Malawi 2010 Demographic and Health Survey Shows Great Strides in Maternal and Child Health, Slow Fertility Decline
by Carl Haub, senior visiting scholar
The Malawi 2010 Demographic and Health Survey (DHS) is the latest in a regular series of DHS surveys that began in 1992. The survey interviewed 23,020 women ages 15 to 49 and 7,175 men ages 15 to 54 from June to November 2010. The total fertility rate (TFR — the average number of children would bear in her lifetime if the birth rate of a particular year were to remain constant) obtained in the survey was 5.7 for the three-year period preceding the survey. For urban women, the TFR was 4.0 and, for rural women, who were a 81.3 percent of the sample, 6.1. This is a fairly typical difference between urban and rural fertility found in surveys. TFR decline has been quite consistent, although slow. The fastest annual decline in survey TFRs was between the 2000 and 2004 surveys at -0.8 while annual decline from 2004 to 2010 was a bit less. If the -0.05 annual change currently observed in the TFR continued, it would take Malawi over 70 years to reach the two-child family. Regarding possible future fertility trends, 51.4 percent of women with four living children said that they not wish to have any more as did 61.9 percent of those with six or more living children.
In the survey, 46.1 percent of currently married women said that they were using some form of family planning, 42.2 percent a modern method. As in much of sub-Saharan Africa, injectables were by far the most frequently used method, used by 25.8 percent of the women. This method was followed by the pill (2.5 percent) and the male condom (2.4). The use of injectables showed the largest increase, from 18 percent in the 2004 DHS.
Note: TFRs are for the three years before the surveys.
Source: National Statistical Office Zomba, Malawi, Malawi Demographic and Health Survey 2010 (Calverton, MD: ICF Macro, 2011).
The decline in infant and child mortality has been somewhat slower than in other African countries. The infant mortality rate in the five years before the 2010 DHS was 66 infant deaths below age 1 per 1,000 live births, down from 81 in the five to nine years before the survey and 92 in the 10 to 14 years before the survey. The decrease in the child death rate, ages 1-4, was more substantial, having declined to 50 deaths per 1,000 five years before the survey, from 79 five to nine years before the survey, and 97 10 to 14 years before it.
Of children under age 5, 47 percent were stunted (height-for age), down from 53 percent in 2004. and 13 percent were underweight, down from 17 percent in 2004. The World Health Organization (WHO) recommends that breastfeeding should be supplemented with solid/mushy food at the child’s sixth month. At ages 4 to 5 months, less than half of infants (40.5 percent) were exclusively breastfed and that figure dropped to only 6.8 percent at ages 6 to 8 months. But at this age, 85.8 percent did receive supplemental food so that WHO recommendations are largely being followed. The proportion of young children receiving all required vaccinations is high. Among children ages 12 to 23 months, 80.9 percent had received all child vaccinations and only 1.5 percent had received no vaccinations. The proportion in rural areas was actually slightly higher than in urban areas. About three-fourths of mothers were able to produce a vaccination card so that mother’s memory did not have to relied upon in many cases.
Levels of prenatal care and delivery assistance from a skilled provider (doctor, clinical officer, nurse, or midwife) were very high. Fully 94.7 percent of mothers who had given birth up to five years before the survey had had prenatal care from a skilled provider, 82.9 percent from a nurse or midwife. Of those, 49.4 percent had had two to three antenatal visits and 45.5 percent had had four or more visits. The figures were quite close for both urban and rural mothers. The proportion receiving care from a skilled provider at birth, as well as births occurring in a health facility, were quite high. Of births in the past five years, 71.4 percent had delivery assistance from a skilled provider and a nearly identical proportion, 73.2 percent of births were in a health facility. There were differences between urban and rural areas with 84 of urban women having a skilled attendant at delivery and 85.9 percent of births in a health facility. Comparable figures for rural areas were 69.2 percent and 71.0 percent, respectively. Protection from neonatal tetanus, at 88.9 percent was also quite high.
Malawi has made great strides in maternal and child health but the rate of fertility decline remains quite slow.