Analytical summary - Child and adolescent health
The National Nutrition Survey Report 2008 indicates that the prevalence of acute wasting in Swaziland is 1.1 per cent and there are no significant differences between rural and urban settings. Similarly, the prevalence of acute malnutrition was estimated at 1.1 per cent for 0-59 months old. This situation might change though due to a number of socio-economic factors, such the increase in the number of child headed households and the prevalence of significant food poverty.
While acute malnutrition has remained at reasonable low levels over the years, prevalence of chronic malnutrition has shown at steady rise from routine nutrition monitoring systems. At national level 40.4 per cent of children under five are stunted, while the proportion of severely stunted is 12.6 per cent. From the survey it could be inferred that stunting is more prevalent in rural areas than urban areas. The prevalence of underweight children was estimated at 7.2 per cent in 2008 and the prevalence of severely underweight children was 1.1 per cent.
These figures show that there is a considerable problem of malnutrition among children in the country. The National Youth Policy defines youth as young women and men aged 15 to 35 years. The current census figures indicate that young people aged 10-24 years constitute 37 per cent of the population in Swaziland. This is significant in that a majority of these are not married yet they are sexually active and without the benefit of contraception.
Early sexual relations and pregnancy were identified as problems facing adolescents by programme as well as policy people during our interviews. The 2006-07 SDHS reports the median age at first sex is just over18 years for women and a year later for men aged 20 to 24 years. Causes of early sexual debut are not clearly understood but it has been suggested that this is a result of number of reasons such as parental negligence, high incidence of poverty, some cultural traits, a more permissive society and lack of information. By the age 24 years, at least 30.2 per cent of women had at least a child. These call for multifaceted and multispectral approach to address adolescent sexual reproductive health issues to reduce early pregnancies.
Sexual abuse is more prevalent in the country. Abuse is typically perpetrated by relatives, members of the family and in some instances older men. This makes disclosure and prevention a great hurdle to surmount. Emotional and physical abuse sometimes coexist with sexual abuse, and for some young people, this can lead to risky sexual behaviour exposing them to HIV infection and unwanted pregnancy. When parents divorce, children often stay with one of the parents and if one remarries the children end up living with a step parent.
Such situations are interpreted to be recipe for emotional, psychological, physical trauma as well as sexual assault. In worst case scenario the step children may be denied basic social services such as health, education, sports, entertainment and the biological parent may be sometimes be an unwilling accomplice. Contraceptive knowledge is high in this age group but that there are unwanted pregnancies which indicate that there is unmet need for contraception. HIV infection in the youth group is high and therefore, there is still unmet need for use of technologies for dual protection.
The legal environment offers protection to women and the girl child through the constitution and legal instruments that are due for submission to parliament. The important legislation is the Girls and Women’s Act, No 39 (1920) which prohibits any form of sexual intercourse with a girl less than 16 years. The Sexual Offences and Domestic Violence Bill protect survivors and prohibit risky cultural practices such as wife inheritance, forced marriage and non-consensual marriage.
Despite all these legal documents with very good intention to protect and preserve the well-being as well as dignity of women and young girls, cases of sexual assaults are rampant as indicated above, as too are other forms of gender discrimination. Access to HIV testing and counselling services for those less than 16 years, services for young girls with abortion complications and unwanted pregnancy remain problematic. The Integrated SRH Strategic Plan (2008-2015) and the national Youth Action Plan (2009-2013) provide further support to improved access to SRH services for young people.