CHAPTER 1 INTRODUCTION 1.1 Geography, History and the Economy Geography Malawi is a landlocked country bordered to the north and northeast by the United Republic of Tanzania, to the east, south and southwest by the People's Republic of Mozambique and to the west by the Republic of Zambia. It is 901 kilometres long and ranges in width from 80 to 161 kilometres. The country has a total area of 118,484 square kilometres, of which 94,276 square kilometres is land area. Fifty-six percent of the land area is arable. Malawi's most striking topographic feature is the Rift Valley which runs through the entire length of the country, passing through Lake Malawi in the northem and central part of the country to the Shire Valley in the south. To the west and south of the lake are fertile plains and high mountain ranges whose main peaks range from 1,698 to 3,002 metres. The country is divided into three administrative regions; Northern, Central and Southern. There are twenty-four districts, five in the Northern Region, nine in the Central Region and ten in the Southern Region. In each district there are Traditional Authorities (or chiefs) and the smallest administrative unit is the village. There are 43 Traditional Authorities in the Northcrn Region, 79 in the Central Region and 83 in the Southern Region. Malawi experiences a tropical continental climate with some maritime influences. Rainfall and temperature are greatly influenced by the lake and altitude, which varies from 37 to 3,050 meters above sea level. From May to August, the climate is cool and dry. From September to November, average temperatures rise and the rainy season begins towards the end of this period. The rainy season extends to April or May. History Based on the examination of earliest human remains and stone-aged tools, people who are known as Abathwa, Akafula or Mwandionerakuti lived in Malawi since around 8000 BC. During the 9th Century AD, a group of people known by the name of Pule, Lenda or Katanga from the shores of Lake Tanganyika settled in Malawi. Between the 13th and 16th Century AD, Bantu speakers known as Maravi settled in central and southern Malawi. Those who eventually settled in central Malawi are known as Chewa while those who settled in southern Malawi are known as Mang'anja or Nyanja. The Tumbuka, Tonga, Ngonde, and Lambya eventually came to settle in northem Malawi. Later, during the 19th Century AD, the Ngoni, Yao, Lomwe and Sena settled in Malawi. It was also during this period that Europeans arrived in Malawi. On 14th May 1891, the British declared the country a British Protectorate under the name of Nyasaland District Protectorate which was then changed to British Central African Protectorate in 1893. Opposition to colonial adminstration culminated in the uprising led by John Chilembwe in 1915. In 1953 the Federation of Rhodesia and Nyasaland, which was also known as the Centred African Federation, was instituted comprising three countries, namely, Zimbabwe (then Southern Rhodesia), Zambia (then Northern Rhodesia) and Malawi (then Nyasaland) despite protests from Africans in Malawi through the Nyasaland African Congress, which was a nationalist movement founded in 1944. On 3rd March 1959 a state of emergency was declared by the colonial government and the Nyasaland African Congress, whose leaders were arrested and detained, became a banned party. In September 1959 the Malawi Congress Party was formed and on 19th September 1959 the Malawi News was launched as the official organ of the Party. On 15th August 1961 the first multiparty general election was held wherein four political parties contested. The Malawi Congress Party won all twenty seats on the lower roll plus two which it contested on the higher roll. As a result of the general election, the country formed an internal self-government. In April 1964 another general election was held wherein all candidates of the Malawi Congress Party were returned unopposed. On 6th July 1964 Nyasaland became the independent state of Malawi under the monarchical constitution which was replaced by a republican constitution as of 6th July 1966 when Malawi bec~une a Republic and a one-party state. On 14th June 1993 a National Referendum was eonductcd which resulted in Malawi becoming a multiparty state. The Economy Malawi is predominantly an agricultural country. Agricultural produce accounts for 90 percent of Malawi's exports; tobacco, tea and cotton are the major export commodities. The country is largely self- sufficient in food. The economy of Malawi improved in 1991 over performance in the three preceding years. Real gross domestic product (GDP) grew at a rate of 7.8 percent in 1991 compared to growth of 4.8 percent, 4.1 percent and 3.3 percent recorded in 1990, 1989 and 1988, respectively. The agricultural and distribution sectors accounted for most of the increase in real GDP. 1.2 Population and Family Planning Policies and Programmes The major source of demographic data Table 1.1 Selected demographic indices fi~r Malawi is the population census. Population censuses have been taken in Malawi during the years 1891, 1901, 1911, 1921, 1926, 1931, 1945, Census year 1956, 1966, 1977 and 1987. Additional popula- tion data have been collected through nationwide Index 1966 1977 1987 demographic and other related surveys. These are the Malawi Population Change Survey in Population I 4039583 55474611 7988507 1970-72, the Malawi Demographic Survey in Intercensal growth rate 2 - 2.9 3.2 Total area (sq. kin.) 118484 118484 118484 1982, the Malawi Labour Force Survey and the Land area (sq. kin.) 94079 94276 94276 Survey of Handicapped Persons in 1983, and the Density (pop./sq. kin.) 43 59 85 Family Formation Survey in 1984. Table 1.1 Percentage urban 5.0 8.5 10.7 Women of childbearing age provides some demographic indices for Malawi. as percentage of female population 47.6 45.1 44.2 The population of Malawi is growing at Sex ratio 90 93 94 Crude birth rate 48.3 41.2 a rate of around 3.2 percent per year based on Total fertility rate 7.6 7.63 the 1987 census, up from 2.9 percent in 1977 Crude death rate 25.0 14. I (this considers only natural or intrinsic growth Infant mortality rate 165 1513 and does not include refugee populations, esti- Life expectancy' mated at about 1 million persons in 1992). The Male 39.2 41 4 total Malawian population in the 1987 census Female 42 4 44.6 was enumerated at around 8 million persons, IDe facto population having roughly doubled since the 1966 census. 2Natural increase; excludes migration, refugees Given current growth rate estimates, the 1994 3Based on the 1984 Family Formation Survey population will reach approximately 10 million 2 persons. With a doubling of the size of Malawi's population over the last two decades has come a doubling of the population density from 43 to 85 persons per square kilometre during the period 1966 to 1987. By 1994, Malawi's population density will exceed 100 persons per square kilometre. A national population policy for Malawi has been prepared. The policy aims at achieving lower population growth rates compatible with attainment of the country's social and economic objectives in addition to reducing morbidity and mortality among mothers and children. It aims at improving the status of mothers and children in all spheres of development as well as improving information, education and communication on the use of contraceptives and benefits of small family sizes. In the education sector, the policy will enhance the relevance of formal and informal education. The policy stresses the importance of the creation of employment and food self-sufficiency especially for pregnant and lactating mothers as well as children. Last but not least, the policy aims at improving the collection, analysis and dissemination of demographic, environment and employment data, by gender, and the utilisation of these data for social and economic planning. A technical secretariat for the National Population Advisory Committee (NPAC) composed of all relevant ministries and non-government organisations (NGOs) was recently established in the Office of the President and Cabinet (OPC). The Secretariat's overall responsibility is to coordinate and monitor the implementation of population programmes and projects and to develop population guidelines for the country. 1.3 Health Priorities and Programmes Health services in Malawi are provided by the Ministry of Health, the Ministry of Local Government and the NGOs, particularly mission organisations. The Ministry of Health is responsible for planning and developing health policies and for providing health care in all government hospitals. The Ministry of Local Govemment is in charge of health care delivery at the district level and below. NGOs provide services to both hospitals and smaller medical units. In Malawi, the provision of curative services takes a large proportion of the total government funds allocated to the health sector. The lack of an effective outreach capacity in the system has been recognised by the Ministry of Health, and strategies for creating a community-based distribution system are being implemented despite a severe lack of trained medical personnel in the country. Currently, the government is developing a health policy with the goal of achieving health for all by the year 2(g30. 1.4 Objectives, Organisation, and Design of the Survey Objectives The Malawi Demographic and Health Survey (MDHS) was a national sample survey of women and men of reproductive age designed to provide, among other things, information on fertility, family planning, child survival, and health of mothers and children. Specifically, the main objectives of the survey were to: Collect up-to-date information on fertility, infant and child mortality, and family planning Collect information on health-related matters, including breastleeding, antenatal and maternity services, vaccinations, and childhood diseases and treatment Assess the nutritional status of mothers and children Collect information on knowledge and attitudes regarding AIDS • Collect information suitable for the estimation of mortality related to pregnancy and childbearing Assess the availability of health and family planning services.