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Table of ContentsPreface ....................................................................................................
Table of FiguresFigure 1 MENA population under 25 years of age...............................................................
Table of TablesTable 1 Percent of regional populations living in absolute vs. relative poverty………………………………………30Table 2 Cha...
Acronyms and AbbreviationsCEDAW          Convention on the Elimination of all Forms of Discrimination against WomenCSEE & ...
TFR      Total Fertility RateTIMMS    Trends in International Mathematics and Science StudyUAE      United Arab EmiratesUN...
Executive SummaryThe Middle East and North Africa (MENA) region is experiencing an unprecedented boom in thenumbers of you...
continuing challenge. An effective transition from school to decent employment remains an unrealizedgoal for many youth. A...
sexuality, in order to understand the situation of youth and to create policies to promote a successfultransition to adult...
1. IntroductionYoung people must be endowed with the knowledge, skills and capacities necessary to assume theirroles as ad...
2. Methodological noteThe Review focuses primarily on a regional overview of trends and issues, and is not intended to ana...
Annexes III and IV list the proposed indicators and describe the intended uses of each. These lists werecreated through a ...
A. Bridging discrepancies in definitionsDisparities in age group classifications by different organizations complicate com...
3. Demographic trendsBoth national and international estimates indicate that more than half of the total population in the...
Figure 1 MENA population under 25 years of age.                                                                           ...
youth in MENA will drop to 17 percent by 2025, from its current level of approximately 21 percent.6Those countries with a ...
Figure 3 Adolescent Fertility Rates.Source: UN Population Division, World Fertility Patterns 2007.Youth (20 24) fertility ...
Figure 4 Youth Fertility Rate.                                       450                                       400   Birth...
Figure 5 Ratio of change in adolescent and youth fertility rates.Source: UN Population Division, World Fertility Patterns ...
chronic diseases than do those of the older generation.7 Young people generally, and young menspecifically, face a higher ...
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    ...
while still around the regional average, the probability of death for adolescents in Qatar increased by0.01 percent from 1...
Figure 8 Probability of death as a percentage (ages 15 24, 1996 2006).     8.00     7.00     6.00     5.00     4.00     3....
this section, the size of a population depends on three factors: the fertility rate, the mortality rate, andnet migration....
Diagram 1 Sample Population Pyramid in Society Experiencing a “Youth Bulge”.Source: United Nations Programme on Ageing. Av...
Diagram 2 Population Pyramid of MENA Region and WorldThe creation of a large cohort of young people marks the opportunity ...
opportunity, or potential challenge, of investing in the human and social capital of its youth to propelthe region forward...
and youth empowerment advance the ideal of an inclusive society, promoting shared ideals and socialbonds. Efforts to deepe...
4. Poverty trends  General poverty issues facing MENA  Poverty data are available for eight of the 20 countries in the MEN...
the population lives below this benchmark, a reduction of 14 percent since 1990. Comparing percentagereduction figures for...
Figure 10 Percentage of the total population living in relative poverty (less than $2 per day)   50.00%   45.00%   40.00% ...
Table 2 presents the change in absolute poverty as a percentage of the change in relative poverty forcountries where data ...
find employment that generally helps lift them from the poverty cycle. Extrapolation of adolescent andyouth poverty rates ...
percentage in absolute poverty. This contrast indicates that while absolute poverty rates in MENA arerelatively low, a far...
ILO estimates of regional youth working poverty rates indicate that almost 40 percent of MENA’semployed youth were living ...
5. Health trendsPromoting health is an essential component of strengthening populations’ human security. The right tohealt...
Young people’s sexual and reproductive health (SRH)Adolescence is a time of physical, physiological, and social transition...
Schools do not provide information on young people’s sexual and reproductive health;             Young people have not had...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
The Situation of Adolescents and Youth in the Middle East and North Africa Region: A Desk Review of Data on Current Trends...
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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

  1. 1. !! 2!
  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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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

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