Cultural factors that affect sexual and reproductive health in Malawi.

©FSRH J Fam Plann Reprod Health Care 2008: 34(2) Background Malawi is one of the countries worst hit by the HIV/AIDS epidemic, with an infection rate among the childbearing age group of 12.0%.1 Young people aged 15–24 years account for 46% of new HIV infections, of which 60% occur in girls. HIV prevalence is even higher in some rural districts (17.5%, p<0.01).2 In common with many other sub-Saharan Africa countries, HIV in Malawi is mainly spread through heterosexual sex, hence it is an important reproductive health issue.3 HIV/AIDS control efforts are hampered by low voluntary counselling and testing uptake,4 which indicates that a high level of HIV/AIDS knowledge is not translating into significant behaviour change. The maternal mortality rate almost doubled in Malawi between 19925 and 20006 and still remains very high. Furthermore, there are many other sexual and reproductive health (SRH) problems, which include unwanted pregnancies, reproductive tract infections including sexually transmitted infections (STIs), abortion complications, sexual and gender-based violence, infertility, and adolescent reproductive health. The role of condom use for dual protection has not yet been fully taken advantage of in Malawi7 and, like many African countries, Malawi needs to reposition family planning through the provision of comprehensive SRH services for both men and women that embrace and invigorate family planning.8 Poverty explains much of the gender dimension of the HIV epidemic in Malawi. Research has already concluded that improving economic opportunities for women may reduce their need to rely on men who pay them for sex.9