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Fertility rate is, basically, the number of children that the average woman will have in her lifetime.
Some are more complex: Suppose that in a given society the average woman is having less than two children. In fact, this is exactly what is happening in the United States and some European countries right now.
Fertility levels are lower in developed countries than in developing nations because more women in developed countries work outside of the home and tend to marry later and to use contraception and abortion to delay or prevent childbearing.
Life expectancy is trending upward around the world, but a substantial gap remains between developing and developed countries (Fig.
New threats to health are continually emerging, and often are spread across international borders through trade and human or animal migration. Another step that increases life expectancy is creating a public health infrastructure that can identify and respond quickly to disease outbreaks, famines, and other threats.
The third major factor that drives population trends is migration, which includes geographic population shifts within nations and across borders. But growth of the mainly Arab countries of the Middle East and North Africa has been slowed by a veritable revolution in marriage and childbearing in recent decades. In Iran, Lebanon, Tunisia, and Turkey, fertility was at or below the replacement level of about 2.1 children per woman. Note: The total fertility rate refers to the average number of children born per woman given current birth rates. Strong cultural values attached to the family and traditional marriage and childbearing practices delayed the transition to lower fertility in MENA. But several changes in recent decades hastened the decline in fertility: delayed marriage, wider acceptance of and access to family planning services, and increased education of girls and young women.


But now, women are waiting until they are older to marry and are marrying men closer to their own age. Another remarkable shift in marriage patterns of some countries is the increase in number of women who are not married by the time they reach their late 30s, many of whom will never marry.
The delay in marriage also reflects rising economic aspirations for young people, including a trend toward more couples living on their own.
The rising marriage age, along with increases in education and family planning use, has helped lower fertility in the region.
Farzaneh Roudi-Fahimi is director of the Population Reference Bureau's Middle East and North Africa Program.
Carla Makhlouf Obermeyer, "Reproductive Choice in Islam: Gender and State in Iran and Tunisia," Studies in Family Planning 25, no. Hoda Rashad, Magued Osman, and Farzaneh Roudi-Fahimi, Marriage in the Arab World (Washington, DC: Population Reference Bureau, 2005). Dominique Tabutin and Bruno Schoumaker, "The Demography of the Arab World and the Middle East From the 1950s to the 2000s," Population-E 60, nos. Value of Social Security and home equity made up almost all net worth of 2 in 3 US elderly (ages 66-69 in 2008). The probability that a child will die at a given age drops through childhood and adolescence after she passes through the vulnerable early years, then starts to rise gradually in mid-life.
While a young population structure ensures momentum for future growth, the pace has slackened thanks to fertility declines in some of the region's largest countries. In some countries, the laws that have restricted women's rights and participation in the wider society are being relaxed. The fertility decline of the past few decades is likely to continue, even accelerate, as education, economic opportunities, and access to family planning services expand.


MENA's total fertility rate (TFR), or average number of children born per woman, declined from about seven children in 1960 to three children in 2006.1 The decline started first in Lebanon, then in a few other countries, including Egypt, Iran, and Tunisia. Israel's TFR was the region's lowest in the 1950s, but has not declined as far as in many other countries (see Figure 2). Families provide social security for the elderly, sick, or disabled, and an economic refuge for financially dependent relatives.3 Accordingly, universal marriage and large families were highly valued in MENA. Until the last few decades, women throughout the region typically married while still in their teens or early 20s. The universal value placed on marriage, compounded by religious and social condemnation of premarital and extramarital sexual relationships, encouraged girls to marry young and to bear children soon thereafter.
While the average age at first marriage for women was between 18 and 21 in most countries in the 1970s, it was between 22 and 25 by the late 1990s. Women who marry while still in their teens typically are more socially isolated, know less about family planning and reproductive health services, and often lack the power to make decisions about their own health, especially if their husbands are much older.
Marriage may cut short girls' formal education and often traps them in a vicious cycle of low education, high fertility, and poverty. The average marriage was above age 25 in all the North African countries except for Egypt, where it was just 22 in 1998.



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