The DHS Program

Calverton, MD - One in seven children born in Swaziland dies before reaching his or her fifth birthday, and 70 percent of these deaths take place during the child's first year, according to the nationally representative 2006-07 Swaziland Demographic and Health Survey (SDHS). Reflecting the spread of HIV in Swaziland, mortality rates for infants and children have risen in recent years. The infant mortality rate is now 85 deaths per 1,000 live births, estimated for 2002-06. Addressing HIV/AIDS and, particularly, preventing mother-to-child transmission, would save many young lives.

More young children would also survive if they received the full series of recommended vaccinations, obtained early treatment for the common childhood diseases, and had adequate nutrition. Vaccination coverage has increased substantially in recent years, but one child in four still does not receive the full recommended series of vaccinations in the first year of life. In addition, about 3 in 10 children (29 children) under age five are stunted, including 10 percent who are severely stunted. Stunting reflects failure to receive adequate nutrition over a long period, and is also affected by recurrent and chronic illnesses.

Number of Orphans and Vulnerable Children Increase
The HIV/AIDS epidemic has led to a growing number of orphaned and vulnerable children (OVC) in Swaziland. Today, about 3 in 10 Swazi children under age 18 are orphans and/or considered vulnerable because of their living arrangements, according to the SDHS. Whether orphaned or not, children living in a household in which parents or other adults are very sick often face serious hardships, as chronic illness often limits resources for child care and challenges the very survival of many households.

Many Pregnancies Not Wanted
About half of married women age 15-49 use family planning, but many women are having unwanted pregnancies. Only about one-third of births are wanted at the time of conception, according to the survey. Thirty-seven percent are unwanted and 27 percent are mistimed. If all women could avoid unwanted childbearing, Swaziland's total fertility rate (TFR) would be 2.1 children per woman, far below the current TFR of 3.8 children.

The three most widely used contraceptive methods among currently married women are injectables (17 percent), male condoms (12 percent), and oral contraceptive pills (10 percent). Unmet need for family planning is substantial: about one-quarter of married women are not using any contraceptive method even though they do not want to become pregnant.

Maternal Deaths Often Preventable
The majority of pregnant women (74 percent) give birth in health care facilities, most in public clinics or hospitals. This is one of the highest rates in Africa. Despite this marked success, 26 percent of women still give birth at home. Home births are most often attended by relatives or traditional birth attendants. Four percent of women deliver with no assistance at all. Still, many women in Swaziland face serious problems getting medical care. Over three-quarters (78 percent) said they had had at least one such problem-primarily related to service delivery.

As in other African countries, pregnancy can pose serious health risks for women. In Swaziland, for every 1,000 births, an estimated six women die of maternal causes (mortality associated with pregnancy and childbearing). The maternal mortality rate would be even higher if not for the current high level of HIV/AIDS-related mortality among women. Most maternal deaths could be prevented with good antenatal, obstetric, and postnatal care.

For more information about the 2006-07 Swaziland DHS, please contact Central Statistical Office (CSO), Ministry of Economic Planning and Development, P.O. Box 456 Mbabane, Swaziland H100. Telephone 268-404-2151; Fax 268-404-3300; e-mail: statistics@africaonline.co.sz