Analytical summary - Gender and women's health
Adolescent health is a public health issue in Malawi in a number of ways. Demographically, the adolescent group (aged 15–24 years) constitutes about 20% of the total population of the country. These adolescents face many challenges due to harmful and cultural practices, premarital sex and lack of access to family planning education and services resulting in, among other things, unwanted pregnancies, unsafe abortions and early childbearing.
The Malawi demographic and health survey 2010 also indicates that people marry early, as the mean age at marriage is 17.8 years for females and 22.5 years for males. Sexual activity among adolescents in Malawian society starts early: 26% of young women aged 15–19 years had started childbearing, 20% were mothers and 6% were pregnant with their first child. This early exposure to sexual activity exposes adolescents to pregnancy and sexually transmitted infections, including HIV/AIDS.
The Ministry of Health has developed a youth-friendly health services strategy and standards to improve availability and accessibility to such services at all levels. By June, 2011, youth-friendly health services provision was at 75%, surpassing the target of 60% by 2015. Using the available youth-friendly health services standards, a total of 64 sites in phase 1 were accredited across the country. Despite these interventions, it would be interesting to show if this intervention has resulted in improvement in accessibility to the youth services.
The National Sexual and Reproductive Health and Rights Policy 2009 provides a framework for implementing sexual and reproductive health programmes across the country. It offers a comprehensive approach to sexual and reproductive health opportunities to improve not only the health of childbearing women but also the needs of youth. The Policy also covers men. A number of reproductive health services target adult women of reproductive age (15–49 years) family planning, maternal and neonatal health, prevention of mother-to-child transmission, obstetric fistula, sexually transmitted infections, HIV/AIDS and reproductive cancers.
Despite efforts to make services accessible to all, total fertility of 5.7 is still high. While family planning knowledge is universal (98%), the unmet need for family planning for married women aged 15–49 years is 26%. Cervical cancer constitutes 78.6% of all documented female cancers while breast cancers are also on the increase.
Passive surveillance for sexual and reproductive health is through the routine health management information system, which has been operational countrywide since 2002 and through the cancer registry maintained in central hospitals. Surveys such as the demographic and health surveys are also conducted at regular intervals to provide data on the various aspects of sexual and reproductive health.