As the year 2000 approaches, humanity has passed an important milestone, one that has nothing to do with the new Millennium, but which may have many more consequences than the Y2K bug. On October 12, the world’s population officially passed six billion. While pundits debated whether this was cause for concern or celebration, it is worth noting how we got here and where we’re headed. Population issues are particularly relevant in the Middle East and North Africa (MENA), where the population has more than doubled in size since the mid-1960s and will likely increase by another 50 percent by the year 2025. 
These trends pose both promise and peril for the region as a whole — the economic promise of a growing labor force and declining numbers of dependents, and the peril of resource scarcities and environmental challenges that threaten the region’s economic future and the health of its people.
In assessing demographic challenges facing the MENA region, two concerns stand out: the need for fresh water resources critical for long-term economic development, and the status of women. Perhaps surprisingly, the two are closely linked. Women’s status is an important factor in their reproductive behavior, in turn a determinant of rates of population growth crucial for assessing the region’s environmental prospects, including those relating to water.  Mediating the two are government policies and programs in the region.
From Demographic Transition…
The world is undergoing a demographic transition  — one that is all but complete in the countries of the industrialized North, but still underway or just beginning in most of the South. While high levels of fertility and high rates of natural increase characterized developing countries in the 1960s and 1970s, the picture is much different today. Fertility in some developing countries — mostly in East Asia — has declined to a level consistent with an eventual stabilization of population size (roughly 2.1 children per woman). In Latin America, fertility is generally less than 50 percent higher than this “replacement level fertility,” while in most countries of sub-Saharan Africa, women typically give birth to more than five children.
Demographic diversity is evident in the Middle East and North Africa, where the onset of fertility decline began as long ago as the mid-1800s in Turkey,  yet has barely begun in Yemen. For most countries of the region, however, the demographic transition began in the mid-1980s.  Fertility is low (fewer than three children, on average, per woman) in Lebanon, Turkey, Iran and Israel; at intermediate levels (between three and five children) in 12 countries, including Kuwait, Tunisia, Egypt, Iran and Syria; and high in Iraq, Saudi Arabia, Yemen and Oman. In the Gaza Strip, women have, on average, more than seven children — one of the world’s highest fertility rates.
The population of the MENA region has more than doubled since the mid-1960s, reaching more than 370 million in 1995. By 2025, the region’s population will likely increase by another two-thirds, to more than 600 million, according to the United Nations’ medium population projection. At 2.25 percent, the rate of growth for the region as a whole has slowed since the mid-1960s, but worldwide only Central America and sub-Saharan Africa are growing more rapidly.
Within the region, growth rates also vary significantly. Seven countries are growing at less than two percent per year, including Lebanon, Tunisia, Turkey and Israel, while rates exceed three percent in Saudi Arabia, Jordan, Oman, Yemen, the West Bank, and Gaza Strip. Despite gradually slowing growth rates, however, the number of people being added to the region’s population each year has almost doubled since the mid-1960s, to more than 8 million people — equivalent to adding a country the size of Tunisia each year.
The key challenge facing the region is the population’s age structure. With more than one-third of its population under age 15, the region would expect significant growth — even in the absence of high average fertility — due to the “momentum” generated by large numbers of young people yet to enter their reproductive years. Population momentum explains why the world’s population would still grow to more than 8 billion by 2050, even if each woman, as of this moment, bore an average of only two children.
Excluding Israel, Lebanon, Turkey and Tunisia, where fertility began declining somewhat earlier, MENA countries have young populations.  By 2025, however, only Oman, Yemen and the Gaza Strip will be considered to have young populations, as they are just now entering the demographic transition and have high levels of fertility as well as high rates of natural increase. Declining fertility rates elsewhere in the region will lead to an increase in the proportion of the population that is elderly in the 21st century. Most MENA countries will have “mature” populations by the year 2025.
….to Demographic “Bonus”
As fertility declines, countries typically pass through a time of high ratios of working age to non-working age people. This reduction in the dependency ratio produces the “demographic bonus”: the large size of the work force relative to the general population has the potential possibility to affect economic growth. The fact that most MENA countries are in the middle of the transition from young to mature populations affords opportunities for economic development, if proper investments in human capital and economic reforms are made.
This is a big “if.” According to Cincotta and Engelman, the shift to smaller families in the so-called Asian Tigers had three important repercussions.  Growth in the numbers of school-age children slowed while governments’ and families’ education investments per child increased, with an emphasis on primary and secondary education. As the trend towards smaller families intensified, family savings increased while governments were able to reduce public expenditures. Indeed, by the mid-1990s, the Asian Tigers were net exporters of capital. Finally, as labor force growth slowed, wages increased, and under the government’s leadership, the private sector moved into fields requiring skilled labor.
Whether the MENA region will witness such a positive outcome is debatable. Underemployment and unemployment are high in the region — unemployment alone is well above ten percent in several countries. Women’s low, but increasing labor force participation rates constitutes a further challenge.  In 1995, between 15 and 50 percent of women in the region were active inn the labor force; their share of the labor force is gradually increasing.  In countries with high unemployment, job creation has already fallen short, a factor which tends to reinforce existing biases against women. In countries where traditional norms about women endure, female participation in the labor force is still resisted. An aging population structure brings its own challenges as well, including old-age pension systems that, if they exist at all, follow the “pay-as-you-go” model developed in the industrialized countries of the North. Influencing all these trends are the social and economic policies of the region’s governments.
Factors in Fertility Decline
While access to family planning services is key to a women’s control over her own fertility, later marriage is the dominant factor influencing fertility decline in the region.  Both average age at first marriage and the proportion of women who never marry are rising. Underlying these changing is an array of factors reflecting modernization — and in some cases, rising economic constraints — which have influenced desired family size and levels of contraceptive use.
Concerning access to family planning, the region’s governments have taken very diverse approaches towards providing these services. Mohammed Bouzidi, in a 1999 conference presentation, compared the experiences of several countries to make this point.  In Tunisia, the state took the lead in the family planning arena in the 1960s, reinforcing its efforts with policies aimed at improving women’s status and an explicit recognition of the links between population growth and socioeconomic development. In Morocco, strong state support for family planning services came later, but the Moroccan Family Planning Association (founded in 1971) fostered a positive environment around family planning. 
In Iran, state support for family planning disappeared during the first decade of the Islamic Revolution, only to begin anew in the late 1980s. Iran’s approach is particularly noteworthy because it emphasizes the benefits of family planning to individual health and well being, as well as to society as a whole.
Throughout the region, governmental attitudes towards their citizens’ reproductive behavior vary. Five of six North Africa countries, plus Iran, Jordan, Turkey and Yemen, view their birthrates as “high.” Only two countries in the region as a whole — Iraq and Israel — view their birthrates as being “low,” while the remaining eight countries term their birthrates “satisfactory.”  Variations in attitude have less to do withy actual variations in fertility than with governments’ perceptions of their economic and/or geopolitical needs. In the case of the wealthy Gulf states, most notably Saudi Arabia, higher fertility rates were seen as a solution to national dependence on a large foreign labor force, while Israel traditionally views itself as competing demographically with a faster-growing Palestinian population.
Since the 1994 International Conference on Population and Development, which explicitly rejected demographically driven approaches to family planning service provision, more and more countries in the region are expanding access to these services, for health reasons and associated social benefits alone.  This expansion is critical, since women continue to pay the price of high fertility, frequently with their lives. Maternal mortality remains relatively high in the region, including in such wealthy countries as Saudi Arabia — perhaps due to the still high rates of pregnancy among girls aged 15-19. And while contraceptive use is rising, access to a broad range of methods is still the exception rather than the norm.
Transforming Impact of Education for Girls
A key factor in the social changes occurring in the region, including late age at marriage, is the impact of girls’ greater access to education. Primary school enrollment of girls now exceeds 90 percent in all but a handful of countries in the region.  Only in Yemen and Sudan are fewer than 50 percent of primary school-age girls enrolled. Even more significant are gains at the secondary school level since 1985; female enrollment now exceeds 50 percent in all but six countries of the region. These figures reflect a 50 percent or greater increase in secondary enrollment in half a dozen countries and significant increases in others. Leading the pace of change is Oman, where high school enrollment of girls increased nearly fourfold since 1985. For the many countries of the region still experiencing rapid growth in their school-age populations, these achievements are even more remarkable.
Also significant is regional progress toward closing the gender gap in education. Oman, Algeria, Saudi Arabia, Lebanon, Egypt and Iran were among ten countries recognized in a 1998 study for realizing progress towards this goal.  Unfortunately, a few countries have also seen decreased in female secondary school enrollment, most notably Jordan and Syria (in the case or Jordan probably due to increased demands on school capacity caused by the influx of Palestinians following the 1991 Gulf War).
The impact of education opportunity for girls in the region is significant. Girls who reach secondary school are more likely to delay marriage and childbearing, their children tend to be healthier, and their participation in the labor force greater — with corresponding benefits to national economic growth and productivity.  In addition, educated women tend to have fewer children — as many as two to four fewer children than women lacking formal education.  These statistics bespeak a regional tendency toward greater autonomy, status and negotiating power for women — a slow and uneven process of change that may prove unstoppable in the long run.
The Challenge of Increasing Urbanization
Urbanization has proceeded rapidly in the Middle East and North Africa. While typically viewed as a force for modernization — which often translates into lower fertility within a single generation — urbanization is a double-edged sword. Those moving to cities often gain better access to social services, including education and healthcare. But the resulting expansion of urban settlements results in the loss of scarce arable land, among other negative environmental impacts. And while urbanization is swallowing up arable land in the region, food needs continue to increase.
In cities such as Cairo, Tehran and Istanbul, air quality is often dangerously poor. Whether sulfur dioxide, particulate matter, nitrous oxide, lead, or some combination thereof, levels of air pollutants in these cities often exceed guidelines established by the World Health Organization — in some cases by a factor of two of three.  Leaded gasoline, the norm in the region, carries the risk of heightened lead concentrations in the blood and, in the case of children, decreased IQ.  Overall, according to scientist Allen Hammond, “more than 60 million people live in cities with dangerously high levels of air pollution.” 
The greatest long-term challenge facing the region, however, is a dearth of renewable fresh water supplies.  In the 1950s, 14 million people in 7 of 20 MENA countries were already living in conditions of water scarcity or stress.  By 1995, that figure had increased to nearly 200 million people in 14 countries, including Egypt. By 2025, Iran and Lebanon will have joined this group, and the combined population of the 16 affected countries will have reached 400 million people. Regionally, demand for water is expected to exceed renewable supplies by a factor of four by 2025.
Yet these numbers cannot do justice to the complexity of water scarcity in a region where irrigation is the lifeblood of agricultural production. Egypt depends on the Nile River for 97 percent of its renewable fresh water supply. But the 1959 agreement between Egypt and Sudan that allocated the lion’s share of the Nile’s resources to Egypt is on its last legs, as countries upstream, such as Ethiopia, Kenya and Tanzania, devise plans for their own use of the Blue and White Nile. All nine of Egypt’s upstream neighbors have high rates of population growth, requiring increased land cultivation and use of water for irrigation. 
Tensions between Turkey, Syria and Iraq over the Euphrates River continue as Turkey’s Greater Anatolia Project (GAP) moves forward. While Turkey hopes to use the system’s dams to irrigate at least 1.5 million hectares of land, these dams could also cut the river’s flow into Syria by 40 percent and into Iraq by 60 to 80 percent. Iraq confronts the possible loss of irrigation water for as much as one-fifth of its arable land (1 million hectares). 
These risks pale, however, compares to the looming water crises facing Jordan, Israel and lands under Palestinian control. Here, conditions of “absolute scarcity” already exist. Israel is largely in control of water resources, whether from the Jordan River or from aquifers under the West Bank, and acts as “a great sponge that leaves the Palestinians dry.”  Water from two of the West Bank’s three aquifers comprises fully one-quarter of Israel’s total water supply. In the Gaza Strip, the situation is even worse: Seawater is seeping into a rapidly deteriorating and increasingly depleted aquifer.
The largely waterless countries of the Arabian Peninsula and Libya also face special challenges. Both Saudi Arabia and Libya are mining “fossil water” so intensively that some water experts anticipate the total depletion of the former country’s water reserves in the first quarter of the twenty-first century. Ten countries in the region already use more than 100 percent of their annual renewable supplies of fresh water. 
With agriculture absorbing more than 80 percent of the region’s renewable water supplies, water scarcity presents serious obstacles to industrialization, including energy generation. A strong attachment to the ideal of food self-sufficiency exacerbates this problem. An extreme example in the early 1990s was the Saudi government’s subsidies for producing wheat that “could have been purchased on the world market for the for a fifth of that price.” 
Further compounding the region’s water scarcity/food production dilemma is a shortage of arable land in several countries, particularly Egypt, Yemen, Jordan, Israel and Saudi Arabia. Given such low levels of arable land per capita, modern agricultural techniques are imperative, though they pose environmental risks associated with intensive use of pesticides and nitrogen-based fertilizers.
One of the few causes for optimism in this regional scenario is that population growth has slowed earlier than expected. Current population projections for 2025 indicate a total population of around 620 million in the Middle East and North Africa — nearly 100 million fewer people than had been projected for 2025 in 1992.
Writing in these pages before the 1994 International Conference on Population and Development, demographer Philippe Fargues declared that “the demographic explosion has run its course, and today cedes place to the social rupture.” Fargues argued that increasing access to and rising levels of education would upset existing hierarchies of power within the family and society, and that concerns about a population “explosion” indicated a lack of understanding of the trend toward lower fertility and slower growth.
While the trends described by Fargues are indeed continuing and accelerating, more must be done. Further investments in education (particularly for girls) and increased provision of healthcare, coupled with other efforts to improve women’s status, would increase the range of choices available to women and, as a result of their impact on fertility, augment governments’ choices, too. Similarly, MENA governments must invest in environmental protection and technologies that promote the efficient use of natural resources. New policies to mitigate the impact of resource scarcities are imperative.
Demography isn’t destiny, but choices — choices made or unmade, or, in some cases, imposed by external constraints. The cultural and political transformations quietly rippling through the region may bring the possibility of more choices, particularly for individual women and men. The question remains whether governments in the region will be able to support, encourage and benefit from the changes taking place — particularly the gradual evolution in women’s status and autonomy.
 For the purposes of this article, the Middle East/North Africa region includes UN-member states north of the Sahara, plus Sudan, and those of Western Asia (including Turkey and Israel) plus Iran. Data on the territories under the Palestinian Authority (Gaza Strip and West Bank) are not generally available. Limited data on the Gaza Strip are included where possible.
 Unless explicitly states, the reference is to “Rate of Natural Increase.” Migration is the third component after births and deaths in the technical term “Population Growth Rate” and has had a significant impact on a number of countries in the region. For example, Kuwait’s growth rate exceeded ten percent in 1960-65 and was negative 4.8 percent in 1990-95, due to the impact of migration into and out of the country.
 The demographic transition is characterized by a shift from high death and bird rates to low ones. Declines in death rates come as a result of lower infant mortality and overall improvements in health.
 The evidence of fertility decline in Istanbul is traced back to the mid-1800s with credit given to reliance on traditional methods, particularly withdrawal. Urbanization and growing unemployment were factors in the Turkish government’s shift away from a pro-natalist view of population growth in the 1960s. Ministry of Health in Turkey, Hare Hepe University Institute of Population Studies and Macro International, Inc., Turkish Demographic and Health Survey 1993 (Ankara, Turkey: 1993).
 Youssef Courbage, Economie et Politique de la Transition Feconde du Mond Arabe: Questions Resolue et Celles Qui Sont Moins (Paris: INED, 1997).
 A mature population has a median age greater than 20 and also has more than 5 percent of its population over age 65.
 Richard P. Cincotta and Robert Engelman, Economics and Rapid Change: The Influence of Population Growth. Occasional Paper 3, October 1997. Washington, DC: Population Action International, 1997.
 Population Reference Bureau, 1988 Women of Our World. Washington, DC: PRB, March 1998.
 The World Bank, World Development Indicators 1998. Washington, DC: The World Bank, 1998.
 Hoda Rashad and Zeniab Khadr, “The Demography of the Arab Region: New Challenges and Opportunities.” Paper presented at the AFESD and ERF Conference on Population Challenges in the Middle East and North Africa. Cairo, November 2-4, 1998.
 See Mohammed Bouzidi, “Population Policies in the Maghreb: Similarities and Contrasts.” Paper presented at the Fourth Annual Conference “Population Challenges and Economic Growth: Middle East and North Africa Region,” sponsored by the Middle East Institute and the World Bank, Washington, DC, April 1999.
 Population Reference Bureau, World Population Data Sheet 1999 (Washington, DC: Population Reference Bureau, 1999).
 It is estimated that use of family planning could prevent at least 25 percent of deaths relating to pregnancy and childbirth and many of the deaths associated with unsafe abortions. Infant and child deaths would also decline: Simply spacing all births at least two years apart could reduce infant and child deaths, on average, by 15 to 20 percent, or about three million.
 UNESCO 1997 Statistical Yearbook (Paris: UNESCO, 1998).
 Population Action International, Educating Girls: Gender Gaps and Gains (Washington, DC: PAI, 1998).
 The economic benefits of educating girls are often higher than for boys. UNICEF, State of the World’s Children 1996 (New York: UNICEF, 1996).
 UN Population Division, Women’s Education and Fertility Behaviour: Recent Evidence from the Demographic and Health Surveys. ST/ESA/SER.R/137. New York: United Nations, 1995.
 See World Resources Institute, World Resources 1998-99 on the theme of “Environmental Change and Human Health” (New York: Oxford University Press, 1998, pp. 264-65.)
 Allen Hammond, Which World? Scenarios for the 21st Century (Washington, DC: Island Press, 1998), p.205.
 Renewable water refers to water resources that are “continuously renewed within reasonable time spans by the hydrologic cycle, such as in streams, reservoirs or other sources that refill from precipitation or run-off. To the extent the water is withdrawn faster than its source is recharged, it cannot be considered renewable.” (Engelman and LeRoy, op. cit., p. 12)
 The Swedish hydrologist Malin Falkenmark pioneered the concepts of water scarcity and water stress. She estimated that 100 liters per person per day is a minimum requirement for basic household needs and that 5 to 20 times that amount is needed to satisfy the needs of the agricultural and industrial sectors. Based on these figures, Falkenmark then classified countries as being water stressed (less than 1700 cubic meters per person per year) or water scarce (less than 1,000 cubic meters per person). Countries with less than 500 cubic meters per person are facing absolute scarcity. Water stressed countries tend to experience chronic and widespread water shortages. Water scare countries, according to Falkenmark, will experience chronic water shortages that may hamper economic development. For more on Falkenmark’s work, see Robert Engelman and Pamela LeRoy, Sustaining Water: Population and the Future of Renewable Water Supplies (Washington, DC: Population Action International, 1993.); and Tom Gardner-Outlaw and Robert Engelman, Sustaining Water, Easing Scarcity: A Second Update (Washington, DC: PAI), 1997.
 Engelman and LeRoy, op. cit., p. 26.
 The Economist, December 23, 1995, p. 54.
 Hammond, op. cit., p. 205.