Miryam lives with her family in Manshiyat Nasir, originally a squatter settlement at the foot of Cairo’s Muqattam hills, now largely a brick-built community of small apartment buildings and box-like single family homes. Most now have piped-in water and electricity. Her family is one of the thousands of zabbalin (garbage collector) families comprising a large Christian minority among Manshiyat Nasir’s mostly Muslim residents. They live in a two-story, warehouse-like structure perhaps 25 feet high and about 20 feet square. Off to the side of the main living space, a narrow room has just enough space for a loom; a walled-in area behind the house is home to the family’s 18 pigs.
Miryam is 17, and not yet married. What distinguishes her from many of her neighbors is the loom in her home, and the fact that she is literate in Arabic and beginning to learn English. Walking through the neighborhood, Miriam is an enthusiastic guide to her community — pointing out a recycling workshop housing a machine for crushing plastic for reuse, the veterinary clinic established by the zabbalin association and a day care center for young children.
Through a convergence of local community activism and international assistance, the zabbalin and other residents of Manshiyat Nasir have witnessed some important changes in their lives. Improved pumping systems ensure that a majority of residents have access to potable water; immunization campaigns have all but eliminated tetanus and other vaccine-preventable diseases among women and children. Tacit government recognition of the settlement means that residents can, in effect, buy and sell property. Voluntary organizations such as the Association for the Protection of the Environment sponsor projects for women that combine teaching functional literacy with ways of earning money — thus the loom in Miryam’s home. 
Despite these improvements, Manshiyat Nasir is still an urban environmental nightmare. Zabbalin women sort through the garbage collected by their husbands and children with bare hands, fearing that gloves will slow down their work and add to their onerously long day. And the refuse of modern-day Cairo — replete with deteriorating batteries, broken glass and hospital waste, mixed in with the food waste that goes to feed the pigs — poses a great threat to public health. Among the tasks assigned to children is the disassembling of used plastic syringes from Cairo’s many hospitals.
Any garbage that cannot be reused in some way ends up back in Manshiyat Nasir’s narrow pathways until it is taken to be burned. It covers the asphalt and mud streets with a thick, soft and often slippery layer of trash. Inadequate sewage systems overflow frequently, further endangering the health of residents.
Manshiyat Nasir can be viewed as one extreme of urban environmental hazard in the Middle East and North Africa. It reflects social, economic and demographic trends and circumstances common to most countries in the region: rapid population growth and increasing urbanization; scarcity of land, water and other economic resources; and limits on women’s social and economic autonomy.
Many governments in the region view one or even all of these factors as obstacles to economic and social development, but often their policy responses have been ambivalent. Programs aimed at slowing rates of population growth have tended to focus solely on female reproductive behavior through the provision of modern contraceptives, paying far less attention either to men’s roles in reproductive decisions or to women’s other health needs. In addition, governments often fail to take into account other factors that influence women’s reproductive choices, such as their education, job opportunities and overall status.
Equally important is the failure of some governments to persuade their citizens that slowing population growth has benefits for them as individuals. Few have effectively communicated the extent of natural resource limitations in the region. And citizens’ general alienation from their political systems reinforces their suspicions that efforts to slow population growth are merely another way in which governments seek to protect the lifestyles of wealthy elites by reducing pressures to achieve greater social and economic equity. “Why is it easier to insert Norplant in a woman’s arm than to tell a man in Muhandisin not to drive his Mercedes?” asks Aida Sayf al-Dawla, a founding member of New Woman, a research and study center. 
In some countries, such a politically provocative question is hardly ever raised. For the oil-rich states of the region, high rates of population growth (above 3 percent in most cases) have been viewed as satisfactory by governments eager to meet the demand for labor but ambivalent or even opposed to increased women’s work outside the home. This view persists despite very real natural resource constraints. In Saudi Arabia, Bahrain, Qatar and the United Arab Emirates, per capita annual availability of renewable fresh water is less than one third of the 1,000 cubic meters regarded as a benchmark of water scarcity. 
Beyond the limited availability of cultivable land and fresh water, the degradation of existing resources is a problem throughout the region. Concentrations of air pollutants such as sulfur dioxide (in Istanbul) and lead (in Cairo) are well above the levels considered safe.  Water pollution is also a serious problem due to industrial wastes, agricultural pesticides and other chemicals. The quality — and thus the productivity — of agricultural land is threatened by salination, which is a consequence of the expansion of irrigated agriculture in countries like Egypt and Iraq.
Awareness of these environmental problems is growing in the region, according to Mostafa Tolba, the former head of the UN Environment Program and now the president of a non-profit environmental consulting firm. “Developing countries no longer see concern for the environment as a luxury,” says Tolba.  And environmental “problems” are being defined more broadly to encompass such concerns as health, bad housing and poor sanitation.
Yet teaching alternative, more environmentally sound behavior is extremely difficult, according to ‘Imad ‘Adli, secretary-general of the Arab Office for Youth and the Environment. “You can’t ask people to dispose of garbage properly if there’s nowhere to put it; you can’t really talk about water conservation without the technology to make it happen; and you can’t buy healthy food if it is not on the market. The fact is that there are few alternatives to the way most people currently live their lives.” 
At the international level, as awareness of the challenges posed by population growth and environmental degradation has increased, so has concern for how linking the two might affect women. Particularly troubling is “the implication that women are responsible for environmental degradation as long as high fertility rates are viewed as a significant cause of environmental pollution.” Such a perspective reduces choices of family planning “to a means to an end rather than a legitimate end in itself.” 
These concerns provoked sharp debate at the forum of NGOs held concurrently with the 1992 UN Conference on Environment and Development in Rio de Janeiro. By the time of the summit, population had been downgraded from primary importance to a number of “cross-cutting” issues; and the Vatican, with the help of a few countries, succeeded in weakening Agenda 21’s language on family planning such that the word “contraceptive” never even appeared. At the NGO forum, those gathering in the women’s tent went back to the beginning to ask: Is there a causal relationship between population increase and environmental deterioration? Given the emphasis of many developing countries’ family planning programs on numerical demographic goals, rather than on the right of individual women and men to plan their families, would a framework linking population and the environment further strengthen the emphasis on top-down, coercive population control? For the majority of those attending the discussions, the answer was yes.
Two years after Rio, the International Conference on Population and Development (ICPD) is taking place in Cairo. Focusing on population and sustainable development, the ICPD reflects many of the concerns raised by women in Rio, and includes a much greater emphasis on women’s needs and aspirations. The ICPD’s draft Program of Action’s more holistic approach acknowledges that population, reproductive rights and health, gender equality, the environment and development are inseparable.
Moving beyond “family planning” is a recurrent theme of the articles in this issue of Middle East Report. Philippe Fargues posits changes in population structure and inter-generational and gender hierarchies as sources of social change. Challenging the accepted wisdom regarding the Arab world’s demographic explosion, Fargues argues that the demographic transition to lower fertility in the region is, for the most part, well underway. The crisis is social and political, not demographic.
Homa Hoodfar notes the success of Iran’s government in communicating the relevance of the population issue for that society, the international community, and individuals. At the same time, she emphasizes the contradiction between the government’s programmatic emphasis on female contraceptive methods and its reluctance to grant greater freedom and decision-making authority to women.
Non-programmatic factors affecting reproductive attitudes and behavior are also the focus of Youssef Courbage’s essay. He calls attention to how varying patterns of international migration have led to the “diffusion” of contrasting norms of ideal family size, which is also being affected by labor force participation of women.
Back in Manshiyat Nasir, Miryam is part of the changes in the hierarchy Fargues describes. By learning to read and write, she has already gone far beyond her parents. With an independent source of income, her role in such decisions as who she will marry and how many children she will bear will be much stronger than her mother’s. And her travels outside Manshiyat Nasir — made possible by the association in which she is emerging as a leader — are expanding her perception of the possible.
Yet the interventions that have helped bring some change to Miryam’s life do not come cheap. While the preparatory process for Cairo has helped resolve some of the political tensions evident in Rio, the issue of resources remains problematic: will those with greatest control over the world’s wealth be willing to make available even the limited funds explicitly called for in the draft Program of Action — $17 billion by the year 2000, one third of which is slated to come from donors? Reflecting on progress since the Earth Summit — and other international conferences going back almost 20 years — Mostafa Tolba, for one, has his doubts.
“The Rio conference called for a total of $725 billion, $600 billion of which is to come from developing countries and $125 billion in aid,” he recalls. “What is available now? The Global Environmental Facility has gone from just $1.3 billion to $2 billion in three years — an extra few hundred million. And the same will happen in Cairo. Money, where will it come from and where will it go? The fact is we, as an international community, are not serious. If all the resolutions, declarations, and action plans promulgated and adopted had actually been translated into deeds, we would not have environmental problems. Instead, we have an environmental crisis.”
Effective change also carries a political price tag. While NGOs are expected to play a key role in pushing forward the agenda that emerges from Cairo — as they have in Manshiyat Nasir — they cannot substitute for government action. “Everyone is putting great hope in the role of NGOs, but it’s too much,” says Aida Sayf al-Dawla. “They are not an alternative to a corrupt government that consistently seems to prove that it doesn’t really care about the well-being of its people.” Following the Cairo Conference, with all its extravagance and whatever the merit of its proclamations, the task of pushing the process of change in the face of existing hierarchies of wealth and power will remain.
 For a more complete account of both the history and the health profile of Manshiyat Nasir, see Belgin Tekçe, Linda Oldham and Frederic C. Shorter, A Place to Live: Families and Child Health in a Cairo Neighborhood (Cairo: American University in Cairo Press, 1994). See also Marie Assaad and Nadra Garas, “Experiments in Community Development in a Zabbaleen Settlement” Cairo Papers in Social Science 16/4 (Winter 1993-1994).
 Interview, June 1994.
 For more on Saudi Arabia’s water resources and the concepts of water stress and water scarcity. see Robert Engelman and Pamela LeRoy. Sustaining Water: Population and the Future of Renewable Water Supplies (Washington, DC: Population Action International, 1993).
 WHO/UNDP, 1992 Urban Air Pollution in Mega-Cities of the World (Oxford: Blackwell, 1992).
 Interview, June 1994.
 Interview, April 1994.
 Susan Cohen, “The Road from Rio to Cairo: Toward a Common Agenda,” International Family Planning Perspectives 19/2 (June 1993), p. 61.