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

Table of Contents
Preface .......................................................................................................................................................... 2
Table of Figures............................................................................................................................................. 4
Acronyms and Abbreviations ........................................................................................................................ 6
Executive Summary....................................................................................................................................... 8
1. Introduction ........................................................................................................................................ 11
2. Methodological note........................................................................................................................... 12
A. Bridging discrepancies in definitions................................................................................................... 14
3. Demographic trends ........................................................................................................................... 15
4. Poverty trends..................................................................................................................................... 30
5. Health trends ...................................................................................................................................... 37
6. HIV and AIDS trends............................................................................................................................ 55
7. Education trends ................................................................................................................................. 63
B. Mind the gap: the school to work transition and the informal economy........................................... 75
8. Livelihoods and economic participation trends.................................................................................. 79
9. Migration trends ................................................................................................................................. 91
10. Political and civic engagement trends ............................................................................................ 98
11. Child protection trends ................................................................................................................. 102
12. Conflict and emergency ................................................................................................................ 113
C. Youth and adolescents in post conflict situations............................................................................. 120
13. Conclusions ................................................................................................................................... 121
Annex I: Recommendations for improving understanding of MENA youth ............................................. 123
Annex II: Introduction to Core and Extended Indicator Lists.................................................................... 126
Annex III: Core Indicator List ..................................................................................................................... 129
Annex IV: Extended Indicator List ............................................................................................................. 133
Annex V: Major household surveys in MENA countries .......................................................................... 152
Annex VI: Institutional definitions of MENA ............................................................................................. 153
Annex VII: Bibliography............................................................................................................................. 155
Annex VIII: Glossary .................................................................................................................................. 166

3

Table of Figures
Figure 1 MENA population under 25 years of age...................................................................................... 16
Figure 2 Total Fertility Rate, 1989 & 2009. ................................................................................................. 17
Figure 3 Adolescent Fertility Rates. ............................................................................................................ 18
Figure 4 Youth Fertility Rate. ...................................................................................................................... 19
Figure 5 Ratio of change in adolescent and youth fertility rates................................................................ 20
Figure 6 Probability of death as a percentage (ages 10 24, 1996 2006). ................................................... 22
Figure 9 Percentage of total population living in absolute poverty (less than $1.25 per day)................... 31
Figure 10 Percentage of the total population living in relative poverty (less than $2 per day) ................. 32
Figure 11 Per annum percentage change in absolute and relative poverty rates...................................... 32
Figure 12 Youth working poverty rate, ages 15 24, 2005........................................................................... 35
Figure 13 Minimum legal age of marriage.................................................................................................. 41
Figure 14 Percentage of women age 20 24 married before age 18. .......................................................... 42
Figure 15 Percentage of students (age 13 15) currently smoking cigarettes............................................. 46
Figure 16 Percentage of students (ages 13 15) who are obese. ................................................................ 48
Figure 17 Proportion of population below the minimum level of dietary energy consumption by sub
region. ......................................................................................................................................................... 49
Figure 18 Percentage of students (ages 13 15) experiencing food insecurity. .......................................... 50
Figure 19 Primary causes of death and disability, men ages 15 29............................................................ 51
Figure 20 Primary causes of death and disability, women ages 15 29 ...................................................... 52
Figure 21 Percentage of students aged 13 15 who felt lonely most or all of the time during the preceding
12 months. .................................................................................................................................................. 53
Figure 22 HIV prevalence by gender........................................................................................................... 61
Figure 23 Gross Enrollment Ratio, secondary school. ................................................................................ 66
Figure 24 Youth literacy rate by gender ..................................................................................................... 68
Figure 25 Regional youth unemployment rates ......................................................................................... 82
Figure 26 Youth labor force participation rates.......................................................................................... 82
Figure 27 Country specific labor force participation rates ......................................................................... 86
Figure 28 Youth unemployment rates, by gender ...................................................................................... 89
Figure 29 Net migration (thousands).......................................................................................................... 94
Figure 30 Net migration per 1,000 population ........................................................................................... 95
Figure 31 Percentage of youth reporting "that they are likely to move away from the city or area where
they currently live. ...................................................................................................................................... 97
Figure 32 Percentage of students (ages 13 15) physically attacked in the past year............................... 105
Figure 33 Percent of females reporting Female Genital Mutilation/Cutting............................................ 108
Figure 34 Total Population of Concern by UNHCR Regions, 2008 ............................................................ 115
Figure 35 Population of Concern by MENA country of asylum ................................................................ 116
Figure 36 Demographic data coverage for Population of Concern .......................................................... 117
Figure 37 Net refugee flow by country of asylum .................................................................................... 118

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Table of Tables
Table 1 Percent of regional populations living in absolute vs. relative poverty………………………………………30
Table 2 Change in absolute poverty rate as a percentage of change in relative poverty rate…………………33
Table 3: Regional fertility rates and maternal mortality rates……………………………………………………………….43
Table 4 Reported HIV cases……………………………………………………………………………………………………………………57
Table 5 Young women with comprehensive, correct HIV knowledge in MENA countries……………………….58
Table 6 Distribution of Migrants from Select MENA Countries………………………………………………………………93
Table 7 Youth specific organizations in MENA……………………………………………………………………………………..100
Table 8 Birth registration rates, 2000 2007………………………………………………………………………………………….103
Table 9 Child Discipline and Domestic Violence……………………………………………………………………………………104
Table 10 Prohibition of Corporal Punishment in MENA Countries………………………………………………………..107
Table 11: Children in Detention in Available MENA Countries……………………………………………………………..110

Table of Diagrams
Diagram 1 Sample population pyramid in society experiencing a “Youth Bulge”……………………………………26
Diagram 2 Population pyramid of MENA region and world…………………………………………………………………..27
Diagram 3 2007 adult HIV prevalence estimates. ………………………………………………………………………………….57
Diagram 4 Sub regional dependency ratios, 1950 2050………………………………………………………………………..85
Diagram 5 Share of unemployed youth in total unemployed and age transition in LFPR…………………….87

Please note that figures and tables in the report were created by the authors with data from the source
cited. Diagrams are figures from other publications which are reproduced in the Review. Both the
publication and the original source of the data are cited whenever possible. When data for a country
were not available, that country was omitted from the figure.

5

Acronyms and Abbreviations

CEDAW Convention on the Elimination of all Forms of Discrimination against Women
CSEE & CIS Central and South eastern Europe (non EU) & Commonwealth of Independent States
(ILO region)
CRC Convention of the Rights of the Child
DALY Disability adjusted Life Year
DevInfo a database, formerly known as ChildInfo, with UN Development Group endorsement
EA 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, WHO
ESCWA United Nations Economic and Social Commission for Western Asia
DEEU Developed economies and European Union (ILO region)
GCC Gulf Cooperation Council: Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, & UAE
GER Gross Enrollment Ratio
HDI Human Development Index
HIV and AIDS Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome
ICT Information and Communication Technology
IDP Internally Displaced Persons
ILO International Labour Organization
FGM/C Female genital mutilation/cutting
LABORSTA an International Labour Office database on labor statistics
LAC Latin America & Caribbean (World Bank region, ILO region)
LAS League of Arab States
LFPR Labor Force Participation Rate
MDG Millennium Development Goal
MENA Middle East and North Africa
MENARO Middle East and North Africa Regional Office, UNICEF
MICS Multiple Indicator Cluster Survey
MICS4 4th Round of the Multiple Indicator Cluster Survey
NER Net Enrollment Ratio
NGO Non governmental organization
oPt occupied Palestinian territory
PSER Primary School Enrollment Ratio
PAPFAM Pan Arab Project for Family Health
SA South Asia (World Bank region, ILO region)
SEA&P South east Asia and the Pacific
SSA Sub Saharan Africa (World Bank region, ILO region)
SSER Secondary School Enrollment Ratio

6

TFR Total Fertility Rate
TIMMS Trends in International Mathematics and Science Study
UAE United Arab Emirates
UNAIDS Joint United Nations Programme on HIV/AIDS
UNDESA United Nations Department of Economic and Social Affairs
UNDP United Nations Development Programme
UNESCO United Nations Educational, Scientific and Cultural Organization
UNFPA United Nations Population Fund
UNHCR United Nations High Commissioner for Refugees
UNICEF United Nations Children’s Fund
UNODC United Nations Office on Drugs and Crime
WB The World Bank
WDI World Development Indicators, published by the World Bank
WHO World Health Organization
WPAY United Nations World Programme of Action for Youth to the Year 2000 and Beyond

7

Executive Summary

The Middle East and North Africa (MENA) region is experiencing an unprecedented boom in the
numbers of young people. All countries in the region have a youth population (here defined as ages 10
24) comprising 22 to 36 percent of the total population; proportions unlikely to change in the near
future. The growing numbers of youth (projected at 121 million for the region in 2009) presents an
exciting window of opportunity for the countries of the region to capitalize on this abundance of young
people and to translate it into human, material and economic gains. To convert this potential asset into
tangible social development gains, countries have to ensure that the policy environment enables young
people to realize their full potential and capacities. To be effective, the diverse needs of young people
have to be addressed by a range of public and private agencies and institutions, each with a distinctive
contribution to make to youth well being. UNICEF thus presents this Review of key domains for
assessing the quality of life for young people across the 20 countries in the UNICEF MENA region and
proposes 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 analysis
of 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, child
protection, and conflict and emergency), the Review highlights trends and assesses the state of data and
indicators for each one. A summary follows.

Both relative and absolute poverty rates for the general population in MENA compare favorably to other
global regions, although youth specific poverty estimates are not generally available. Great disparities
persist within the region. The World Bank estimates that 3.6 percent of the MENA region’s population
lived in absolute poverty in 2005, defined as less than $1.25 per day, whereas 16.9 percent lived in
relative poverty (<$2 per day). ILO estimates of regional youth working poverty rates indicate that
almost 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 in
most cases to fertility data. Estimates of HIV prevalence in MENA countries remain low compared to
other global regions and cases are concentrated in high risk groups. Child marriage remains common in
many 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 is
a rising concern.

In recent decades, MENA has seen enormous gains in access to formal education. Many countries are
approaching or have achieved full enrollment in basic education. Secondary and tertiary education rates
are on a par with other countries at comparable levels of development. Nevertheless, enrollment rates
for girls lag behind those for boys in half of the countries in the region, while enrollment rates for both
sexes are low in several of the region’s poorer countries. Education quality is uneven and represents a

8

continuing challenge. An effective transition from school to decent employment remains an unrealized
goal for many youth. Although young people in MENA comprise approximately one third of the working
age population, they account for almost 50 per cent of the region’s total unemployment. The ILO
estimated youth unemployment in the region at 22 percent in 2007. Many MENA youth and parents
prefer public sector employment. As private sector growth has not kept pace with the rapid expansion
of the labor force, informal jobs are often the only choice. Young women face additional barriers to
obtaining 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 of
foreign workers who are adolescents or youths or the flow of young migrants within the region. In
general cultural norms create a barrier for women wanting to migrate, as do the lack of economic
opportunities 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, though
the spread of Information and Communication Technologies (ICT) is allowing youth to engage in their
communities in non traditional ways.

Data on child protection trends point to important shortfalls in safeguarding young people across the
region. Exposure to violence is widespread. Female genital mutilation/cutting (FGM/C) remains common
in four countries. Legal systems are poorly adapted to the unique needs of juvenile offenders. Nearly six
million orphans live in the region, while efforts to enumerate the number of street children have failed
to produce an estimate of this sizable and vulnerable population.

Several countries in the MENA region currently experience precarious security conditions. Adolescents
and young people, in addition to suffering the effects of conflict and emergency, are also potential
agents for positive change. Engaging young people in the dialogue of peace may help protect states
against instability.

While the population trends mentioned above have resulted in increased attention towards the role of
youth in MENA society, data collection efforts have not kept pace with this new found interest. A
recurring theme in the Review is the critical need for complete and timely data for youth in all countries
of 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 relevant
characteristics, such as socio economic status, highlight disparities and allow users to tailor measures to
sub groups of interest. A central, publically accessible database of current and historic youth data, if
established and supported, could expedite dissemination and promote evidence based youth policy and
programming.

Much of the data currently available on youth consist of objective measures and fail to capture a holistic
picture of contemporary youth experiences in the region. New indicators are needed to describe
important constructs, such as identity and job quality. Data producers also have to advocate for the
collection of information in sensitive and illegal areas, such as substance abuse and extra marital

9

sexuality, in order to understand the situation of youth and to create policies to promote a successful
transition to adulthood. UNICEF’s upcoming round of the household survey, MICS4, presents an exciting
opportunity 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 for
monitoring all aspects of the experience of adolescents and youth in the region, so that countries can
better understand young peoples' capabilities and needs, and in turn maximize the promise offered by
the next generation. UNICEF is poised to take a leadership role in this effort.

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1. Introduction

Young people must be endowed with the knowledge, skills and capacities necessary to assume their
roles 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 its
youth. Despite significant challenges, the burgeoning young population has the capacity to propel the
region forward and to deliver on the promise of a greater tomorrow. With more than half of the region’s
people under the age of 25, MENA has the opportunity to strengthen its economies, empower its
citizens, and guarantee the fundamental rights of all within its borders. Leaders throughout the region
seek development that can be facilitated by investing in the utility of the region’s young people. The first
step on this path is to create an enabling and supportive environment for adolescents and youth to
realize their potential.

Increased attention to the needs of young people is a common theme across many countries in the
region. The renewed efforts of many countries to meaningfully address young people’s needs have
revealed the paucity of data on MENA’s youth and adolescents. Decision makers must be empowered to
create policies and programs that are efficient and effective by drawing on reliable information. The
situation of the region’s young people lacks comprehensive analysis, and therefore requires novel
approaches to assessing adolescents’ and youths’ assets and vulnerabilities.

This Desk Review, commissioned by the UNICEF MENA Regional Office, takes a close look at the
situation of adolescents and youth age 10 to 24 in the MENA region with a view to informing such a
comprehensive approach. In assessing the status of key aspects of young peoples’ lives in MENA, the
Review analyzes what is known about adolescents and youth in the region, and also outlines
fundamental gaps in current knowledge. As such, it seeks to highlight both the knowns and the
unknowns: 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 the
promise of young people.

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2. Methodological note

The Review focuses primarily on a regional overview of trends and issues, and is not intended to analyze
country data nor to make intra regional comparisons. Some country specific information is raised in
order to highlight or illustrate a particular trend or issue. For a detailed list of references reviewed for
this exercise, please refer to Annex VII.

Defining age scope
The Review uses the following age definitions: Children: 0 17 years; Adolescents: 10 19 years; Young
People: 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 young
people, 10 24 years old. Many excellent data sources include only children or youth, for example, or
define 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 Discrepancies
in Definitions section for more information.

Defining the MENA region
The 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 MENA
region differently or use different terminology to refer to the region (e.g., Eastern Mediterranean, Arab
States, Western Asia, or simply Middle East or North Africa separately). Annex VI provides a list of
major international agencies and their regional definitions of MENA or the closest equivalent. For
consistency, the Review refers to the MENA region, using this term exclusively. When citing a source
with a different regional definition, differences in regional groupings are highlighted. Any lack of
regional 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 MENA
region contributes to the data gaps for young people in the region. When agencies provide regional
averages for MENA, these figures may only approximate the true value for UNICEF’s MENA region when
the data collector has used a different list of countries in its regional definition. Furthermore, regional
data collection efforts led by other agencies may result in a partial list of national figures for UNICEF’s
MENA region when an alternative list of countries in the region is used.

Defining adolescent and youth indicators
The Review examined the Youth Development Index (YDI). Spearheaded by UNDESA, it represents the
only intra agency effort to define common youth indicators. Furthermore, it reviewed the indicators
used and data available from other sources, including the MDGs, UNICEF MENARO’s 2006 List of
Indicators on Adolescents, ChildInfo, the World Youth Report, World Development Indicators, the Global
School based Student Health Survey, Global Youth Tobacco Survey and others.

12

Annexes III and IV list the proposed indicators and describe the intended uses of each. These lists were
created through a process of expert consultation with leaders at both Harvard School of Public Health
and the UNICEF MENA Regional Office. A list of indicators drafted for an earlier version of the desk
review served as an additional source.

Desk Review process
The Review is organized by domain, taking in turn each of the major areas affecting youth. For each
domain, the Review summarizes the status of youth in the region, the status of data on youth in the
region and recommendations for improving current knowledge.

The Review was initiated with a study of secondary data sets and analyses produced by UNICEF, UN
agencies, World Bank, League of Arab States, international research institutions and others. Materials
reviewed include regional and global reports on young people, as well as general reports involving
young people in the region and globally (see Annex VII). Since the Review focuses on regional data
rather than country specific data, individual country MICS or DHS surveys were not individually
reviewed, although data sources were referred to throughout the process. Where regional data were
not available through international databases because regional selection was incompatible (as was the
case with ILO, UNESCO), global and regional reports generating regional comparisons were consulted.

Organization of Desk Review report
The Review contains an overview of the current status of data on adolescents and youth in MENA and
an assessment of current trends and issues facing young people in MENA today. The latter also includes
recommendations on ways to close the existing knowledge gaps and improve data collection and
analysis on young people in the region. The annexes provide supporting documentation and additional
information, including a set of core indicators that provide a snapshot of the situation for youth in each
MENA country.

13

A. Bridging discrepancies in definitions
Disparities in age group classifications by different organizations complicate comparative analysis, and
reduce the utility of data that is available. For example, the WHO disaggregates age into three
categories: 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 further
disaggregates into smaller categories, including youth and adolescents. UNDESA, the publisher of the
recent World Youth Report 2007, presented data conforming to the UN definition of youth as those
aged between 15 and 24, but further disaggregated this category into two age groups: 15 19 and 20 24
to capture differences between younger and older youths. The ILO’s international database presents its
labor statistics in the same manner. UNHCR defines youth as individuals aged 5 to 17. The World Bank’s
World Development Report 2007 broadened the definition of youth to include all ages between 12 and
24. Private organizations, such as Gallup Inc. and the World Values Survey each have their own
definition of youth. Additionally, for some topic areas, surveys of students are the best current source of
data, and surveys poll students whose age range does not align with other organizations. The Global
School 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 have
linked the ‘legal age of majority’ typically 18 years with the definition of youth.1 As a result, some
reports are inconsistent across countries, such as the WHO’s Surveillance of Chronic Disease Risk Factor
Report, 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 and
classified according to the established definitions set forth by the United Nations, and in some
circumstances, in smaller component age groups. Not only will this classification yield a more detailed
picture of the phenomenon of interest, but will allow for ease of comparison with other organizations
and 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.

3. Demographic trends

Both national and international estimates indicate that more than half of the total population in the
MENA region is under the age of 25. While the age distributions of the populations of countries in the
region vary widely, it is estimated that the under 25 population in MENA region constitutes
approximately 53 percent of the total population; the second highest proportion in the world after sub
Saharan Africa (63 percent).2 Adolescents and youth each constitute over 20 percent of the total
population, comprising 20 percent and 21 percent of the region’s 396 million people respectively, as
depicted in Figure 1. The demographic shift currently underway has serious social and economic
implications for individual countries and the region as a whole. At present, it is estimated that there are
approximately 121 million young people in MENA. That figure is expected to grow to around 133 million
by 2015; an increase of 12 million young people in six years.3 Over the same period, however, the total
MENA population is expected to increase by approximately 109 million, as the current large cohort of
youth and adolescents passes age 25. As a result, the youth and adolescent component of the
population 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 its
current level of 53 percent to 45 percent by 2025. As today’s young people make the transition from
youth and adolescents to adulthood, this wave of new adults will place new demands on social
resources and infrastructure. The public and private sectors of today’s MENA region have to rapidly
evolve 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 17
September 2009.
3
United Nations Population Division, World Population Prospects: The 2008 Revision Population Database,
http://esa.un.org/unpp/, accessed 17 September 2009.

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 estimates

Fertility in MENA
As with estimates of the population distributions of countries in MENA, fertility rates vary widely
throughout the region (Figure 2). A country’s Total Fertility Rate (TFR) is the average number of children
a woman would be expected to bear throughout her lifetime if she experienced the currently observed
age specific fertility rates until the end of her reproductive life. Some countries in MENA exhibit TFRs
much 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).4,5
When countries exhibit a TFR above replacement level, usually around 2.1, their population will
increase, while if it is below, the size of the population will decrease in size in the longer term. As
displayed 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 of
young people in MENA countries’ total populations today are primarily the result of high TFRs in the
past. While other considerations such as life expectancy, migration and the trend in TFR both before and
after the birth of this cohort of young people contribute to the population distribution, past high TFRs, in
conjunction with TFR reductions since then, has resulted in today’s high young person to population
ratio. It is for this reason, in addition to trends in migration and life expectancy at birth, that the
continued decline in the TFR of many MENA countries will result in a lower proportion of young people
in MENA in the future. In 2007, the Population Reference Bureau estimated that the overall share of

4
September 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 weighted
average TFR of the oPt is 3.92 based on 2009 estimates.

16

youth in MENA will drop to 17 percent by 2025, from its current level of approximately 21 percent.6
Those countries with a lower TFR are likely to see this change the soonest, as the current youth and
adolescent 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 Region
Source: US Census Bureau International Database.

Adolescent (15 19) Fertility in MENA
Over the past 30 years, the adolescent fertility rate has fallen in all but two countries in the MENA
region; Egypt, where it has increased by 26 births per 1,000 adolescent women, and oPt, where it has
increased 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 from
previous levels. In 1970 75, only six countries with available data exhibited an adolescent fertility rate
lower than the world average of 71 births per 1,000 women aged 15 19, while 11 had adolescent
fertility rates higher than the world average. For the period 2000 2005, however, only three countries
had an adolescent fertility rate greater than the world average of 55 births per 1,000 women aged 15
19: the oPt (60), Syria (58), and Yemen (83). Due to the marked reduction in adolescent fertility over the
past 30 years by all countries except two of those with data between 1970 and 1975, the region’s
average adolescent fertility rate is now significantly below the global average. Of countries in the MENA
region, 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

Figure 3 Adolescent Fertility Rates.

Source: UN Population Division, World Fertility Patterns 2007.

Youth (20 24) fertility in MENA
Youth fertility in the region has also shown a marked decline (Figure 4). In the period 1970 1975, only
Egypt (157), Lebanon (184) and Qatar (169) were below the global average youth fertility rate of 231
births per 1,000 women aged 20 24. The remaining 14 countries for which data are available displayed
age 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 MENA
countries except Egypt (increasing by 25 births per 1,000 women aged 20 24) and the oPt (where it has
decreased by 9 births per 1,000 women aged 20 24; a relatively small decrease). All but three countries
have fertility rates in the 20 24 age group lower than the world average in 2000 2006 of 159 births per
1,000 women: the oPt (233), Syria (165), and Yemen (245).

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 Arabia


Adolescent (15 29) versus youth (20 24) fertility rates
Most countries in the region now have fertility rates for age groups 15 19 and 20 24 below the world
average. While the absolute age specific fertility rates may have both decreased, this change has not
been proportional. Figure 5 displays the ratio of reductions in the age specific fertility rates of both age
groups. Countries with a value greater than one have decreased their adolescent (15 19) fertility rate
faster than their youth (20 24) fertility rate, while those with a value of less than one have decreased
their youth fertility rate faster than their adolescent fertility rate. In the case of Egypt, the change
represents the ratio of increasing age specific fertility rates. In Egypt, the adolescent fertility rate has
increased at only 14 percent the rate of the youth fertility rate. Data from the oPt are not displayed, as
the adolescent fertility rate has increased in the Territory, while the youth rate has decreased.

19

Figure 5 Ratio of change in adolescent and youth fertility rates.


As presented in Figure 5, the youth fertility rate has fallen faster than the adolescent fertility rate in all
countries available for comparison except for Lebanon and Syria, where the adolescent rate has fallen
faster. As such, the percentage reduction in age specific fertility has been greater in the age group 20 24
than amongst the 15 19 year olds. While the percentage reduction has generally been greater among
those ages 20 24, the adolescent fertility rate has been falling in all countries in the MENA region over
time. In MENA today, the 20 24 age group contribute more births to the Total Fertility Rate than does
the 15 19 age group but greater percentage reductions since the early 1970s have been seen among
those aged 20 24.

Mortality in MENA
Young people as a group face different health challenges to young children and older people. On the
whole, young people in the MENA region experience lower rates of death from communicable and

20

chronic diseases than do those of the older generation.7 Young people generally, and young men
specifically, face a higher burden of disease from accidents, injuries and mental health issues.8 Young
women in the region face the additional risk of maternal health complications. Taken together, these
four realms contribute roughly 66 percent of women’s total burden of disease in the MENA region, and
approximately 71 percent of men’s. The burden of disease will be discussed further in Section 5 – Health
trends.

Young people
Since 1996, the death rates for young people have declined in most countries (Figure 6). In the decade
1996 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 and
Sudan, 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 this
age group. In contrast, Bahrain (0.74 percent), Kuwait (0.64 percent) and the United Arab Emirates (0.55
percent) exhibited the lowest probability of death, all below 0.75 percent. Of all countries in the MENA
region, Iran has seen the greatest reduction in the period 1996 2006, falling 1.35 percent from 2.57
percent in 1996 to 1.22 percent in 2006. While the general trend in the probability of death for young
people in the region is decreasing, the three exceptions of Iraq, Qatar and Sudan require particular
attention.

7
World Health Organization, The Global Burden of Disease, 2004 Update, WHO, Geneva, 2008. World Bank MENA
region (16 countries)
8
Ibid.

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 Arabia

Source: WHOSIS Database. Accessed at: http://apps.who.int/whosis/database/life_tables/life_tables.cfm.

Adolescents
Similar to young people generally, the probability of dying between ages 10 19 has generally fallen
across 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 an
increase of 1.85 percent and 0.09 percent from 1996 levels, respectively. While still one of the highest in
the region, Djibouti’s probability of death for adolescents marks a reduction of 0.39 percent. However,

22

while still around the regional average, the probability of death for adolescents in Qatar increased by
0.01 percent from 1996 to 2006, to 0.59 percent.


3.00

2.00

1996
1.00
2006

Change 1996-2006
0.00

-1.00
Morocco

Tunisia
Djibouti

Iran

Lebanon

Sudan

Yemen
Jordan
Algeria

Qatar


In contrast, Bahrain (0.39 percent), Kuwait (0.36 percent), Oman (0.44 percent), and the United Arab
Emirates (0.29 percent) experienced the lowest probability of death for adolescents in 2006; all under
0.5 percent. Bahrain, Kuwait and the United Arab Emirates also displayed the lowest regional rates in
MENA in 1996; however Qatar previously had a lower probability of death than Oman (0.58 percent and
0.77 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.

Youth
Four countries in the region displayed an increase in the probability of death for youth between 1996
and 2006, while the remaining 15 countries for which data were available displayed a reduction (Figure
8). Bahrain and Qatar witnessed increases of 0.01 percent and 0.22 percent, resulting in probabilities of
death between the ages of 15 24 of 0.63 percent and 0.91 percent respectively. The increase in youth
mortality in Iraq may be attributable to conflict, resulting in an increase of 5.33 percent in Iraq to a 2006
level of 6.85 percent, and an increase of 0.02 percent in Sudan to a 2006 level of 6.85 percent.

23


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

Qatar


Four countries in the region exhibited a probability of mortality between ages 15 24 of less than 0.75
percent: 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 youth
mortality 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 the
adolescent and youth age groups experienced an increase in the probability of death between 1996 and
2006, whereas Oman experienced a decrease in both age groups.

MENA’s demographic shift and the potential window of opportunity
While MENA’s total population will continue to grow in the medium term future, the average
population growth rate peaked in the latter half of the 1980s at approximately 3 percent per year, and
has declined to approximately 2 percent per year since.9 In comparison, the global growth rate peaked
in the mid 1960s at 2 percent per year, and currently rests at 1.2 percent per year. As noted earlier in

9
Population Reference Bureau. Youth in the Middle East and North Africa: Demographic Opportunity or Challenge?
PRB, Washington DC, April, 2007.

24

this section, the size of a population depends on three factors: the fertility rate, the mortality rate, and
net migration. Estimates of these three factors conclude that MENA’s population will continue to grow
in the medium term due to birth rates above replacement level and increasing life expectancies in the
majority of countries. While there will be a greater flow of migrants leaving MENA than entering10, this
negative factor will not offset growth due to fertility and delayed mortality. Should fertility decrease to
replacement level or below, the region will still experience growth, as the large cohort of children and
young people move into their reproductive years and have children of their own. Though this cohort will
be having fewer children per person than the current adult population, growth will continue due to the
larger size of the population of reproductive age.

Declining fertility in the region will result in a ‘youth bulge’, in which the proportion of the population
comprised of adolescents and youth peaks and then declines. The hypothetical population pyramid
depicted in Diagram 1 displays this phenomenon, as the proportion of the population aged 10 19 is
larger than any other 10 year age bracket older or younger. Diagram 2 displays a population pyramid
comparing the MENA region and the global average population distribution. The global population
distribution displays this youth bulge, where the proportion of people in the 10 14 age bracket is larger
than any before or after it. As MENA’s fertility rate declines, the number of children born in each new
cohort will decline as a percentage of the total population. As the ‘youth bulge’ cohort reaches
adolescents and youth, countries in the region have the opportunity to harness the potential of a
generation equipped with the human and social capital to propel the region forward, or miss the
opportunity and face substantial economic, social and political challenges as this large generation
reaches adulthood.

10
September 2009.

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

Diagram 2 Population Pyramid of MENA Region and World

The creation of a large cohort of young people marks the opportunity for countries and the region as a
whole to transform the cohort’s skills and knowledge into growth. As they move through adolescence
and into adulthood, the cohort becomes part of the working age population. The country or region’s
success in forming appropriate policy and planning for the needs of adolescents and youth will
determine 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’s
potential supply of labor. As the youth bulge moves into this age category, there is the potential to
translate this window of opportunity into a ‘demographic dividend’.11 This increase in the proportion of
the population who are of working age decreases the dependency rate; the ratio of the working age
population to the sum of those aged less than 15 and over 65. By utilizing the working age population in
decent and productive work, countries translate their human capital resources into economic growth. A
fall in the dependency ratio, if planned and managed effectively, can lead to increased productivity, as
well as higher incomes, savings and investment, as seen in the case of the ‘East Asian Tigers’. Increasing
productivity and incomes can be transformed into benefits for the young and elderly also, either directly
through families, or indirectly through higher government revenues channeled into programs. The
demographic dividend has the potential to significantly boost the sensitive economies of individual
countries, and the region as a whole. Should the youth bulge not be adequately planned for and
sufficient investments made, countries face the risk of higher general and youth specific
unemployment, reduced productivity, stymied investment and stunted economic growth. As
investments in social infrastructure must be planned in advance, the MENA region now faces the
11
Bloom, David E., Canning D and Sevilla, J., The Demographic Dividend: A New Perspective on the Economic
Consequences of Population Change, Population Matters Monograph MR 1274, RAND, Santa Monica, 2003.

27

opportunity, or potential challenge, of investing in the human and social capital of its youth to propel
the 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 year
period when countries experience a low dependency rate due to the youth bulge moving through the
working ages. Following this period of potentially significant economic growth, the dependency ratio
again increases, as the large cohort moves out of the working age band and retires, once more
becoming primarily dependents. UN ESCWA and LAS estimated that in the MENA region, the
demographic window of opportunity opened in 1995, and is expected to close around 2045 throughout
the region. Never has there been a more important time to invest in MENA’s young people to develop
and 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 among
them is the creation of an education system that equips students with the knowledge and skills they will
need in their future careers. Simply providing places in primary, secondary and tertiary education is
necessary, but not enough. Countries must ensure that school curricula improve the quality of education
by 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 leaders
themselves, through developing entrepreneurial ability and fostering opportunity.

Second, governments must become employment enablers and not constrainers. By creating an enabling
environment for the private sector, governments can encourage job creation and opportunities for
young people entering the workforce. By motivating industry to provide productive, decent work, policy
makers can ensure that the rights of workers are upheld while promoting a dynamic economy that
responds to the needs of its customers and community. Growing productive economies create job
opportunities, reducing both the unemployment rate and the demand on resources it creates, allowing
individuals to claim income with dignity.

Third, countries must invest in their social capital, particularly in the areas of health and pension
systems. Healthcare should not merely respond to disease and disability after it has occurred; health
policy should seek to prevent, as well as cure the burden of disease. Primary prevention is an
inexpensive 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 systems
should strive to be efficient, cost effective and accessible, providing the care that is required when
treatment becomes necessary. Similarly, in the longer term, governments must ensure that when the
current youth bulge reaches retirement, they are able to lead full and fruitful lives without
compromising the opportunities for the rest of the population. Policies must allow for individuals to
contribute to their own retirement while working, and also support solvent and economically sound
pension 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 skills
necessary to become the leaders of tomorrow. Policies encouraging community engagement and female

28

and youth empowerment advance the ideal of an inclusive society, promoting shared ideals and social
bonds. Efforts to deepen intergenerational relations and community belonging enhance social cohesion
and the development of a just society, consolidating communities’ willingness to contribute to their own
development.

Through such measures, countries in the MENA region can strengthen their ability to fully benefit from
the valuable demographic opportunity before them. By investing in the social and human capital of its
population, and especially its adolescents and youth, the MENA region stands to reap the demographic
dividend. Should the region’s countries fail to adequately plan and respond to this window of
opportunity, they stand not only to miss out on the potential benefits of the demographic dividend, but
also to bear the burden of high unemployment and low economic growth, and a future which will leave
them 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

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 Percentage
Region 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

the population lives below this benchmark, a reduction of 14 percent since 1990. Comparing percentage
reduction figures for absolute and relative poverty reductions show that MENA states have reduced the
proportion of their population living on less than $1.25 per day faster than the proportion living on less
than $2 per day. While decreases in both rates are positive, disparities between reduction rates raise
the concern that the absolute poor are merely shifting from one state of poverty to another, and not
experiencing meaningful increases in incomes. While this is less of a concern in MENA than in any other
global region, individual countries in MENA should be aware of the total income distribution of their
population to ensure that economic gains are spread throughout society.

Available poverty data for eight countries in the region display heterogeneity in both levels of absolute
and relative poverty rates themselves, and states’ success in assisting their poor out of poverty (Figures
9 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 (absolute
poverty: 0.38 percent, relative poverty: 8.02 percent), others such as Djibouti (absolute poverty: 18.84
percent, 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 in
absolute and relative poverty rates have been mixed in MENA (Figure 11), with Djibouti and Yemen
displaying large increases in both absolute and relative poverty rates (Yemen: 0.66 percent & 1.46
percent, Djibouti: 1.97 percent & 3.49 percent increases per annum, respectively), while Morocco and
Tunisia have experienced significant decreases (Morocco: 0.53 percent & 1.31 percent, Tunisia: 0.79
percent & 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%


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%


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

Iran

Source: Calculated from statistics presented in Ravallion, M., Chen, S., "The developing world is poorer than we thought, but
no less successful in the fight against poverty", World Bank 2008.

32

Table 2 presents the change in absolute poverty as a percentage of the change in relative poverty for
countries where data were available. The distribution of poverty rate change has differed between
countries in the region, with only Jordan reducing absolute poverty at a faster per annum rate than
relative poverty, though the absolute difference is small due to Jordan’s low baseline rate for the period
of analysis. Change in absolute poverty rates in the four other countries for which data are available
occurred at approximately half the rate of relative poverty. In Morocco and Tunisia, these changes were
a decrease; in Djibouti and Yemen, the relative poverty rate increased at twice the rate of absolute
poverty. In Egypt, absolute poverty fell at only 6 percent the rate of relative poverty. Proportional
comparisons were not possible for Algeria and Iran, because absolute poverty rates increased, while
relative 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, but
no 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. In
many cases, poverty information is not collected regularly, while in other cases, data are collected but
either not shared, or made available to only a limited audience. As such, poverty data analysis in MENA
is stifled by a lack of both data collection and data dissemination.12 Reliable population wide data is
available only for eight countries in the region, and is not available for any of the GCC states.

Youth specific poverty in MENA
Internationally, adolescents and youth are typically overlooked in poverty data collection and poverty
reduction strategies.13 Even in cases where national data are collected, findings are not disaggregated by
age to allow for reliable adolescent and youth specific estimates. In comparison to adults, young people
often experience a “dynamic”, acute form of poverty, while adults face more chronic, long term
economic difficulties. As young people complete their education and move to the labor market, they

12
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

find employment that generally helps lift them from the poverty cycle. Extrapolation of adolescent and
youth poverty rates from national poverty figures is therefore an imprecise measure, as young people
make the transition from the economic circumstance of their families to their own. Data collection and
analysis strategies that overlook this factor risk presenting an unrealistic and inaccurate picture of the
poverty situation of young people in MENA.

In addition to the paucity of population wide poverty data for the vast majority of countries in the
MENA region, there is a particular dearth of adolescent and youth specific poverty information,
rendering regional aggregation and comparison problematic. Although limited data from the 2007
World Youth Report reveals estimated youth poverty rates for seven countries in the region, these data
suffer 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 national
percentage of the population living in poverty multiplied by the number of youths in the population at
that time. These estimates therefore assume that the youth specific poverty rate is identical to the
population wide poverty rate. As such, the data do not lend themselves to calculation of a youth specific
poverty rate, but indicate the number of youth living in poverty if they experience poverty rates
identical to the population average.

Second, estimates are not presented for adolescent poverty rates or levels. This may be due to two
factors: 1) poverty data are not disaggregated at the time of collection to allow for adolescent specific
calculations, due to methodological restrictions; and 2) while a number of agencies work with
adolescents, there is no dedicated global or regional publication dedicated to adolescents, such as the
World Youth Report. Estimates and analysis of adolescent issues therefore do not have a “reference
publication”, where adolescent specific data would be presented.

Both of these considerations limit the validity and reliability of adolescent and youth poverty estimates
in MENA. The prima facie lack of available poverty data, and the scarcity of national adolescent and
youth specific poverty estimates complicate calculation of accurate regional levels and trends. Where
household surveys are conducted, it is still difficult to disaggregate the data collected at the household
level. Household members are not questioned individually about their income, making any form of data
disaggregation virtually impossible.14 To arrive at accurate estimates of adolescent and youth specific
poverty 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 of
development between states in the region. While a large percentage of Djibouti and Yemen’s
populations live on less than $2 per day, the other five countries with available data display much lower
rates of poverty; 2) the percentage of people in absolute poverty (living on less than $1.25 per day) is
notably low in five of the eight countries, ranging from less than half of a percentage point to two and a
half 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 the

14

34

percentage in absolute poverty. This contrast indicates that while absolute poverty rates in MENA are
relatively low, a far higher proportion of national populations are still subject to very low incomes
throughout the region.

It is important to note that key international institutions providing poverty reduction support have
launched initiatives to make poverty reduction policy in low income countries more effective. The World
Bank and the International Monetary Fund have launched the Poverty Reduction Strategy (PRS)
Initiative, in which countries seeking debt relief must demonstrate through Poverty Reduction Strategy
Papers (PRSPs) how savings will contribute to poverty reduction. However, a 2006 review of 55 PSRP
found that “young people are under represented, despite their large share of the populations of poor
countries.”15 As one of the largest segments of MENA’s population, with distinct needs and
expectations, national poverty reduction strategies must take into account the unique circumstances of
youth and adolescents in order to design effective poverty reduction initiatives.

Youth working in poverty
Of related concern to poverty rates themselves, the ILO has recently calculated the regional share of the
working youth population who do not earn enough to lift themselves out of poverty (Figure 12). Such a
situation is concerning, as it suggests that many young people who find work still do not earn enough to
meet their basic needs. Youth working poor are therefore all of those aged 15 to 24 who work but who
do not receive enough to surpass the $1.25 or $2 a day poverty thresholds through decent and
productive work. The youth working poor are more likely to be employed in the informal economy,
earning low wages with little job security or benefits.16

Figure 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

Percentage

Source: Global Employment Trends for Youth. ILO, 2006.

15
UNFPA. Putting Young People into National Poverty Reduction Strategies: A guide to statistics on young people in
poverty. UNFPA, New York, 2008.
16

35

ILO estimates of regional youth working poverty rates indicate that almost 40 percent of MENA’s
employed youth were living on less than $2 a day in 2005. While this is a high percentage, the region
fares better than four of the six other ILO regions. Latin America and the Caribbean has a slightly lower
proportion of working youth living on less than $2 per day (35 percent), but a higher proportion of its
working 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 many
others. However, to narrow the gap further, and to meet states’ commitments made in 2000, these
efforts 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

5. Health trends
Promoting health is an essential component of strengthening populations’ human security. The right to
health is a fundamental human right, and MENA states’ commitment to fulfilling the promise of health
provides a standard against which they may be held accountable. While adolescents and youth are a
relatively healthy population, their well being is subject to vulnerability that is different to most other
age groups. Challenges to young peoples’ health in MENA are primarily the result of exposure to risky
health behavior. Many young people underestimate their risk of disease, injury and vulnerability to risk
factors such as smoking and obesity. Behavioral patterns expose young people to greater risk from
nutritional, lifestyle, and sexual choices, among others, that amplify their risk of adverse outcomes.17
The lack of resonant and accessible preventive and restorative health information available to young
people limits their ability to make informed decisions, leading to excess mortality and morbidity in the
MENA region.18 Compounding these challenges is the dearth of youth and adolescent specific health
data, 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 9
years), maternal health (15 49 years) and general adult health (15 49 years). Recognition of the
importance 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 of
age specific data empowers policy makers to identify needs and formulate policies that positively affect
the 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 analyzed
worldwide rates and patterns of mortality between early adolescent and young adulthood. Findings for
the MENA region are discussed later in this section.19

This section will examine the available data and identify gaps in information on adolescent and youth
health 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, and
adolescent 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 in
this section. Adolescent and youth fertility and mortality rates are discussed in Section 3 – Demographic
trends 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 is
important to note that youth who earn their living in the informal economy may be at increased risk of
occupational safety hazards due to the absence of any regulatory authority promoting safe workplace
behavior 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

Young people’s sexual and reproductive health (SRH)
Adolescence is a time of physical, physiological, and social transition into adulthood. Sexual
development is a natural part of this process, but not all adolescents are exposed to the appropriate
information and services to help them further understand this transition in their lives.20 Social and
demographic 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 face
a transition very different from that of their parents. Delayed completion of key rites of passage to
adulthood, such as marriage and employment, create a gap between adolescence and adulthood. More
than any other time, it is in this period that young people face increased risk of unintended pregnancy
and sexually transmitted infections (STIs).21 Reducing these risks and vulnerabilities requires the
formulation 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 International
Covenant on Economic, Social, and Cultural Rights (ICESCR), as well as participated in the Convention on
the Elimination of all Forms of Discrimination against Women (CEDAW) and Beijing Conferences (original
and the Beijing +5). Participation in these treaties indicates governments’ willingness to meet the
commitments necessary to fulfill young peoples’ right to access SRH information, education and
services. A key study in the field of young people’s SRH in MENA, “Breaking the Silence and Saving
Lives”, emphasizes the failure of many states to meet their commitments due to community taboos and
disapproval of behaviors such as premarital sexual activity or substance abuse. By not fulfilling their
responsibilities, states tacitly contribute to the further marginalization and vulnerability of young
people.22

Little data have been generated on adolescent and youth sexual and reproductive health in MENA. The
few groundbreaking studies that have been conducted are necessarily limited, due to challenges in data
collection on sensitive topics. Taboos against discussion and analysis of the reproductive health of young
people pose a major obstacle to further research on the topic. The lack of services for unmarried young
people also contributes to the shortage of data generation, as the majority of data are derived from
operational research. As such, social taboos and cultural sensitivities have been the primary factor
contributing to the current paucity of data on young people’s sexual and reproductive health.23 A
number 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, October
2006, 849 851.
21
Population Reference Bureau. Young People’s Sexual and Reproductive Health in the Middle East and North
Africa., 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

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.24

As a result of shortages of data collection, analysis and dissemination of accessible information and
services, 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 to
misconceptions of opponents of sexual and reproductive health education for young people, reviews of
sexual education programs show that sexual education does not promote early sexual activity, but can
rather delay initiation and promote safer practices.26

Within MENA, sexually transmitted disease surveillance capabilities remain weak; cases are under
reported, with relatively few country specific studies on STI incidence among young people. Of the
limited data available on STIs, which are seldom disaggregated by age, findings indicate that STIs are
more common among younger adults (15 29) than those in older age groups. Few studies have
examined young people’s knowledge of STIs, however available research suggests that correct
knowledge about STIs and their transmission is low.27

Surveys in a limited number of MENA countries have aimed to collect information on STIs, including HIV
AND AIDS. Results indicate that although many young people had heard of HIV AND AIDS, most knew
little about its transmission or about other STIs. The results also demonstrated that young Tunisians
were better informed than those in Syria and Algeria, indicating the success of different government
policies.28

Given the lack of data directly addressing young people’s sexual and reproductive health knowledge in
MENA, this review will use the proxy measures of early marriage, adolescent fertility and adolescent
maternal mortality to indicate the extent of health risk and protective factors. Additionally, these
aspects constitute key outcomes of sexual and reproductive knowledge and behaviors, allowing a
rudimentary evaluation of state performance.

Early marriage
Early marriage is closely associated with adolescent fertility, which carries significant maternal and
infant health risks. Early marriage can also lead to other non health related consequences. Women who
marry early are more likely to: 1) become school drop outs and be socially isolated; 2) receive pressure
from their family and social circle to have children quickly; 3) have less knowledge about family planning

24
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

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

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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