Aboulghasem Pourreza - Department of Health Management and Economics,School of Public Health, Tehran University of Medical Sciences
Ahmad Sadeghi - Department of Public Health, Esfarayen Faculty of Medical Sciences
Mostafa Amini Rarani - Social Determinants of Health Research Center, Isfahan University of Medical Sciences
Rahim Khodayari-Zarnaq - Assistant Professor, Tabriz Health Services Management Research Centre, Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences

Background: The Total Fertility Rate (TFR) in the Middle East and North Africa has experienced a declining trend in recent years. Accordingly, the present study was conducted to provide a clear picture of the most critical factors affecting the TFR decline in this region. Methods: This study was a systematic review between the years 2000 and 2016. The different databases like Cochrane, Pub Med, Scopus and Science Direct and the Google Scholar search engine were used.At first, 290 articles and then, 18 articles were selected for the final analysis. Results: The results indicated a declining trend in the TFR in the Middle East and North Africa, as in other parts of the world, but with a differentslope. Regarding the causes of this declining trend, several factors were identified and categorized into five groups of health care-related, cultural, economic, social and political. Conclusions: While taking advantage of the experiences, it is necessary to identify the five factors and their subsets and consider them in the population policy making.

Total Fertility Rate, Systematic Review,Middle East And North Africa, Determinant Factors