Results of 2000 Malawi Demographic and Health Survey launched

Findings show improved use of family planning, lower fertility and better birth spacing and child survival; but rising adult death rates point to impact of AIDS epidemic.

Findings of the 2000 Malawi Demographic and Health Survey (MDHS) point to important changes in Malawi’s health and demographic profile. Rapid increases in the use of modern contraception in the late 1990s is leading to declines in the fertility rate. Early childhood survival has improved and may be related to gains in access to clean water sources, more exclusive breastfeeding, better spacing of births, better education of women, and the institution of malaria control initiatives during the last decade. On the other hand, during the same period, the death rate among men and women has increased sharply. The latter finding is likely the result of the prevailing AIDS epidemic. Maternal mortality, or mortality related to pregnancy and childbearing, has as well risen rapidly since the last MDHS in 1992.

Fertility and Family planning

• Findings from the 2000 MDHS indicate a modest decline in fertility since the 1992 MDHS. The total fertility rate has dropped from 6.7 births per woman to 6.3 births per woman. Although a reduction in the number of unplanned births would further reduce fertility levels significantly, the average married man and woman in Malawi continues to express a desire for a family of more than five children.
  
  
• The issue of adolescent fertility has important health and social implications. Mothers age 15-l 9 are at increased risk of illness and death and have decreased educational opportunities. The results of the survey indicate that one-third of adolescent females are already mothers or pregnant with their first child. More than half of women have had a child by the time they reach age 20.
  
  
• Knowledge and use of family planning has continued to rise in Malawi. Current use of a modern family planning method has more than tripled since 1992, from 7 to 26 percent of all married women. Increasingly, women are choosing to use injectables,which are the predominant method, followed by female sterilisation and the pill. There was also a small rise in the use of condoms. 
  
  
• Despite increased use of contraceptive methods, the 2000 MDHS indicates that 30 percent of married women have an unmet need for family planning in Malawi; that is, they are not using contraception although they do not want more children, or want to wait at least two years before having another child. Although this represents a decline in unmet need since 1992, there are large numbers of women who’s need for family planning remains unsatisfied.
  
  

Child health and survival

• Mortality of children under age 5 has declined since the early 1990s. During the period 1988-1992, the under-five mortality rate was 234 deaths per 1,000 live births, compared with 189 per 1,000 between 1996-2000. Although this represents important progress, the rate of the downward trend is modest and childhood mortality remains at a very high level.
  
  
• An important reason for the decline in childhood mortality may be improved access to clean drinking water in the country. Overall, 65 percent of Malawian households have access to clean water sources (piped water and protected wells or boreholes), which represents a substantial increase since the 1992 survey, when only 47 percent had access to water from such sources.
  
  
• While sanitation improved, there was a setback in the fight against vaccine-preventable diseases in Malawi since the early 1990s. The MDHS reveals that full vaccination coverage has fallen from 82 percent in 1992 to 70 percent in 2000. Full vaccination coverage includes the BCG and measles vaccine and at least three doses of both DPT and polio vaccine among children age 12-23 months. 
  
  
• The MDHS collected data on the height and weight of all children under age five. The findings show that the nutritional status of young children has not changed since 1992. It remains true that nearly half (49%) of under-fives are stunted, or too short for their age, an indication of chronic nutritional deficit.
  
  
• The MDHS collected new information on the percentage of the population using bednets, which provide protection against the bites of malaria-transmitting mosquitoes. The results indicate that 8 percent of women and children and 6 percent of men slept under a bednet on the night before the survey.
  
  

Adult mortality 

• The link between rising adult death rates and the AIDS epidemic is reflected in the changing age-pattern of mortality. The largest change in mortality from all-causes for men occurs from age 30 and older, whereas for women, an earlier impact is observed at age 20 and older. This pattern of results is consistent with the pattern observed in other countries in sub-Saharan Africa with high HIV infection rates.
  
  
• Survey findings also reveal an increase in maternal mortality from 620 maternal deaths per 100,000 live births estimated from the I992 A4DHS for the period 1986-1992 to 1,120 estimated in 2000 for the period 1994-2000.
  
  

HIV/AIDS

• Knowledge of means to prevent HIV transmission among men and women has improved since 1996. This improved base of knowledge has however not translated to changes in behaviours that would help to limit the spread of the AIDS epidemic. The data show that condom use outside of the context of marriage has improved slightly but that use during sex with marital partners has not improved and may have declined slightly. Among men reporting sex with a commercial sex worker in the last 12 months, only 35 percent said they used a condom on the last occasion.
  
  

• The MDHS finds that 9 percent of women and 15 percent of men reported that they have been tested for the AIDS virus. Three-quarters of men and women, while not having been tested, report a desire to be tested for HIV. More widespread voluntary counseling and HIV-testing is promoted as a means to encourage both improvement in AIDS prevention behaviours and steps to mitigate the epidemic’s impact on the individuals, households, and communities.
  
  

The 2000 Malawi Demographic and Health Survey (MDHS) is a nationally representative survey of 14,213 households, 13,220 women age 15-49 and 3,092 men age 15-54. The 2000 MDHS was implemented by the National Statistical Office. ORC Macro (DHS) furnished technical assistance in the design and implementation of the survey. Funding for the 2000 MDHS survey was provided by the Inited States Agency for International Development (USAID/Malawi), the Department fo International Development (DFID/Malawi), and the United Nations Children's Fund (UNICEF/Malawi). Data collection was conducted from July to November 2000.