Swaziland

Swaziland, in southern Africa, is bordered to the north, south, and west by South Africa, and to the east by Mozambique. It is an extremely poor country with a low standard of national health, and recently surpassed Botswana as the nation with the highest known human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) prevalence rate: 26.1 percent of adults are HIV positive or have AIDS.

The 2009 population is estimated at 1.1 million, with the disproportionately young age structure typical of developing countries. The median age is 18.8 years, with 39.4 percent of the population aged 14 years or younger. Swaziland has a negative population growth rate (minus 0.459 percent) despite a high total fertility rate (an estimate of the number of children per woman) of 3.24; deaths due to infectious disease keep the death rate (30.7 per 1,000) higher than the birth rate of 26.6 per 1,000.

Childbearing many years before marriage is a normal part of Swazi society, and also keeps the birthrate high: an interlocking pattern of obligations helps to support children born outside marriage. The sex ratio in the population is 0.95 males per female. The people are 97 percent African, 3 percent European, and the predominant religions are Zionist (40 percent: a blend of Christianity and ancestor worship), Roman Catholic (20 percent), and Muslim (10 percent). Literacy is approximately equal for males (82.6 percent) and females (80.8 percent).

Agriculture and foreign remittances are the major factors in the Swaziland economy. The estimated Gross Domestic Product (GDP) per capita in 2008 was estimated at $5,100, with a 40 percent unemployment rate and high inequality (Gini index of 50.4). Swaziland spends 6 percent of its GDP on health, of which about 60 percent is supplied by the government; annual expenditure on health in U.S. dollars is $66 per capita. Life expectancy is quite low, due largely to the high rates of HIV and other infectious diseases; for men the life expectancy at birth is 31.6 years, while for women it is 32.3 years.

Maternal and child health is not of a high standard, although improvements have been made recently. Twenty-six percent of women use modern methods of contraception and 70 percent of births are attended by trained personnel. There were approximately 38,000 live births in Swaziland in 2000, with a maternal mortality ratio of 370 per 100,000 live births, a stillbirth rate of 34 per 1,000 total births, an early neonatal mortality rate of 28 per 1,000, and neonatal mortality rate of 38 per 1,000 live births.

Save the Children, an international organization devoted to improving maternal and child health, places Swaziland in its Tier II or less developed countries, where it ranks 63rd out of 66 countries on the Women's Index (taking into account factors such as life expectancy, maternal mortality, availability of modern contraception, and maternity leave benefits) and 62nd out of 66 countries on the Mothers' Index (taking into account additional factors related to children's health and well-being, such as the under-5 mortality rate and gender parity in primary school enrollment).

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