Malawi’s 2018 GHI score is 26.5, considered serious, down from 44.7 in 2000, when it was categorized as alarming. Underlying this improvement are reductions in three of the four indicator values used to calculate the GHI: child stunting, child wasting, and child mortality (Figure 2). Given the importance of child nutritional status for well-being from birth through adulthood, Malawi’s progress in this area is notable. In contrast, Malawi’s undernourishment rate—the prevalence of the population with inadequate access to calories—decreased modestly between 2000 and 2010 but has since increased, nearly erasing previous progress.
While it may seem counterintuitive that children’s nutritional status has improved despite lack of comparable progress on undernourishment for the population as a whole, children’s nutritional status is influenced by a variety of distinct factors, including inadequate intake of food in terms of either quantity or quality, poor utilization of nutrients due to infections or other illnesses, or a combination of these. These, in turn, are caused by a range of other factors, including household food insecurity; inadequate maternal health or childcare practices; or inadequate access to health services, safe water, and sanitation. The following sections thus consider the food and nutrition security situation of Malawi’s population as a whole and then that of its children, including the conditions that have contributed to recent developments.
Food Security in Malawi
Malawi’s undernourishment rate has fluctuated over the two decades since 1999–2001 (Figure 2). Between 2004–2006 and 2007–2009 it underwent a period of decline, but increased between 2013–2015 and 2015–2017 (FAO 2018), coinciding with the 2015 flooding and 2015/16 drought that crippled the agricultural sector in Malawi and beyond. This trend is also reflected in the latest Integrated Household Survey (IHS), which show food insecurity increasing between 2010/11 and 2016/2017 (NSO 2017).
The Malawian diet consists largely of staples, primarily maize, as well as rice and cassava. Most Malawians consume foods rich in micronutrients and/or protein, such as fruits, vegetables, and animal-source foods, in limited quantities (GoM 2018b; Aberman, Meerman, and Benson 2018). The Government of Malawi has prioritized maize production since at least the mid-1970s (Dorward, Chirwa, and Jayne 2011). In 2005/06, the government instituted the well-known Farm Input Subsidy Program, with the goals of increasing maize production, promoting household food security, and enhancing rural incomes (Lunduka, Ricker-Gilbert, and Fisher 2013). Even with this program, the country occasionally faces years when it produces insufficient maize for its own consumption. Also, some segments of the population have inadequate access to calories even in years when there is a surplus of maize (FAO 2015b, 2018).
Weather shocks such as droughts, floods, and high temperatures frequently decrease food production and increase food insecurity in Malawi, in part because of the difficulties of implementing food price and food stock policies to effectively mitigate these challenges (Minot 2010). Temperatures that exceed seasonal averages push down food consumption and caloric intake by decreasing food production and raising food prices. Disaggregated results show that this effect is most significant for households where the land is managed solely by women in parts of the country where land inheritance is patrilineal, perhaps because women with insecure land tenure are less likely to invest in agricultural technologies that could mitigate the effects of weather shocks (Asfaw and Maggio 2018).
Gender is an important determinant of food security in Malawi. While data on the intrahousehold distribution of food are largely lacking (and thus the extent to which women and men or girls and boys have equitable access to food is not well understood), there is evidence that female-headed households generally have poorer food security than male-headed households in Malawi (Kakota et al. 2015;
Kassie et al. 2015). In the context of farming households, this is not only because female-headed households have fewer resources with which to work (such as land, education, inputs, and training), but
also because the returns to the same level of resources are lower for female-headed households than for male-headed ones, suggesting they face multiple forms of discrimination (Kassie et al. 2015).
Malawi’s high prevalence of HIV/AIDS, currently at 10.6 percent of adults aged 15–64 years (corresponding to about 900,000 Malawians living with HIV), has also contributed to malnutrition and hunger in Malawi. HIV reduces the body’s ability to utilize nutrients and people’s capacity to produce or access adequate food (MoH 2017; Nyantakyi-Frimpong et al. 2016).
Improvements are necessary in not only the quantity but also the quality of people’s diets (Aberman, Meerman, and Benson 2018). Diet and nutritional status are influenced by the types of foods that
households can either produce themselves or purchase from markets. The variety of crops grown on farms has been shown to be positively related to household dietary diversity and intakes of calories and protein in Malawi (Jones 2017; Koppmair et al. 2017). Studies also link crop diversity with households’ access to important micronutrients: iron, folate, vitamin A, and zinc (Jones 2017; Mazunda,
Kankwamba, and Pauw 2018). In some contexts, access to markets for buying and selling food and produce influences dietary diversity more than crop choice does (Koppmair et al. 2017).
Children’s Diet and Nutrition
Malawi’s rates of child stunting (low height-for-age) and child wasting (low weight-for-height) have fallen substantially since 2000, according to the most recent data. Its child wasting rate declined from 6.8 percent in 2000 to 2.7 percent — considered “low” — in 2015–2016. At 37.1 percent in 2015–2016, Malawi’s child stunting rate was still considered “very high,” but it declined impressively relative to its 2000 rate of 54.6 percent (NSO and ORC Macro 2001; NSO and ICF 2017; de Onis et al. 2018). This improvement is likely due to reductions in childhood illnesses that inhibit the utilization of nutrients, the scaling up of direct nutrition interventions, and underlying factors such as economic growth. Nutrition programs included expansion of vitamin A supplementation and deworming for children, the promotion of proper nutrition during pregnancy and adequate infant and young child feeding practices, and the nationwide implementation of community-based treatment of children with severe acute malnutrition (Kanyuka et al. 2016).
Malawi’s mortality rate among children under age five decreased between 2000 and 2016 from 17.5 to 5.5 percent (UN IGME 2017). Analysis shows this improvement can be attributed to treatment for diarrhea, pneumonia, and malaria; insecticide-treated bed nets; vaccines; reductions in wasting and stunting; facility birth care; and prevention and treatment of HIV. These in turn were made possible
by increased funding for Malawi’s health sector and by policies and interventions aimed at improving child health and nutrition (Kanyuka et al. 2016). Malawi achieved the Millennium Development Goal target of reducing child mortality by two-thirds between 1990 and 2015, yet the current rate is still higher than the Sustainable Development Goal target of 2.5 percent by 2030 (UN 2018).
Infant and young child feeding practices in Malawi have shown both significant gains and recent slumps. As of 2015–2016, 61 percent of children under six months of age nationally were exclusively breastfed. This is a remarkable improvement relative to 1992, when the rate was just 4 percent, and 2000, when the rate was 44 percent. Still, it represents a decline relative to 2010, when the rate was 72 percent (NSO and ICF 2017). The improvement between 1992 and 2010 is attributed to a variety of factors, including strong government commitment to improving infant and young child feeding practices and national advocacy to increase breastfeeding knowledge (WHO 2014). The recent decline may stem from higher employment rates for women, the availability of breastmilk alternatives, and unfavorable public opinion regarding breastfeeding, among other things (Gangire 2017). Understanding these factors is important because exclusively breastfed infants under six months of age have higher length for age and weight for age than non-exclusively breastfed infants (Kuchenbecker et al. 2015). Meanwhile, just 8 percent of children between 6 and 23 months consume a minimum acceptable diet, which also represents a worsening of the situation since 2010, when this rate was 19 percent (NSO and ICF Macro 2011; NSO and ICF 2017).
Children’s nutrition in Malawi improves with the education level of the mother, particularly when the mother attains 10 or more years of education—that is, when she reaches senior secondary school or beyond. Women’s education may benefit children’s nutrition through a variety of channels, including improved feeding practices, better knowledge about health care, and economic advantages, such as increased command over household resources by mothers (Makoka and Masibo 2015).
For each of the three GHI indicators with subnational data (child stunting, wasting, and mortality), there is considerable variation at the district level, with some districts, particularly in the Central and Southern regions, standing out with higher rates (see Table 1). The Northern region has the lowest level of multidimensional poverty, which takes into account health, education, and living standards (World Bank 2016). The Northern region also fares better than the other regions in terms of several indicators related to child nutrition and health, including higher educational attainment rates of both men and women, better handwashing facilities, and a lower total fertility rate (NSO and ICF 2017).