Malawi, home to 6.8 million children (51 percent of the total population), presents a number of opportunities and challenges for its youngest citizens and their families. The prospects for child survival have improved over the past few years: prudent economic management, stable macroeconomic conditions and increasing agricultural production are helping to reduce poverty and hunger, and Malawi’s HIV prevalence rate seems to have stabilised at 12 percent.
On the down side, poverty continues to be chronic and widespread and the country’s development is thwarted by a fast growing population, limited arable land, cyclical natural disasters, food insecurity, malnutrition, HIV and AIDS, and a high incidence of malaria, one of the leading killers of children under the age of five. Children and women are becoming more vulnerable as their ability to recover from these unrelenting risks and shocks weakens.
Many challenges ahead
Malawi has made significant progress in realising some of the key child-related Millennium Development Goals (MDGs). Malawi currently shows a sharp decline in infant and under-five mortality rates per 1,000 live births, from 104 and 189 deaths in 2000 to 72 and 122 in 2006 respectively. If the current trend continues, Malawi is likely to achieve the MDG 4 goal of reducing infant and child mortality by two thirds.
Factors that contributed to the decline include sustained high coverage of immunisation and Vitamin A supplementation, elimination of neonatal tetanus, malaria control activities, increased rates of exclusive breastfeeding and better access to safe water. However, access to improved sanitation is still lagging behind, at 61 percent. School children continue to be at risk in approximately 20–25 percent of government schools that do not have a protected water supply and where an average of 150 pupils use one latrine. Poor hygiene practices also contribute to Malawi’s poor health indicators for mothers and children.
Despite progress in child mortality reduction, one in eight children are still dying, mostly of preventable causes such as neonatal conditions, pneumonia, diarrhoea, malaria and HIV-related diseases. Malnutrition levels remain high and account for about half of all child deaths. Malawi faces many challenges in order to achieve the MDGs, including widespread poverty, weak institutional and human capacity, limited resources because of competing needs and deep-rooted harmful traditional practices.
Poverty undermines children’s development
Since the early 1990s, Malawi, a landlocked and predominantly agricultural and rural nation, has ranked amongst the world’s 20 least developed countries on the Human Development Index. More than half of the population (52 percent) lives on less than USD $ 0.32 a day. This includes around four million children living in poverty. Moreover, one in every five Malawians lives in ultra poverty or on less than USD $0.20 US cents a day and cannot afford to feed themselves. Poverty hits children the hardest and threatens their most basic rights to survival, health and nutrition, education, participation and protection from harm and exploitation.
The poor are vulnerable to a host of shocks and hazards. These include droughts that comes in cycles of three to five years, yearly floods and storms, and man-made hazards such as economic shocks, and HIV and AIDS. Malawi’s dependence on natural resources and rain-fed agriculture makes the country particularly vulnerable to the effects of climate change.
Malnutrition is still high
Malnutrition is devastating and the single biggest contributor to child death. In Malawi, there has unfortunately been no change in children’s nutritional status since 1992 and malnutrition rates remain unacceptably high. Around 46 percent of children under five are stunted, 21 percent are underweight, and four percent are wasted. Micronutrient deficiencies are common. The Ministry of Health’s Micronutrient Survey (2001) revealed that 60 percent of children under five and 57 percent of non-pregnant women had sub-clinical Vitamin A deficiency. Vitamin A deficiency lowers children’s immunity and reduces their chances of surviving a serious illness. The causes of malnutrition in children include poor childcare practices, diets lacking in calories and nutrients, frequent bouts of disease and chronically under-nourished pregnant and breastfeeding women.
Mothers at threat
For every 100,000 live births in Malawi, 807 mothers die as a result of pregnancy and childbirth related causes. Diseases such as malaria and HIV, nutritional deficiencies and women’s low socio-economic standing underpin what is one of the world’s highest maternal mortality rates. This is a clear indication of women’s limited access to quality reproductive health services.
Malawi stands little chance of reaching the MDG 5 target of 155 maternal deaths per 100,000 live births by 2015 unless drastic measures are taken to improve maternal health. Nonetheless, the Government is increasing the availability of emergency obstetric care, accessibility of antenatal services and use of skilled health personnel during pregnancy, child birth and the post natal period at all levels of the health system. According to MICS 2006, 97 percent of pregnant women receive antenatal care, skilled attendants assist 54 percent of births and only 33 percent of mothers benefit from postnatal care.
HIV and AIDS
Malawi’s HIV prevalence rate among adults aged between 15 and 49 years has stabilised at about 12 percent, signifying a degree of progress in meeting the sixth MDG of combating HIV and AIDS, malaria, tuberculosis and other major diseases. The prevalence translates to an estimated one million Malawians living with HIV, 58 percent of whom are girls and women. What is now needed is to accelerate the rate of decline (HIV prevalence dropped from 14.6 percent in 1999 to 14 percent in 2005) so that by 2015, the targets are met and HIV is controlled.
The pandemic however continues to infect 10,000 people a year. Around 46 percent of new infections occur among young people aged 15 to 24. Young people start having sex early in life – 14 percent of girls in the 15–19 age group have had sex before the age of 15 – which increases the risk of HIV infection. Poverty prompts women and girls to engage in transactional sex as a source of income and puts them at risk of trafficking and sexual exploitation. Traditional reproductive roles and harmful cultural practices such as wife inheritance and early marriage put girls and women at further risk of infection. It is no wonder that girls and women in the 15–24 age group account for 58 percent of infections.
Almost all Malawians have heard of HIV and AIDS but only 55 percent of women and men know the three main ways of preventing infection (fidelity, condom use and abstinence). Many people continue to have unsafe sex and remain reluctant to know their status. A culture of silence on sex and sexuality denies people access to correct information.
Young children are not spared from HIV infection. An estimated 89,000 children under the age of 15 are living with the disease. Most were infected through mother-to-child transmission, which accounts for close to 30,000 of infections among newborns every year. Only 24 percent of HIV positive pregnant women attending antenatal clinics are receiving anti-retroviral prophylaxis to prevent transmission of the virus to their baby.
The impact of the epidemic has affected all levels of society but nowhere has it been more devastating than on children. Of the one million orphans in Malawi, 500,000 have lost one or both parents to AIDS. Without parental protection, these children are exposed to neglect, abuse and exploitation and lack access to basic necessities and services. Orphaned children also suffer immense emotional turmoil, which leaves deep psychological scars.
Despite the abolition of school fees in 1994, over 10 percent of school aged children do not attend primary school. Net enrolment rates for both boys and girls are high in the first two grades but only 26 percent of children complete the entire primary school cycle. Of these, a meager 16 percent are girls. Drop out averages around 15 percent, with half of the children dropping out before the forth grade.
Children leave school for a variety of reasons, citing poverty, long distances to school, early pregnancies and the poor quality of education. School environments often discourage girls and boys from attending class. Overcrowded classrooms, an absence of sports and play areas, shortages of teaching and learning material, low teacher morale and the lack water and separate toilets for boys and girls do not create a space where children are able or willing to learn and thrive. Added to this are cases bullying, sexual harassment and corporal punishment, which often go unreported and threaten children’s safety and dignity.
Given that 74 percent of pupils do not complete a full course of primary schooling, it is unlikely that Malawi will achieve the MDG 2 on attaining universal primary education by 2015. The drive to put an equal number of girls and boys into school has been achieved for primary education while the ratio of girls to boys in secondary education is improving. This means that Malawi is set on track to achieving the MDG 3 target of eliminating gender disparities in education. What is worrying, however, is the high drop out rate of female pupils in primary school.
Poverty, hunger, HIV and AIDS and inadequate social services combine to create circumstances where child abuse, exploitation and violence are tragically common, especially for the growing numbers of orphaned and vulnerable children. The Government estimates that 1.4 million children are involved in hazardous child labour.
The Child Labour Survey (2001) revealed that the child labour market is dominated by domestic workers who toil from morning till late at night and that many children under the age of ten work with their parents as full time workers in tobacco cultivation. Sexual exploitation, abuse and child trafficking are thought to be increasing, but more reliable statistics are needed. Certain traditional practices such as early marriage or ‘fisi’ – a type of formalised rape – are harmful to the wellbeing and health of children. There is no birth registration system in the country, making children that do not have an official identity vulnerable to neglect, abuse and trafficking.