The image of the Middle East and North Africa (here referred as MENA) has been shaped by recent incidents, such as the migration wave in 2015, the Israel-Palestine crisis or the US-Iranian trade war. Political and economic issues agitating the region have influenced our perception of the region. It has mainly been the young generation that is still aspiring social and political change resulting in the Green Revolution ten years ago. However, it is this generation that is in the centre of recent debates. More and more young mothers give birth to their first child later in life or even decide not to have children at all. This has led to a decline in the total fertility rates (TFR) in many MENA countries and sometimes even to an ageing population, causing a shift in the region’s demographic and cultural patterns.
The boom and bust in MENA’s fertility rates
From the 1950s until the early 2000s MENA’s population size has quadrupled to the size of 430 million people and is projected to surpass 700 million by 2050. During the first surge Turkey, Iran and Egypt counted the biggest population (75.498, 74.877 and 71.208 thousand accordingly) and Jordan, Kuwait and the United Arab Emirates experienced the strongest growth (62.9, 33.6 and 18.7 times accordingly). The main factors that drove this rapid rise in population were two: a declining mortality rate caused by improved medical services and public health interventions, such as antibiotics, immunization and sanitation; and economic expansion caused by the strive in oil revenues in the 1970s. But cultural values also played an essential role, such as the high status of the family, but also praised traditional marriages and childbearing practices. All in all, high rates of fertility have reflected an interplay between economic, social and religious factors.
In the new millennium, MENA’s fertility rates started to fall causing a decline in population growth since the early 21st century. According to the UN popular division, the total fertility rate in MENA region (or an average number of children born per woman) has more than halved from about seven children in 1960 to three in 2006 standing at, or even below, the replacement level in many countries. Lebanon was the first country to face this change in fertility rate, followed by Egypt, Iran and Tunisia. Growing prosperity, higher education levels among women and enhanced reproductive health rights led to delayed marriages and hence, to a decline in the childbirth rate. Some countries have also actively adopted childbirth policies to lower fertility rates in order to better control population growth, such as promoting and introducing the use of (especially modern) contraception. In conclusion, the fall in both mortality and fertility rates led to a strong rise in the average age of many middle eastern countries and therefore to an ageing population.
Childbirth policies in Iran: Praise and curse at the same time
Population control policies have been widely common among MENA countries. Iran’s demographic changes in the last three centuries account for one of the best-practise cases in implementing family planning policies. Hence, it is worth examining this example in greater detail.
In the early 1970s under the former Shah, Iran’s government implemented a new family planning policy to curb the rising TFR. It was promoted under the motto “Two children are enough”. However, after the Islamic Revolution in 1979, the initiative was soon dismantled since the new government regarded the policies related to the former royal leader as too western. Policies were reversed by promoting large family sizes and providing socio-economic benefits for bigger families. During the Iran-Iraq war, these policies were reinforced. Nevertheless, it was soon realized that it was necessary to reduce family sizes by family-planning policies to fix the economy that was weakened by the war. Hence, free contraceptives were introduced. Experts, on the other hand, suggest that the role of contraception has been overestimated by policymakers. In fact, fertility rates in Iran began to decline four years before the introduction of new family planning policies in 1989. Studies claim that reduced TRF was caused by the pursuit of Iranian women to obtain higher education and the shift in socio-cultural norms.
The slope in Iran’s TRF might have been too successful. Iran’s TRF plummeted from 6.5 births per woman in 1976 to 1.6 births per woman in 2012. Two factors are especially striking: first, the speed and level of decline in the TFR. Iran’s first official target was to reduce the TFR to 4.0 births per woman by 2011. Nonetheless, the rate was already down to 2.0 by 2000. Second, the scope of declining TRF in the countryside. In Iran’s rural areas the TFR declined from 8.1 in 1976 to 2.4 births per woman in 2000.
The low and stagnating fertility rates nowadays could lead to a TFR even below the replacement level, i.e. having more deaths than births per year. This is causing great concern among the Iranian health ministry, that eagerly strives to rise fertility rates to help compensate the ageing population. Concretely, that would mean rising the TRF per woman to 3 children by the age of 30. In order to initiate a rapid shift in the family planning strategies, the government aims to restrict access to contraceptive use and permanent contraception surgeries, such as vasectomies and tubectomies. In 2012 the family planning budget was officially cut extensively, and the motto turned to “at least two children is ideal”. Although currently the access to free contraceptives is not banned, the use is restricted to a great extent. Due to the inhibited use of vasectomies and tubectomies, except for life-saving cases, doctors can face a punishment of up to 5 years of imprisonment. Besides, this policy initiative is highly critical since it will affect mostly low-income families, and therefore will potentially augment the inequality gap. Additionally, restricting access to contraception could reverse the years, resources and efforts spent on promoting safe sex and reducing sexually transmitted diseases among the population. Vulnerable women, such as female sex workers and drug users, will especially suffer under this policy.
Furthermore the government is facing huge challenges in promoting pregnancy amidst an economy suffering from one of the most durables international trade wars. Western sanctions caused inflation to hit the 40% latter. High unemployment rate, lack of housing and job insecurity also put pressure on Iranian’s youth. Most of the young people prefer to study and do not have the financial resources to marry let alone raise children. The government declared plans to rise the 77 million population to 150 million people in 2030. One of the strategies include rising the length of maternity leave from six to nine months, and establishing a parental leave besides the maternal. Still, governments statistics claim that Iranian family culture has changed substantially independent of the economic situation. Young people prefer a modern and independent lifestyle that is shaped by western culture and media. The average age for marriage has risen from the early 20s to the late 20s. Furthermore, most of the parents prefer less children to provide them better education and a higher quality of life instead of having numerous children.
MENA’s population: a black box
The decline in fertility rates is expected to continue in the region. Nonetheless, the overall population is expected to grow for the following several decades. MENA’s population is currently increasing at an annual rate of 2%. Accounting for the world’s second highest rate after sub-Saharan Africa, it grows by almost 7 million people per year and is expected to double in the next 50 years.
It is unclear how the fertility rates will develop in MENA in the future. However, it can be concluded that government policies have had a substantial impact on the demographic development of MENA’s society. Their implementation can have a wide and sometimes unpredictable scope. The complexity of the societies and the divergent cultural and behavioural patterns require to examine the statistical data in greater detail.
 Roudi-Fahimi, F.; Mederios Kent, M. (2007, June). Challenges and Opportunities— The Population of the Middle East and North Africa. Population Bulletin, Volume 62 (No.2), Retrieved from https://www.prb.org/wp-content/uploads/2008/05/62.2MENA.pdf
 Tabutin, D.; Schoumaker, B. (2005). The Demography of the Arab World and the Middle East. Population, Volume 60, 588-90.
 Carl Haub, 2006 World Population Data Sheet (Washington, DC: Population Reference Bureau, 2006); UN Population Division, World Population Prospects: The 2006 Revision.
 C. Haub, 2006 World Population Data Sheet (www.prb.org, accessed May 1, 2007); UNICEF, Statistics: Multiple Indicator Cluster Survey 3, Survey Reports: OPT and Iraq (www.childinfo.org, accessed May 15, 2007); League of Arab States, PAPFAM Version 3.0 (CD-ROM, 2007).
 Karamouzian, M.; Sharifi, H.; Akbar, A. (2014, September 2). Iran’s shift in family planning policies: concern and challenges. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4204741/
 Malkin, B. (2014, January 6) Iran attempts to reverse falling birth rate. Retrieved from https://www.telegraph.co.uk/news/worldnews/middleeast/iran/10554866/Iran-attempts-to-reverse-falling-birth-rate.html
 Roudi-Fahimi, F. (2001, December 1). Population Trends and Challenges in the Middle East and North Africa. Retrieved from https://www.prb.org/populationtrendsandchallengesinthemiddleeastandnorthafrica/