 Melchiorre A. At What Age Are School Children Employed, Married and Taken to Court? Second Edition, Right to Education Project, 2005.121 Ibid.122 United Nations Educational, Scientific, and Cultural Organization, EFA Global Monitoring Report 2008. ArabStates: An Overview, UNESCO, 2008.123 Ibid. 71
  • 71. Education and economic and social developmentPer capita economic growth in MENA over the last 20 two decades has been relatively low, despiteimprovements in educational attainment highlighted above. The World Bank finds that education gainsdid not significantly contribute to economic growth or productivity in the region in the 1980s and1990s.124 Possible reasons include 1.) quality of instruction that is too low for education to contribute toproductivity, 2.) the fact that despite education advancements in the region, other regions haveoutperformed MENA, drawing innovation and investment, 3.) the unequal distribution of educationalattainment in MENA, which is negatively correlated with higher economic growth, and 4.) the high levelsof unemployment and low numbers of internationally competitive economic sectors. 125 Incomedistribution in MENA is relatively even, despite widening education distribution, suggesting thatincreased education does not translate into higher earnings in the region. Low rates of return to highereducation may account for this problem, which is in turn due to low economic growth.Improving quality through reformNow that many countries in MENA have achieved the goal of basic instruction for all, they are faced withthe task of improving instruction across all levels of their systems. Education reform must respond tothe need to prepare students to compete in the globalized knowledge economy. An index whichmeasures the degree to which countries successfully engage in the knowledge economy finds MENAcountries mostly below the middle range of distribution.126 Countries that perform well on this indextend to emphasize foreign language, science, problem solving and communication skills. While mostMENA countries rely on a traditional form of pedagogy where teachers do not interact extensively withstudents and copying from the blackboard is a common practice, state of the art practices make use ofinquiry based learning and adapt teaching methods to respond to the needs of individual students. 127Education systems that are succeeding in the knowledge economy are also flexible, particularly at thepost compulsory level. In MENA, once a student selects a field of study, there is little opportunity tochange fields. It is difficult to return to schooling after spending time in the labor market, and vocationaltraining programs rarely permit students to continue their education at a higher level. Examinations arefor selection purposes rather than accreditation. Tunisia and Jordan are examples of MENA countriesstarting to address these challenges through quality assurance systems, more school autonomy, andlifelong learning initiatives, however much work remains to be done in the region.128As the youth boom enters the school systems, schools must undertake reform while dramaticallyincreasing capacity; over the next 30 years, the secondary education population will increase by a thirdwhile the tertiary population will more than double.129 The resources necessary to scale up services willrequire novel approaches to reform. Currently, private funding of education is low in MENA due in partto countries’ commitment to free education. MENA countries also spend substantially more on124 The World Bank. The Road Not Traveled: Education Reform in the Middle East and North Africa, The WorldBank, Washington DC, 2008.125 Ibid.126 Ibid.127 Ibid.128 Ibid.129 Ibid. 72
  • 72. secondary and tertiary education as a percentage of GDP per capita than their middle incomecounterparts in other regions. And in the years ahead, MENA countries will have to resist the temptationto channel funds from primary school to fuel the expansion of higher levels of education.Monitoring learningTo monitor quality standards, some MENA countries are beginning to make use of learning assessmentsto identify problems and inform education policy, although these systems are still in their infancy. TenMENA countries had conducted at least one national learning assessment between 2000 and 2006.130These assessments tend to focus on grades 4 through 6 and are oriented towards specific subjects,rather than assessing cross curricular knowledge, skills or competencies.131 As mentioned above, thefindings of international assessments suggest overall low levels of achievement in MENA. Nationalevaluations confirm these findings; an assessment of grade 6 students in Morocco found that masteryrates were quite low – 7 percent in Arabic, 1 percent in French, 11 percent in mathematics, and 20percent in science. Not all countries have carried out periodic assessments, making it difficult to assesschanges over time.The role of teachersTo improve standards of quality and equity, MENA school systems will have to improve systems forteacher recruitment, deployment, motivation, assessment, and supervision. As the EFA GlobalMonitoring Report 2005 pointed out, teaching related issues such as poor mastery of the curriculum,rigid teaching practices, lack of textbooks and other teaching materials, as well as insufficientinstructional time are all causes for concern in MENA.132 In addition, teacher shortages result inovercrowded classrooms and high student to pupil ratios, undermining learning outcomes. Between1999 and 2005, the number of primary education teachers in MENA grew by 16 percent – the secondlargest increase globally – and by over 23 percent in secondary education.133 In some countries such asOman and Tunisia, expansion of teachers took place even while enrollments were declining. Howeversome countries still face shortages of trained teachers. Only 14 percent of primary teachers in Lebanonwere trained in 2005; the figure rose to 60 percent in Sudan and UAE.134 Other problems persist.Teacher salaries are near or even below the poverty line in some MENA countries, which detracts fromteacher motivation and standards. Hiring contract teachers is one approach to addressing teachershortages at low cost, however long term reliance on this approach can lead to lower standards forteaching staff overall, so must be used with caution.130 United Nations Educational, Scientific, and Cultural Organization, EFA Global Monitoring Report 2008. ArabStates: An Overview, UNESCO, 2008.131 Ibid.132 United Nations Educational, Scientific, and Cultural Organization, EFA Global Monitoring Report 2006. ArabStates: An Overview, UNESCO, 2006.133 Ibid.134 Ibid. 73
  • 73. RecommendationsData on education is widely collected and has been the subject of much analysis both regionally andglobally. Data for regional comparisons were collected from regional and global reports, as well as frominternational databases and regional studies. While UNESCO’s Education for All series provides a host of global and regional trends and data, as does the World Youth Report, its database is likely to benefit from further revisions to enhance its practicality, including more flexibility in selecting variables and regions. Better data are needed on out of school adolescents and youth. Currently, UNESCO collects only data on the rate of out of school children of primary school age. This makes it difficult to get a true sense of drop out activity among youth in the region. Additional planning will be necessary to take into account out of school youth when trying to prepare them for the school to work transition and decent livelihoods. Please see Mind the gap: the school to work transition and the informal economy for more information on the school to work transition. Many of the proposed adolescent and youth indicators were available on a regional basis and are, for the most part, available for each of the MENA countries. These data tend to be disaggregated by sex more than by age, as most education indicators do not necessarily require the further breakdown of age. However, there are several topic areas in the education sector where data collection can be improved. There are no data available for adolescent literacy, as this is not a traditionally collected indicator, nor were data identified on the proportion of children and adolescents with disabilities enrolled in school. Additionally, no data were available on enrolled students who study and work or out of school youth. There is also a paucity of data related to education reform efforts. For example, gathering information on the number of employer associations participating in curricula reform could shed light on progress to make students’ educational experience more relevant to the needs of the working world. Please refer to Annex IV for an extended list of important indicators in the domain of education. Nations should be encouraged to conduct regular assessments at several different grade levels to monitor progress on school quality over time. 74
  • 74. B. Mind the gap: the school to work transition and the informal economyYouth entering the labor force in the Middle East and North Africa face a series of challenges. Highfertility and low infant mortality created a ‘youth bulge’ which has dramatically expanded the size of thelabor force in the last decade. However, despite economic expansion and an overall increase in jobs inthe region in recent years, older, more seasoned workers, and in some cases migrant laborers, havebenefited from the drop in unemployment rates more than MENA’s young workers, even though today’syouth represent the most highly educated generation the region has ever produced.135 Labor markets inthe region are characterized by high shares of public sector employment, which cannot grow in stepwith the increase in young workers. Formal private sector job growth has failed to keep up with thenumber of new job seekers, resulting in high numbers of unemployed youth. Aggregate unemploymentfor 15 24 year olds in the Middle East is nearly 25 percent, compared to a world average of 14percent.136 Many young workers see no alternative but to seek jobs in the informal sector, resulting in acascade of personal and societal consequences. Though the size of the informal economy is difficult tomeasure, it is clearly a large share of the total economy in most MENA countries. One analysis suggeststhat the informal economy was 36 percent of the official GDP in Algeria and 37 percent of official GDP inEgypt.137Many MENA youth and parents prefer public sector employment. Government jobs are perceived as aroute to economic stability, providing good salaries and benefits, including pensions and job protection.Indeed, one analysis found that public sector wages were 30 percent higher than private sector wages inMENA, unlike other regions where private sector compensation typically exceeds that of the publicsector.138 The extraordinary demographic shift underway in MENA means that there is not a civil serviceposition available to all young job seekers. Middle and upper class youth may be able to afford to waitfor the ‘right’ job upon leaving school, depending on their family to provide support, whiledisadvantaged youth may be forced into the informal sector or unpaid family work if they are unable toafford a prolonged period of unemployment. Because private sector growth has not kept pace with therapid expansion of the labor force, informal jobs are often the only choice.Jobs in the informal economy are characterized by low wages, reduced job security, and diminishedaccess to social safety nets. Indeed, informal sector jobs are less likely to meet ILO criteria for a ‘decentjob’.139 Yet this sector has become a refuge for young workers entering the job market during the135 Dhillon N, Salehi Isfahani D, Dyer P, Yousef T, Fahmy A, Kraetsch M. Missed by the Boom, Hurt by the Bust. 13May 2009. <http://www.shababinclusion.org/content/document/detail/1352/> accessed 16 July 2009.136 Ibid.137 Schneider, Friedrich. “Shadow Economies of 145 Countries all over the World: What do we really know?”Presented at, “Hidden in plain sight: Micro economic measurements of the informal economy: Challenges andopportunities”, September 4 5, 2006, London, UK.138 United Nations Department of Economic and Social Affairs, World Youth Report, 2007, United Nations, NewYork, 2007.139 Dhillon N, Salehi Isfahani D, Dyer P, Yousef T, Fahmy A, Kraetsch M. Missed by the Boom, Hurt by the Bust. 13May 2009. <http://www.shababinclusion.org/content/document/detail/1352/> accessed 16 July 2009. 75
  • 75. current global economic downturn. Almost three quarters of first time workers in Egypt were employedin the informal economy in 2006.140While many families in the region connect high quality jobs with university degrees, education providesno guarantee against unemployment. In fact, in some countries in the region, such as Egypt and Iran,unemployment rates increase with increasing educational attainment. This trend is particularlypronounced for women.141 One factor is the mismatch between what is taught in school and what skillsthe region’s employers require. For years, the region’s educational systems have been tasked withpreparing students to serve in the public sector. It is no longer, however, the primary employer ofeducated graduates.142 With growing market economies, new technologies, and a shrinking publicsector, youth are increasingly required to look to emerging industries in the private sector. Meanwhile,their education systems have not necessarily ensured that strong links exist between what students arelearning and the needs of the global labor market. Furthermore, many schools’ emphasis on rote andnon participatory learning rather than problem solving and critical thinking leaves graduates underprepared to contribute to new enterprises, particularly in science and technology. A number ofcountries have introduced efforts to expose students to modern business practices in hopes ofimproving their ability to compete in the global marketplace, however these programs are underscaled.143Save the Children’s pan regional INJAZ program is an example of a program that has shown success inintroducing students to the world of entrepreneurship and business. The program offers studentstraining in the following areas to better prepare them for livelihood opportunities: 1) entrepreneurship,2) economics, 3) business skills, 4) financial literacy, 5) business ethics, and 6) work, career, and lifeskills. INJAZ currently operates in 12 MENA countries (Jordan, oPt, Lebanon, Iraq, Oman, Kuwait, UAE,Saudi Arabia, Qatar, Bahrain, Morocco and Egypt), with plans to expand to Algeria, Tunisia, Libya, Syriaand Yemen.144 Further operational research on this type of programming will provide valuableinformation and data with which to further address school to work transitions of youth in the region.Very little data exist on the transition from school to work. In 2006, the ILO conducted a global schoolto work transition survey to measure some aspects of young people’s transition into the workforce.Within MENA, data were collected from young people in Egypt, Iran, Jordan and Syria, and constitutesthe only large scale school to work transition study in the region. Four key findings were presented: 1)young women are largely economically inactive; 2) most of the youth covered in the study were intemporary or non career jobs; 3) a higher education level does not guarantee an easier transition or140 Ibid.141 Ibid.142 Population Reference Bureau. Youth in the Middle East and North Africa: Demographic Opportunity orChallenge? PRB, Washington DC, April, 2007.143 United Nations Department of Economic and Social Affairs, World Youth Report, 2007, United Nations, NewYork, 2007.144 INJAZ Al Arab. www.injaz arabia.org, accessed 17 September 2009. 76
  • 76. guarantee work; and 4) education levels are important for skilled jobs, whereas work experience is moreimportant for employers of manual laborers.145Many young people turn to the informal economy after schooling is complete. Though these youngworkers view informal jobs as a temporary measure, it is often difficult for these workers to transitioninto the formal sector. A study in Egypt found that only 11 percent of those whose first job was in theinformal sector were able to move into the formal sector. By contrast, only 7 percent of those withformal first jobs later moved to informal employment.146Informal employment has social as well as economic consequences, such as forcing youth to delaymarriage and family formation. Not just a temporary issue, informal sector employment has lifelongconsequences for youth – lower lifetime earnings, lost opportunities to develop skills necessary to moveinto better positions, and reduced access to benefits tied to employment, such as pensions. From amacro economic standpoint, informal sector employment represents a missed opportunity for theregion to capture the full potential of this historically unprecedented youth cohort to provide aneconomic boost.147Certain groups of youth are particularly vulnerable to informal employment: those in conflict situations,disabled youth and women. Youth in conflict and post conflict situations are particularly at risk forinformal sector employment, as they negotiate unstable formal economies or migrate in search of safetyand stability. Conflict is correlated with physical and psychological injury and youth are no exception.Thus youth in conflict are at increased risk for injury, which could further hamper their ability to secureformal employment. The presence of a disability, whether congenital blindness or post traumatic stressdisorder, creates further challenges for young job seekers. The World Youth Report asserts that fewerthan 10 percent of secondary school students with disabilities receive vocational or technical training, anessential link between school and employment for this doubly challenged group.148Young women seeking employment are disadvantaged by both age and gender. Labor forceparticipation rates for women in the region have long been among the lowest in the world, but haverecently been increasing in many MENA countries.149 The combination of current demographic trendsand growing labor force participation among women may increase the competitiveness of the jobmarket for occupations traditionally dominated by women, such as clerical and service oriented jobs.Job creation efforts often favor older workers or economic migrants, excluding youth from obtainingformal sector jobs and reinforcing the trend of informal sector employment for young workers.Migration is an option for some youth, though cultural norms typically exclude young female job seekersfrom moving to obtain work. Furthermore, the departure of young job seekers creates a ‘brain drain’145 International Labor Office, Global Employment Trends for Youth, ILO, Geneva, 2006.146 Ibid.147 United Nations Department of Economic and Social Affairs, World Youth Report, 2007, United Nations, NewYork, 2007.148 Ibid.149 Ibid. 77
  • 77. with significant economic and social consequences. When firms downsize, youth, who are less likely tobe covered by job protection policies, are more likely to lose their jobs. For economic migrants, job lossmay precipitate a return home, putting additional strain on the labor markets of labor exportingcountries, such as Morocco and Yemen, and labor exporting regions, such as rural areas.MENA’s governments have an opportunity to intervene at this key juncture for the ‘youth bulge’,replacing the uncertainty of informal employment with the opportunity for economic and socialadvancement offered by formal employment. Increased access to capital is an important part of thesolution. Youth may engage in entrepreneurial projects, generating job growth, or reduce unwanteddelays in marriage and family formation during a period of un or under employment. Countries in theregion should also invest in skills development to raise the value of informal jobs. By keeping pace withthe skills development of their formally employed peers, youth in the informal economy will be betterable to transition into the formal sector. Social protection for all workers, both male and female, isimperative. While changes in job protection schemes are politically unpalatable, enhanced socialinsurance policies for all workers, such as unemployment insurance, could provide a safety net for youngworkers as they struggle to establish themselves. The region also needs to document, evaluate anddisseminate results of programs for building entrepreneurship among youth. As economies becomemore competitive, young people need access to loans and credit programs in order to becomeeconomically active entrepreneurs. A multi sectoral response is urgently required, with active linkagesbetween the Ministries of Education, Labor, Family and Youth to ensure that young people, especiallythose with special vulnerabilities, are prepared for the jobs of the future, and that these jobs provide afoundation for a secure transition to adulthood. 78
  • 78. 8. Livelihoods and economic participation trendsYoung people play a key role in the labor market and the economy, both as direct and indirectbeneficiaries of labor policies, and as contributors to the changing composition of the labor market. Theextent and type of their employment are key determinants of young peoples’ well being. However,these are not the only important characteristics of young people’s economic engagement. Assessmentof young people’s involvement in the economic sector must move beyond the narrow confines ofemployment and income generation and ensure that the effects of these activities on adolescents’ andyouths’ livelihoods form the basis of analysis.Several studies and trend analyses conclude that given rapid youth population growth in MENA, theregion requires 80 million new jobs by 2020 to accommodate future job entrants who are part of the“youth bulge”. To redress current high unemployment rates, the region must generate 100 million newjobs by 2020 to reduce the regional unemployment rate to 15 percent; a doubling of the current numberof jobs in the region.150LivelihoodsLivelihoods analysis extends beyond employment and takes into account a sustainable approach forbuilding adolescent and youth capabilities, resources, and opportunities to enable young people topursue individual and household economic goals.151,152 Livelihoods approaches to development promotedecent and productive employment, equipping young people with the skills and empowermentnecessary for making informed life decisions.153 Its goal is for young people to acquire skills to becomeeconomically productive, have economic literacy, engage in social development, have access to savings,credit, entrepreneurship and formal and informal sector employment”.154 Livelihoods becomesustainable when these economic goals can endure, as well as recover from economic stressors andprovide opportunities for future generations.155 It is a rights based perspective derived from theprovisions of the Convention of the Rights of the Child and other relevant Conventions, providing ahuman security and capital approach to economic analysis.156 In contrast, a narrow employment focus150 The World Bank. Unlocking the employment potential in the Middle East and North Africa: Toward a new socialcontract, The World Bank, Washington DC, 2004.151 UNICEF and Population Council. The Role of Social Support and Economic Skill Building Programs in Mitigating Adolescents’ Vulnerabilities: Perspectives and UNICEF’s Experience to Date. Year not specified.152 Chambers, Robert and Gordon R. Conway. Sustainable rural livelihoods: Practical concepts for the 21st Century. Discussion paper no. 296. Sussex: United Kingdom: Institute of Development Studies, 1992. As cited in Adolescent Girls’ Livelihoods: Essential Questions, Essential Tools. A Report on a Workshop. Population Council and the ICRW. 2000.153 Brown, N. Promoting Adolescent Livelihoods: A discussion paper prepared for the Commonwealth Youth Programme and UNICEF. Commonwealth Youth Programme and UNICEF, 2001.154 UNICEF and Population Council. The Role of Social Support and Economic Skill Building Programs in Mitigating Adolescents’ Vulnerabilities: Perspectives and UNICEF’s Experience to Date. Year not specified.155 Brown, N. Promoting Adolescent Livelihoods: A discussion paper prepared for the Commonwealth Youth Programme and UNICEF. Commonwealth Youth Programme and UNICEF, 2001.156 Ibid. 79
  • 79. limits performance to job growth and incomes, neglecting an analysis of the impact on young peoples’lived economic experiences. Livelihoods analysis is a holistic approach.Livelihoods represent the link between education, the school to work transition, and young people’sultimate economic participation. Gainful, decent and productive employment allows a young person notonly to generate income, but also develop skills, increase his/her knowledge base, build self esteem andfoster an optimistic view of the future.157While livelihoods approaches are gaining increased recognition as a contextualized tool for evaluatingeconomic circumstance, there are currently no indicators that holistically measure the phenomenon.Existing indicators use a silo approach, whereby specific aspects of economic well being (such as thenumber of hours worked, average wages, etc.) are assessed separately. This piecemeal approachneglects the mutual complementarity of different aspects of economic livelihoods, reducing youngpeople’s lived experiences to categorical estimates. A comprehensive understanding necessitates anintegrated systems approach, reflecting the relationships between its components and other systems.As livelihood system indicators do not currently exist, this section of the Review examines some of thecomponents that comprise livelihoods for which data are available.Transition from school to workThe transition from school to work among youth in MENA is a crucial time for optimally translating higheducational attainment into ‘decent’ and productive jobs for a stronger economy. Currently, youngpeople’s prospects of finding work after school are hampered by discordance between their preparationin school and the needs of the employment market. For further exploration of this topic, please see thepreceding case study, Mind the gap: the school to work transition and the informal economy.UnemploymentAlthough young people in MENA comprise approximately one third of the working age population, theyaccount for almost 50 per cent of the region’s total unemployment (Figure 24). This proportion hasdecreased only slightly since 1997; a reduction of 3.3 percent over the 10 year period. While such areduction is positive given the large cohort of youth entering the labor market, the pace of reduction hasbeen lower than many other regions. However, analysis of the proportion of total unemploymentcontributed by youth obscures absolute levels. If both total and youth specific unemployment increasedat the same rate, this would not be shown by proportional analysis. It is therefore necessary to observeyouth specific unemployment rates in isolation to reveal the employment experience of youth in theregion.157 UNICEF and Population Council. The Role of Social Support and Economic Skill Building Programs in Mitigating Adolescents’ Vulnerabilities: Perspectives and UNICEF’s Experience to Date. Year not specified. 80
  • 80. Figure 24 Youth share of total unemployment 70 59 60 55 56 52 48 48 47 50 45 4241 42 43 42 40 35 3130 29 1997 30 27 2007 20 10 0 World MENA DEEU CSEE & SA SEA&P EA LAC SSA CISSource: UNDESA World Youth Report 2007As shown in Figure 25, unemployment among youth in MENA is the highest for any ILO global region,averaging over 22 percent in 2007. Compounding this concern, youth Labor Force Participate Rates(LFPR) in MENA are the lowest in the world, currently standing at 40 percent (Figure 26). Simply put,this indicates that youth in the MENA region are the least likely to be seeking work, and that those thatare seeking work have the lowest chance of obtaining it. These statistics underscore the level ofeconomic vulnerability experienced by youth in the region. The region also holds the second highestaverage gap in female to male youth labor participation in the world (only preceded by South Asia).Female youth in MENA have a LFPR 29 percent lower than their male counterparts, highlighting genderdiscrepancies in economic opportunity in many countries in the region. 81
  • 81. Figure 25 Regional youth unemployment rates 30.0% 24% 25.0% 22% 21% 20.0% 18% 16% 15% 15% 15.0% 14% 12% 12% 12% 1997 12% 11% 11% 10% 10.0% 2007 7% 7% 7% 5.0% 0.0% World MENA DEEU CSEE & SA SEA&P EA LAC SSA CISSource: ILO, Global Employment Trends for Youth 2008Figure 26 Youth labor force participation rates 80% 70% 70% 60% 55% 57% 57% 55% 58% 56% 53% 53% 54% 51% 51% 49% 50% 45% 47% 39% 40% 37% 36% 1997 30% 2007 20% 10% 0% World MENA DEEU CSEE & SA SEA&P EA LAC SSA CISSource: ILO, Global Employment Trends for Youth 2008 82
  • 82. Between 1995 and 2005, the youth labor force increased by a staggering 30 percent.158 However,despite increases in the youth labor force, the regional economy has not expanded to accommodate thegrowing numbers of new job entrants and seekers, increasing youth unemployment and in many casescreating discouragement and drop outs among young job seekers159.In MENA, unemployment rates tend to be lower: 1) among those who have not completed primaryeducation and/or come from low income households who cannot afford unemployment; and 2) amonguniversity graduates in the GCC countries and Iran, where the public sector is the largest employer.160Employment and LFPR vary across the MENA region. All MENA countries experienced demographicchange that contributed to high shares of youth in the working age population since the 1990s.However, the economic impact of this change has differed across MENA sub regions. GCC countries arenet importers of labor, while non GCC countries are generally net labor exporters. As a result, states inthe region display different economic profiles and challenges: “for non GCC countries, the main issue iscreating enough jobs to accommodate entering cohorts. For GCC countries, the main issue is ensuringthat entering cohorts of young nationals are able to find appropriate jobs that match their skills and payacceptable wages”.161Available figures for the GCC countries162 illustrate lower unemployment rates for youth than non GCCcountries. According to a World Bank study on employment in the region, Kuwait, Qatar and UAE,countries with high proportions of guest workers, had lower youth unemployment rates than all nonGCC countries.163 On the other hand, Saudi Arabia and Bahrain had relatively high youth unemploymentrates – 28 and 20 per cent, respectively because expatriate workers represent a smaller share of theyouth labor force in these countries. The presence of young expatriate workers masks the magnitude ofyouth unemployment in the GCC, as these workers are considered part of the labor force, and typicallyassume positions that local GCC residents largely avoid, thus keeping them out of the labor market.In many MENA countries, high unemployment rates are the result of the large proportion of the totalpopulation who are youths entering the labor market. In most countries in the region, the majority ofunemployed youth are first time job seekers, as in the cases of Egypt, Qatar, Iran, Syria, and Bahrain,where first time job seekers, particularly youth, account for more than two thirds of totalunemployment.164Employment prospects for youth in MENA remain precarious. Significant investments in education haveyielded few increases in worker productivity and employability. This discrepancy suggests that education158 United Nations Department of Economic and Social Affairs, World Youth Report, 2007, United Nations, New York, 2007.159 Ibid.160 Ibid.161 The World Bank. Youth Employment in the MENA Region: A Situational Assessment, The World Bank,Washington DC, 2005.162 GCC countries include Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the UAE.163 The World Bank. Youth Employment in the MENA Region: A Situational Assessment, The World Bank,Washington DC, 2005.164 Ibid. 83
  • 83. systems in MENA: 1) are of uneven quality and relevance; 2) do not consistently prepare and guidestudents to suitable and desirable careers; 3) lack feedback loops between the education system andthe needs of the labor market; and 4) do not inform graduates of how to apply learned skills to theworkplace.165 These themes are also explored in Section 7 – Education Trends.It is important to note that youth unemployment rates themselves do not completely capture thelivelihood challenges faced by youth. Although youth may be categorized as employed, there are nodata available assessing whether and to what extent young people’s livelihoods and jobs are ‘decent’.The issue of decent work has recently received attention within the ILO; however the body is stilldevising mechanisms for its measurement and evaluation. Without data on livelihoods aspects of youtheconomic participation, such as unreasonable work hours, insufficient remuneration, and job security,the effect of existing economic opportunities on youth livelihoods and poverty reduction remainsunmeasured. Throughout the developing world, new jobs and employment opportunities have typicallyarisen from the informal sector, raising concerns of indecent and insecure work for youth andadolescents in the MENA region.166 Please see the Mind the gap: the school to work transition and theinformal economy for a more detailed analysis of this situation.Youth labor force participationDemographic shifts in MENA’s population contributing to the “youth bulge” have led to a significantgrowth (32 percent) in the youth labor force throughout the region. Recent estimates project a 40percent increase in the size of the regional labor force between 2000 and 2010, and an 80 percentincrease between 2000 and 2020.167 By 2020, 43 million new entrants will join the labor force; almost asmany as the total labor force from 1950 to 1990.168 Countries can potentially benefit from such youthlabor force growth as younger age groups reach working age and become productive workers. It istherefore incumbent on governments in the region to create an enabling environment to accommodateand foster this economic growth, and reap the demographic dividend of high worker to dependantratios (Diagram 4).165 United Nations Department of Economic and Social Affairs, World Youth Report, 2007, United Nations, New York, 2007.166 United Nations. Follow up to the World Programme of Action for Youth to the Year 2000 and Beyond: Report of the Secretary General. General Assembly Economic and Social Council, November 2006.167 The World Bank. Unlocking the employment potential in the Middle East and North Africa: Toward a new social contract, The World Bank, Washington DC, 2004.168 The World Bank. Youth Employment in the MENA Region: A Situational Assessment, The World Bank, Washington DC, 2005. 84
  • 84. Diagram 4 Sub regional Dependency Ratios, 1950 2050Labor Force Participation Rates are a key indicator for the vitality of a population’s economicengagement. The labor force is the total population either employed, or unemployed who are activelyseeking work, within the national working ages (usually 15 64). The youth labor force is therefore thepopulation aged 15 24 either employed or seeking work. The youth Labor Force Participation Rate is theproportion of youth who are currently part of the labor force. In MENA, the population wide LFPR isbroadly in line with global trends; however the youth specific LFPR is lower than any other global region.As seen in Figure 27, the youth LFPRs for the two GCC countries for which data are available are higherthan all other MENA countries, likely due to the presence of guest workers, except Morocco, which alsodisplays a high youth LFPR. 85
  • 85. Figure 27 Country specific labor force participation rates 0.6 0.5 0.4 0.3 Youth Labor Force Participation Rate Per annum change in Youth 0.2 LFPR, where available 0.1 0 Egypt Oman UAE Morocco Syria oPt Iran Bahrain Kuwait Tunisia 0.1ILO, Global Employment Trends for Youth 2008, International Labour Organization. Available at:http://www.ilo.org/public/english/region/ampro/cinterfor/temas/youth/gety/gety_08.htm.Throughout MENA, women’s participation in the labor force remains low.169 For female youth aged 1524, labor force participation is consistently lower than that of male counterparts. However, Syria, Sudan,Djibouti, Morocco, Tunisia, Iran, Algeria and Libya have higher labor force participation among femalesaged 15 19 than among males of the same age.170Of particular note is the low labor force participation rate for females aged 15 19 in the oPt (1.2percent) and the relatively high age transition rate of 9.8 (Diagram 5), for an increase in labor forceparticipation for the 20 24 year old cohorts to nearly 12 percent. These increases are consistent withthose of the GCC countries, indicating increases in young female participation as they either enter theworkforce after completing their studies or bypass social and cultural barriers preventing them fromentering the workforce earlier. However, the overall labor force participation of young women aged 2024 in the oPt is relatively low compared to almost all other non GCC countries in MENA. The World Bankattributes this low rate to the presence of multiple Israeli checkpoints and other movement and accessrestrictions in the occupied Palestinian territory. Also worthy of note is the high labor force participationrate among young Iranian women relative to their young female counterparts in the region. Almost 50169 The World Bank. Youth – An Undervalued Asset: Towards a New Agenda in the Middle East and North Africa.The World Bank, Washington DC, September 2007.170 Ibid. 86
  • 86. percent of women aged 20 24 are involved in the youth labor force, significantly higher than rates inother GCC and non GCC states.Diagram 5 Share of Unemployed Youth in Total Unemployed and Age Transition in LFPR. 90 10 80 9 Age Transition Ratio 70 8 7 60 6 Percent 50 5 40 4 30 3 20 2 10 1 0 0 Syria Morocco Tunisia Algeria Iran Egypt oPt Saudi UAE Qatar Arabia Total Unemployment Share of unemployed youth in total unemployed (percentage) Age transition in LFPR, total for 15-2Source: UNDESA, World Youth Report 2007.A low youth labor force participation rate does not always imply a dearth of economic opportunitiesavailable to youth. Low rates may reflect high retention rates for secondary and tertiary education.Furthermore, low rates may reflect family structures that permit young people more time to find moreappropriate and ‘decent’ jobs, particularly in wealthier countries in the region, where families are lessdependent on young people’s income and can act as a ‘safety net’.171Youth inactivityYouth who are not unemployed and who are not seeking employment are not considered unemployed,but inactive. MENA continues to have the highest rate of youth inactivity. Globally, high youth inactivityrates are the result of low levels of female youth labor participation due to cultural barriers. As such, thefemale share of global youth inactivity rates tends to be higher than that of their male counterparts.However, a recent ILO study on global youth employment concluded that unique country circumstancespreclude the adoption of blanket explanations of youth economic inactivity.172 For instance, youthinactivity is not a viable option in poor MENA countries due to the necessity of work for some families tomeet their basic needs. Thus, inactivity rates in some states can be explained by increases in schoolenrollment at the secondary and tertiary levels, given the ability of cohorts in wealthier countries tosubstitute education for labor. Both sub regional and state specific investigation is required todetermine factors contributing to youth inactivity in the MENA region, information that has not beenwidely collected until the advent of the Silatech Knowledge Consortium.171 The World Bank. Youth – An Undervalued Asset: Towards a New Agenda in the Middle East and North Africa. The World Bank, Washington DC, September 2007.172 International Labor Office, Global Employment Trends for Youth, ILO, Geneva, 2006. 87
  • 87. In 2007, the ILO conducted a global school to work transition survey that included questions on youthinactivity in a sample of countries including Syria, Jordan, Iran and Egypt. Preliminary results indicatedthat 60 percent and 58 percent of young women in Egypt and Syria, respectively, stayed at home ratherthan work or attend school, citing cultural barriers to economic engagement. In Jordan and Syria, themajority of surveyed youth held temporary employment while awaiting more permanent jobs, whilethose in Egypt and Iran preferred to wait for better employment opportunities before entering theworkforce. Most youth in Jordan and Egypt identified a general lack of available jobs or insufficient levelof education as their biggest obstacle to finding preferred work.173 More surveys of this nature areneeded to better understand the complex phenomenon on youth inactivity.Education and employmentIn most MENA countries, workers with little or no education, as well as those with post secondaryeducation, constitute a smaller proportion of the total unemployed relative to their size in the overallregional population. Most unemployed workers are either semi skilled or have intermediate orsecondary education; a sign of the undervaluation of their training in the economy.174,175 In manycompetitive MENA labor markets, such as Jordan and Tunisia, youth with high education levels maycompete with less educated candidates for the same work opportunity.176 Youth with basic orintermediate education experience may struggle to enter the labor market, as they lack both theeducation of some of their peers, and the experience of those who did not complete school. As a result,youth with intermediate level education lack the economic opportunities of those with both more andless formal education, while those with higher qualifications find their tertiary education superfluous tothe needs of the labor market. For further discussion of this topic, see also Mind the gap: the school towork transition and the informal economyGender and employment in MENAMost countries in the MENA region have succeeded in narrowing the gender gap in educationalachievement; however this has so far failed to translate into an improvement in labor market prospectsfor the region’s young women. The MENA region has the largest gender gap in unemployment ratesamong youth in the world. Among some of the reasons cited for this significant disparity are: “1) thefailure of private firms in MENA to substitute for governments in employing young women, includinghighly segregated labor markets along gender lines; 2) employers unwilling to assume the added cost of173 International Labour Organization, School to Work Transition Survey,http://www.ilo.org/public/english/employment/yett/swts.htm , accessed 17 September 2009.174 The World Bank. Unlocking the employment potential in the Middle East and North Africa: Toward a new socialcontract, The World Bank, Washington DC, 2004.175 Population Reference Bureau. Youth in the Middle East and North Africa: Demographic Opportunity orChallenge? PRB, Washington DC, April, 2007.176 The World Bank. Youth – An Undervalued Asset: Towards a New Agenda in the Middle East and North Africa.The World Bank, Washington DC, September 2007. 88
  • 88. maternity leave and child care; and 3) women’s limited geographic mobility; and the limited growth oflabor intensive, export oriented industries that might otherwise employ women.”177Generally, female youth suffer a greater burden of unemployment than adult women. The data are lessconsistent, however, when comparing female and male youth unemployment rates for the seven MENAcountries for which disaggregated data are available (Figure 28). In Egypt, for example, 51 percent offemale youth were unemployed in 2001, compared to 19 percent of their male counterparts. A similarsituation is found in Syria, where male youth unemployment was 17.5 percent lower than female youthunemployment. Interestingly, the opposite is observed in Morocco and Tunisia, where male youthunemployment is higher than that of female youth.178Figure 28 Youth unemployment rates, by gender 60% 51% 50% 46% 45% 43% 39% 39% 40% 32% 31% 29% 30% Female Youth 20% 21% 19% 20% 16% 14% Unemployment Rate 10% 2% 2% Male Youth 0% Unemployment Rate -10% -4% -6% -20% -12% -18% Difference between male -30% and female youth -40% -32% unemployment rates Moroccoo Tunisia Iran Egypt oPt Algeria SyriaSource: World Bank: The Status and Progress of Women in the Middle East and North Africa, 2007.Young women in MENA face a series of interrelated issues: they are becoming more educated, marryinglater, and confronting resistance from the private sector, with many companies maintainingdiscriminatory practices that prevent women from accessing economic opportunity. As a result, womenare predominantly hired by the public sector, where they do not face the same level of discrimination,177 Population Reference Bureau. Youth in the Middle East and North Africa: Demographic Opportunity orChallenge? PRB, Washington DC, April, 2007.178 The World Bank. The Status and Progress of Women in the Middle East and North Africa, The World Bank,Washington DC, 2007. 89
  • 89. or opt not to enter the work force entirely. In some cases, women are restricted by law to work only incertain capacities and at only certain times of the day.179Minimum age of employmentThe employment of young people is not automatically negative as long as employment is notdetrimental to the individual’s health or educational opportunities. While adolescent and youthemployment is potentially beneficial for all parties, there is a need to establish clear and enforceableregulations prohibiting child labor and exploitative work, as well as to establish legal minimum ages foremployment that take into account young people’s vulnerabilities. The Convention of the Rights of theChild (CRC) does not establish a specific minimum age to be uniformly set throughout the world, butrather requires that participating countries "provide for a minimum age or minimum ages for admissionto employment". The ILO stipulates that the minimum legal working age should be no less than the ageof completion of compulsory schooling, and not less than 15.Throughout the world, many countries have established legislation that prohibits the employment ofchildren below a certain age. However, in the MENA region, many countries continue to have minimumemployment ages below the compulsory schooling age (Bahrain and Jordan), while others do not haveany clearly defined minimum employment age (Djibouti, Iraq, Lebanon, Qatar and Yemen)180.ConclusionsYouth employment experiences must be understood from a holistic, ‘livelihoods’ perspective, to capturethe range of ways that economic participation affects individuals, families and communities. Currentdata sources largely fail to capture the links between economic activity and other aspects of youngpeoples’ lives. In general, youth are underemployed across the region, especially young women, and it isdifficult to discern how many youth are voluntarily vs. involuntarily inactive. Dissemination of reportsfrom programs promoting entrepreneurship and the school to work transition could increase the spreadof best practices. Labor importing and exporting countries have diverse needs, but the overarching goalfor all youth in the region is decent work which permits completion of the transition from childhood toadulthood.Recommendations Carefully track youth inactivity to monitor the relationship between school completion, employment and family formation. Improve measurement of youth engaged in the informal sector. Develop indicators on decent and productive work.179 Ibid.180 Melchiorre A. At What Age Are School Children Employed, Married and Taken to Court? Second Edition, Right toEducation Project, 2005. 90
  • 90. 9. Migration trendsMigration is the third demographic factor determining the size and structure of a population withrespect to its size and sex ratio. While the other two factors, fertility and mortality, have been discussedin Section 3 – Demographic trends, migration is a factor which must be examined in terms ofinternational trends and flows, necessitating a more complex analysis. An analysis of migration requiresexamining both the origin of the migrant population as well as its final destination.Migration is a topic severely lacking quality data and indicators. While individual governments maintaindatabases of the flow of migrants both into and out of their borders, there are few reliable internationalor regional databases reporting these statistics with accuracy. Institutions such as the InternationalOrganization for Migration, UNHABITAT and the UN Statistical Division all provide information regardingmigration rates and trends, however in some cases estimates vary markedly between them, sometimeswithin the same database. This phenomenon may point to the inherent complexity of measuringmigration. Different countries may use different definitions for migration, complicating the oneemigrant = one immigrant equation. Countries have different capacities for enumerating migration, withdifferent coverage rates and level of detail. Calculating migration rates, such as migrants per 1,000population, requires an accurate knowledge of the size of the total population, which may not exist incountries that have not recently undertaken a census with 100 percent coverage. Additionally,administrative data collection, such as country reporting, inescapably includes only legal or detectedmigration, missing potentially large numbers of migrants not using official channels. These challengesreduce the reliability of reported migration data, complicating data analysis. As a result, caution shouldbe exercised when reviewing the statistics quoted in the present report. While the UN data presentedhere is useful for examining trends and drawing broad conclusions, it may suffer from the setbacks listedabove. While those migration estimates presented in this Review reflect the best knowledge available,individual data points may not reveal the full extent of migration in MENA.Types of migrationMigration in MENA is generally of three types: rural to urban (domestic), intra regional (within MENA),and inter regional (outside MENA). Migration in the region is usually one way: while immigrants mayreturn to their community or state of origin, they seldom do so permanently.Rural Urban migrationNot only is the MENA population growing, especially due to the maturation of the adolescent and youthpopulation, it is also becoming more urban. In 2007, the UN Department of Economic and Social Affairsestimated that 59 percent of the MENA population lived in urban areas in 2003.181 The region’stransition preceded that of the global average; the UN Population Fund declared in its 2008 report thatfor the first time in human history, 50 percent of the world population resided in urban areas.182 The181 United Nations Department of Economic and Social Affairs, World Youth Report, 2007, United Nations, NewYork, 2007.182 United Nations Population Fund, State of World Population 2008, UNFPA, 2008. 91
  • 91. MENA region continues to urbanize, with UN DESA estimating that by 2030, approximately 70 percent ofthe region’s population will live in urban areas.183 This transition will have a fundamental impact on theregion’s ability to provide a policy environment conducive to harnessing the potential of its youth. Notonly will young people require housing and water infrastructure, but also education and economicopportunity to assist them to reach their potential. It is necessary for decision makers to understand thesize, composition, and future location of the youth population in MENA to inform planning decisionsthat create an enabling and supportive environment.Intra regional migrationIntra regional migration provides populations in the region an opportunity to fulfill their needs withoutabandoning many aspects of their identity. Due to the similarity of language, communication, cultureand tradition across the region, migration within MENA typically does not present as many obstacles asmoving outside the region. Nationals of many MENA countries do not need visas to enter others,reducing the administrative burden of migration. Furthermore, income disparities between MENAcountries means that economic opportunity can be found without leaving the region. Many in the regionhave seized this opportunity, and send remittances to their families and communities in their countriesof origin.The increase in the price of oil since 1970 significantly increased national revenues, especially in the Gulfcountries. This increase in revenue, spurred by increasing global demand, fuelled the need for a largerlabor force in oil producing states. These countries lacked a ready supply of labor with the necessaryskills and desires to meet demand. As a result, migration to oil producing states provided an opportunityfor many in the region to fulfill their economic needs. It has been estimated that by 1990, approximatelytwo million Egyptian nationals were working in Iraq. Between 1970 and 1990, the number of foreignworkers in the Gulf states rose from 1.1 million to 5.2 million. While the majority of these foreignworkers were from Bangladesh, India, Indonesia, Pakistan and the Philippines, MENA nationals alsomigrated. One regional examination observed that the majority of intra regional migration occurredfrom non oil producing countries to those with oil resources and others with high income potentials.184The study also showed that while most migrants in the Maghreb sub region (Algeria, Morocco andTunisia) seek economic opportunities in Europe, many others sought work in the GCC and other MENAstates, as do those from Yemen and Egypt. As a result, foreigners now outnumber nationals in many oilproducing countries. One UN ESCWA study reported that more than 90 percent of private sector jobs inKuwait and Bahrain are held by foreign workers.185 This situation, in which nationals are or are becominga minority in their country, has led to efforts in many GCC countries to curtail the hiring of foreignworkers. While these efforts are designed to address unemployment among nationals and to maintainpolitical advantage, they have also resulted in the severing of an economic lifeline for economicmigrants within MENA. Unfortunately, comprehensive data on the proportion and origin of foreignworkers is not available for the majority of states in the region. It is therefore not possible to examine183 UN United Nations Department of Economic and Social Affairs, World Youth Report, 2007, United Nations, NewYork, 2007.184 UN ESCWA and the League of Arab States. The Millennium Development Goals in the Arab Region 2007: A YouthLens. 2007.185 Ibid. 92
  • 92. the percentage of foreign workers who are adolescents or youths, nor the flow of young migrants withinthe region. Table 6, however, shows the percentage of migrants as a share of economically activepopulation for select countries.Table 6 Distribution of Migrants from Select MENA Countries. Migrants as a share of total economically Migrants to Migrants to active Country of European GCC and other Other population Birth countries Arab countries countries Total (percentage)Algeria 991,796 66,398 14,052 1072,246 13.2Morocco 2,616,871 282,772 189,447 3089,090 29.1Tunisia 695,765 116,926 30,513 843,204, 25.9Egypt 436,000 1,912,729 388,000 2,736,729 14.2Lebanon 157,030 123,966 325,604 606,600 44.5Palestine 295,075 4,180,673 231,723 4,707,471 687.5Source: UN ESCWA and League of Arab States. The Millennium Development Goals in the Arab Region 2007: A Youth Lens,2007.International (inter regional) migrationOfficial statistics indicate that the MENA region is currently experiencing net immigration. About half(10) of the countries are experiencing more people leaving and half (9) are experiencing more peoplearriving. (Djibouti officially reports 0 net migration) (Figure 29). However, based on UN estimates for theperiod 2005 2010, approximately 52,000 more people enter the region than leave every year. Six of the10 countries experiencing net immigration are Gulf states, together accounting for 50 percent of netregional immigration. In addition, Syria alone accounts for 33 percent of the region’s net immigration,potentially the result of immigration from Iraq due to the ongoing conflict. Of all countries in the MENAregion, Iraq experienced the highest rate of net emigration (115,000 people per year, or 3.9 percent ofthe total population per annum) (Figure 30). It is important to note that these estimates are based onindividual country migration. As such, movement of populations between MENA countries are thereforecounted as both emigration from the country of origin, and immigration to the destination country. Thehigh number of immigrants in countries such as Syria may therefore be the result of significantemigration from other states in the region, such as Iraq. However, based on the regional data available,MENA as a whole has experienced net immigration. Barring discrepancies in reporting, at least 55,000non MENA nationals have migrated to the region. 93
  • 93. Figure 29 Net migration (thousands). 200 150 100 Thousands 50 0 -50 -100 -150 Kuwait Bahrain Djibouti Lebanon Egypt Jordan Morocco oPt Oman UAE Yemen Algeria Qatar Tunisia Iraq Libya Syria Saudi Arabia World Iran SudanSource: UN Data. Accessed at: http://data.un.org/Data.aspx?d=PopDiv&f=variableID%3a85. 94
  • 94. Figure 30 Net migration per 1,000 population 100 80 60 40 20 0 20Source: UN Data. Accessed at: http://data.un.org/Data.aspx?d=PopDiv&f=variableID%3a85.Young women and migration in MENAWhile little demographic data are available, young women in MENA do not enjoy the same freedom tomigrate as men. Local cultural norms and traditions create a barrier for women wanting to migrate, asdoes the lack of economic opportunities available to women generally in the region. This limitation isparticularly pronounced in the oil economies of the Gulf states. While the region offers the prospect ofemployment for young men, the jobs available in the oil industry are not considered suitable forwomen. While men may seek foreign employment, women are therefore denied these opportunities.186By extrapolation, it can be inferred that this situation also limits young women’s domestic opportunityfor migration. Because young women’s options for economic participation and empowerment are morerestricted than men’s, their work is often relegated to the informal sector.Underlying motivationsAlthough there are many reasons driving migration in the region, insecurity and the search for economicopportunity are the two primary factors motivating migration from and within the MENA region.187 Highyouth unemployment rates, coupled with difficult living conditions in many major cities in the region,186 The World Bank. Youth – An Undervalued Asset: Towards a New Agenda in the Middle East and North Africa.The World Bank, Washington DC, September 2007.187 United Nations Department of Economic and Social Affairs, World Youth Report, 2007, United Nations, NewYork, 2007. 95
  • 95. induce young people to search for livelihoods outside their country of origin. From the data available,migration is typically a masculine activity, with a higher proportion of men willing and able to migratethan women. There is a paucity of data on numbers of youth who are trafficked or forced to migratedue to conflict, and this involuntary migration is worthy of further study.In 2006, a very limited survey was undertaken by UNDP and the League of Arab States (LAS).188 Whileoriginally intended to survey only 24 young people aged 15 20, the poll eventually gathered theperspectives of 240 young people. While the sample size surveyed was not large enough to draw strongstatistical inferences, the results strongly suggest underlying discontent among young people. 51percent of those surveyed expressed a desire to migrate to another country. Among those wishing tomigrate, 46 percent wanted to move to Europe, while 36 percent wanted to move to the United States,and 13 percent to other Arab countries. Further research on why youth would select countries thatpresent significant cultural differences ahead of regional destinations would be useful for understandingyouth perspectives on the region. The survey results also indicated that young women had less desire tomigrate than young men.UNICEF country office reports indicate that Morocco, Libya and Tunisia are significant corridors of illegalmigration to Europe. Migrants from these countries include people from sub Saharan Africa, as well assignificant numbers of Maghreb nationals. In 2006, the Public Health Institute of Tunisia reported that60 percent of young people were willing to leave, with the majority citing that they “don’t have a futurein (their) country”. The study also found that 28.7 percent of young males surveyed were willing tomigrate illegally, despite it being a criminal offence in Tunisia.189A region wide study of attitudes to migration was undertaken as part of the Gallup World Poll.190 Thesurvey asked youths whether they were likely to move away from the city or area where they lived inthe next year. While information on the motivation for migration is not available, the results signify ahigh region wide desire to migrate, whether domestically or internationally (Figure 31). The survey mayunderestimate the proportion of young people wanting to migrate, as the question asked whether itwould be “likely” in the next year. In some situations, such as the oPt, young people who may want tomigrate, may not be able to. As such, the high proportion of young people reporting that they are likelyto migrate is indicative of the pervasiveness of this desire. Migration offers the hope of safety andeconomic opportunity. The hope of prosperity is not unfounded. Remittances form a large part of manycountries’ GDPs in MENA: Moroccan emigrants alone sent back $4.2 billion in 2004, accounting for 8.5percent of Morocco’s GDP. As long as countries in the MENA region fail to provide economic and socialopportunity for their adolescents and youth, the desire to migrate, either legally or illegally, will remainan attractive option for many in the region. While investments in human capital are necessary to propelthe region into the future, countries must also ensure that their investments are realized by retaining an188 United Nations Development Program and Regional Bureau for Arab States. Arab Human Development Report2002: Creating Opportunities for Future Generations, UNDP, New York, 2008.189 UNICEF MENA Regional Office. A Framework for Rights Based Programming with Adolescents: PromotingDevelopment, Protection and Participation: UNICEF MENA Region. The Adolescent Unit, 2006190 Gallup WorldView, https://worldview.gallup.com, accessed 17 September 2009. 96
  • 96. educated and productive population. Should these populations migrate internationally, countries face a“brain drain”, where the most productive members of their society leave due to better opportunitieselsewhere, limiting the potential for domestic growth.Figure 31 Percentage of youth reporting "that they are likely to move away from the city or area where they currently live. 0% 10% 20% 30% 40% 50% Algeria Bahrain Djibouti Egypt Iran Iraq Jordan Kuwait Lebanon Morocco oPt Qatar Saudi Arabia Sudan Syria Tunisia United Arab Emirates YemenSource: Gallup WorldView survey. Data 2005 2009.Recommendations: Data collected should be disaggregated by age and by sex. Though difficult, an effort should be made to estimate both legal and illegal migrant populations. Surveys should inquire about motivations for migration. Household surveys in the region should include both permanent residents and migrants, given the relative size of these populations in many countries. 97
  • 97. 10. Political and civic engagement trendsPolitical participation and civic engagement is a necessary component of a rights based developmentframework, and an important tool for developing policy and programs that seek to improve the situationof adolescents and youth. In few contexts is the need for engagement and empowerment more acutethan in the MENA region. Decision making structures and chains of authority in the region are typicallyvertical, where decisions are made at an executive level and passed down to those the decisions areattempting to serve. It has been noted that this vertical chain is pervasive throughout many aspects ofsociety. Reverence for higher authority extends through political, social, educational, religious andfamilial structures, often disenfranchising adolescents and young people from making decisions abouttheir lives. From birth through adulthood, individuals in the region pass through the domains of thefamily, the education system, the economy, religion and politics, experiencing life transitions that rarelylead to an increase in self determined authority.In the region, opportunities to exercise decision making power typically expand for male youths as theyenter adulthood in the economic sphere. After completing their education, young men typically gain thecapacity to decide on their future employment. However, their personal economic circumstances, inaddition to limited job opportunities in most countries, often force young men into whatever work isavailable, rather than that of their own free choosing. In some countries in the region, universitygraduates face higher rates of unemployment than non university graduates (see Section 8 –Livelihoods and economic participation trends for more information). In the economic sphere, whereautonomy typically increases for young men, lack of employment opportunities, themselves the result ofvertical decision making structures in the government and private sector, prohibit young men fromexercising greater control over their own lives.For young women in MENA, the same challenges exist as for young men, however in greater magnitude.Young women do not participate in the economic sphere to the same degree as young men, a findingfurther discussed in Section 8. Not only do young women face the challenge of finding productive,decent employment, but in the absence of work must also rely on men to provide economic security,further limiting their autonomy. This factor, in conjunction with cultural traditions of patriarchy, limitsyoung women’s decision making ability. Young women pass from the control of their father to that oftheir husband and have few opportunities to exercise decision making skills. While the level of women’spolitical and civic participation varies between MENA countries, generally young women face morerestrictions than young men. After marriage, household authority typically resides with the man. Youngwomen’s ability to participate in the political and civic life of society therefore becomes more limitedthan men’s, reinforcing the traditional masculinity of authority in the region.A vivid civil society is a key component in facilitating civil and political participation. Some countries,such as Lebanon, have an active and growing civil society, while others suffer from a dearth of entrypoints for young people wishing to contribute. The importance of order in MENA society has led to asocial consciousness that does not promote organizations seeking to change the status quo. Theexception may be youth organizations and the youth component of political parties operating within 98
  • 98. pre existing power structures; however data are not available to confirm or deny this hypothesis. Whiletwo hallmarks of youth are openness to new ideas and a desire to question and improve the status quo,the MENA region generally suffers from a lack of civic engagement. Possible reasons include the lack ofentry points for young people wishing to become involved, a generally apathy towards political and civicengagement, or the lack of an enabling environment where young people feel that their concerns will beaddressed.Available data indicate that civic and political participation among MENA youth remains weak, yet thereare two indications that this may be changing. The first is an increased focus on adolescents and youthat the national level and an associated increase in young people specific NGOs and programs. Thesecond is the spread of Information and Communication Technologies (ICT) which allow youth to engagein their communities in non traditional ways.In 2004, the InfoYouth Middle East Youth Directory gathered information from 10 countries in theregion to enumerate the number of youth specific NGOs, governmental organizations and programsoperating in each. Within the 10 countries selected, there were 221 domestic and regionalorganizations, ministries and/or programs, displayed in Table 7. While not inclusive of all countries inthe MENA region, the findings indicate the range of youth engagement and government attention toyouth issues. Lebanon (89) displayed the highest number of organizations and programs, while SaudiArabia (1) displayed the fewest. Although this is not a complete listing of all organizations, ministries orprograms addressing young people in MENA, it does show the spectrum of institutions in variouscountries. 191 Without comparative data available for the time period before or after 2004, it is difficultto determine the trajectory of these figures. However, with the situation of adolescents and youthemerging as a key factor in the wellbeing of societies in the region, it is expected that this level ofparticipation would increase, subject to an enabling political and social environment.191 The World Bank. Youth – An Undervalued Asset: Towards a New Agenda in the Middle East and North Africa. The World Bank, Washington DC, September 2007. 99
  • 99. Table 7 Youth specific organizations in MENA Total Number of GOs and NGOs with Country Youth Programs Regional 13 Lebanon 89 Jordan 38 oPt 34 Syria 14 Kuwait 12 Bahrain 8 Qatar 5 UAE 5 Oman 2 Saudi Arabia 1Source: Middle East Youth Directory. Available at: http://www.infoyouth.org/cd_rmed/mains/overviewme.htm.Similarly, the spread of Information and Communication Technologies in the region, especially theinternet, opens another avenue for adolescents and youth to engage in political and civic affairs. A June2009 publication from the Berkman Center for Internet and Society at Harvard University studied theArabic blogosphere, identifying 35,000 active web logs (blogs, total collective term: blogosphere),mapping content and links among the blogs192. The report presents a number of findings of relevance toyoung people’s political and civic engagement through the internet. First, “Arabic bloggers arepredominately young and male”, with the highest proportion of female bloggers residing in Egypt.Second, “Those that write about politics tend to focus on issues within their own country and are moreoften than not critical of domestic political leaders.” Third, “(d)omestic news is more popular thaninternational news among general politics and public life topics, especially within large national clusterswriting entirely in Arabic.” Fourth, “(r)eligion is a very popular topic in the blogosphere, and appears tobe discussed more in terms of personal religious thoughts and experiences than in its political ortheological aspects.” Fifth, “Arabic bloggers tend to prefer politically oriented YouTube videos tocultural ones.” Finally, “Arabic bloggers are more likely than not to use their name when blogging, asopposed to writing anonymously or using an obvious pseudonym.” While the study found 35,000 activeArabic language blogs, the Persian blogosphere is estimated to be twice as large. These findings suggestthat youth in the MENA region are seeking ways to engage and participate in the political and civic life oftheir societies, sharing their thoughts and experiences on a variety of topics that may challenge thedominant social beliefs. In this regard, youth in MENA typify youth in other regions: while their capacityto change their communities is limited by a restrictive social and political structure resistant to freeexpression and change, youth actively seek ways to have their thoughts and beliefs heard. The ever192 Etling B et al. Mapping the Arabic Blogosphere: Politics, Culture and Dissent.http://cyber.law.harvard.edu/sites/cyber.law.harvard.edu/files/Mapping_the_Arabic_Blogosphere_0.pdf,accessed 17 September 2009. 100
  • 100. increasing spread of the internet throughout the MENA region will swell this trend, as more youngpeople have access to a medium to share their perspectives.Anecdotal evidence suggests that the internet allows young men and women to interact in a setting freeof the social taboos prevalent across most of the region. Inter gender relations formed on Facebook,MySpace and other social networking sites provide a way for the sexes to interact and developfriendships not limited by social mores. This potential avenue for women’s empowerment, along withattitudes and behaviors regarding political and civic engagement generally, are topics demandingextensive further research. By developing indicators and gathering data on these important aspects ofthe situation of adolescents and youth in MENA, a more holistic picture may be developed and allow forcomparisons over time.Recommendations: Data on political engagement would improve measurement of this important phenomenon over the current indicator on the Core List, which is voting age. Engagement in political, religious, civic, social and athletic groups is a defining aspect of the youth experience for many young people. Data should be collected on this topic. 101
  • 101. 11. Child protection trendsChild protection strategies aim to prevent and respond to violence, exploitation and abuse, to ensurechildren’s rights to survival, development and well being.193 By promoting child protection strategies,communities can break the negative cycle in which children victimized by violence, neglect and abuserisk perpetuating these practices in later life. Promoting a culture of rights protection towards childrenadvances the future establishment of a more just society, as these children become leaders and instillrespect for human rights in future generations.Seven key aspects of child protection are addressed in this section of the Review: birth registration,violence against children, child marriage, female genital mutilation/cutting, children in contact with thelaw, young people without parental care, and street children. Other risk factors, including poverty, childlabor, armed conflict, disability and migration, are found in other sections of this report. For many ofthese topics, data are scarce and difficult to collect. Countries that have gone to great lengths to reporton aspects of child protection should be commended for doing so. As reporting methods improve,prevalence of some problems may rise, not due to an increase in incidence, but through more accuratemeasurement techniques. This may be discouraging to authorities, but should not dissuade them fromcollection efforts. While there may be stigma associated with data on some of these issues, gatheringinformation on the extent of child protection problems is the first crucial step towards understandingwhat the region’s youth are facing and designing responses to safeguard their future.Birth registrationFigures for population projections, which inform policy and planning initiatives of fundamentalsignificance to adolescence and youth, rely on accurate birth registration and other vital statistics toenumerate the size of the population under observation. Governments and organizations usepopulation projections in the budgetary and planning process, for infrastructure such as schools,hospitals and programs affecting young people’s lives. While censuses provide one method forestimating the size and composition of a state’s population, vital registration (registration of births,deaths, marriages and other significant events) is a sentinel surveillance mechanism designed to provideup to date estimates of population levels and trends. Policy and programs for young people, including inthe realms of education, health and poverty alleviation, require high vital registration coverage rates toinform policy makers of current and emerging needs, allowing them to plan accordingly.States within the MENA region can be characterized as either high or low coverage countries. Manystates in the region have birth registration rates over 85 percent, such as Algeria, Djibouti, Egypt, Iraq,Morocco, the oPt and Syria (Table 8). However, Sudan (33 percent) and Yemen (22 percent) exhibitmuch lower rates. This distribution indicates that birth registration rates are not only affected by theeconomic status of a country, as Djibouti and the oPt display high coverage rates, but may primarily bethe result of political will to collect vital registration data.193 UN Economic and Social Council, UNICEF Child Protection Strategy, UNESA, New York, 2008. 102
  • 102. Table 8 Birth registration rates, 2000 2007. Total Urban Rural Algeria 99 99 99 Bahrain Djibouti 89 90 82 Egypt 99 99 99 Iran Iraq 95 95 96 Jordan Kuwait Lebanon Libya Morocco 85 92 80 oPt 96 97 96 Oman Qatar Saudi Arabia Sudan 33 53 22 Syria 95 96 95 Tunisia UAE Yemen 22 38 16 MENA 75 86 67Source: UNICEF. Available at: www.childinfo.org/birth_registration_tables.php.Data collection rates also differ between urban and rural births. As displayed in Table 8, all countries forwhich data are available, except Iraq, show similar or lower coverage rates in rural areas than in urbanareas. This disparity is especially pronounced in the two countries with the lowest birth registrationrates: in Sudan, 53 percent of urban births are registered, compared to 22 percent of rural births, whilein Yemen, 38 percent or urban births are registered, compared to 16 percent in rural areas. Even inthose countries with relatively high coverage, such as Morocco (85 percent) and Djibouti (89 percent),show higher coverage rates in urban areas than rural areas.Low birth registration rates, from a population policy and planning perspective, would not be a problemif the coverage rate was known, and the groups not covered were representative of the population as awhole. However, groups that are not registered typically differ in important ways from registered.Vulnerable groups, such as refugees, displaced people, street children, children born out of wedlock,and others do not usually experience the same coverage rates as less vulnerable groups. As a result,decision makers risk making policy and programming decisions that are inadequately informed of thesituation of vulnerable segments of the population. Low birth registration of these groups complicatesthe planning process, and may result in inappropriate policy for segments of society most in need ofassistance. Birth registration is therefore fundamental for knowing the true population denominator,and assists decision makers in designing effective policies that better reflect the real extent of the issueof interest. 103
  • 103. Violence against young peopleViolence against children is pervasive in the MENA region, with an overwhelming percentage of childrenexperiencing either physical or psychological punishment. In the seven countries for which data areavailable, an average of 89 percent of children aged 2 14 years experience one or more forms ofphysical or psychological punishment every year (Table 9). Of these countries, violence against childrenis most prevalent in Egypt (92 percent), the oPt (95 percent) and Yemen (94 percent), while Djiboutireports the lowest rate at 70 percent. It is likely that these rates underestimate the true prevalence ofviolence against children, as cultural sensitivities may preclude young people from reporting violencefrom those in positions of authority, such as parents. While data are not available for any of the GCCstates, regional analysis suggests that violence against children is widely practiced and accepted acrossthe MENA region.Table 9 Child Discipline and Domestic Violence. Attitudes towards domestic Country Child discipline194 2005–2007 violence195 2001–2007 Algeria 86 68 Bahrain Djibouti 70 Egypt 92 50 Iran Iraq 84 59 Jordan 90 Kuwait Lebanon Libya Morocco oPt 95 Oman Qatar Saudi Arabia Sudan Syria 87 Tunisia UAE Yemen 94 Middle East & North Africa 89Source: State of the World’s Children 2009. UNICEF at http://data.un.org/Browse.aspx?d=POP194 Percentage of children 2–14 years old who experience any psychological or physical punishment195 Percentage of women 15–49 years old who consider a husband to be justified in hitting or beating his wife for at least one of thespecified reasons: if his wife burns the food, argues with him, goes out without telling him, neglects the children or refuses sexualrelations 104
  • 104. The Global School Based Student Health Survey, jointly administered by the World Health Organizationand the US Center for Disease Control and Prevention, collected information on the percentage ofstudents aged 13 15 who had been physically attacked in the past year across 10 MENA countries.196The results of the survey were much lower than the data contained in the UN ChildInfo Database,however this discrepancy may be due to the omission of psychological violence from the surveyquestion. Additionally, definitions of violence may have varied across questionnaires. For the 10 MENAcountries surveyed, 43 percent of children aged 13 15 reported being physically attacked in the pastyear (Figure 32).197 A higher proportion of boys reported being the victims of violence: 53 percentcompared with 31 percent of girls. Unfortunately, data disaggregated by the perpetrator of violence(parents, teachers, etc.) were not available.Figure 32 Percentage of students (ages 13 15) physically attacked in the past year. 70% 60% 50% 40% Total 30% Male 20% Female 10% 0%Source: Global School based Student Health Survey, 2005 2008.Violence against children perpetuates the cycle of violence within society. When children are exposed toviolence, they reach adulthood having internalized the belief that violence is an acceptable way to solvedisputes. Additionally, violence against children further exacerbates their social marginalization,deleteriously affecting their health and educational opportunities.196 Centers for Disease Control, Global School based Student Health Survey,http://www.cdc.gov/gshs/countries/eastmediter/index.htm, available 17 September 2009.197 This average has not been weighted for population; it is the statistical average of country percentages. 105
  • 105. The trend of violence against girls appears to continue into adulthood, reinforced by permissive socialnorms. The MENA region displays high rates of acceptance of domestic violence (Table 5).198 WithinAlgeria, Egypt, Iraq and Jordan, 68 percent, 50 percent, 59 percent and 90 percent of women aged 15 49believed husband’s violence against a wife is justified under some circumstances. These high levelssignify a pervasive culture of violence in the MENA region. This perspective has negative effects both onsociety as a whole, and young people specifically. An accepting culture of violence undermines the goalof a stable, secure, rights based community, where individuals are able to live in dignity and withoutfear. For young people, social tolerance and acceptance of violence, especially when employed by thosein positions of authority such as parents and teachers, leads to negative health and educationaloutcomes, and increase the likelihood that these young people will adopt unhealthy attitudes towardsviolence once reaching adulthood.Some countries in the MENA region have implemented laws and policies to ban violence againstchildren. Of the 20 MENA states, violence against children in schools is prohibited in 12 MENA countries,while it is still legal in the home in all 20 (Table 10). The use of corporal punishment as a sentence for acrime has been banned in 11 MENA states, however it is still legal as a disciplinary measure in 15. OnlyJordan has banned corporal punishment in alternative care facilities. Table 10 illustrates that theprohibition of corporal punishment is uneven across states and settings in the MENA region. Jordan hascome closest to full legal abolition, having illegalized corporal punishment in four of the five domains.While prohibition of violence against children is a positive development towards the protection of youngpeople, it is only the first step in changing social culture, and ensuring that adolescents’ and youths’rights are protected.198 United Nations Children’s Fund, ChildInfo, http://www.childinfo.org/attitudes_data.php, accessed 17September 2009. 106
  • 106. Table 10 Prohibition of Corporal Punishment in MENA Countries Prohibited Prohibited Prohibited in in home in school Prohibited in penal system alternative care As Sentence As Disciplinary Measure Algeria No Yes Yes No NoBahrain No Yes Yes - NoDjibouti No Yes Yes No No Egypt No Yes Yes Yes No Iran No Yes No No No Iraq No Yes Yes Some No Jordan No Yes Yes Yes Yes Kuwait No Yes Yes No -Lebanon No No Yes Yes No Libya No Yes No - -Morocco No No Yes Yes No Oman No Yes - No No oPt No Some No No No Qatar No No No No No Saudi No No No No No Arabia Sudan No Some No Some Some Syria No No Yes - No Tunisia No No Yes Yes No UAE No Yes No No No Yemen No Yes No No No Total: 0 12 11 5 1 Source: Global Initiative to End All Corporal Punishment of Children. http://www.endcorporalpunishment.org/pages/frame.html Child marriage Child marriage has a range of detrimental effects spanning the breadth of young people’s lived experience, especially for women. Married young women do not enjoy the same educational opportunities as unmarried women, and married and unmarried young men. In some MENA countries, education is seen as an asset that increases a woman’s value as a partner. However, women often do not continue their studies after marriage, limiting their economic opportunity and personal growth later in life. Young married women bear increased risks of mortality due to adolescent pregnancy, as well as lower survival rates for their infants. Child marriage is both a symptom and cause of low gender equity and female empowerment, as young girls often marry older men and relinquish decision making power to their new husbands. Women married at younger ages may lack the ability to consent, further marginalizing their empowerment within the personal sphere. Data on child marriage remains incomplete across the MENA region. Some countries, such as Bahrain (0 percent) Algeria (2 percent), experience little or no child marriage, whereas Sudan (34 percent) and Yemen (32 percent) have the highest recorded rates in the region (Figure 13). Child marriage rates are typically higher in rural areas than in urban areas, indicating that both tradition and socio economic 107
  • 107. factors may increase the likelihood of child marriage. However, disaggregated data by socio economicstatus and other potentially contributing factors do not exist. Similarly, percentages are not currentlydisaggregated for women aged 15 or younger and 16 18. Data collection must be expanded to morecountries in the region, as well as allow for disaggregation by other potentially relevant factors such asthe age gap between spouses.Female genital mutilation/cuttingFemale Genital Mutilation/Cutting (FGM/C) is a phenomenon largely confined to four countries in theMENA region: Djibouti, Egypt, Sudan and Yemen. In Djibouti, Egypt and Sudan, more than 85 percent ofall women aged 15 49 had experienced FGM/C, while 23 percent of women in Yemen were affected(Figure 33). In many cases, FGM/C is considered an investment in young women’s value in theiradolescent and youth years, as it is within these ages that marriage, and therefore the importance ofsexual “purity”, is consummated.Figure 33 Percent of females reporting Female Genital Mutilation/Cutting 100 90 80 70 60 Percent 50 40 Female Genital Mutilation/Cutting 30 Women (15 49 years) Percentage 1997 2006 20 10 0 Morocco Qatar Algeria Djibouti Egypt Libya oPt Syria Bahrain Iran Iraq Jordan Kuwait Oman Lebanon Saudi Arabia Tunisia UAE Yemen Sudan Sample consisted of ever married women only for Egypt, Sudan, and Yemen.Source: UNICEF. http://www.childinfo.org/fgmc_tables.phpPrevalence of FGM/C is not homogenous across all population sub groups in these four countries.Unfortunately, disaggregated data for Djibouti are not available. However, prevalence rates vary bygeographic and socio economic characteristics in Egypt, Sudan and Yemen. 108
  • 108. In Egypt, prevalence varies by education status of the mother, economic status, and whether the familylived in urban or rural areas. 92 percent of young women with secondary education or higher havesuffered FGM/C, while 98 percent of those with no or primary level education had received the practice.98 percent of young women in the poorest 20 percent of households live with FGM/C, 10 percent higherthan the rate for those in the top 20 percent income bracket. Similarly, 98 percent of women living inrural areas had received the practice, compared to 92 percent of their urban peers.199In Sudan, prevalence rates sharply vary by region and ethnicity. While 87 percent of women in theEastern region have undergone FGM, only 65 percent of women in Darfur have suffered FGM. It is worthnoting that data on the prevalence of FGM/C in Sudan is only available for north Sudan (approximately80% of the total population), with no data available for the remaining southern regions.200Similar to Sudan, FGM/C prevalence rates differ markedly between regions in Yemen. While prevalencein the Costal region is high (69 percent), those in the Mountainous and the Plateau and Desert regionsare significantly lower, at 38 percent and 48 percent, respectively. In addition, educational status is alsoa determinant factor. However, unlike Egypt, young women in Yemen with higher educational status(secondary education or above) display a prevalence of 35 percent, while only 22 percent of illiteratewomen have undergone the process.201Recently, greater advocacy has sought to expose the issue for public debate and acknowledgement of itsharmful consequences. While progress has been achieved, the sensitivity of the topic has limited thepotential for responsive monitoring tools. As such, while the issue may now be more acknowledged inthe public consciousness, it is difficult to determine the degree of influence this has had on socialpractices.Young people in contact with the lawDespite the formality of legal systems in most countries in MENA, little data are available on youngpeople in contact with the law. This population includes both young people in conflict with the law (suchas those suspected or found to be in breach of the law) as well as those who are the victims andwitnesses of crimes. Young people in contact with the law can therefore be regarded as all of those whoare directly affected by its breach, either as perpetrators, victims or witnesses.Though young people are widely viewed as a destabilizing force in society, the lack of publically availabledata supporting this assertion makes its validity difficult to assess. Although the police and judicialsystems are generally well organized in MENA countries, sensitivities surrounding data on criminaljustice issues make efforts to analyze and respond to pertinent issues extremely difficult. Data collectionstrategies at the local police station, where most young people come into contact with the law, areeither non existent or not disseminated in a timely manner. Where data are collected, it may not beshared, complicating efforts to evaluate programs and policies seeking to improve security and199 United Nations Children’s Fund, ChildInfo, http://www.childinfo.org/files/Egypt_FGC_profile_English.pdf,accessed 17 September 2009.200 Ibid.201 Ibid. 109
  • 109. strengthen the rule of law. Indicators on the number of young people suspected of criminal acts, thenumbers of victims and witnesses of offences, the number of young people in detention, and theproportion of young offenders benefiting from diversion and alternatives to detention do not exist.Similarly, data of children in contact with the law, rather than in conflict with the law, are also eitheruncollected, or remain unshared. To develop effective, evidence based policy, decision makers must beequipped with comprehensive information on young people in contact with the law. Without suchinformation, programmers and policy makers will be unable to design best practice policy, nor monitorand evaluate the effectiveness of policies against desired outcomes.In collaboration with UNICEF, the United Nations Office on Drugs and Crime has devised a set of 15Juvenile Justice Indicators to measure the extent of juveniles’ experience with the law, in addition toaspects of national policy.202 Unfortunately, data collection for these 15 indicators is in its initial stages,however future governmental reporting will provide a valuable tool for examining young peoples’experiences in MENA states.Five countries in the world have executed children under the age of 18 since 2005; four of thosecountries are in the MENA region. Iran (28), Saudi Arabia (2), Sudan (2) and Yemen (1) all continue toallow the death penalty for minors, despite international concern.203 While the imposition of the deathpenalty is relatively uncommon in those four countries, its continued acceptance is of concern to childprotection advocates.The International Center for Prison Studies at King’s College, London, has compiled a global database ofincarceration statistics. From their analysis, a limited amount of information on imprisoned children isavailable, however further disaggregation by age, or simultaneous disaggregation by age and sex, is notavailable. According to the database, children constitute between 0.6 percent (UAE) and 7.6 percent(Morocco) of the total detained population in MENA (Table 11). Without more detailed information,such disaggregation by type of crime or length of sentence, it is difficult to compare the relativepositions of detained youth between countries in the region.Table 11: Children in Detention in Available MENA Countries Number of Percentage of Total State Children Population in Detention Algeria 648 1.20 % Egypt 673 1.04% Iran 2,375 1.50% Morocco 4,072 7.60% Saudi Arabia 401 0.90% UAE 68 0.60% Total: 8237Source: Prison Briefs, International Center for Prison Studies, King’s College London, www.kcl.ac.uk/depsta/rel/icps202 UN Office on Drugs and Crime, Manual for the Measurement of Juvenile Justice Indicators, UNODC, New York,2006.203 UNICEF, Child Protection in MENA internal background note, 2009. 110
  • 110. Despite nominal efforts by some countries in the region to adopt a juvenile justice system, theexperience of many young people remains troubling. Minors are regularly tried without the presence ofa lawyer or guardian, and are sometimes held in detention centers mixing adults and children. Long pretrial detention periods increase psychosocial risks, especially when young people are held alongsideadults and those already convicted of an offense. Young people are also seldom given the opportunity tobenefit from alternatives to detention, such as community service. As only partial data are available, it isdifficult to present the variety of experiences across countries. From a regional perspective, the juvenilejustice system in MENA suffers shortcomings of serious concern, requiring a substantial commitment bygovernments in the region to improve the relationship between young people and the law.Young people without parental careAs a transitional life period, adolescence and youth require a positive social environment to enableyoung people to develop positive roles in their communities as they adopt new responsibilities. Asupportive family structure is a critical element of this environment, however many young people in theregion lack necessary levels of care and support to smooth their transition. Estimates of the number oforphans and other children living without parental care in MENA countries are scarce, with dataavailable for only three out of the total 20 states in the region. Children living without parental care arenot necessarily orphans, but may also include those living on the street, and those living outside aformal family setting. However, available data indicate that children without parental care constitute asignificant proportion of all children in the region. In Iran and Sudan, orphans comprise 7 percent and 9percent of the total under 18 population, while in Djibouti, 11 percent of all children are withoutparental care.204 In these three countries combined, it is estimated that there are 3,248,000 childrenliving without parental care.205 UNICEF projections estimate that these levels will remain relativelyconstant in the short term, and will marginally decrease over the next five years.Young people living in the streetsLocalized studies in MENA countries conclude that street children are a significant proportion of theyoung population in urban areas. No reliable country or region wide data exist on the number of streetchildren in MENA countries, as their vulnerability automatically complicates enumeration strategies.Measurement of any group, including young people living in the street, who contravene the law orparticipate in hidden and clandestine activities offer significant challenges for accurate data collection,As such, along with trafficked children, street children are one of the most understudied andunderrepresented segments of MENA society. However, while they are understudied, they are not aninsignificant part of the population. In 1999, estimates of the number of Egyptian street children rangedfrom 93,000 to 2 million.206 In Morocco, social activists providing services in major cities report between30,000 and 100,000 street children.207 An unpublished study by the Supreme Council for Motherhood204 Joint United Programme on HIV/AIDS, United Nations Children’s Fund, United States Agency for InternationalDevelopment, Children on the Brink 2004, UNICEF, New York, July 2004.205 Ibid.206 United Nations Office on Drugs and Crime, Rapid Situation Assessment,http://www.unodc.org/pdf/youthnet/egypt_street_children_report.pdf, accessed 17 September 2009.207 Enfants des rues. http://www.bayti.net/, accessed 17 September 2009. 111
  • 111. and Childhood, funded by the Arab Council for Childhood and Development, estimated that there areapproximately 30,000 street children in Yemen, the majority of who are separated from their families.Of the 30,000, 60 percent worked and slept on the streets, while the remaining 40 percent returned tosome kind of home at night.208In general, street children are not orphans, and many are either in contact with their families or workingspecifically to increase their household’s income. There are more male street children than female,potentially due to the higher tolerance of physical and psychological abuse experienced before fleeinghome. Once on the street and not in school, both boys and girls are exposed to increased risks anddecreased access to supportive structures. Street children often come into contact with the law, andmay experience discrimination and violence as a result of their status.Efforts to estimate the number of street children in MENA countries have been stymied by a lack ofpolitical will, technical challenges in data collection, and information restrictions by states refusing toauthorize the collection or dissemination of data. Until valid and reliable data are available, it will remainimpossible to monitor and evaluate programs already in place, and improve policy and programming torespond to the issue.Recommendations: Data collection methodologies, such as those employed by the UNICEF MICS survey and others should strive to include representative samples of vulnerable young people to document their situation. These include street children, young people without parental care, and other marginalized groups. Prioritize data gathering on young peoples’ experiences of violence to better understand the scope of the issue. Research should include a number of realms, including corporal punishment at school and at home, domestic violence, bullying, the effects of early marriage, and FGM/C. The development of the set of juvenile justice indicators provides a valuable opportunity for standardized, rights based assessment of children in conflict with the law which should be adopted by all parties working on juvenile justice issues.208 Supreme Council for Motherhood and Childhood (SCMC), funded by the Arab Council for Childhood andDevelopment, http://www.ilo.org/public/english/employment/gems/eeo/law/yemen/dep4.htm, accessed 17September 2009. 112
  • 112. 12. Conflict and emergencySeveral countries in the MENA region currently experience precarious security conditions, includingAlgeria, Iran, Iraq, Lebanon, the occupied Palestinian territory, Sudan and Yemen. Conflict andemergency leaves lasting scars on populations in excess of physical infirmity. Enduring effects includepsychological and social distress, economic loss, long lasting political instability, degradation ofsupportive social structures and service delivery, particularly at community levels, large refugee andinternally displaced populations, and a fragmented sense of community. These effects manifest in amyriad of ways, including large numbers of orphans and single parent, often female headed,households, a reversion to exclusionist social groups, insecurity about the future, and a desire to migrateto escape a bleak future with little or no positive prospects. The possibility of resurgent violence is alltoo real. In his 2005 report “In Larger Freedom”, then UN Secretary General Kofi Annan noted withconcern that “roughly half of all countries that emerge from wars lapse back into violence within fiveyears”.209 Adolescents and young people, in addition to suffering the effects of conflict and emergency,are also potential agents for positive change. Engaging young people in the dialogue of peace helpsprotect states against instability. Ensuring social conditions conducive to the gainful enjoyment of rightsdiminishes the threat of resurgent insecurity. Young people are not only victims of conflict, but also apotential catalyst for restitution and prevention.In conflict and emergency situations, young people are likely to suffer severe risks to their personalsafety and well being. Their vulnerability exacerbates these risks. Threats of death, injury and disability,psychological and social distress, loss of education and economic opportunities, sexual exploitation andabuse, and recruitment by armed groups affect adolescents and youth in many ways that are distinctfrom very young children and adults. Protection of all children from involvement in any form of conflicthas been recognized by the international community as a fundamental aspect of conflict mitigation.210 Inaddition to these measures, adolescents and youth must be integrated in demobilization, disarmamentand reintegration to re establish a culture and mindset of lasting peace. Child protection strategies thatshield young people from conflict, and sow the seeds of peace in the young people of today contributeto the creation and maintenance of stability for generations into the future.The 2007 World Youth Report asserted that the MENA region is subject to several factors that increasethe risk of prolonged conflict. The region’s large youth population, wealth of natural resources, historyof armed conflict, large numbers of refugees and IDPs, low civic engagement, political exclusion, poorsocial protection, and large informal economy are all risk factors contributing to instability. Uncertaintyabout the future, exacerbated by poor economic prospects, increases the likelihood that young peoplewill look elsewhere to provide for their needs. Reducing the risk of conflict requires states to commit toaddressing the root causes of conflict and engage in preventive measures before tensions erupt; a209 The Secretary General, In Larger Freedom: Towards Development, Security and Human Rights for All: Report ofthe Secretary General, U.N. Doc. A/59/2005, par. 114, 2005.210 The Secretary General, Children and Armed Conflict: Report of the Secretary General, U.N. Doc. A/63/785, 2009. 113
  • 113. principle asserted by the International Committee on Intervention and State Sovereignty.211 As one ofthe most dynamic segments of the MENA population, young people can be agents of change for betteror for worse. It is imperative that states engage and empower young people to find solutions toconflict’s root causes and address its risk factors. Young people in MENA can contribute to the creationand maintenance of security, helping to avert the scourge of war and forge a lasting peace.While young people have the capacity to be positive agents for peace, far more research is required todetermine how this goal can be realized. Young people generally, and young men specifically, are oftenallegedly associated with deviance, and perceived as a destabilizing force in society. While this has beentrue in a number of contexts, what has been less studied is how young men and women’s social assetscan be used to avert crises before they begin. What is called for is both a new framework for youngpeople and their impact on security, and indicators and data to substantiate their potential capacity tobuild their societies and states. Without a novel approach, MENA’s risk of conflict remains elevated.However, should the unique position of young people in MENA be adequately channeled intopreventing, responding to, and rebuilding from conflict, young people have the potential to provide astabilizing force for security in the MENA region.MENA hosts the second largest number of “populations of concern” of any UNHCR region (see Annex VIfor a regional definition). In 2008, there were an estimated six million refugees, IDPs, asylum seekersand stateless persons in the UNHCR region, surpassed only by the Asia and Pacific region hostingapproximately 10 million (Figure 34). Using the UNICEF regional definition, this number is greater:approximately 7.1 million refugees, IDPs, asylum seekers and stateless persons. Within MENA, 83percent of the total population of concern resides in four countries: Iran (12 percent), Iraq (37 percent),Sudan (18 percent), and Syria (17 percent) (Figure 35). Similarly, refugees originating from Iraq, the oPtand Sudan account for approximately 6.9 million of the total 7.1 million refugees in MENA; or roughly 96percent. It is worth noting that the UNHCR database includes only Palestinian refugees who haveregistered with UNHCR. Under these guidelines, 67 percent of the region’s refugees are from Iraq, 4.8percent are from the oPt, and 25 percent are from Sudan. However, after including Palestinian refugeesregistered with the UN Relief and Works Agency, the total population of concern reaches 11.8 million, ofwhich 41 percent originated in Iraq, 42 percent from the oPt, and 15 percent from Sudan. In the shortterm, these populations strain the resources of host countries, placing demands on host governments toprovide services and opportunities. The influx of refugees raises prices due to an increase in demand,while decreasing average wages due to the ready supply of labor. Conflict and emergencies thusexacerbate other challenges facing their host communities, at least in the short term, furthercomplicating efforts to provide for the needs of the non refugee community.211 International Committee on Intervention and State Sovereignty The Responsibility to Protect, InternationalDevelopment Research Center, Ottawa, 2001. 114
  • 114. Figure 34 Total Population of Concern by UNHCR Regions, 2008 12,000,000 10,000,000 8,000,000 6,000,000 4,000,000 2,000,000 0 and North… Southern Africa Western Africa Europe Middle East Americas Central Africa- East and Horn Asia and Pacific Great Lakes of AfricaSource: UNHCR. 2008 Global Trends: Refugees, Asylum seekers, Returnees, Internally Displaced and Stateless Persons.http://www.unhcr.org/4a375c426.html. 115
  • 115. Figure 35 Population of Concern by MENA country of asylum 3,500,000 3,000,000 2,500,000 2,000,000 Total Population of Concern by 1,500,000 Country of Asylum, 2003 Total Population of Concern by 1,000,000 Country of Asylum, 2008 500,000 0 Egypt Morocco Algeria Djibouti Syria Bahrain Jordan Oman Lebanon UAE Sudan Qatar oPt Iran Iraq Kuwait Libya Saudi Arabia Yemen TunisiaSource: UNHCR. 2008 Global Trends: Refugees, Asylum seekers, Returnees, Internally Displaced and Stateless Persons.http://www.unhcr.org/4a375c426.html.Out of 20 countries in the region, 12 have collected demographic data on over 30 percent of thepopulation of concern residing within their borders (Figure 36). From this level of coverage, it is possibleto extrapolate the demographic distribution of these populations with a high degree of accuracy.UNHCR uses six age categories, with the category aged 12 17 matching closest the UNICEF definition ofadolescents and youth. In most of these 12 countries, between 10 percent and 20 percent of the totalpopulation of concern is aged 12 17. In the other three countries, the proportion is somewhat lower:Bahrain (2.1 percent), Oman (3.7 percent), and Tunisia (2.8 percent). It is worth noting that the TotalFertility Rates (TFR) observed in Bahrain and Tunisia in 1989 were among the lowest in the region,suggesting that the refugee population may have assumed the TFR of the local population. As a result,the population of concern aged 12 17 today may be smaller than would have been the case if thispopulation had maintained the TFRs of their country of origin. However, this is not the case in Oman,which had one of the highest TFRs in the region in 1989. 116
  • 116. Figure 36 Demographic data coverage for Population of Concern 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Morocco Kuwait Tunisia Djibouti Bahrain Iran Lebanon Sudan Yemen Egypt oPt Oman UAE Algeria Jordan Qatar Iraq Libya SyriaSource: UNHCR. 2008 Global Trends: Refugees, Asylum seekers, Returnees, Internally Displaced and Stateless Persons. Saudi ArabiaUnited Nations High Commission for Refugees. June 2009. http://www.unhcr.org/4a375c426.html.Since 2003, five countries in the MENA region have experienced a severe increase in the population ofconcern residing in their country: Iraq (3,037,758), Jordan (493,169), Sudan (1,338,889), Syria(1,397,985), and Yemen (178,410) (Figure 37).212 In the case of Iraq, Sudan and Yemen, this increase isprimarily due to larger numbers of IDPs as a result of conflict within the country, while increases in Syriaand Jordan can be attributable to an influx of refugees from neighboring states. While five countrieshave experienced a decrease since 2003 (Algeria, Djibouti, Iran, Libya & Morocco), the others haveexperienced low to moderate increases. Three countries of origin in the region account for 99.9 percentof the gross increase in the regional population of concern since 2003: Iraq (78 percent), Sudan (20percent), and Yemen (2 percent).213 These three countries have all experienced ongoing or recurrentconflict in the past five years, leading to an increase in the number of both refugees and IDPs.212 United Nations High Commission for Refugees, 2008 Global Trends: Refugees, Asylum seekers, Returnees,Internally Displaced and Stateless Persons, UNHCR, June 2009.213 Ibid. 117
  • 117. Figure 37 Net refugee flow by country of asylum 3,500,000 3,000,000 2,500,000 2,000,000 1,500,000 1,000,000 500,000 0 500,000 Egypt Morocco Algeria Djibouti Syria Bahrain Jordan Oman Lebanon UAE Sudan Qatar oPt Iran Iraq Kuwait Libya Saudi Arabia Yemen TunisiaSource: UNHCR. 2008 Global Trends: Refugees, Asylum seekers, Returnees, Internally Displaced and Stateless Persons.http://www.unhcr.org/4a375c426.html.Collection of demographic data on refugees and IDPs remains dichotomous in the region. Countries withsignificant demographic data collection coverage of age and sex all exhibit rates over 78 percent of thetotal population of concern registered with UNHCR. The remaining eight countries, while jointly hosting36 percent of the regional total of UNHCR’s population of concern, all have sex and age demographicdata collection rates below 23 percent. While data collection challenges exist in some of these countries,such as Iraq, the oPt and Sudan, others such as Kuwait, Qatar and Saudi Arabia are free from thesechallenges but have not achieved significant coverage rates. Without demographic information onpopulations of concern within these countries, decision makers are denied a fundamental tool to therealization of successful and appropriate policy and programs. Especially in countries with a high ratio ofrefugees, IDPs, asylum seekers and stateless persons to citizens, knowledge of the demographiccharacteristics of a state’s vulnerable populations is crucial to evidence based policy and programming.Similarly, the lack of UNHCR age disaggregation into UN wide standardized categories limits thecomparability and analysis of data concerning populations of concern. Standardization is a crucialcomponent for enhancing the accessibility and ease of use of data for both governments and nongovernmental bodies alike, and must be addressed in order to serve this most vulnerable of groups. 118
  • 118. Recommendations Increase the coverage of demographic data for UNHCR and UNRWA’s Population of Concern in countries throughout MENA. Pursue research on youth contributions to the peace building process in post conflict settings, with emphasis on collecting ‘best practices’ for promoting youth involvement in community rebuilding. Continue to build on the body of knowledge relating to the mental, psychological and social effects of conflict on young people, especially trans generational effects. 119
  • 119. C. Youth and adolescents in post conflict situationsDespite their potential contribution to post conflict peace building, youth and adolescents are generallytypified either as sources of instability and insecurity, or as passive victims. In many cases, young menare viewed as violent negative social influences, while young women are perceived as helpless victims,with neither group effecting peace within the community. While a large body of research exists on theexacerbation of conflict by young people, far less attention has been paid to the resources and capacityof youth and adolescents to positively contribute to peace making and peace building. Research has notbeen translated into policy and practice drawing on young people’s peace building capacity, and in mostcases has not been operationalized. The focus on “research to know” rather than “research to change”has failed to shift the dominant perspective that young people are a force to be mitigated in postconflict situations, rather than a force for the advancement of peace, stability and human rights. Thepotential dividend of promoting young people as peace builders is particularly pertinent in the MENAregion, both due to high demand (six countries are in a state of instability with recent histories ofconflict), and the large number of young people (31 percent of the total MENA population) in the region.Young people in post conflict situations face many of the same challenges confronting adults, as well asspecial challenges related to their transition from childhood to adulthood. What are the fundamentalself identified rites of passage for young people to enter adulthood, and what challenges exist in postconflict settings? What assets do young people have to make this transition, and how could theircapacity be bolstered? Additionally, what are the consequences of failure, both for young peoplethemselves and for the community as a whole? Contextually specific initiatives to increase the capacityof young people to transition from adolescence and youth to adulthood must be incorporated into postconflict recovery programming and policy.Several structural and institutional barriers exist for realizing the peace building potential of youngpeople. Foremost is the pervasive belief that young people, especially young men, are a destabilizinginfluence. This perspective must be critically revised before operational activities can succeed. Second,the unique needs of youth and adolescents in post conflict settings are under represented ininternational fora, such as the UN Peacebuilding Commission. Post conflict offers an opportunity toensure that fragile or lapsed education and health systems, as well as psychosocial support services forthose who live through conflict, are rebuilt or provided for the first time with an eye towards beingyouth friendly. Currently youth post conflict programming, however does not have an institutionalchampion to advocate its interests at the international level. Third, collaborative decision making whichempowers young people in rebuilding and recovery activities needs to become the norm, and not theexception, though in practice this will be difficult to achieve. Participatory analysis of the needs anddemands of youth and adolescent populations are an irreplaceable component of a successful andenduring post conflict strategy. Finally, youth programs and policies by both government and NGOactors alike must be tailored and continually updated to the dynamic social context, linking capacity withdemand and opportunity. Through the implementation of the findings of rigorous inquiry, youth andadolescents may be recast not as a destabilizing force to be contained, but as agents of peacebuilding tobe utilized in the quest for enduring peace. 120
  • 120. 13. ConclusionsThe continuing rapid growth in MENA’s population, leading to youth cohorts of unprecedented absoluteand proportional size, poses a novel set of challenges that require a clear, evidence based approachfrom policy makers and regional leaders. The region is characterized by a diversity of economic andpolitical environments, yet a number of themes emerge from the Review.Nearly one in five MENA residents lives in poverty. Despite advances in educational enrollment in recentdecades, many youth struggle to secure decent employment. The policy environment fails to support aneffective school to work transition for many youth. Employment in the informal sector, unemploymentand economic inactivity are common. Young women and other vulnerable sub populations, such asthose with disabilities, face additional challenges to entering the labor market.Health needs of the Region’s young people range from malnutrition to obesity and maternal health tosubstance use. The heavy burdens of death and disability from neuropsychiatric conditions and injuries,especially road traffic accidents, are noteworthy.Many young people migrate for economic opportunity; others are forced from their homes due toarmed conflict. Orphans, street children, children in contact with the law and other vulnerable groupsrequire special support to achieve a successful transition to adulthood, yet major gaps in enumeratingand serving these populations remain.Young women in the region face particular challenges, framed by traditional views of femininity. Whilesome young women enjoy a modern education and are able to pursue family formation, a career orboth, others face limitations on their education, health, employment and personal freedom because oftheir gender.Despite numerous data collection activities in the region, troubling data gaps remain and comparabilityis impaired by inconsistencies among data producers. Standardization of age groups, such as ‘youth’,and regional definitions, such as MENA, would improve data usability across organizations. In order tofully understand the situation in the region, data are needed from all countries. A standardized, regionwide tool to collect key data on youth is desperately needed, such as a MICS4 youth module andanalogous survey for non MICS countries.Recognizing the distinctiveness of the adolescent and youth experience, indicators are needed whichcapture the most important aspects of young people’s lived experiences, including measures of asuccessful and timely transition to adulthood. Surveys of youth should include both young men andwomen, regardless of marital status, with emphasis placed on knowledge, attitudes, beliefs andbehaviors in addition to traditional, objective indicators. Of key importance is the inclusion of vulnerablepopulations, including those not residing in traditional households, such as youth living on the street andincarcerated or otherwise institutionalized youth. Many key youth topics are culturally sensitive. 121
  • 121. Nevertheless, valid and reliable data on sensitive subjects are required in order to promote youthdevelopment.Increased collaboration between data users, data producers and implementing agencies could improverelevance and promote direct indicators over proxies. Key to these efforts is the creation of centralizeddatabases where data is available from all relevant sources, such as Arabstats and UNData. Timelydissemination of data maximizes its value to policy makers and researchers, promoting a climate ofevidence based youth policy.UNICEF may benefit from a continuous assessment of its unique role and contributions to the collectionand dissemination of youth data in the region, given the evolving landscape of players, such as Silatechand the Gallup WorldView Poll. The MICS surveys are a defining contribution to international datacollection efforts and the addition of a youth module would allow for periodic monitoring of key youthindicators across the MENA region. 122
  • 122. Annex I: Recommendations for improving understanding of MENA youthDemography Collect data on both internal and international migration among youth and ensure that non national youth populations are included in national surveys. Improve existing data on child marriage by stratifying between those who were married before 18 and those who were married before 15. Standardize age categories across agencies collecting data in the region.Poverty Adolescent and youth specific poverty data must be collected, both in order to review young person specific levels and trends, and also to allow comparison between young peoples’ experience of poverty with those of other age groups. Data collection methodologies should expand to include measures of deprivation, in areas such as shelter, food and nutrition, sanitation, water, and other key areas. These non income poverty indicators exist in other areas, but have not been collected within the MENA region. Future surveys of young people should also include subjective indicators exploring motivations for delayed marriage and family formation, as no data currently exist on this phenomenon, limiting policy makers ability to reduce barriers to these rites of passage to adulthood.Health Culturally sensitive data collection methodologies must be developed and applied to gather data on the range of sensitive health topics discussed above, including sexual and reproductive health, substance use and abuse, and death rates from causes subject to social taboo. Data producers should utilize standardized definitions for “overweight”, “obesity” and “underweight” to simplify comparison and allow for complementarity between data sources, reducing the need for duplicate evaluations. Youth and adolescent health data must become a priority area for data users and decision makers, spurring the collection of disaggregated statistics on health risk factors, disease prevalence, and causes of mortality. Mental and psychosocial health indicators should be developed and implemented for population wide estimation. Data producing organizations should incorporate mental and psychosocial health questions in country and regional surveys, to provide baseline estimates to be refined with the further development of indicators.HIV and AIDS Donors collaborating with national governments and regional bodies expand the range of issues addressed in nationally representative health and development surveys on adolescents and youth; Inter disciplinary research on adolescents and youth be expanded, and include both quantitative and qualitative methods, particularly on social protective and risk factors, and in particular, HIV related knowledge, social norms and behavior; 123
  • 123. Data are disaggregated by age, sex and, where appropriate, marital status, both in primary research on HIV AND AIDS as well as in secondary analysis of existing data sets that include young people; Pre existing data sets are made publically available for policy makers, programmers and the general public; and Inter disciplinary research is supported to fill specific knowledge gaps that could include young people’s perceptions of service needs and quality, as well as issues related to correct and comprehensive knowledge about HIV AND AIDS and STI prevention.214Education While UNESCO’s Education for All series provides a host of global and regional trends and data, as does the World Youth Report, its database is likely to benefit from further revisions to enhance its practicality, including more flexibility in selecting variables and regions. Better data are needed on out of school adolescents and youth. Currently UNESCO collects only data on the rate of out of school children of primary school age. This makes it difficult to get a true sense of drop out activity among youth in the region. Additional planning will be necessary to take into account out of school youth when trying to prepare them for the school to work transition and decent livelihoods. Many of the proposed adolescent and youth indicators were available on a regional basis and are, for the most part, available for each of the MENA countries. These data tend to be disaggregated by sex more than by age, as most education indicators do not necessarily require the further breakdown of age. However, there are several topic areas in the education sector where data collection can be improved. There are no data available for adolescent literacy, as this is not a traditionally collected indicator, nor were data identified on the proportion of children and adolescents with disabilities enrolled in school. Additionally, no data was available on enrolled students who study and work or out of school youth. There is also a paucity of data related to education reform efforts. For example, gathering information on the number of employer associations participating in curricula reform could shed light on progress to make students’ educational experience more relevant to the needs of the working world. Please refer to Annex V for an extended list of important indicators in the domain of education. Nations should be encouraged to conduct regular assessments at several different grade levels to monitor progress on school quality over time.Livelihoods and economic participation Carefully track youth inactivity to monitor the relationship between school completion, employment and family formation. Improve measurement of youth engaged in the informal sector. Develop indicators on decent and productive work.214 Shepard, B. and DeJong, J. Breaking the Silence and Saving Lives: Young People’s Sexual and Reproductive Health in the Arab States and Iran. Harvard School of Public Health, Boston, 2005. 124
  • 124. Migration Data collected should be disaggregated by age and by sex. Though difficult, an effort should be made to estimate both legal and illegal migrant populations. Surveys should inquire about motivations for migration. Household surveys in the region should include both permanent residents and migrants, given the relative size of these populations in many countries.Political and civic engagement Data on political engagement would improve measurement of this important phenomenon over the current indicator on the Core List, which is voting age. Engagement in political, religious, civic, social and athletic groups is a defining aspect of the youth experience for many young people. Data should be collected on this topic.Child protection Data collection methodologies, such as those employed by the UNICEF MICS survey and others should strive to include representative samples of vulnerable young people to document their situation. These include street children, young people without parental care, and other marginalized groups. Prioritize data gathering on young peoples’ experiences of violence to better understand the scope of the issue. Research should include a number of realms, including corporal punishment at school and at home, domestic violence, bullying, the effects of early marriage, and FGM/C. The development of the set of juvenile justice indicators provides a valuable opportunity for standardized, rights based assessment of children in conflict with the law which should be adopted by all parties working on juvenile justice issues.Conflict and emergency Increase the coverage of demographic data on UNHCR’s population of concern in countries throughout MENA. Pursue research on youth contributions to the peace building process in post conflict settings, with emphasis on collecting ‘best practices’ for promoting youth involvement in community rebuilding. Continue to build on the body of knowledge relating to the mental and psychosocial effects of conflict on young people. 125
  • 125. Annex II: Introduction to Core and Extended Indicator ListsThe two indicator lists included in Annexes III and IV have been developed to capture different dataneeds for two different audiences of stakeholders. The first is a core list of indicators, whose audiencewill primarily be regional and global bodies, presenting an overview of the situation for youth across keydomains. The second list of indicators is designed with the interests and needs of country level actors inmind, and is a more in depth set of measurement tools. These lists are referred to as the ‘Core List’ andthe ‘Extended List’The Core ListThe Core Indicator List provides an overview of the status of youth (ages 10 24) in UNICEF’s Middle Eastand North Africa (MENA) region. Making use of the best publically available data, the list creates a‘snapshot’ for regional and national policy makers across key domains for youth in the region, includingeducation, health, economic livelihood, migration, violence, civic participation, media and quality of life.The design of the core indicator list provides a broad view, rather than attempting to be exhaustivewithin any one area of youth life. The extended list offers a comprehensive list of youth indicators,arranged by domain and suggested priority level, regardless of current data availability. By contrast, theselection of indicators on the Core List was limited to those with available data and balances coverage,currency and comparability. The indicators represent a compromise between what policy makers wouldlike to know about the region’s youth and what is currently measured by international surveillanceefforts with longstanding reputations for reliability and validity, such as MICS, DHS, Global YouthTobacco Survey and others. Certain key areas, such as substance abuse and adolescent need forcontraception, belong among the priority topics on the Core List, but have been excluded due to lack ofdata. Disaggregation was limited to gender.The Core Indicator List is the centerpiece of the 2009 MENA youth datasheet prepared in conjunctionwith this report. The datasheet includes summary data for the Core List, and displays select graphics toillustrate the situation of youth in the region. It has been designed for distribution within UNICEF andamong relevant regional partners.The Extended ListThe intended audience of the extended list is country level actors, including UNICEF country offices,governments, NGOs, scholars and other stakeholders. Unlike the Core List, which seeks to presentindicators representative of broader themes, the Extended List delves further into the detail necessaryfor policy makers and project managers to make informed decisions within the domains affecting youth.The indicators contained in the list were drawn from a wide review of UN sources, otherintergovernmental bodies, reputable surveys and items in the academic literature. While the list is by nomeans definitive, it highlights the most necessary information required by policy makers. 126
  • 126. PrioritizationNo government, UN agency, NGO or other body has limitless resources. Similarly, not all information isof equal value. As such, this report prioritizes the list of indicators to help countries and country officesdecide which areas are most worthy of further inquiry and data collection. These prioritizations arebased on the data needs of countries in the region on the whole, rather than tailored to a countryspecific context. Therefore, it is expected that individual country offices will review this list and, wherenecessary, adjust the proposed prioritization in accordance with their national circumstances. As anexample, the Sudan Country Office may elevate the priority of FGM/C prevalence to reflect itsimportance as a country specific issue, while Lebanon may drop this indicator entirely. Theprioritizations included in this list are intended as a guide, and should be tailored to the individualcountry context.Process of prioritizationThe prioritization process took into account two factors: the necessity of the information for rigorous,evidence based policy making, and the ease of data collection. Factors influencing the ease of datacollection include a range of considerations, such as the level of technical analysis required, and issuesof cultural sensitivity and/or resistance. Therefore, an indicator may still be classified as a priority 1indicator due to its importance for evidence based policy or programming, even if that indicator isdifficult to collect for other reasons. Broadly speaking, the priority areas can be characterized as follows:Priority 1: Indicators that are very important for evidence based policy or programming, and have eithermoderate or low barriers for collection of dataPriority 2: Indicators that may have less importance for evidence based policy or programming thanpriority 1 indicators, but also have low or moderate barriers for data collection. Alternatively, priority 2indicators may be very important for evidence based policy or programming, but pose relativelysignificant barriers for data collection.Priority 3: Indicators that are not as important for evidence based policy as a whole, but are necessaryfor specific policy or programming within a domain affecting youth. Alternatively, priority 3 indicatorsare of sizable importance, but the difficulty in data collection mean that resources may best be utilizedelsewhere.DisaggregationBoth versions of the Extended List contain columns of suggested disaggregation. While best practicewould dictate a more thorough disaggregation process, these themes have been identified as ofparticular relevance, and are suggested in cases where they are most appropriate. Data collection,analysis and management strategies, especially for survey data, should be careful to disaggregate alongthese lines. Data producers and disseminators should consider disaggregation using additional criteria.However, the following demarcations were deemed especially important:Gender: In most cases, gender is the most important criteria for disaggregation. The knowledge,attitudes, beliefs, practices and needs of youth and adolescents in MENA often differ substantially bygender. 127
  • 127. Stratified age: Due to the dynamism of youth and adolescents, it is often necessary to furtherdisaggregate age into 5 year, rather than 10 year, intervals. As the domains of ‘youth’ and ‘adolescents’overlap by 5 years, further stratifying age allows us to observe issues in more detail. For many of theindicators, calculations for adolescents, youth and young people are important to highlight the specificneeds of each age sub group.Urban vs. Rural: Stark differences between rural and urban populations often exist, both in terms ofaccess to opportunity and outcomes.Socio Economic Status: Similar to the urban rural divide, disparities in access to opportunity andoutcomes frequently exist between those of high and low socio economic status. While it is outside thescope of this report to suggest how socio economic status should be classified or benchmarked, it isimportant to consider it when collecting or disseminating data.Ethnicity and Religion: Because religion and ethnic identity playing such an active part in societies inthe MENA region, it is important to disaggregate data by ethnicity, religion, or both. The circumstancesof each country will vary, and so disaggregation by ethnicity may provide the most useful information inone setting, religion may be more important in another. Therefore, disaggregation should be tailored tothe situation of the country in which data are being collected.Level of education: The level of education achieved by the youth or adolescent will in many ways guidetheir future. Education assists in the personal development process, and may influence the perspectivesof youths and adolescents later in life. For this reason, it is important to disaggregate by the level ofeducation to determine its effect on the youth experience. 128
  • 128. Annex III: Core Indicator ListPlease see Annex II for more information about these indicators. Theme Indicator Definition Source Number of Young People Population aged 10 to 24 United Nations (in thousands) (2005). Population Division Young people as a Percent of 10 24 year olds United Nations percentage of total in total population. Population Division Demography population Child marriage Percentage of women 20– State of the World’s 24 years old married or in Children 2009 union before age 18. Young people living in Estimated percent of 15 24 World Bank Poverty poverty year olds living in poverty Assessments (less than US$2 per day). Poverty Young people living in Estimated percent of 15 24 World Bank Poverty absolute poverty year olds living in absolute Assessments poverty (less than US$1 per day).i Youth literacy rate Number of literate persons State of the World’s aged 15–24, expressed as a Children 2009 percentage of the total population in that age group. Gross Enrollment Ratio Ratio of young people State of the World’s (secondary) enrolled in secondary Children 2009 school, regardless of age, to the total number of young Education people of official secondary school age.i ii Net Enrollment Ratio Ratio of young people State of the World’s (secondary) enrolled in secondary Children 2009 school of official secondary school age, to the total number of young people of official secondary school age. 129
  • 129. Gender Parity Index Ratio of females of official State of the World’s secondary school age Children 2009 enrolled in secondary school to males of official secondary school age enrolled in secondary school. Progression to Secondary The number of new UNESCO Institute for School entrants to the first grade Statistics/World Bank of secondary school in a EdStats Query given year as a percentage of the number of students enrolled in the final grade of primary school in the previous year. Economically Active Youth The number of ILO LABORSTA Participation economically active youth, Database 15 24 (thousands). Economically active refers to all persons of either sex who furnish the supply ofEconomic Livelihood labor for the production of goods and services during a specified time reference period. Definitions of ‘Economically Active’ may differ between countries. Youth Unemployment Rate All persons aged 15 24 UNData who, during the reference period were: without work, currently available for work and seeking work. Life expectancy at age 15 Average number of years a Life tables for WHO person surviving to age 15 Member States for expects to live. 2006 Percentage of young Percentage of students (age Global School based Physical Health people experiencing food 13 15) who went hungry Student Health insecurity most of the time or always Survey during the past 30 days because there was not enough food in their home. 130
  • 130. Percentage of young Percent of students (age Global School based people who are obese 13 15) who were at or Student Health above the 95th percentile Survey for BMI. Percentage of young Percentage of 13 to 15 year Global Youth people who are current olds in school who are Tobacco Survey smokers current smokers. Adolescent fertility rate Births per 1,000 women UN Population age 15 19. Division Comprehensive knowledge Percentage of young MICS 2006 of HIV among youth women (aged 15 24) who correctly identify the two major ways of preventing the sexual transmission ofReproductive Health HIV (using condoms and limiting sex to one faithful, uninfected partner), who reject the two most common local misconceptions about HIV transmission and who know that a healthy looking person can be HIV infected. Estimated number of Number of youth (ages 5 UNHCR Country Data internally displaced and 17) counted among Sheets 2007 refugee young people UNHCRs population of concern. Number shown may underreport due to absence of complete demographic data. Is corporal punishment Intentional application of Global Initiative to Violence legally permitted in physical pain as a method End All Corporal schools? of changing behavior. Punishment for Students Percentage of young Percentage of students age Global School based people who have been 13 to 15 who were Student Health physically attacked physically attacked one or Survey more times in the past 12 months. Mental Health Percentage of young Percentage of students age Global School based people who felt lonely 13 to 15 who felt lonely Student Health 131
  • 131. always or most of the time always or most of the time Survey during the past 12 months. in the last 12 months. Number of government The number of government UNICEF Country social workers per 100,000 social workers, per 100,000 Office Annual population population Reports Voting Age Legal voting age in national ACE Electoral Civics elections Knowledge Network Internet access in schools Score on a 1 7 scale of a Arab Statistics, large sample group in a UNDP POGAR particular country responding to the question ICT of whether internet access in schools in their country is (1= very limited, 7= pervasive most children have frequent access). Young peoples perceived Percentage youth (age 15 Gallup Worldview ability to pursue goals to 24) who report satisfaction with their freedom to choose what to do with their life. Value young people place Percentage of 15 to 29 year World Values Survey on peer relationships olds who rate friends as very important or rather important.Attitudes/Outlook Value young people place Percentage of 15 to 29 year World Values Survey on inter generational olds who rate family as relationships very important or rather important. Likelihood of migrating Percentage of youth (15 Gallup Worldview 24) who report being likely to move away from the city or area where they live in next year. 132
  • 132. Annex IV: Extended Indicator ListPlease see Annex II for more information about this list. Disaggregation Socio economic status (10 14, 15 19, 20 24) Level of education Ethnicity/Religion Urban vs. rural Stratified age Priority Proposed indicator by domain Other Sex Demography 1 Number of young people X X X X 1 Young people as a percentage of the total population X X 1 Percentage of young people who are married X X X X 2 Age dependency ratio (<15 years to working age population) X 2 Percentage child marriage X X X 2 Minimum legal age for marriage with parental consent X 2 Minimum legal age for marriage without parental consent X 2 National average age of first marriage X X X X X 3 Percentage of marriages that were arranged X X X Proportion of married young women who are not the first concurrent wife of their 3 husband X Poverty 1 Percentage of young people living in poverty X X X X 1 Percentage of national population living in poverty X X 1 Percentage of young people living in absolute poverty X X X X 1 Percentage of national population living in absolute poverty X X 2 Percentage of malnourished young people (measured by BMI) X X X X X 2 Percentage of young people deprived of water X X X 2 Percentage of young people deprived of shelter X X X Youth needs specifically addressed in national poverty reduction strategy papers 2 and policy documents, especially in employment and education 133
  • 133. Disaggregation Socio economic status (10 14, 15 19, 20 24) Level of education Ethnicity/Religion Urban vs. rural Stratified agePriority Proposed indicator by domain Other Sex2 Average number of household years wages to afford the average house price2 Percentage of young people deprived of sanitation X X X Education1 Adolescent literacy rate X X X X1 Youth literacy rate X X X X1 Gross enrollment ratio, primary X X X X1 Gross enrolment ratio, secondary/vocational X X X X1 Completion proportion, basic education X X X X1 Gender parity index for primary education X X X1 Gender parity index for secondary/vocational education X X X Difference between national average of TIMMS test results compared to global by thematic area1 average X X X X Percentage of population scoring acceptably on core skill areas in PISA by skill area1 standardized test X X X X2 Ratio of male to female literacy rates for adolescents X2 Ratio of male to female literacy rates for youth X X2 Net enrollment ratio, primary X2 Net enrollment ratio, secondary/vocational X2 Completion proportion, primary education X X X X2 Completion proportion, secondary/vocational education X X X X2 Progression proportion to secondary education X X X2 Progression proportion to tertiary/professional education X X X2 Gender parity index for tertiary/professional education X X X2 Student per class ratio for primary education X2 Student per class ratio for secondary education X2 Proportion of secondary school students in vocational versus academic track, X X X X 134
  • 134. Disaggregation Socio economic status (10 14, 15 19, 20 24) Level of education Ethnicity/Religion Urban vs. rural Stratified agePriority Proposed indicator by domain Other Sex where applicable2 Proportion of students who both study and work X X X X Percentage of school aged disabled young people enrolled in any type of education2 or training institution X Existence of formalized process for employer associations participation in2 education reform process2 Percentage of students who repeated a school level this year X X X X2 Percentage of students who feel safe at school X X X X Percentage of students who remain in school because of poor employment2 prospects X X X X X Percentage of young people who left school sooner than desired in order to2 contribute financially to their family X X X X X X2 Perceptions of young people regarding the relevance of curricula to their career X X X X X X2 Government education spending as a percentage of GDP X2 Government education spending as a percent of total government spending X3 Ending age of compulsory education X3 Gross enrollment ratio, tertiary/professional X X X X3 Net enrollment ratio, tertiary/professional X3 Completion proportion, tertiary/professional education X X X X3 Total costs, including ancillary costs, of 1 year of public primary education X X3 Total costs, including ancillary costs, of 1 year of public secondary education X X3 Total costs, including ancillary costs, of 1 year of public tertiary education X3 Total costs, including ancillary costs, of 1 year of public vocational education3 Student teacher ratio for primary education X3 Student teacher ratio for secondary education X3 Student teacher ratio for tertiary education X 135
  • 135. Disaggregation Socio economic status (10 14, 15 19, 20 24) Level of education Ethnicity/Religion Urban vs. rural Stratified agePriority Proposed indicator by domain Other Sex3 Student teacher ratio for vocational education X3 Student per class ratio for tertiary education X3 Student per class ratio for vocational education X3 Proportion of tertiary enrollees with a general/academic secondary qualification X X X Percentage of young people who felt they participated more in school/work than3 last year X3 Percentage school attendance (from school records) X X X X3 Total number of formal academic years of primary and secondary education Recognition of and proposed plan of action in official education policy and plans to3 address gender disparities Recognition of and proposed plan of action in official education policy and plans to3 address urban rural disparities3 Years since last major education curriculum reform Reason for studying at university (youth interested in topic, parental pressure,3 perception that tertiary education necessary for good job, etc.) X3 Percentage of students with a private tutor X X X X Livelihoods and Economic Participation1 Percentage of working age population who are youth X1 Economically Active Population Rate X X X X1 Ratio of youth to adult unemployment rate X1 Young person unemployment rate X X X X X X2 Economically Young Person Population Rate X X X X X2 Adolescent Labor Force Participation Rate X X X X X2 Youth Labor Force Participation Rate (YLFPR) X X X X X X2 Female/male YLFP ratio X2 Share of youth in total unemployed 136
  • 136. Disaggregation Socio economic status (10 14, 15 19, 20 24) Level of education Ethnicity/Religion Urban vs. rural Stratified agePriority Proposed indicator by domain Other Sex2 Proportion of youth employment by sector: public, formal private, informal X X X X2 Percentage of youth financially dependent on their family X X X X2 Average time between completing vocational education and finding a job X X X2 Average time between completing tertiary education and finding a job X X X2 Average time between completing secondary education and finding a job X X X2 Average monthly wage for young people X X X X X work sector whether concurrently2 Average number of hours worked per week by young people X X X X X studying2 Average age of first paid employment X X X X3 Age transition in LFPR X3 Ratio of female/male youth unemployment X3 Proportion of youth not working and not in school X X X X X X3 Optimism about employment prospects X X3 Proportion of young people whose first job was in the informal sector X X X X3 National Gini coefficient3 Number/proportion of child labor, according to ILO definition X X X Proportion of youth hired by process: public advertisement, personal application,3 recommendation/referral/networks, etc. X X3 Existence of career guidance centers with a feedback loop to the education sector3 Percentage of new jobs filled by non nationals work sector3 Percentage of total jobs filled by non nationals work sector3 Percentage of youth who have started their own business X X3 Percentage of new businesses started by youth3 Percentage of working young people employed in temporary work X X X X X X Percentage of youth reporting that a lack of credit affects their entrepreneurial3 potential X X X X X 137
  • 137. Disaggregation Socio economic status (10 14, 15 19, 20 24) Level of education Ethnicity/Religion Urban vs. rural Stratified agePriority Proposed indicator by domain Other Sex Percentage of youth reporting that a lack of credit affects their expected age of3 marriage X X X X X3 National legal age of employment3 Percentage of youth who plan to start a business in the next year X X X X X Physical Health1 Life expectancy at age 15 X X X X1 Top 3 reported deaths by cause for young people X X X X X1 Young person obesity rate X X X1 Percentage of young people with access to affordable health care X X Percentage of the population with access to affordable psychosocial support (social1 workers, psychologists/counselors, psychiatrists, etc.) X X2 Gender gap in life expectancy at age 15 X X Proportion of total adolescent deaths attributable to leading causes of death2 among adolescents X Proportion of total adolescent deaths attributable to second leading causes of2 death among adolescents X Proportion of total adolescent deaths attributable to third leading causes of death2 among adolescents X Proportion of total youth deaths attributable to leading causes of death among2 youth X Proportion of total youth deaths attributable to second leading causes of death2 among youth X Proportion of total youth deaths attributable to third leading causes of death2 among youth X2 Number of young person deaths attributable to honor killings X X X Proportion of young people reporting violence in the past month from: family2 (parents, siblings, grandparents, aunts and uncles), partners, teachers, X X 138
  • 138. Disaggregation Socio economic status (10 14, 15 19, 20 24) Level of education Ethnicity/Religion Urban vs. rural Stratified agePriority Proposed indicator by domain Other Sex police/authority, peers, strangers Percentage of youths in a household that has faced catastrophic health expenditure2 (40% of non subsistence income paid to the health system) in the past year X X Percentage of the youth and adolescent population covered by health insurance of2 any kind X X X X3 Probability at 15 years of age of surviving to 25 X X X X3 Number/Percentage of total deaths among young people X Percentage of total young person deaths attributable to injuries from armed3 conflict X X3 Percentage of total young person deaths attributable to occupational injuries X X3 Percentage of total young person deaths attributable to violence X X3 Percentage of total young person deaths attributable to gender based violence X X3 Percentage of total young person deaths attributable to substance abuse X X3 Percentage of total young person deaths attributable to HIV AND AIDS X X3 Percentage of total young person deaths attributable to accidents X X3 Percentage of total young person deaths attributable to road traffic accidents X X3 3 main causes for young person hospitalization X X3 Ordered list of types of healthcare most utilized by young people X X3 Proportion of young people with a disability X X X X X Percent of young people who did not go out (to school, work, etc.) one or more3 times in the past 30 days because they were afraid for their safety X X Percentage of household income spent on young peoples health care in the past3 year X Proportion of young people who have been so sick that they have had to miss at3 least 2 days of normal activity (school, work, etc.) in the past 30 days X X X3 Age at which a person may go to a health clinic without parental consent X3 Age at which a woman may go to a health clinic without her partners consent 139
  • 139. Disaggregation Socio economic status (10 14, 15 19, 20 24) Level of education Ethnicity/Religion Urban vs. rural Stratified agePriority Proposed indicator by domain Other Sex From what source do young people get their general health information (doctor,3 family, friends, internet, TV, posters, etc. X X X X X Sexual and Reproductive Health1 Young person fertility rate (births per 1,000 young women) X X X X X Percentage of young women who received prenatal care at least once during their1 last or current pregnancy X X X X X1 Young person maternal mortality rate X X X X1 National maternal mortality rate1 Knowledge of safe sex practices among young people X X X X2 Young person fertility as a percentage of total fertility2 Percentage of female youth who have given birth before age 18 X X X X2 Age at first pregnancy of young women X X X Percentage of young people with affordable access to reproductive health services2 (prenatal care, etc.) X2 Percentage of births attended by skilled personnel X X X X2 Number/proportion of young person births out of wedlock X X2 Percentage of married or in union young women using modern contraception X2 Percentage of young people with access to family planning services if desired X X2 Maternal mortality ratio for 15 – 19; 20 24 year olds2 Young person abortion rate X X2 Prevalence of STIs among young people X X2 HIV incidence among young people X2 Percentage of anemia among young women X3 Perceived social pressure for women to have a child within 5 years of marriage X X marital status at3 Average age of sexual debut X X sexual debut 140
  • 140. Disaggregation Socio economic status (10 14, 15 19, 20 24) Level of education Ethnicity/Religion Urban vs. rural Stratified agePriority Proposed indicator by domain Other Sex3 Percentage of young people having sex before marriage X X X3 Percentage of sexually active young people using a condom at first sex X X X X3 Percentage of sexually active young people using a condom at last sex X X X X3 Percentage of young person obstetrical admissions due to abortion complication X3 HIV prevalence among young people X X X X3 Presence of HIV education in schools3 Percentage of diagnosed HIV+ children receiving antiretroviral therapy X Percentage of youth who have correct knowledge of HIV (can identify 2 ways to avoid contraction, reject common myths, know that a healthy looking person can3 be HIV infected) X X X3 Presence of school based health and reproductive health education3 Health and reproductive health programs for out of school young people From what source do young people get their reproductive health information3 (doctor, family, friends, internet, TV, posters, etc. X X X X X Mental and Psychosocial Well being Percentage of young people with diagnosed mental health conditions,1 disaggregated by condition X X X X1 Top three mental health conditions for young people X X X1 Percentage of young people who feel safe in public X X X X1 Young people’s perceived access to mental health care X X X X X X1 Number of government social workers per 100,000 population1 Number of pediatric mental health professionals per 100,000 population By designation Percentage of young people who feel they can trust most people in their1 community X X X X X X Percentage of young people who were depressed most or all of the time during the2 past month X X X2 Percentage of young people who report having one or no close friends X X X 141
  • 141. Disaggregation Socio economic status (10 14, 15 19, 20 24) Level of education Ethnicity/Religion Urban vs. rural Stratified agePriority Proposed indicator by domain Other Sex Percentage of young people who believe that if they had an important emotional2 issue, they could talk to their family about it X X X X Percentage of young people who believe that if they had an important emotional2 issue, they could talk to their friends about it X X X X2 Percentage of young people who feel safe at work X X X X2 Percentage of young people who feel they can trust their friends X X2 Percentage of young people who feel they can trust their neighbors X X X X X2 Percentage of young people who feel they can trust the government X X X X X X2 Percentage of young people who feel they can trust the media X X X X X2 Percentage of young people who feel that their country is on the right track X X X X X X Percentage of young people who feel that the economic situation will improve in2 the next year X X X Percentage of unemployed young people who feel that they will be able to find a2 decent job in the next year X X X X2 Percentage of young people who believe they have valuable skills and knowledge X X X X X Percentage of young people who believe that they can make a positive contribution2 to society X X X X X X Percentage of young people who believe they have a positive influence on those3 around them X X X Percentage of young people who feel that if they had an important issue or needed3 to talk to their feelings, they have someone they could talk to about it X X Percentage of young people who could not sleep because of stress or anxiety at3 least once in the past week X X X X Percentage of young people who are happy with the level of care provided by their3 family X X X3 Percentage of young people who feel safe in their family X X X3 Percentage of young people who feel they can trust members of their extended X X 142
  • 142. Disaggregation Socio economic status (10 14, 15 19, 20 24) Level of education Ethnicity/Religion Urban vs. rural Stratified agePriority Proposed indicator by domain Other Sex family3 Percentage of young people who feel they can trust their coworkers X X X3 Percentage of young people who feel they can trust their teachers X X X3 Percentage of young people who feel that they can trust their boss X X X X X Percentage of young people who feel that community morality (trust, interpersonal3 relationships, etc.) is going in the right direction X X X X3 Percentage of young people who believe they make friends easily X X3 Percentage of young people whose closest friends were made 2 or more years ago X X X X X Percentage of young people who are quite sure or certain of what they will be3 doing in a year X X X X Substance Use/Abuse Percentage of young people who smoked at least one cigarette or other tobacco1 product during the past 30 days X X X X X X Percentage of young people who drank at least one drink containing alcohol in the1 past 30 days X X X X X X1 Lifetime prevalence rate of drug abuse among young people X X X X X X drug type Percentage of those young people who drank alcohol who drank so much they2 were drunk at least once during the past year X X X X X X2 Average age at first drink X Percentage of young people who have injected a drug at least once during the past2 year X X2 Percentage of young people who used kat during the past 30 days X X X X X X3 Average age at first cigarette X3 Minimum legal smoking age3 Minimum legal drinking age 143
  • 143. Disaggregation Socio economic status (10 14, 15 19, 20 24) Level of education Ethnicity/Religion Urban vs. rural Stratified agePriority Proposed indicator by domain Other Sex The proportion of those who have injected drugs in the past year who used a clean3 needle at last injection X Migration international vs.1 Ratio of young person to adult migrants X X domestic1 Percentage of young people who want to live in their home country as adults X X X X2 Percentage of young people migrating X X 3 major reasons for wanting to migrate among those young people who do not2 want to live in their home country as adults X X X Civic Participation1 Voting age X Voting rate for those eligible under the age of 25 in last head of state election,1 where applicable X X X X Voter registration rate for those eligible under the age of 25 in last head of state1 election, where applicable X X X X1 Numbers/Percentage of young people participating in civil society organizations X X2 Age to stand for public office X2 Existence of national youth council2 Existence of national youth policy2 Number of registered youth organizations Existence of formalized process for young people’s input into policy and budgetary2 process2 Young people’s participation in private sector and civil society decision making Percentage of young people who volunteered at least 2 hours of time in the past2 week X2 Percentage of schools/universities with a student government 144
  • 144. Disaggregation Socio economic status (10 14, 15 19, 20 24) Level of education Ethnicity/Religion Urban vs. rural Stratified agePriority Proposed indicator by domain Other Sex Percentage of members of youth organizations and other associations in3 management/leadership positions X3 Percentage of students involved in participatory structures in schools X X3 Proportion of young people who are members of registered political parties X3 Engagement of young people in public demonstrations X3 Percentage of schools with a parent teacher association Proportion of young people involved in religious organizations X Globalization2 Percentage of young people who have traveled abroad X3 Number of international students X X X X home country Armed Conflict and Emergencies1 Estimated number of young person refugees X X X country of origin1 Estimated number of internally displaced young people X X2 Availability of small arms2 Presence of a national service requirement X Number of children currently voluntarily or involuntarily associated with security or2 armed forces X X X2 Number of children without parental care of any kind Proportion of young people who have lived at least 2 years of their life in a country3 in conflict X3 Number of children demobilized or with past service in the armed forces X3 Proportion of young people injured by armed conflict X X3 Number of deaths/injuries due to landmines X 145
  • 145. Disaggregation Socio economic status (10 14, 15 19, 20 24) Level of education Ethnicity/Religion Urban vs. rural Stratified agePriority Proposed indicator by domain Other Sex Child Protection1 Percentage of children registered at birth X X X Proportion of adults who believe corporal punishment is an acceptable means of1 discipline X1 Number of children identified as victims of trafficking X X X foreign and national1 Is the death penalty legal for children?1 Number of homeless young people X X X X X1 Status of ratification of the CRC and Optional Protocols2 Proportion of child homicides per total number of homicides X incoming and2 Proportion of trafficked children repatriated X X outgoing2 Percentage of children aged 5 14 years involved in child labor X X X2 Age at which people are held liable as adults before the law2 Number and rate (per 100,000 child population) of young people in detention X X X2 Rate of young person victimization of violent crime X X X2 Rate of young person perpetration of violent crime X X X Percentage of young people who have used violence or threats of violence to get2 their way or solve a dispute in the past month X X X X Percentage of young people who have been the victim of violence by their family2 members or care givers in the past year X X X X X X3 Percentage of women 15 49 years with at least one mutilated/cut daughter X X3 Percentage of women 15 49 having undergone FGM/C X X3 Number of young people in contact with the law in the past year Proportion of young people in contact with the law in the past year who benefit from alternative measures (e.g. mediation, alternatives to detention such as3 community service and reparations) X X3 Number/Percentage of young people who attempt to commit suicide 146
  • 146. Disaggregation Socio economic status (10 14, 15 19, 20 24) Level of education Ethnicity/Religion Urban vs. rural Stratified agePriority Proposed indicator by domain Other Sex3 Number/Percentage of young people committing suicide3 Legal status of corporal punishment of children in the home3 Legal status of corporal punishment of children in school3 Legal status of corporal punishment of children as a sentence for a crime Legal status of corporal punishment of children as a disciplinary measure in penal3 institutions3 Legal status of corporal punishment of children in alternative care Percentage of young people who believe that sometimes it is better to ‘agree to3 disagree’ rather than to convince the other person that you are correct X X X Percentage of homeless young people maintaining contact with their direct or3 extended family X X Information and Communication Technology unisex vs. non1 Percentage of schools with computer access for students X X unisex1 Proportion of young people who used computer in last 3 months X X X X X X1 Proportion of young people who used the Internet in last 3 months X X X X X X1 Percentage of young people with mobile phones X X X X X X unisex vs. non2 Percentage of schools with internet access for students X X unisex2 Point of usual access of the internet: home, work, internet café, school, etc. X Proportion of young people accessing news from any source (TV, radio, newspaper,2 internet, etc.) X X X X2 Percentage of young people who are computer literate X X X X X X3 Percentage of young people with an email address X X3 Internet cafés per 10,000 population X Frequency of young people using: TV, radio, newspaper, magazines, non3 school/work books, computer, internet, going to a movie, hiring a movie X X X 147
  • 147. Disaggregation Socio economic status (10 14, 15 19, 20 24) Level of education Ethnicity/Religion Urban vs. rural Stratified agePriority Proposed indicator by domain Other Sex3 Computer sciences included as part of national school curriculum X3 Percentage of households with a computer X X X X3 Percentage of households with internet access X X X X Leisure/Culture1 Young person membership in sporting clubs and associations X X Percentage of adolescent girls allowed to perform activities (sports,1 clubs/organizations, etc.) without a male chaperone X X X X X1 Perception of mobility ability to move domestically for work, school, etc. X X2 Average amount of young people leisure time per week X X2 Leisure activities performed in the past month by young people X2 Percentage of young people engaged in non sport club or association X X Frequency of young peoples visits to cultural events, such as art galleries, music2 recitals, theatre performances, etc. X Percentage of young people with access to cultural events and sport/leisure2 activities in their community X X X2 Percentage of young people attending weekly religious services X X X X X X2 Average amount of time young people spend in their house X X X X X X2 Average number of hours young people voluntarily spent with their friends X X X X X X3 Frequency of leisure activities performed in the past month by young people X X3 Sports activities performed by young people in the past month X X3 Frequency of sports activities performed by young people in the past month X X3 Proportion of young people engaged in regular organized sports activities X X3 Percentage of young people who speak a language other than their native language X X3 Percentage of young people who play a musical instrument X X Percentage of young people who have read non school/work related material3 (novels, newspapers, magazines, etc.) in the past week X X X X X 148
  • 148. Disaggregation Socio economic status (10 14, 15 19, 20 24) Level of education Ethnicity/Religion Urban vs. rural Stratified agePriority Proposed indicator by domain Other Sex Social Cohesion and Intergenerational Relations1 Percentage of young people living in a household where no member is employed X X X X1 Average proportion of the household who are young people X Proportion of people primarily identifying themselves by: religion, nationality,1 ethnicity, gender, occupation, etc. X X X X X1 Percentage of young people reporting religion as being very important X X X X X Percentage of young people who feel that they have enough control over the1 direction of their life X X X X X X Percentage of young people who believe violence is an acceptable way to solve1 some problems X X X X X2 Median age of the population Percentage of young people whose parents/household income provider have2 secure employment X X X2 Average number of days young people shared a meal with family in the past week X X X Proportion of young people who are orphans, per 10,000 population (lost 1 or both2 parents) X X2 Average marriage cost as a multiple of average annual household expenditure X X X Percentage of young people who feel they contribute to the decision making2 process of their household X X X X X2 3 primary reported barriers to marriage for young people X X X X Percentage of young people who feel that they have the capacity to influence their2 local community X X X X X X Percentage of young people who feel that they have enough influence in decisions2 in the family X X X X X Percentage of young people who believe they are capable of making decisions2 about things X X X 149
  • 149. Disaggregation Socio economic status (10 14, 15 19, 20 24) Level of education Ethnicity/Religion Urban vs. rural Stratified agePriority Proposed indicator by domain Other Sex Percentage of young people who believe that there are some problems that can2 only be solved by violence X X X X Percentage of young people who feel that violence against a wife is acceptable2 under certain circumstances X X X X X3 Percentage of young people not living with either parent X X X X3 Perceived importance of marriage to young people X X X X X X3 Percentage of young people who have moved house in the past year X X X X Percentage of young people who feel that they have the capacity to influence their3 country X X X X X Average amount of time young people spend doing activities with their family3 outside the house X X X Average amount of time young people spend doing activities with their family in3 their house X X X Life Satisfaction Young people’s overall life satisfaction Percentage of youth that are very or1 somewhat satisfied with their life. X X X Young people’s satisfaction with family Percentage of children that are often or2 almost always satisfied with family. X X Young people’s satisfaction with friends Percentage of children that are often or2 almost always satisfied with friends. X X Young people’s satisfaction with school Percentage of children that are often or2 almost always satisfied with school. X X Young people’s satisfaction with living environment Percentage of children that2 are often or almost always satisfied with living environment. X X Young people’s satisfaction with self Percentage of children that are often or2 almost always satisfied with self. X X 150
  • 150. Disaggregation Socio economic status (10 14, 15 19, 20 24) Level of education Ethnicity/Religion Urban vs. rural Stratified agePriority Proposed indicator by domain Other Sex Young people’s satisfaction with coworkers Percentage of youth that are very or2 somewhat satisfied with their coworkers, if applicable. X X X3 Average Satisfaction with Life Scale (SWLS) score for young people X X X 151
  • 151. Annex V: Major household surveys in MENA countries Living Trends in Global The Arab Population Standards World International School Family Council Measurement Health Mathematics based Health Youth Survey (World Survey and Science Health Census DHS MICS1 MICS2 MICS3 Survey Survey Bank) (WHO) Study Survey Algeria 2008 1995 2000 2006 2002 2007 Bahrain 2001 2000 2007 Djibouti 1983 2006 2002 2007 Egypt 2006 2008 1996 2009 2007 2006 Iran 2006 2007 Iraq 1997 2000 2006 2006 Jordan 2004 2009 2007 2007 Kuwait 2005 2007Lebanon 1970 2000 2006 2003 2007 2005 Libya 1995 2003 2006 2007 2003 2003Morocco 2004 2004 2000 2006 2004 1991 2002 2007 2006 oPt 2007 2004 2000 2006 2006 2007 Oman 2003 2006 2007 2005 Qatar 2004 2007 Saudi Arabia 2004 2007 Sudan 2008 1990 2000 2006 2006 Syria 2004 2000 2006 2001 2003 Tunisia 2004 1988 2000 2006 2001 2002 2007 2008 UAE 2005 2002 2007 2005 Yemen 2004 1997 2006 2003 2003 2008 152
  • 152. Annex VI: Institutional definitions of MENAThe following listing was compiled from organization’s websites as well as from their respectivepublications. Countries listed as bolded text are to highlight differences from UNICEF regional definition.ESCWA:(uses same sub regional definition as League of Arab States)Mashreq: Egypt, Iraq, Jordan, Lebanon, Palestine, Syrian Arab RepublicMaghreb: Algeria, the Libyan Arab Jamahiriya, Morocco, TunisiaGCC: Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, the United Arab EmiratesArab Least Developed Countries (LDCs): the Comoros, Djibouti, Mauritania, Somalia, Sudan, Yemen.Does not include IranILO:Global Employment Trends (General report): (Separates North Africa from Middle East) North Africa:Algeria, Egypt, Libya, Morocco, Sudan, Tunisia and Middle East: Bahrain, Iran, Iraq, Jordan, Kuwait,Lebanon, Oman, Qatar, Saudi Arabia, Syria, UAE, West Bank and Gaza, and Yemen.Global Employment Trends (Youth 2006): Algeria, Bahrain, Djibouti, Egypt, Iran, Iraq, Jordan, Kuwait,Lebanon, Libya, Morocco, Oman, Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, West Bank andGaza, YemenLeague of Arab StatesMashreq: Egypt, Iraq, Jordan, Lebanon, Palestine, Syrian Arab RepublicMaghreb: Algeria, the Libyan Arab Jamahiriya, Morocco, TunisiaGCC: Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, the United Arab EmiratesArab Least Developed Countries (LDCs): Comoros, Djibouti, Mauritania, Somalia, Sudan, YemenDoes not include IranUNAIDS:Afghanistan, Algeria, Bahrain, Djibouti, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco,Oman, Palestine, Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, UAE, and Yemen.UNDESA:World Youth Report Algeria, Bahrain, Djibouti, Egypt, Islamic Republic of Iran, Iraq, Israel, Jordan,Kuwait, Lebanon, Libyan Arab Jamahiriya, Malta, Morocco, Oman, Qatar, Saudi Arabia, Syrian ArabRepublic, Tunisia, United Arab Emirates, Occupied Palestinian Territory, Yemen (does not includeSudan).UNESCO:Algeria, Bahrain, Djibouti, Egypt, Iraq, Jordan, Kuwait, Lebanon, Libya, Malta, Mauritania, Morocco,Oman, Palestine (in data), Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, United Arab Emirates,Yemen (excludes Iran). 153
  • 153. EFA regions Arab States Algeria, Bahrain, Djibouti, Egypt, Iraq, Jordan, Kuwait, Lebanon, Libyan ArabJamahiriya, Mauritania, Morocco, Oman, Palestinian Autonomous Territories, Qatar, Saudi Arabia,Sudan, Syrian Arab Republic, Tunisia, United Arab Emirates, Yemen (does not include Iran and Sudan).UNFPA:In State of the World Population:Northern Africa: Algeria, Egypt, Libya, Morocco, Sudan, Tunisia.Western Asia: Iraq, Israel, Jordan, Kuwait, Libya, oPt, Oman, Saudi Arabia, Syria, Turkey, UAE andYemen (does not include Iran).UNICEF:Algeria, Bahrain, Djibouti, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, oPt, Qatar,Saudi Arabia, Sudan, Syria, Tunisia, United Arab Emirates, Yemen.UNHCR:Middle East and North Africa Region consists of: Algeria, Bahrain, Egypt, Iraq, Israel, Jordan, Kuwait,Lebanon, Libya, Mauritania, Morocco, Oman, oPt, Qatar Saudi Arabia, Syria, Tunisia, United ArabEmirates, Western Sahara Territory, Yemen (does not include Djibouti, Iran, or Sudan).WHO:Afghanistan, Bahrain, Cyprus, Djibouti, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco,Oman, Pakistan, Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, UAE, Yemen (does not includeAlgeria).World Bank:Programmatic work for the MENA Region includes: Algeria, Djibouti, Egypt, Iran, Iraq, Jordan, Lebanon,Libya, Morocco, Oman, Saudi Arabia, Syria, Tunisia, West Bank and Gaza, Yemen (does not includeBahrain, Kuwait, Qatar, Sudan, United Arab Emirates).Data from WDI: Includes Israel and Malta and excludes Sudan 154
  • 154. Annex VII: BibliographyMENA specific Publications or Reports on Young PeopleARC & Save the Children Sweden. Adolescents, Early Marriage and the Convention on the Rights of theChild in Arab Societies. Summary report of regional workshop, held 1 4 March 2001, Larnaca, CyprusAssaad, R. & Barsoum, G. Youth Exclusion in Egypt: In Search of “Second Chances”, Middle East YouthInitiative, 2007. http://www.shababinclusion.org/content/document/detail/540/Barber, L. “Restive Young A Matter of National Security.” Financial Times, June 2, 2008.http://www.ft.com/reports/youth2008Buck, T. “Paces: Getting Girls Out and About.” Financial Times, June 2, 2008.http://www.ft.com/reports/youth2008Center for Arab Women for Training and Research (CAWTAR). Second AWDR Arab Adolescent Girl:Reality and Prospects, 2003. http://www.cawtar.org/index/Lang/en en/Topic/Arab_Adolescent_GirlChaaban, J. The Costs of Youth Exclusion in the Middle East. The Middle East Youth Initiative WorkingPaper. Wolfensohn Center for Development – Dubai School of Government. May, 2008.http://www.shababinclusion.org/content/document/detail/983/1DeJong, J. and El Khoury, G. Reproductive Health of Arab Young People. Analysis and Comment on theBritish Medical Journal, October 2006.http://bmj.bmjjournals.com/cgi/content/full/333/7573/849DeJong, J., Jawad, R., Mortagy, I. and Shepard, B. Young People’s Sexual and Reproductive Health in theMiddle East and North Africa. Population Reference Bureau, 2007.Dhillon, N., Salehi Isfahani, D., Dyer, P., Yousef, T., Fahmy, A. & Kraetsch, M. Missed by the Boom, Hurtby the Bust; Making Markets Work for Young People in the Middle East, Middle East Youth Initiative,2009. http://www.shababinclusion.org/content/document/detail/1352/Khalaf, R. “A Region Worries About Its Young.” Financial Times, June 2, 2008.http://www.ft.com/reports/youth2008Mediterranean Initiative for Child Rights. Towards a New Agenda for Children in the SouthernMediterranean Countries: A Rights Based Analysis. UNICEF Innocenti Research Centre, no year give.http://www.unicef irc.org/research/ESP/medin/chap1 introduction sept2001.pdfMiddle East Youth Initiative. Inclusion: Meeting the 100 Million Youth Challenge. Wolfensohn Center forDevelopment at the Brookings Institute and the Dubai School of Government, 2007.http://www.shababinclusion.org/content/document/?countries=8 155
  • 155. Negus, S. “Education: System with Little Relevance to the Market.” Financial Times, June 2, 2008.http://www.ft.com/reports/youth2008Negus, S. “Entrepreneurship: Where Old Habits Die Hard.” Financial Times, June 2, 2008.http://www.ft.com/reports/youth2008Population Reference Bureau. Youth in the Middle East and North Africa: Demographic Opportunity orChallenge? Population Reference Bureau, 2007. http://www.prb.org/pdf07/YouthinMENA.pdfSilatech Knowledge Consortium. The Silatech Index: Voices of Young Arabs. June, 2009.Silver, H. Social Exclusion: Comparative Analysis of Europe and Middle East Youth, Middle East YouthInitiative, Dec 2007. http://www.shababinclusion.org/content/document/?topic=8Shepard, B. and DeJong, J. Breaking the Silence and Saving Lives: Young People’s Sexual andReproductive Health in the Arab States and Iran. Harvard School of Public Health,2005.http://www.hsph.harvard.edu/pihhr/files/Shepard_publication.pdfUNDESA. World Youth Report 2007 Young People’s Transition to Adulthood: Progress and Challenges.UNDESA, 2007.Chapter on MENA: http://www.un.org/esa/socdev/unyin/documents/wyr07_chapter_4.pdfUNDP. Arab Youth Strategising for the Millennium Development Goals (MDGs). 2006.http://www.un.org/esa/socdev/unyin/documents/arabyouthmdgs.pdfUNICEF. A Framework for Rights Based Programming with Adolescents: Promoting Development,Protection and Participation. UNICEF MENA Regional Office – Adolescent Unit, 2006.UNICEF MENA Regional Office. A Framework for Rights Based Programming with Adolescents: PromotingDevelopment, Protection and Participation: UNICEF MENA Region. The Adolescent Unit, 2006.World Bank. Youth – An Undervalued Asset: Towards a New Agenda in the Middle East and North Africa.World Bank Policy Note, 2008.World Bank. Youth Employment in the MENA Region: A Situational Assessment. World Bank, 2005.http://siteresources.worldbank.org/SOCIALPROTECTION/Resources/SP Discussion papers/Labor MarketDP/0534web.pdfWorld Bank. Youth in Numbers Series: Middle East and North Africa. World Bank, 2004.http://www.unesco.org/ccivs/New SiteCCSVI/institutions/jpc youth/youth openforum/Section_for_Youth/Resources_and_tools/Other_documents_on_youth/YIN MENA.pdfWHO. Trends in Tobacco Use among School Students in the Eastern Mediterranean Region.WHO/EMRO, 2007. http://www.emro.who.int/TFI/PDF/Tobacco%20_among_school_students.pdf 156
  • 156. Zaalouk, M. Quality Education and Youth Participation: The Case of Social Protection in the Middle Eastand North Africa. Working Paper, 2007.MENA specific Publications or Reports GeneralCAWTAR. Arab Women’s Development Report 2001: Globalization and Gender: Economic Participationof Arab Women, undated.European Training Foundation. Employment Policy Reforms in the Middle East and North Africa: SelectedIssues on the Functioning of the Labor Market. European Training Foundation, 2006.http://www.etf.europa.eu/web.nsf/pages/EmbedPub_EN?OpenDocument&emb=/pubmgmt.nsf/(WebPublications%20by%20yearR)/DBDD107020FC45B2C12570930053C0BB?OpenDocumentJenkins, C. and Robalino, D. HIV/AIDS in the Middle East and North Africa: The Costs of Inaction. WorldBank, 2003. http://lnweb18.worldbank.org/MNA/mena.nsf/Attachments/menaaidscomplete/$File/menaaids complete.pdfObermeyer, C. HIV in the Middle East. Analysis and Comment on the British Medical Journal, October2006. http://bmj.bmjjournals.com/cgi/content/full/333/7573/849Population Reference Bureau. Challenges and Opportunities — The Population of the Middle East andNorth Africa. Population BULLETIN, 2007. http://www.prb.org/pdf07/62.2MENA.pdfRoudi Fahimi, F. and Ashford, L. Sexual and Reproductive Health in the Middle East and North Africa: AGuide for Reporters. Population Reference Bureau, 2008. http://www.prb.org/pdf08/mediaguide.pdfUNAIDS and WHO. Middle East and North Africa: AIDS Epidemic Update Regional Summary 2007.UNAIDS, 2008. http://data.unaids.org/pub/Report/2008/jc1531_epibriefs_mena_en.pdfUNDP/Regional Bureau for Arab States and the League of Arab States. Arab Human Development Report2002: Creating Opportunities for Future Generations. UNDP, 2002.http://www.pogar.org/publications/other/ahdr/ahdr2002e.pdfUNDP/Regional Bureau for Arab States and the League of Arab States. Arab Human Development Report2003: Building a Knowledge Society. UNDP and Arab Fund for Economic and Social Development, 2003.http://hdr.undp.org/en/reports/regionalreports/arabstates/arab_states_2003_en.pdfUNDP/Regional Bureau for Arab States and the League of Arab States. Arab Human Development Report2005: Towards the Rise of Women in the Arab World. UNDP 2006.UNESCO, Education for All Global Monitoring Report, 2009, UNESCO, 2009.http://www.unesco.org/en/efareport 157
  • 157. UNESCO, Education for All Global Monitoring Report, Arab States, An Overview, UNESCO 2006, 2007,2008, 2009. http://www.unesco.org/en/efareport/regions/arab states/UNESCWA and the League of Arab States. The Millennium Development Goals in the Arab Region 2007:A Youth Lens, 2007. http://www.escwa.un.org/information/publications/edit/upload/ead 07 3 e.pdfWorld Bank. Preventing HIV/AIDS in the Middle East and North Africa: A Window of Opportunity to Act.A World Bank Regional Strategy, 2005.http://siteresources.worldbank.org/INTMENA/Resources/Preventing_HIV__Regional_Strategy_full.pdfWorld Bank. Sustaining Gains in Poverty Reduction and Human Development in the Middle East andNorth Africa, 2006. http://siteresources.worldbank.org/INTMENA/Resources/Poverty_front_06.pdfWorld Bank. Unlocking the Employment Potential in the Middle East and North Africa. World Bank, 2004.http://wwwwds.worldbank.org/servlet/WDSContentServer/WDSP/IB/2004/06/03/000012009_20040603143832/Rendered/PDF/288150PAPER0Unlocking0employment.pdfCountry Specific Reports within MENA:England, A. “Saudi Arabia: Effort to Shake Off a Work shy Reputation.” Financial Times, June 2, 2008.http://www.ft.com/reports/youth2008Kerr, S. “Bahrain: A Radical Overhaul of Education and Labour.” Financial Times, June 2, 2008.http://www.ft.com/reports/youth2008Mryyan, N. et al. New Entrants to Jordanian Labor Market. Al Manar Project, 2007.http://www.almanar.jo/AlManarWeb/Portals/0/PDF2/new%20entrants%20to%20labor%20market.pdfNation Unies, Document de travail “Adolescents et Jeunes, Données et défis” Tunisie, 2007http://www.onu tn.org/document/doc_Adolescents_et_Jeunesdo_nées_et_défis_version_finale_06juin_07.pdfSpierings, N. Women’s Labour Market Participation in Egypt, Jordan, Morocco, Syria and Tunisia: AThree level Analysis. Radboud University, 2007.http://www.iza.org/conference_files/worldb2007/spierings_n3399.pdf 158
  • 158. Global Publications or Reports on Young PeopleBakar, A. Index to Gauge the Efficiency of Development Projects, The Brunei Times, August 3, 2008.Commonwealth Secretariat. Report on the Inter Agency Consultation on the Formulation andDevelopment of the Youth Development Index. Meeting held 11 12 July 2005, Marlborough House,London.http://www.thecommonwealth.org/document/154211/154259/youth_development_report.htmCurtain, R. What to Do When Jobs Are Scarce: Promoting Young People’s Livelihoods in Timor Leste,Papua New Guinea and Pacific Island Countries. UNICEF East Asia and Pacific Regional Office, 2007.Deslisle, H. et al. Should Adolescents be Specifically Targeted for Nutrition in Developing Countries? ToAddress which Problems and How? Universite de Montreal, undated. http://www.who.int/childadolescent health/New_Publications/NUTRITION/Adolescent_nutrition_paper.pdfILO. Global Employment Trends, 2008. http://www.ilo.org/wcmsp5/groups/public/ dgreports/dcomm/documents/publication/wcms_090106.pdfILO. Global Employment Trends for Youth, 2006. http://www.ilo.org/wcmsp5/groups/public/dgreports/ dcomm/documents/publication/wcms_077664.pdfILO. Joining Forces with Young People: A Practical Guide to Collaboration for Youth Employment –Public Draft. Youth Employment Network, 2007.Jacobo, J. The UNESCO Youth Development Index. UNESCO. 2004(?)Making Cents, International. Youth Microenterprise and Livelihoods: State of the Field. Lessons from the2007 Global Youth Microenterprise Conferene, 2008.http://www.imaginenations.org/Documents/MakingCentsInternationalYouthEnterpriseLivelihoods021108.pdfPopulation Council. The Role of Social Support and Economic Skill building Programs in mitigatingAdolescents’ Vulnerabilities: Perspectives and UNICEF’s Experience to Date, Population Council andUNICEF, undated.Save the Children. State of the World’s Mothers 2004: Children Having Children. 2004.http://www.savethechildren.org/publications/mothers/2004/SOWM_2004_final.pdfSave the Children. State of the World’s Mothers 2008: Closing the Survival Gap for Children Under 5.2008. http://www.savethechildren.org/publications/mothers/2008/SOWM 2008 full report.pdfSchneider, Friedrich. “Shadow Economies of 145 Countries all over the World: What do we reallyknow?” Presented at, “Hidden in plain sight: Micro economic measurements of the informal economy:Challenges and opportunities”, September 4 5, 2006, London, UK.www.dur.ac.uk/john.ashworth/EPCS/Papers/Schneider.pdf 159
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  • 162. World Bank. World Development Report 2007: Development and the Next Generation, 2006.http://wwwwds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2006/09/13/000112742_20060913111024/Rendered/PDF/359990WDR0complete.pdfWHO. Adolescent Friendly Health Services, 2002.http://whqlibdoc.who.int/hq/2003/WHO_FCH_CAH_02.14.pdfWHO and UNFPA. Married Adolescents: No Place of Safety. WHO, 2006.http://whqlibdoc.who.int/publications/2006/9241593776_eng.pdfGlobal Publications or Reports GeneralInternal Displacement Monitoring Centre. Internal Displacement in the Middle East: Global Overview ofTrends and Developments in 2007. 2008. http://www.internaldisplacement.org/8025708F004CE90B/(httpRegionPages)/F4C363E496AB88D1802570A6005599C7?OpenDocumentUNAIDS. AIDS Epidemic Update 2007. UNAIDS and WHO, 2007.http://data.unaids.org/pub/EPISlides/2007/2007_epiupdate_en.pdfUNAIDS. Report on the Global AIDS Epidemic 2006: Executive Summary, UNAIDS, 2006.http://data.unaids.org/pub/GlobalReport/2006/2006_GR ExecutiveSummary_en.pdf (other chapters:http://www.unaids.org/en/KnowledgeCentre/HIVData/GlobalReport/default.asp)UNDESA. Youth Development Indicators. Youth at the United Nations, 2008.http://www.un.org/esa/socdev/unyin/youthindicators2.htmUNFPA. State of the World Population 2003 Making One Billion Count: Investing in Adolescents Healthand Right, 2003. http://www.unfpa.org/upload/lib_pub_file/221_filename_swp2003_eng.pdfUNFPA. State of the World Population 2007: Unleashing the Potential of Urban Growth, 2007.http://www.unfpa.org/swp/2007/presskit/pdf/sowp2007_eng.pdfUNSTATS. Official List of the Millennium Development Goals Indicators (as of January 2008).http://mdgs.un.org/unsd/mdg/Host.aspx?Content=Indicators/OfficialList.htmWorld Bank. Global Monitoring Report 2007: Confronting Challenges of Gender Equality and FragileStates, 2007. http://wwwwds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2007/04/11/000112742_20070411162802/Rendered/PDF/394730GMR02007.pdfWorld Bank. World Development Report 2007: Development and the Next Generation, 2007. 163
  • 163. http://wwwwds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2006/09/13/000112742_20060913111024/Rendered/PDF/359990WDR0complete.pdfWHO. Injury: A Leading Cause of the Global Burden of Disease, 2000.http://whqlibdoc.who.int/publications/2002/9241562323.pdfWHO. Maternal Mortality in 2005: Estimates Developed by WHO, UNICEF, UNFPA and World Bank,2007. http://www.who.int/reproductive health/publications/maternal_mortality_2005/mme_2005.pdfWHO/CDC. Global Youth Tobacco Survey. Available at:http://www.who.int/tobacco/surveillance/gyts/en/index.htmlDatabases and other sources for core indicator listCenters for Disease Control & Prevention. Global School based Student Health Survey 2004 2008.http://www.cdc.gov/gshs/countries/eastmediter/index.htmGallup Inc. Gallup Worldview, 2009. (WorldPoll of 100 questions asked in all countries)https://worldview.gallup.com/Global Initiative to End All Corporal Punishment of Children, 2009.http://www.endcorporalpunishment.org/pages/frame.htmlInternational Labour Organization. LABORSTA Internet, 2009. http://laborsta.ilo.org/default.htmlUNDP POGAR. ArabStats, 2008. (A repository of statistical indicators for human development in theArab Region.) http://arabstats.org/UNHCR Country Data Sheets 2007. http://www.unhcr.org/statistics/STATISTICS/464478a72.htmlUNICEF. ChildInfo, 2008. http://www.childinfo.org/United Nations Population Division. World Population Prospects: The 2008 Revision PopulationDatabase, 2008. http://esa.un.org/unpp/index.asp?panel=2United Nations Statistics Division. UNdata, 2009. (Pools major UN and large international organizationdatatbases into a single internet environment) http://data.un.org/Default.aspxWorld Bank. EdStats Query, 2009. (draws on data from UNESCO Institute for Statistics)http://web.worldbank.org/WBSITE/EXTERNAL/TOPICS/EXTEDUCATION/EXTDATASTATISTICS/EXTEDSTATS/0,,contentMDK:21528247~menuPK:3409442~pagePK:64168445~piPK:64168309~theSitePK:3232764,00.html 164
  • 164. World Health Organization. Life Tables for WHO Member States 2006.http://apps.who.int/whosis/database/life_tables/life_tables.cfmWorld Health Organization. WHO Surveillance of Chronic Disease Risk Factors Report (SURF2) 2005.http://apps.who.int/infobase/surf2/country_list.htmlWorld Values Survey, 2009. (Survey on values and cultural change in societies worldwide)www.worldvaluessurvey.org 165
  • 165. Annex VIII: GlossaryDataAge Specific Rates: Calculated by dividing the number of cases of deaths or other health variableoccurring in each specified age group by the corresponding population or survey sample in the same agegroup (Source: WHO Global InfoBase Glossarywww.who.int/infobase/help.aspx?typecode=hp.tc.001#80)Denominator: The lower part of a fraction used to calculate a proportion or ratio, which in the contextof the Review refers to the population base, i.e. youth literacy rate is the number of literate youth 15 24(numerator) divided by the total population 15 24 (denominator)Disaggregation of data: The breakdown of observations, usually within a common branch of a hierarchy,to a more detailed level to that at which detailed observations are taken (Source: OECD Glossary ofStatistical Terms http://stats.oecd.org/glossary/index.htm)Indicator: A measurement that reflects the status of a system. Indicators reveal the direction of asystem (a population group, a community, the economy, the environment, etc), whether it is goingforward or backward, increasing or decreasing, improving or deteriorating, or staying the same (Source:National Public Health Performance Standards Program – Glossary of Terms 2007.www.cdc.gov/od/ocphp/nphpsp/documents/07_110300%20Glossary.pdf)Numerator: The upper portion of a fraction used to calculate a proportion or ratio, which in the contextof the Review is the interest point for the indicator identified through a proportion or ratio, i.e. youthliteracy rate is the number of literate youth 15 24 (numerator) divided by the total population 15 24(denominator)Percentage: A percentage is a special type of proportion where the ratio is multiplied by a constant,100, so that the ratio is expressed per 100 (Source: OECD Glossary of Statistical Termshttp://stats.oecd.org/glossary/index.htm)Ratio: A ratio is a number that expresses the relative size of two other numbers – a numerator and adenominator. The result of dividing a number X by another number Y is the ratio of X to Y (Source:OECD Glossary of Statistical Terms http://stats.oecd.org/glossary/index.htm)Variable: A variable is a characteristic of a unit being observed that may assume more than one of a setof values to which a numerical measure or a category from a classification can be assigned (e.g. income,age, weight, etc., and “occupation”, “industry”, “disease”, etc. (Source: OECD Glossary of StatisticalTerms http://stats.oecd.org/glossary/index.htm)DemographicsDemographic transition: The historical shift of birth and death rates from high to low levels in apopulation. The decline of mortality usually precedes the decline in fertility, thus resulting in rapid 166
  • 166. population growth during the transition period (Source: Population Reference Bureau’s Glossary ofDemographic Terms www.prb.org/pdf04/glossary)Dependency ratio: The ratio of the economically dependent part of the population to the productivepart; arbitrarily defined as the ratio of the elderly (ages 65 and older) plus the young (under age 15) tothe population in the “working ages” (ages 15 64) (Source: Population Reference Bureau’s Glossary ofDemographic Terms www.prb.org/pdf04/glossary)Growth rate: The number of persons added to (or subtracted from) a population in a year due tonatural increase and net migration expressed as a percentage of the population at the beginning of thetime period (Source: Population Reference Bureau’s Glossary of Demographic Termswww.prb.org/pdf04/glossary)Total fertility rate: The average number of children that would be born alive to a woman (or group ofwomen) during her lifetime if she were to pass through her childbearing years conforming to the agespecific fertility rates of a given year. This rate is sometimes stated as the number of children women arehaving today. See also gross reproduction rate and net reproduction rate (Source: PopulationReference Bureau’s Glossary of Demographic Terms www.prb.org/pdf04/glossary)Youth bonus/Youth bulge: The increase in the proportion of 15 to 24 year olds in the total population,a population with a relatively high proportion of children, adolescents, and young adults; a low medianage; and thus a high growth potential (Source: Youth in the Middle East and North Africa: DemographicOpportunity or Challenge? and Population Reference Bureau’s Glossary of Demographic Termswww.prb.org/pdf04/glossary)PovertyExtreme poverty: The share of people living on less than the international poverty line of $1 per capitaa day (Source: World Bank. Global Monitoring Report 2007: Confronting Challenges of Gender Equalityand Fragile States, 2007. http://wwwwds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2007/04/11/000112742_20070411162802/Rendered/PDF/394730GMR02007.pdf)Poverty: The share of people living on less than the international poverty line of $2 per capita a day(Source: World Bank. Global Monitoring Report 2007: Confronting Challenges of Gender Equality andFragile States, 2007. http://wwwwds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2007/04/11/000112742_20070411162802/Rendered/PDF/394730GMR02007.pdf)Purchasing power parity (PPP): An exchange rate that accounts for price differences among countries,allowing international comparisons of real output and incomes (Source: Education for All: GlobalMonitoring Report’s Glossary http://portal.unesco.org/education/en/ev.phpURL_ID=43385&URL_DO=DO_TOPIC&URL_SECTION=201.html) 167
  • 167. Youth working poor: The average of the youth share in total employment and the youth share in totallabour force applied to the total regional working poor (under US$1 and US$2 a day levels) to get a totalnumber of youth working poor living below these levels (Source: Global Employment Trends for Youth2006. ILO, 2006 www.ilo.org/wcmsp5/groups/public/ dgreports/dcomm/documents/publication/wcms_077664.pdf)HealthAdolescent fertility: The number of live births among girls ages 15–19 divided by the number of girls inthat age group expressed per 1,000 population (Source: Global Data on HIV/AIDS, TB, Malaria andMore. Kaiser Family Foundation http://www.globalhealthfacts.org/glossary.jsp)Maternal mortality ratio (MMR): Number of maternal deaths during a given time period per 100,000live births during the same time period (Source: WHO. Maternal Mortality in 2005: Estimates Developedby WHO, UNICEF, UNFPA and World Bank, 2007. http://www.who.int/reproductivehealth/publications/maternal_mortality_2005/mme_2005.pdf)Prevalence: The prevalence of a disease/risk factor in a statistical population is defined as the ratio ofthe number of cases of a disease present in a statistical population at a specified time and the numberof individuals in the population at that specified time. In plain English, "prevalence" simply means"proportion" (typically expressed as a percentage) (Source: WHO Global InfoBase Glossarywww.who.int/infobase/help.aspx?typecode=hp.tc.001#80)HIV AND AIDSConcentrated epidemic: An epidemic is considered ‘concentrated’ when less than one per cent of thegeneral population but more than five per cent of any ‘high risk’ group are HIV positive (Source: UNICEF“Children and HIV/AIDS” www.unicef.org/aids/index_epidemic.html)Generalized epidemic: An epidemic is considered ‘generalized’ when more than one per cent of thepopulation is HIV positive (Source: UNICEF “Children and HIV/AIDS”www.unicef.org/aids/index_epidemic.html)HIV prevalence rate: Percent of people estimated to be living with HIV, at any disease stage, includingAIDS. It is usually presented as percent of adult population (ages 15 49) estimated to be HIV positive.When actual surveillance data are not available, the prevalence rate is usually estimated based on HIVprevalence among pregnant women attending antenatal clinics (Source: WHO Global InfoBase Glossarywww.who.int/infobase/help.aspx?typecode=hp.tc.001#80)Surveillance: Continuous analysis, interpretation and feedback of systematically collected data,generally using methods distinguished by their practicality, uniformity, and rapidity rather than byaccuracy or completeness. By observing trends in time, place and persons, changes can be observed oranticipated and appropriate action including investigative or control measures, can be taken. Sources ofdata may relate directly to disease or to factors influencing disease (Source: WHO Global InfoBaseGlossary www.who.int/infobase/help.aspx?typecode=hp.tc.001#80) 168
  • 168. EducationGross enrolment ratio (GER): Total enrolment in a specific level of education, regardless of age,expressed as a percentage of the population in the official age group corresponding to this level ofeducation. For the tertiary level, the population used is that of the five year age group following on fromthe secondary school leaving age. The GER can exceed 100% due to early or late entry and/or graderepetition (Source: Education for All: Global Monitoring Report’s Glossaryhttp://portal.unesco.org/education/en/ev.phpURL_ID=43385&URL_DO=DO_TOPIC&URL_SECTION=201.html)Net enrolment ratio (NER) for primary and secondary: Enrolment of the official age group for a givenlevel of education, expressed as a percentage of the population in that age group (Source: Education forAll: Global Monitoring Report’s Glossary http://portal.unesco.org/education/en/ev.phpURL_ID=43385&URL_DO=DO_TOPIC&URL_SECTION=201.html)Out of school children and youth (OSCY): Individuals ages 6 years and up to about 20 years of age whoshould be in compulsory schooling, but are not. Overall, about 15–20 per cent of school aged childrenand adolescents are currently out of school because they: (i) have never attended school; (ii) have notcompleted primary school; and/or (iii) have not attended or completed compulsory secondary school(Source: World Bank. The Road Not Traveled: Education Reform in the Middle East and North Africa.Middle East and North Africa Region, 2008.http://siteresources.worldbank.org/INTMENA/Resources/EDU_Flagship_Full_ENG.pdf)Youth literacy: Number of literate persons aged 15 to 24, expressed as a percentage of the totalpopulation in that age group (Source: Education for All: Global Monitoring Report’s Glossaryhttp://portal.unesco.org/education/en/ev.phpURL_ID=43385&URL_DO=DO_TOPIC&URL_SECTION=201.html)Livelihoods and Economic ParticipationEmployed youth: Individuals between the ages of 15 and 24 who performed some work for wage,salary, profit or family gain (Source: Global Employment Trends for Youth 2006. ILO, 2006www.ilo.org/wcmsp5/groups/public/ dgreports/ dcomm/documents/publication/wcms_077664.pdf)Inactive youth: Individuals between the ages of 15 and 24 who are neither employed or unemployed, orwho are not in the labor force (Source: Global Employment Trends for Youth 2006. ILO, 2006www.ilo.org/wcmsp5/groups/public/ dgreports/ dcomm/documents/publication/wcms_077664.pdf)Labor force participation rate (LFPR): The sum of persons between the ages of 15 and 24 in the laborforce as a percentage of the working age population and serves as an indicator of the size of the laborsupply available (Source: Global Employment Trends for Youth 2006. ILO, 2006www.ilo.org/wcmsp5/groups/public/ dgreports/ dcomm/documents/publication/wcms_077664.pdf) 169
  • 169. Unemployed youth: Individuals between the ages of 15 and 24 who were (a) without work, (b) currentlyavailable for work, and (c) actively seeking work (Source: Global Employment Trends for Youth 2006. ILO,2006 www.ilo.org/wcmsp5/groups/public/ dgreports/dcomm/documents/publication/wcms_077664.pdf)Youth inactivity rate: The sum of all inactive persons between the ages of 15 and 24 as a percentage ofthe working age population who do not supply labour (it is also known as the inverse to the labour forceparticipation rate) (Source: Global Employment Trends for Youth 2006. ILO, 2006www.ilo.org/wcmsp5/groups/public/ dgreports/ dcomm/documents/publication/wcms_077664.pdf)Youth labor force: The sum of all persons between the ages of 15 and 24 who were either employed orunemployed over a specified, short reference period (also used interchangeably with “currently activeyouth population”) (Source: Global Employment Trends for Youth 2006. ILO, 2006www.ilo.org/wcmsp5/groups/public/ dgreports/ dcomm/documents/publication/wcms_077664.pdf)MigrationEmigration/international migration: The process of leaving one country to take up permanent or semipermanent residence in another (Source: Population Reference Bureau’s Glossary of DemographicTerms www.prb.org/pdf04/glossary)In migration/internal migration: The process of entering one administrative subdivision of a country(such as a province or state) from another subdivision to take up residence (Source: PopulationReference Bureau’s Glossary of Demographic Terms www.prb.org/pdf04/glossary)Migration: The movement of people across a specified boundary for the purpose of establishing a newor semi permanent residence, divided into international migration (migration between countries) andinternal migration (migration within a country) (Source: Population Reference Bureau’s Glossary ofDemographic Terms www.prb.org/pdf04/glossary) 170