Safe Motherhood: A Review - Family Care International

Malawi
National Programs, Policies,
and Budgetary Commitments for Safe Motherhood
Malawi is a landlocked country in
Central Africa, with a total surface
area of just over 118,000 sq km, of which 80%
is land. 59 The total population is currently
estimated at 12 million people, with a
population density of 105 persons per square
kilometer. This is not evenly distributed: the
more fertile plains in the Southern Region of
the country are more densely populated than
the drier, rocky, and hilly areas.
The annual population growth rate is 2.0%,
and life expectancy is 40 years for males and
44 years for females. 60 Life expectancy has
deteriorated over the past 10 years mainly due
to the HIV/AIDS epidemic, which is considered
the number one cause of death among
adults. 61 The total fertility rate has dropped
from 7.6 in 1977 to 6.3 in 2000, with urban
areas having a lower level than rural areas,
(4.5 vs. 6.7 respectively). These are higher
than the desired fertility, 5.2 nationally and 3.5
for urban and 5.5 for rural residents, possibly
indicating the degree of unmet need for family
planning and extent of unplanned pregnancy.
In the early 1990s the estimated national
MMR in Malawi was 620 per 100,000 live
births. Between 1992 and 2000, the MMR
increased from 620 to 1,120 per 100,000 live
births based on local surveys; WHO/unicef/
UNFPA (2000), however, estimates that the
MMR stands at 1,800 per 100,000 live births,
making Malawi the country with the second
highest MMR in Africa, and the third highest
globally. Preliminary results of the 2005
Malawi DHS indicate that the MMR may have
risen even higher.
The national increase in MMR has been
mirrored by an increase in institutional MMR;
for example, at the Central Teaching Hospital
in Blantyre, the MMR increased from 476 in
1994–1996 to 1,125 per 100,000 live births
in 1999–2000. A 2005 national assessment
of emergency obstetric care showed a case
fatality rate of 3.4%, which is higher than the
recommended level of 1% by UN process
indicators. The impression of many health
care providers in the country is that the
current MMR may actually be much higher
than what is seen in health facilities.
Several factors have been cited as
contributing to the high MMR in Malawi.
There has been a significant decline in the
quality of health care delivery nationally. This
has been documented in studies, surveys, and
assessments conducted nationally or within
health institutions. Over the past ten years,
the country has witnessed an unprecedented
depletion of the workforce within the health
sector, through death from the HIV/AIDS
epidemic or resignations due to the low pay.
Hundreds of nurses have left the country
for overseas posts or public service for local
NGOs. Physicians training overseas have not
returned home for economic reasons. Many
health facilities have no qualified staff and
therefore essential services such as deliveries
are conducted by unqualified auxiliary staff.
59 National Statistical Office (2000). Malawi Demographic and Health Survey, 2000. Zomba, Malawi.
60 National Statistical Office (1998). National Housing and Population Census, 1997. Zomba, Malawi.
61 National Statistical Office (2000, 1998, 1977). National Housing and Population Census. Zomba, Malawi.
61