The Dynamics of Deprivation in Malawi: The multi-dimensional effects of the lean season on children By Robert Hopper A study commissioned by UNICEF Malawi, Social Policy Section in collaboration with Child Protection, Education, Health, Nutrition, and WASH sections. October 2020 1 Acknowledgments I would like to thank a number of people for their support and assistance throughout this study. Within UNICEF Malawi, essential contributions to study design and feedback on findings were provided by Mesfin Senbete, Patrick Okuni, Wilfred Bengnwi, Benson Kazembe, Xinxin Yu, Mutsinzi Heinrich Rukundo and Nami Nakatani, whose wealth of knowledge on the specific deprivations relative to their sections was extremely beneficial. Furthermore, a very special thanks needs to go to Maren Platzmann for her patience, guidance, and input into all facets of the study. I am also grateful to a number of persons external to UNICEF Malawi for their invaluable contributions. These include, but are not limited to, Frank Otchere and Kaku Attah Damoah at UNICEF Innocenti, Chris Burningham and Karishma da Silva at World Bank Malawi, and Simon Haenni and Mirela Sabotic at the Department of Economics, University of Zurich. Their contributions and advice advanced this paper significantly. Preface The idea of assessing the dynamics of deprivation in a more structured, holistic way was developed by the UNICEF Malawi team working on shock-sensitive social protection, supported by Maxi Ussar. The intention was to look beyond seasonal food insecurity, to better understand and in consequence address the multiple and nuanced ways children are affected every year by immense risks that can have lasting consequences on child wellbeing, development and Malawi’s human capital. Understanding the predictability of risks and nature of seasonal deprivations for children, was for the team a way to better inform and advocate for increased coverage, adequacy, and services under Malawi’s National Social Support Programme, in line with seasonal, recurrent shocks. 2 Table of Contents Executive Summary ......................................................................................................................... 6 1. Introduction ............................................................................................................................ 17 Background and Country Context ........................................................................................................... 17 2. Approach and Methods ............................................................................................................ 19 Research Design ...................................................................................................................................... 19 Research Questions ................................................................................................................................ 19 Research Methods ................................................................................................................................... 20 Interpretation of Quantitative analysis ................................................................................................ 21 Data Sources ........................................................................................................................................... 22 Limitations of Analysis .......................................................................................................................... 22 3. Findings of Research .............................................................................................................. 23 Seasonal Fluctuations in Education Outcomes ........................................................................... 23 Seasonal education expenditure patterns ........................................................................................... 24 Socio-economic characteristics of low education expenditure households ..................................... 25 Seasonal school enrolment and attendance ........................................................................................ 26 Socio-economic characteristics of households with low seasonal attendance and enrolment ..... 28 Seasonal Fluctuations in Child Labour......................................................................................... 31 Child labour in Malawi ........................................................................................................................... 31 Determining factors of child labour .................................................................................................... 34 The geography of child labour in Malawi ........................................................................................... 34 Socio-economic characteristics of child labour .................................................................................. 36 Seasonal Fluctuations in Child Marriage .................................................................................... 40 The seasonal nature of child marriage in Malawi ............................................................................... 41 Socio-economic characteristics of child labour .................................................................................. 42 Seasonal Fluctuations in WASH, Health and Nutrition ............................................................. 46 The seasonal nature of vector and water borne diseases in Malawi ................................................ 47 Causal factors of disease prevalence in Malawi: An examination of malaria, diarrhoea and pneumonia .............................................................................................................................................. 50 Socio-economic characteristics of malaria prevention and contraction .......................................... 51 Socio-economic characteristics of pneumonia vulnerable households ............................................54 Socio-economic characteristics of diarrhea vulnerable households ................................................. 56 The seasonal nature of malnutrition and mortality in Malawi ........................................................ 60 Acute malnutrition ................................................................................................................................ 60 Socio-economic characteristics of children susceptible to acute malnutrition .............................. 62 3 Chronic malnutrition ............................................................................................................................ 63 Child mortality ....................................................................................................................................... 68 Socio-economic characteristics of child mortality ............................................................................. 70 4. Conclusion and Recommendations ........................................................................................ 73 References ...................................................................................................................................... 75 Annex 1: Secondary data sources ................................................................................................... 83 Annex 2: U-report Survey Example ............................................................................................... 83 Annex 3: Education Analysis .......................................................................................................... 85 Annex 4: Child Labour and Marriage Analysis .............................................................................. 87 Annex 5: Malaria, Pneumonia and Diarrhoea Analysis .................................................................. 91 Annex 6: Analysis on malnutrition ................................................................................................ 94 4 Table of Figures Figure 1: Seasonal deprivations in Malawi .................................................................................................... 7 Figure 2: Malawi’s seasonal calendar and associated impacts on wellbeing ............................................. 17 Figure 3: Total monthly rainfall (mm) and max temperatures (oC), 2017* .............................................. 18 Figure 4: School fees over the school calendar .......................................................................................... 24 Figure 5: Education Expenditure (%) by income group and primary school fess (MKW) ...................... 24 Figure 6: Trend in Primary School Enrolment (Net Enrolment Rate, %) ................................................ 26 Figure 7: Child labour, employment and school attendance ...................................................................... 31 Figure 8: Proportion of Children (age 5-17) that worked in each month ..................................................32 Figure 9: Proportion of girls (left) and boys (right) married before the age of 18 ................................... 40 Figure 10: Under 18 and Under 15 female marriages as a proportion of total marriages per season ..... 42 Figure 11: National Drinking Water Coverage by Wealth Quintile, 2017 .................................................. 46 Figure 12: National Sanitation Coverage by Wealth Quintile, 2017 ........................................................... 47 Figure 13: Malaria seasonal trend (data