Malawi - Population sector review

Reporl No. 5648-MA Malawi Population Sector Review March 10, 1986 Population, Health and Nutrition Department Division I FOR OFFICIAL USE ONLY > | *stt * ; ,, f ,~~~~~~~~~~~~~-., ,;; ;s;C Document of the World Bank This document has a restricted distribution and may be used by recipients only in the performance of their official duties. Its contents may not otherwise be disclosed without brld Bank authorization.  CURRENCY EQUIVALENTS US$ 1 - M.K. 1.74 M. Kwacha 1 - US$ .57 WEIGHTS AND MEASURES 1 Acre (ac) - 0.405 Hectares 1 Mile (mi) - 1.609 Kilometers GOVERNMENT OF MALAWI FISCAL YEAR April 1 to March 31  FOR OMCIAL USE ONLY ABSTRACT _ Malawi is one of the most densely populated countries in Sub-Saharan Africa. The population has increased from 4.04 million in 1966 to an estimated 7.15 million in 1985. The present growth rate is estimated to be 3.2Z per annum. Rapid growth of population is inevitable over the next few decades. Under any plausible assumption of fertility trends the population will increase by roughly 50 to 70 percent over the next 30 years. If fertility does not fall, the rate of population growth will have climbed to 4 percent by 2010-2015 implying a doubling of the population within 17 years. Slowing population growth is needed urgently if most or all of the gains in economic growth and social welfare are not to be threatened. A multi-sectoral population program is recommended, with particular emphasis on the expansion of the availability of child spacing services and the introduction of information and educational programs. I/ This report is based on the findings of a Population mission which visited Malawi in October 1984. The mission was composed of Vulimiri Jagdish (Mission leader, Public Health Specialist, Bank), Althea Hill, (Demographer, Bank), Barbara Kennedy, (Population Specialist, USAID), and Nancy Yinger (Economist, USAID). | Thu document has a restrictd distribution and may be used by recipients only in the peformance of their official dutieL Its contents may not otherwise be discloe without World Bank authorization.  ABBREVIATIONS ACMO Assistant Chief Medical Officer ADD Agricultural Development Districts BER Basic Economic Report CBR Crude Birth Rate CDR Crude Death Rate CEM Country Economic Memorandum CMO Chief Medical Officer CMS Central Medical Stores CO Clinical Officer DCMO Deputy Chief Medical Officer DMO District Medical Officer DPT Diphtheria, Pertussis and Tetanus EAB Extension Aids Branch EN Enrolled Nurse EPD Economic Planning Division EPI Expanded Program of Immmuization FFS Family Formation Survey HA Health Assistant HI Health Inspector HSA Health Surveillance Assistant H USC Health Sub-Center IEC Information, Education and Comunlcatlons DIR Infant Mortality Rate IUD Intra Uterine Device KAP Knowledge, Attitudes and Practice MA Medical Assistant -CH Maternal and Child Health MOH Ministry of Health MOLG Ministry of Local Government NPDP National Physical Development Plan NRDP National Rural Development Progras NSO National Statistical Office NSSA National Sample Survey of Agriculture OPC Office of the President and Cabinet PCS Population Change Survey PHAM Private Hospitals Association of Malawi PEC Primary Healtb Center RNI Rate of Natural Increase SCO Senior Clinical Officer SRN State Registered Nurse TBA Traditional Birth Attendant TFR Total Fertility Rate UNFPA United Nations Fund for Population Activitles UNICEF United Nations Children's Fund USAID United States Agency for International Development WHO World Health Organization  DEFINITIONS Contraceptive Prevalence The percentage of married women of Rate: reproductive age who are using (or whose husbands are using) any form of contracep- tion. Crude Birth Rate: The number of births per 1,000 population in a given year. Crude Death Rate: The number of deaths per 1,000 population in a given year. Dependency Ratio: The ratio of the economically dependent part of the population to the productive part, arbitrarily defined as the ratio of the young (those under 15 years of age) plus the elderly (those 65 years of age and over) to the population in the "working ages" (those fifteen to sixty-four years of age). Infant Mortality Rate: The number of deaths of infants under one year old in a given year per 1,000 live births in that year. Life Expectancy at Birth: The average number of years a newborn would live if current age-specific mortality were maintained. Life expectancy at later ages is the average number of years a person already at a given later age will live. Life expectancy at age five and above can exceed life expectancy at birth substantially if the infant mortality rate is high. Mortality: Death as a component of population change. Rate of Natural Increase: The rate at which a population is increasing (or decreasing) in a given year due to surplus (or deficit) of births over deaths. The rate of natural increase equals the crude birth rate minus the crude death rate per 100 people. It also equals the population growth rate minus emigration. Rate of Population Growth: The rate at which a population is increasing (or decreasing) in a given year due to natural increase and net migration, expressed as a percentage of the base population. Total Fertility Rate: The average number of children that would be born alive to a woman (or group of women) during her lifetime if during her child-bearing years she were to bear children at each age in accord with prevailing age-specific fertility rates.  MALAWI POPULATION SECTOR REVIEW TABLE OF CONTENTS Page No. EXECUTIVE SUMMARY ...................... i - iv I. DEMOGRAPHIC BACKGROUND Population Size and Growth ............ 2 Population Distribution, Urbanization and Internal Migration .o ...... 2....g.......... u 2 External Migration ..... ...... ..... 3 Mortality ...............**......... ...... * 3 Fertility ...*.. 4 Age and Sex Structure ................................ 5 Vital Rates and Natural Increase .......................... 6 II. CONSTRUCTION AND RESULTS OF POPULATION PROJECTIONS Construction of Projections .............................. . 6 Results of Projections ................*........**** 9 III. SOCIO-ECONOMIC IMPLICATIONS OF POPULATION GROWTH Implications for Economic and Agricultural Growth ........ 13 Implications for Provision of Social Services ............ 20 IV. GOVERNMENT POLICIES AND PROGRAMS Government Policies ............ ...e ............ee 25 Present and Potential Population-related Activities ...... 25 V. ISSUES AND RECOMMENDATIONS ................. ............. 36 ANNEXES A Population Projections *.........*.... ................. 41 B - Socio-economic Data .*..............s........se .. 47 C - Key Health Statistics ........ an .. .......seeee*ee... 64 D - Outreach Programs of Ministries other than Ministry of Health ....................e.e...eee*.eee 69 E - Information, Education and Communication Activities ..... 72  NALANI POPULATION SECTOR DEVIUW EXECUTIVE SUiMIAY The Population Problem 1. Malawi's population In 1985 is estimated to be 7.15 million. The rate of natural increase is currently 3.2Z per annum. The country is already one of the most densely populated countries in Sub-Saharan Africa. Population density, 59 Inhabitants per km2 at the time of the 1977 census, may have risen to 74 per km2. External migration, important in past decades, has undoubtedly fallen and is expected to continue to diminish. The level of fertility is high. In the mid 1970., the total fertility rate (TFR) was estimated at between 7.5 and 8.0 ad Is unlikely to have changed since. Regionally the TFR is highest in the Central Region at around 8.5, lowest in the Southern Region between 7 and 7.5. The TFR in the Northern Region is close to the national average. 2. The following table suimarizes the projected size and growth of the population of Malawi over the next 30 years. Rapid population growth is all but inevitable over the next few decades. If fertility remains constant, the population will grow from 7.15 million in 1985 to 11.95 million in 2000 and to 21.31 million by 2015. If there is accelerated decline in fertility, the population will grow to 10.63 million in 2000 and 13.29 million in 2015. By 2000 an accelerated fertility decline could reduce population increase by 121, and within 30 years from now, a fall in fertility would cut the population increase by a quarter to a third. MALAWI: POPULATION PROJECrIONS 1985-2015 Ratio of Population !p'ulation to Base 1985 (In illions) Population in 1985 2000 2015 2000 2015 A. Constant Fertility 7.15 11.95 21.31 167 298 B. Standard Decline 7.15 11.44 17.09 160 239 C. Accelerated Decline 7.15 10.63 13.29 149 186 Implications for Economic and Agricultural Growth 3. There is tremendous potential for Halawi's population to grow with the prospect of a 50 to 70X increase in size over the coming 15 years, and a doubling or tripling within the next 30 years. Such massive and rapid population growth will have significant socio-economic consequences. During the 1970s economic growth averaged 6.8Z annually while the population growth rate during the same period was 2.8 to 2.9Z. This resulted in a continued increase in per capita Income. Between 1979 and 1983 annual growth in GDP has failed to match population growth, with a consequent slight decline in average income. Mach of the economic growth is due to estate agriculture and smallholder agriculture. Continued rapid  - ii - growth in agriculture is essential to provide food for the growing population. However, the growth of the agriculture sector is constrained by shortage of land. All agricultural land in Malawi will have to be brought under cultivation to support the population within the next 30 years if fertility does not fall. By 2015 there will be a land deficit of 13X with constant fertility. The effect on nutritional intake is already being felt. There is evidence that suggests that current domestic food production falls significantly short of required levels. At present this deficit may be as much as 15%. The following table shows the land required to support the population at present nutritional levels and land productivity under three fertility assumptions. Land Needed to Support Percent of Total Land Fertility Assumption Population {kmZ) Resources* Required for Cultivation 2000 2015 2000 2015 Constant Fertility 24,054 42,888 63 113 (deficit) Standard Decline 23,018 34,389 61 91 Accelerated Decline 21,259 26,749 56 71 *Not including land under estate cultivation in 1985. Implications for Social Services 4. If fertility remains constant, the implications are staggering for primary education expenditures. To achieve current enrollment targets for primary education, annual costs will rise from 24.4 million Kwacha in 1985 to 68.2 million Kwacha in 2000 and to 159.3 million in 2015 (a 552% increase). With accelerated fertility decline, annual costs will rise from 24.4 million Kwacha in 1985 to 61.2 million Kwacha in 2000 and to 66.1 million Kwacha in 2015 (a 170% increase). Thus rapid fertility decline could result in annual savings of 93 million Kwacha by 2015. Similarly, a decline in fertility could cut annual secondary education expenditure within 30 years by 17% if moderate, and by 43% if rapid fertility decline occurs. The need for Maternal and Child Health Services will also increase substantially. If no fertility decline occurs, the number of children under 5 years of age will increase by 70% in 15 years and will more than triple within 30 years to 4.5 million. Reduction in fertility will not only reduce health costs, but enable the country to increase the quality and scope of the health services. Government Policies and Programs 5. Although the Government of Malawi has only very recently begun to focus on the economic consequences of rapid population growth, it has  - iii - recognized the link between family planning and maternal and child health (MCH) much longer. The Government in 1982 decided to include child spacing services as part of its MCH program. Although Malawi society still has a positive view of the value of large numbers of children, the introduction of child spacing services has revealed an unexpectedly high level of demand. The Government is taking steps to respond, while leaving individual couples the right to have as many children as desired. This policy deserves support; there is sufficient unmet demand for child spacing, and services should be readily available to those couples who wish to use them. 6. Less than two years old, the child spacing program should be considered a pilot effort, small in scale but clearly sufficiently well run to merit expansion. Currently, child spacing services are available only at three major hospitals; a 350% increase in users at one facility _ alone within one year, however, is considered encouraging. To permit wider dissemination, attention must be paid to increasing facilities which offer services, to providing a reliable supply of contraceptives, and to improving various support procedures. This will necessitate strengthening and expansion of the MCH program. 7. In view of the continuing demand for child spacing services, the Ministry of Health (MOH) has developed a second Child Spacing Plan of Action for 1986-88, which would establish goals for training, education, services and research. Although still a working document, the Plan represents convincing evidence of the Government's commitment to providing families with access to child spacing services. However, given that MOH is already overburdened with many other responsibilities, the Plan would need to take into account other ministries, private and local government health providers and the pharmaceutical sector, all of which could contribute both to the promotion and supply of child spacing activities. Issues and Recommendations 8. Two major recommendations are made for the immediate future. The first is that the&Government establish a formal capacity for population policy formulation and planning. The second is that the MCH program and its child spacing component be further developed and strengthened. For planning it is recommended tile Government establish a population planning capacity in the Economic Planning Division, Office of the President and Cabinet, to develop a multi-sectoral population program. Population related activities should be initially started in priority ministries, such as Education, Community Services, Agriculture and the Information Department of the Office of the President and Cabinet. In parallel, a series of seminars should be held to discuss the implications of population growth involving decision makers and community leaders. Meantime, the MOH should turn its attention to refining and expanding the Child Spacing Program for incorporation into the five-year National Health Plan currently under preparation. Particular attention should be paid to the following issues: (i) manpower and training, to ensure that health workers receive appropriate training and that village level health personnel become involved; (ii) logistics, to determine the most efficient agency and  - Iv - systems for supplying contraceptives; (iII) establishment of a network of child spacing delivery points; and (iv) development of a comprehensive IEC strategy and program, taking into account that this program should be the nucleus of a future organization for coordinating population activities In various ministries outside MOH.  MALAWI: POPULATION SECTOR REVIEW 1. DEMOGRAPHIC BACKGROUND1/ Sources and Quality of Demographic Data 1.01 Sources of demographic data for Malawi are limited, but their quality has in general been reasonably good. Two censuses have been held in the post World War II period, the first in August, 1966 and the second in September, 1977. The 1966 census collected information on occupation and education; there were no questions on mortality and fertility, but households were asked about household members absent abroad. The 1977 census, in addition to questions on occupation and education, collected data on marital status, fertility and mortality, and also on whether household members had ever worked abroad, but no Information on absent migrants was sought. All results have been fully published for both studies. The field work and coverage of both censuses appear to have been good, with the degree of undercount considered to have been no more than a few percent in eitlher. The data on absent migrants from 1966 are broadly consistent with information on Malawians enumerated in contemporary censuses in nearby countries and appear to be fairly reliable. The demographic data from 1977 have proved to be of good quality and are the major source of recent fertility and mortality estimates at national, regional and urban/rural levels. Unfortunately, tabulations at the district level were not included in the tabulation program, and therefore no results are available for districts. Preparations for the next census In 1987 have already begun. 1.02 In addition to census data, a national demographic survey, the Malawi Population Change Survey (PCS), was held between 1970 and 1972; a second national survey in 1982; and a third, the Family Formation Survey (FFS) in 1984. The results of the PCS, which had a sample size of 31,000 persons, have been fully published and have yielded valuable information on earlier mortality and fertility levels both at the national level and for urban and rural populations. The 1982 survey, with a sample of 94,000 households and 500,000 persons, has not yet been fully processed and tabulated. It is said to have encountered some problems with the field work. The FFS, carried out in che context of the current Bank Realth Project, was designed to collect very detailed data on fertility and child mortality, including determinants of both, at national, regional and urban/rural level. The general sample size was 12,000 households, and more detailed questionnaires were administered to 6,400 households. National Statistical Office (NSO) staff consider that the design and field work were excellent, and preliminar) results from hand tabulation of reported births and deaths during the year previoue to the survey look plausible and consistent with estimates from earlier data. Data processing is at present underway, and with assistance from the AID-funded Demographic Data for Development project, tabulations are expected to be ready by the fall of 1985. 1/ For a more detailed account of the demography of Malawi, see the Basic Economic Report of February 1982, and 'The Demography of Malawi": Althea Hill, 1985, PHN Technical Note.  -2- Population Size and Growth 1.03 The population of Nalawl was enumerated as 5.55 million in September, 1977. It had increased by 37 percent since 1966, when the enumerated population was 4.04 million, thus implying an average annual rate of intercensal growth of 2.9 percent. This is close to the estimated rate of natural increase of around 2.8 to 2.9 percent, siith return migration between the censuses possibly also making some slight contribution. Trends since 1977 cannot be fully known until the FFS results become available and the next census (which is scheduled'for 1987) is held. However, it is reasonable to suppose that mortality has declined further, while fertility has remained constant and hence that natural increase and population growth rates have risen higher. Both Bank and NSO projections put current population size at about 7 million, with a current growth rate of 3.2 percent. Population Distribution, Urbanization and Internal Migration 1.04 Malawi is one of the most densely populated countries in Sub-Saharan Africa, equalled or surpassed only by Rwanda, Burundi, Nigeria and Uganda. The national density according to the 1977 census was 59 inhabitants per km2, and this may now have risen to 74 per km2. There is considerable variation within the country, however, with 1977 regional densities ranging from 24 in Northern Region, to 60 in Central Region, to 87 in Southern Region, and district densities varying from 11 to 230 persons per km2. There are two areas of very heavy settlement, one in the Shire highlands of Southern Region (with 1977 densities of 137 to 230) and the other in the southern part of the Central Region, where 1977 densities ranged from 53 to 114. Northern Region and the northern part of Central Region are uniformly sparsely settled, with 1977 densities all under 30 persons per km2. 1.05 The level of urbanization in Malawi is low by any standard. If an urban locality is defined as a locality with a minimum of 2000 inhabitants, 8.5 percent of the population in 1977 lived in urban areas, and only 5 perrent in 1966. The urban growth rate has been high, however, averaging 7.6 percent between 1966 and 1977, and the NSO has projected the current urban population to be about 12 percent of the total population. Three quarters of all urban dwellers in 1977 lived in the four main towns, Blantyre (219,000), Lilongwe (99,000), Zomba (24,000) and Mzuzu (16,000), with nearly half in Blantyre alone. However, the intercensal growth rates of these towns were very different. Blantyre and Mzuzu grew steadily but not spectacularly at annual 6.3 percent and 5.8 percent rates respectively. Zomba's growth rate of only 1.9 percent was actually less than the likely natural increase, implying net outmigration. By contrast Lilongwe, the new capital, experienced explosive population growth of 14.7 percent, quintupling in size between 1966 and 1977. Since 1977 the distribution of urban population between towns may thus have changed significantly, with the share of Lilongwe in part'cular increasing substantially.  1.06 Between 1966 and 1977 rural-to-urban moves made up about 35 to 45 percent of all internal migration. Other important migration atxeams were into areas of commercial agricultural development or new agricultural settlements (such as the north and east of Central Region) and out of areas with population pressure on limited land resources (such as the Shire highlands) or lacking in general economic development (such as most of Northern Region). As a net result of these movements, Northern Region had experienced a continuing net outflow from before 1966 up to 1977, while Southern had developed a smaller net outflow between the censuses; Central Region, by contrast, had attracted an Increasing net inflow from before 1966 up to 1977. Trends since 1977 will not be known till the next census is leld, but the movement into Central Region, at least, is likely to have continued. External Migration 1.07 Though an appreciable stream of imnigrants into Malawi from Mozambique existed earlier this century, a much more important flow for many decades has been of labour migrants out of Malawi to the more developed economies of South Africa, Zimbabwe and Zambia. In 1966, households reported 266,000 relatives working abroad, of which half were in Zimbabwe, a quarter in South Africa, and most of the remainder in Zambia. After the government's withdrawal of Malawian labour from South African mines in 1974, the numbers of migrants to South Africa undoubtedly fell, and even following the later resumption, contract labour may now number less than 20,000 men. Nothing, however, is known of recent trends in emigration to Zimbabwe or Zambia, though it is reasonable to suppose a decline in both cases. Since no relevant data were gathered in the 1977 census, more up-to-date information will have to await the next census. Outflows are expected to continue to diminish in the future because of dwindling labour demand in the host countries, which currently all have rapidly growing domestic labour forces and generally unfavourable markets for minerals. Mortality 1.08 The level of mortality in Malawi from the 1950s to the mid 1970s was exceptionally high by any standard, and declined only very slowly during this period. According to Bank estimates, life expectancy stood at only 37 years in the late 1950s, then rose to 39 years by the mid-1960s and to 41 years by the early 1970s. These low levels of life expectancy are due primarily to extremely heavy mortality in childhood. Even in the early 1970s, the national infant mortality rate (IMB) was as high as 190, with 36 percent of all children dying before reaching their fifth birthday. Childhood mortality as severe as this was exceptional in any part of contemporary Africa, or elsewhere in the world, and was quite unparalleled in Eastern Africa.2/ By contrast, adult mortality appears to be unremarkable by Eastern African standards. 2/ Though there are indications that similarly high mortality is also found in -those parts of Zambia and Tanzania (possibly even Mozambique) that border on Malawi.  1.09 The causes of this anomaloumly high mortality in childhood are not known, although it is hoped that the FFS data may shed come light on them when available. What Is known of patterns of differentials in mortality provides few clues. Childhood mortality in substantially higher in Central Region than in Northern or Southern Reglon, with 38 percent of Central children dying in their first five years of life in 1970-75 versus 29 percent of Northern and 31 percent of Southern children; but levels In all regions are still very high by East African, and Indeed even by West African, standards. Adult mortality, by contrast, varies very little between regions. Urban childhood mortality is very much lower than rural, with 22Z of urban children failing to survive their first five years in 1970-75 versus 34Z of rural children; this is normal In Africa and elsewhere and no doubt reflects the better social services and greater concentration of educated and prosparous families in the towns. Unfortunately, detailed tabulations from the 1977 census of childhood mortality by education and marital status of mother (the first of which factors, at least, is usually an important determinant of mortality level) were not included in the tabulation program, nor were tabulations by district, which might shed some light on environmental or cultural factors. 1.10 Trends in mortality since the early 1970s cannot be established until the FFS data, and possibly also the 1982 survey data, are available. However, it seems likely that the improvements in education and health services, particularly immunization levels, plus general economic growth, will have produced some further decline. Applying standard Bank methodology for projecting mortality decline, current life expectancy in Malawi is estimated at around 44 years, with an IMR of around 160 and about 30Z of children dying before their fifth birthday. The NSO estimate, based on somewhat different methodology, is similar, with a life expectancy of 43 years. These estimates will, of course, be revised once FFS data are available.3/ Fertility 1.11 The level of fertility in Malawi is high. The total fertility rate (TFR) was estimated at between 7.5 and 8.0 for the mid 1970s, and probably had changed little in previous years. Though fertility is high everywhere, there is marked variation by region, with the TFR in Central Region highest at around 8.5, lowest in Southern Region between 7 and 7.5, and Northern Region falling in between with a TFR close to the national average. Urban fertility is somewhat lower than rural fertility, though the difference is not very great; the urban TFR can be put at about 7.5 compared to a rural TFR similar to the national level of 7.5 to 8.0. Such a level of fertility is at the high end of the range even for East 3/ Preliminary figures from a manual tabulation of FFS data on reported deaths during the year before the survey are broadly consistent with these estimates. The reported DIR for 1983/84 was 152, with the highest rate in Central Province (169), the lowest in Southern (138) and Northern falling in between (158).  Africa, with higher national TFRs found only in Kenya, Rwanda and (until recently) in Zimbabwe. It is hlgher than any national TFR in West Africa. Elsewhere in the world, this level of fertility Is paralleled only in a few Middle Eastern countries. 1.12 Little is known of the determinants of fertility in Malawi, although it is hoped the FFS data will prove enlightening on this topic. However, all the information that is available at present indicates an environment favourable to high fertility. Female marriage is early, stable, universal and mainly monogamous. In 1977, half of all women were married by the age of 17 years; 98 percent of all women aged.25-29 years had been married; only 9 percent of women in their early 309 were divorced or separated, and another 2 percent widowed; and not more than a fifth of all men over 40 reported more than one wife. There is little variation by region in these marriage patterns, except that Southern Region had a noticeably higher incidence of marital breakdown (12 percent of women aged 30-34 divorced or separated, versus 3 and 5 percent in Northern and Central respectively); there are also significant regional differences in the prevalence of polygamy, which is highest in Northern (one quarter to one third of men over 40 polygamists), lowest in Southern (10-15 percent) and Central (20-25 percent). Childbearing also begins early; in 1977 half of all women in all regions had borne at least one child by the age of 18 to 19 years. The incidence of sterility was extremely low everywhere, with less than 5 percent of women of all ages over 30 years reporting no live births; however the level of sterility was somewhat higher in Southern Region (4-5 percent) than in Northern (3-4 percent) or Central (2.5-3.5 percent). The practice of modern methods of birth control has up to now been negligible everywhere in Malawi. Almost nothing is known of other crucial determinants of child spacing such as breastfeeding patterns and the practice of post-partum abstinence or other traditional methods of birth control. Detailed data on socio-economic determinants of fertility, such as female education and employment, are also lacking. Trends in fertility since the mid 1970s are not known; however it seems unlikely that there has been any change, since no pertinent changes in key determinants are known to have as yet occurred.4/ Age and Sex Structure 1.13 The very high fertility and very high child mortality of Malawi, coupled with longstanding emigration of adult males, have combined to produce a population structure that is deficient in males and only moderately youthful by the standards of other high fertility countries in East Africa. In 1977, the overall sex ratio was 93, up slightly from 90 in 1966 because of some net return migration after 1974, but still revealing a substantial deficit of adult males. About 45Z of the population was under 15 years of age; this proportion was slightly inflated by the deficit of 4/ Preliminary FFS data on births in the past year confirm a continuing high fertility level, with the reported crude birth rate (CBR) at 57 (almost equally high in Northern and Central, at 60 and 59 respectively, but lower in Southern, at 56).  -6- adults. With a projected decline in mortality from the early 1970s onward (particularly in childhood mortality), the population is projected to have become still more youthful. The proportion of children under 15 is now estimated at aboue 47%, with the elderly of 65 years and over making up only 3.5%, and women of reproductive age about 17Z. The dependency ratio is consequently now about 104 dependents per 100 working-age population, a very high value by world, and even African, standards. Vital Rates and Natural Increase 1.14 The CBR and crude death rate (CDR) have both been distorted by the unbalanced age and sex structure resulting from male emigration. Normally the levels of fertility and mortality estimated above for the early 1970s would be expected to produce a CBR of around 53, a CDR of around 24 and hence a rate of natural increase (RNI) of 2.8 to 2.9 percent. Because of the effect of migration, however, (which inflates the CBR by reducing the non-childbearing segment of the population and also the CDR by reducing the numbers in the lower mortality adult age groups), the rates were actually closer to 56 and 27 respectively. These compensating effects, however, produced an only slightly higher RNI of around 2.9 percent. This is similar to the actual intercensal rate of growth of 2.86 percent between 1966 and 1977, as would be expected given the very minor decrease in mortality over the period. Since the mid-1970s, the RNI is projected to have risen as a result of the projected decline in mortality, and is currently estimated at around 3.2 percent.5/ II. CONSTRUCTION AND RESULTS OF POPULATION PROJECTIONS Construction of Projections 2.01 In order to explore the socio-economic implications of population growth, a set of three population projections for the period 1975-2015 was constructed for Malawi. "/ For all, the base used was the enumerated population from the 1977 census. The age distribution, though irregular, was not smoothed because of the impossibility of allowing adequately for the distorting effects of migration; though this results in minor irregularities later in the projections, it has no significant effect on the broad picture of population trends discussed here. Only one assumption was made about mortality trends, that of a sustained decline from 1975 onwards, following the standard Bank methodology for projecting mortality 5/ Preliminary FFS results on vital events reported for the year previous to the survey are broadly in line with these estimates, with a reported CBR of 57, a CDR of 23 and consequently a rate of natural increase of 3.4 percent. 6/ These are very similar to the set presented in the 1981 Country Economic Memorandum (CEM) but not identical, since the projection methodology used in the Bank has changed in recent years.  decline.7/ Life expectancy is projected to rise from the base level of 41 years indthe early 1970s to 44 years by 1980-85 and thence to 55 years by 2010-15, thirty years from now. Variations in mortality assumptions within any plausible range would have only a minor impact on population growth. The NSO, for example, used both "fast' and "slow" mortality declines in their projections (the fast producing a life expectancy of 54 years around 2000, and the slow 49 years), but the resulting difference in population size by 2000 was less than 4 percent. Only one assumption is made about migration trends also, that of a steady decline from a net outflow of 20,000 migrants during the period 1975-80 to zero by 1995. The net effect on growth is, in fact, negligible at all periods of the projection, since the crude migration rate is always less than .01 percent, even before 2000. 2.02 A base value for the TFR of 7.75 was chosen (the midpoint of the range 7.5-8.0 given previously). Again, this is similar to the NSO estimate, which is 7.6 and is based on an average of a range of estimates. Three assumptions were made about future trends in fertility. The first is of no change in fertility during the projection period, with the TFR remaining at 7.75 throughout. This is not necessarily considered the most realistic assumption, but is certainly a possible scenario, and in any case provides a benchmark against which to measure the effects of any reduction in fertility. The second assumption is of a gradual decline in fertility beginning after 1990, with replacement level fertility not reached until 2040 (55 years from now) and the TFR dropping to around 4 by 2010-15. This path follows normal Bank methodology for projecting fertility decline; it represents the possible evolution of fertility in response to the normal processes of socio-economic development, including some provision of child spacing services through government health facilities, but no major crash government program aimed at fertility reduction. The third assumption is of a much steeper decline in fertility, still beginning after 1990, but achieving replacement level fertility by 2015, (30 years from now) with the TFR falling to 2.8 at that time. This path is based on the fertility declines achieved in the past by countries with successful large-scale national family planning programs; it is again not necessarily considered a realistic assumption, but illustrates the maximum scale of fertility decline that could be expected in Malawi over the next 30 years, if the government were to pursue vigorous family planning policies and programs. All these fertility, mortality and migration assumptions are set out in Table 1. 7/ For details see Vu: -World Population Projections: Short- and Long-term Projections By Age and Sex with Related Demographic Statistics-: World Bank, 1984.  -8- TABLE 1 World Bank Projections of Fertility, Mortality and Migration 1975- 1980- 1985- 1990- 1995- 2000- 2005- 2010- 1980 1985 1990 1995 2000 2005 2010 2015 Mortality Assumption Life Expectancy 42.5 44.1 45.8 47.6 49.4 51.3 53.2 55.1 (in years) Migration Assumption Total Number of Net Migrants -20000 -20000 -12000 -6000 0 0 0 0 Fertility Assumptions A:Constant Fertility TFR 7.75 7.75 7.75 7.75 7.75 7.75 7.75 7.75 B:Standard Decline TFR 7.75 7.75 7.75 7.48 6.89 6.22 5.46 4.59 C:Accelerated Decline TFR 7.75 7.75 7.75 6.06 4.74 3.71 2.90 2.63 2.03 For comparison, the assumptions embodied in the set of projections recently produced by the NSO are shown in Table 2.  - 9 - TABLE 2 NSO: Projections of Fertility, Mortality and Migration 1977-82 1982-87 1987-92 1992-97 1997-2002 Mortality Assumptions 1/ Slow Decline: ea 40.9 43.0 45.1 47.2 49.4 2/ Fast Decline: e