A Problem for Palestine: Gaza's Birthrate Highest in Middle East

By Abdullah Khayat

One of the many challenges for President Yasser Arafat's Palestinian government when it assumes administrative responsibility for Gaza will be the area's extraordinarily high birthrate. Of all the regions in the Middle East for which statistics are available, Gaza has the highest total fertility rate (TFR).

Gaza's TFR is 7.9, meaning the average woman in Gaza will have a total of 7.9 children in the course of her lifetime, given current birthrates. The only figures near that fertility rate anywhere in the Middle East are 7.8 in Oman, 7.6 in Yemen and 7.1 in Syria. By contrast, the West Bank TFR is 5.7, a figure closer to countries at the low end of the scale like Israel with 2.9, Turkey with 3.6, Lebanon with 3.7, Egypt with 3.9 and Bahrain with 4.2.

Fertility rates in Middle Eastern countries vary so widely because of three factors. Some countries, like Egypt, actively encourage family planning either because of population pressures or as a proactive maternal health measure. In other Middle East countries, high levels of education, urbanization and female employment, as in Lebanon and Bahrain, are major factors in reducing birthrates. In other countries, such as oil-rich Saudi Arabia (6.8), Kuwait (6.5) and the United Arab Emirates (5.9), the governments encourage large families in various ways.

In the cases of Gaza and the West Bank, large families are regarded as a form of Palestinian patriotism. They are a practical means of thwarting Israeli occupation policies that seem designed to force Palestinians to emigrate by making life unbearable for them under Israeli occupation. Whether birthrates continue at such a high level after the occupiers withdraw may depend to a large extent upon the policies adopted by the incoming Palestinian administration.

In making their decisions, the Palestinian authorities may find useful a 40-page bulletin of the Population Reference Bureau of Washington, DC entitled "The Middle East Population Puzzle." The booklet, from which the statistics above and below are drawn, was written by Dr. Abdel R. Omran, who teaches at the University of Maryland and George Washington University and is a consultant to the World Bank, Al Azhar University in Cairo and the Pan American Health Organization; and Farzaneh Roudi, population analyst of the Population Reference Bureau. The authors compare Middle East population and health statistics with those in other regions and discuss the reasons for statistical differences between Middle East countries. Their study does not touch on Arab countries of Africa, however, except for Egypt.

The authors point out that "Middle Eastern culture, religion and politics tend to encourage large families" and, "on average, Middle Eastern women give birth to five children by age 45." This is about three more children than women in developed countries and one more than the average for women in all developing countries.

Although most Islamic scholars agree that there is no religious prohibition against family planning, Muslim communities throughout the world tend to have large families. Albania, with a Muslim majority, has the highest fertility level in Europe, Omran and Roudi point out. In Malaysia, where Muslim Malays are one of three major religious communities, they tend to have higher fertility rates than their compatriots of Indian or Chinese descent.

Declining Fertility Levels

Despite current high fertility levels throughout much of the region, however, there is evidence that the rates are falling. Evidence gathered throughout the world indicates that fertility declines as a country's population becomes more urban and as women become more highly educated. These trends have recently become apparent in the Middle East.

In Yemen, a 1991-92 survey measured a total fertility rate of 5.6 for urban women and 8.1 for rural women.

In Egypt, where the government has been heavily engaged in family planning activities for a generation, urban women had a TFR of 2.9 compared to 4.9 for rural women in a 1992 survey. In Jordan, a 1990 survey showed urban women had 4.8 children on average while rural women had 6.9 children.

Similar differentials exist among women at different educational levels. In Jordan, women with no formal education had a TFR of 6.9, while those with a secondary-school or higher education had a TFR of only 4.1 children.

Because there is no generally accepted prohibition of family planning under Islamic law, the reason for the differences in countries like Jordan, which neither discourages nor encourages large families, is the greater acceptance of and access to contraceptives among urban and educated women.

In Egypt, where the government actively encourages family planning, an estimated 45 percent of women of reproductive age used a modern contraceptive method in 1992, compared to 23 percent in 1980. Similarly, in Turkey, combined use of modern contraceptive techniques and traditional contraceptive methods, such as withdrawal or the rhythm method (the latter approved by the Catholic church), has increased from 38 percent in 1978 to 63 percent in 1988. Among married Turkish women, however, only 31 percent used a modern contraceptive method.

In Yemen and Oman, fewer than 10 percent of married women practice a modern method of family planning, according to recent estimates. Physicians in Yemen report, however, that abortion is extremely common.

Differences in contraceptive use between educated and urban women on one hand and uneducated and rural women on the other are most pronounced in Yemen, according to the Omran and Roudi study. In a 1991-92 survey, 28 percent of married urban women and only 6 percent of married rural women used contraception. Similarly, about 40 percent of women with a primary or higher education and only 7 percent of those with no formal education used contraceptives. The fact that 80 percent of Yemeni women live in rural areas, and nearly 90 percent of Yemeni women of reproductive age have no formal education explains the enormous discrepancy between total fertility rates in countries like Yemen and those with higher levels of urbanization and of female education.

Despite the traditional cultural bias toward large families in most Islamic countries, surveys from the 1990s indicate that, when polled individually, most Middle Eastern women would prefer fewer children. Thirty-five percent of married Yemeni women said they did not want any more children. In Egypt, two-thirds of married women and in Jordan 47 percent of married women said they did not want more children.

A 1988 survey of married women in Turkey found that 76 percent did not want more children. The average number of children Turkish women said they desired fell from three in 1978 to just over two children in 1988.

If Middle Eastern women were able to achieve their wishes, the results on overall health and death rates would be dramatic. Maternal mortality would be reduced by about one-fourth in the region, according to a 1984 estimate. According to Omran and Roudi, if no births occurred after age 35, maternal mortality would be reduced by almost one-half.

As a result of decades of high birth rates, the Middle Eastern population is extraordinarily young, according to the statistics presented in the Population Reference Bureau study. More than 40 percent of the region's population is under 15 years of age, while only 4 percent is over age 65. In industrial countries, about 21 percent of the population is under age 15 and 12 percent is 65 or older.

Within the Middle East, there are wide differences from country to country, however. In Qatar, with a TFR of 4.5 children per woman, only 28 percent of the population is under 15. In Gaza and the West Bank, over 50 percent of the population is under 15. The percentage of population over 65 ranges from 9 percent in Israel to 1 percent in some Gulf states.

As a result, in the Middle East there is approximately one working-age adult for every child under 15. In industrialized countries there are almost three adults for every child. The table on page 35 of total fertility rates by country for the Middle East is adapted from the Omran and Roudi study.

"The Middle East Population Puzzle," by Abdel R. Omran and Farzaneh Roudi, from which the statistics (but not all of the conclusions) in this article have been drawn, is available at $7 plus $1 for postage from the publisher, the Population Reference Bureau, 1875 Connecticut Ave. N. W., Suite 520, Washington, DC 20009-5728.

Abdullah Khayat, a former resident of Iraq, writes on societal problems.