Helse 1 Open Conference on Alcohol Problems – An Obstacle to Development and Welfare in Malawi Cross Roads Hotel November 12, 2008 Substance Use and Gender Based Violence in Malawi

Helse 2 Two research projects 1.Substance Use and Abuse and its Implications in a Malawian Context – Pilot Project 1 2.Substance Use and Gender Based Violence in a Malawian Context – Pilot Project 2

Helse 3 Based on initiatives by FORUT, Norway and NGO Gender Coordination Network, Malawi Commissioned by FORUT and NGO Gender Coordination Network Research collaboration between SINTEF Health Research and CSR, University of Malawi Stine Hellum Braathen (MPhil) Alister Munthali (PhD)

Helse 4 ’Substance use and abuse’ includes use and abuse of alcohol and any other psychoactive substances, such as tobacco, cannabis, pills, opiates, inhalants, etc.

Helse 5 Objectives Explore the use and abuse of substances in one urban and one rural location in Malawi. Types of substances used Who uses substances Why do people use substances Status of different substances Explore how substance use has an effect on gender based violence in Malawi. How men’s use of substances put women at risk of being violated physically, mentally and sexually

Helse 6 Findings and trends in previous research Internationally: Substances have important social and cultural meanings in many societies across the world Globally men drink more alcohol than women and men cause more problems when they drink compared to women who drink There has been a ‘rapid’ change in alcohol production and consumption in many developing societies Vicious cycle of poverty and substance use Studies from Senegal, Zimbabwe, Sierra Leone, Nigeria, Uganda and South Africa show that the most commonly used substances are alcohol, cannabis and tobacco

Helse 7 Findings and trends in previous research Previous research from Malawi: Main drugs of abuse: alcohol and cannabis/ chamba Mainly consumed by men Chamba is the cheapest form of intoxication Chamba and alcohol are used mainly as recreational/ social drugs, and not as traditional drugs Tobacco is also used, but to a lesser extent than alcohol and chamba

Helse 8 Findings and trends in previous research Gender Based Violence and substance abuse in Malawi: DHS (2005): Women whose husbands consume alcohol frequently are more likely to report violence compared to women whose husbands do not drink Most common form of intra-household gender violence (Pelser et al 2005): »Physical abuse »Emotional abuse »Sexual abuse »Economic abuse 48% of Malawian women reported some form of intimate partner violence Alcohol was associated with acts of violence, while there was little drug association with violence

Helse 9 Findings and trends in previous research Gender Based Violence and substance abuse in Malawi: Men in Malawi are less likely to justify wife beating than women In comparison with six other African countries, acceptance of wife beating was lowest among men in Malawi Women with disabilities in Blantyre district reported sexual abuse; men tricking disabled women into sex by promising to marry them, and then leaving the women when they get pregnant.

Helse 10 Methods Individual in-depth interviews Key informant interviews (NGOs, Government) Unstructured conversations Observation Fieldworkers: Primary investigator (from SINTEF) and two local research assistants (appointed by CSR) Fieldwork took place in November 2007

Helse 11 Study sites Urban site: Kawale and Chilinde, Lilongwe Rural site: Chembe fishing village, Mangochi

Helse 12 Informants Rural settingUrban setting ChembeKawaleChilindeTotal Chiefs/ Village heads 1214 Men Women married to men who use substances Bar Girls/ Prostitutes 2 2 Kachasu brewers1 1*2 Total

Helse 13 Results

Helse 14 What substances are there? Carlsberg Green Brown Stout Special Brew Kuche Kuche Chibuku Kachasu Malawi Gin/ Imported spirits Marijuana/ Cannabis: Chamba Tobacco Glue

Helse 15 ‘….substance use has nothing to do with money, but just a habit. The only difference is on the type of substances used. For those who have money they would go for bottled beers while for those with less money would go for Kachasu or chamba. What they do is that they first drink the Kachasu and later they visit the bottle stores just for 2 bottles.’ (Man, 29, Chembe)

Helse 16 Where are substances (not) used? Used: Bottle shops/ Bars/ Pubs ‘Kachasu Places’ Lodges/ Guesthouses (Chembe) Private Homes (Lilongwe) Not used: In Chembe substances were commonly NOT used among women, children and parents No substance use in the workplace No chamba use in public

Helse 17 Who uses substances? Rural community (Chembe): Men/ Boys Most common for boys below 25 years Start as years old Often the fishermen and tourguides ‘Rastas’ Bargirls Foreigners (Men and women) ‘It is not strange to see people drinking beer because a lot of people do drink. It only becomes strange when a woman is drunk because she is not supposed to get drunk. Drinking is for men not women’ (Man, 30, Chembe).

Helse 18 Who uses substances? Urban community (Lilongwe): Mostly men/ Boys Some women (only alcohol) Bargirls

Helse 19 Frequency of substance abuse Most of the drinking is done at night in both study sites, but some drink every day, at any time of day: ‘Whenever I am free I go drinking beer with my friends. I used to smoke chamba only once per day, but beer- drinking, it varies from time to time, because sometimes I may only drink once a day, sometimes twice a day, sometimes I could be drinking all day, depending on how much money I have’ (Man, 29, Chembe).

Helse 20 Why use substances? Encouraged by friends/ Social

Helse 21 Why use substances? Encouraged by friends/ Social ‘…the whole idea of smoking or drinking beers is to have fun with friends’ (man, 22, Chembe).

Helse 22 Why use substances? Encouraged by friends/ Social Addictive

Helse 23 Why use substances? Encouraged by friends/ Social Addictive 'When a goat has tasted salt it is difficult to chase it' (Man, 22, Chembe).

Helse 24 Why use substances? Encouraged by friends/ Social Addictive Positive effects: Increased sexual desire Peace of mind Intelligence Escape/ forget problems Clear head Uninhibited Gain strength (physical and mental)

Helse 25 Why use substances? Tour guides want to be like their customers/ blend in with customers (Foreigners) Bargirls work in bars; drinking alcohol is part of their job, and also a way for them to forget problems and cope with their lives

Helse 26 Consequences of substance use Negative side effects: Aggression and violent behaviour Low thinking capacity Inability to take care of oneself Inability to do well in life (education, work, social relationships) Poverty

Helse 27 Economy and substance use People drink beer or smoke chamba regardless of how much money they have The type of substance used depends on the economy 'Those who are rich also drink and smoke the way poor people are doing, the difference is the quality of substance used. Rich people would go for expensive beers and drugs like Carlsberg, and spirits like Chateau, Powers, Malawi Gin, while the poor will go for Kachasu, Chibuku and chamba but the damage made is the same' (Man, 22, Chembe).

Helse 28 'I used up all the money I received as salary in December 2005 on beers. Whenever I try to recall on what happened I feel sorry for myself because the following month I starved very much because I had nothing to feed the family‘ (Man, 34, Chembe)

Helse 29 'Every day he comes home; he comes home drunk' (Woman, 26, Lilongwe). Women’s stories…….

Helse 30 When husbands use substances….. It increases the poverty of the family The husband changes his behaviour Wives are worried about husband’s health Women feel neglected They are not responsible for their families They become violent and aggressive…..

Helse 31 Economic abuse All the women interviewed said that men who drink alcohol are not responsible for their families ‘Had it been that he doesn’t drink we could always have enough food…’ (Woman, 27, Lilongwe).

Helse 32 Physical abuse Of the 12 married women interviewed five regularly experienced physical abuse by their husbands, one woman used to be physically abused, and all the women knew of other women who were regularly abused by their intoxicated husbands Relationship: Lack of money-lack of food-hungry and drunk husband-physical abuse Increase in women coming to clinic in Chembe due to domestic violence, and increase in alcohol use in Chembe Bargirls are often abused physically by their customers

Helse 33 Sexual abuse Of the 12 married women interviewed seven had experienced rape (forced to have sex) by their husbands, and 11 of them knew of women who had been sexually abused by intoxicated men Many of the women knew or suspected that their husbands were unfaithful to them, often with bargirls The wives are afraid the husband will catch HIV and infect them

Helse 34 'I am afraid to go and do an HIV test because I know he has affairs, and maybe he has affected me with the virus. And he has forced me to sleep with him sometimes. I know it's because he has no feelings maybe for me because he has another affair' (Woman, 40, Lilongwe).

Helse 35 Responsibility Most of the women take the responsibility of their husband’s bad behaviour upon themselves: They do their best to be attractive to their husbands to avoid them being unfaithful ‘We tell each other to take care of ourselves, because if we don’t look smart we will lose our husbands. But we have to be always smart, or they will start having other affairs’ (Woman, 27, Lilongwe).

Helse 36 Responsibility Most of the women take the responsibility of their husband’s bad behaviour upon themselves: They do their best to be attractive to their husbands to avoid them being unfaithful Cook nice meals to attract the men home, instead of going out drinking ‘We teach each other how to cook delicious meals for our husbands so we can attract them with food and not going out for drinking.’

Helse 37 The wives often ask their husbands to please stop drinking, but the men will not and can not listen to the women ‘I can not stop drinking because my wife tell me to, because my friends may think that I listen to my wife, and then I am not a proper man. The only reason I would consider stopping would be if the doctor told me to, or if I wanted to go back to church again’ (Man, 27, Chembe)

Helse 38 The story of Chimwemwe…

Helse 39 Summary Mostly men drink alcohol and sometimes smoke chamba Men often behave bad when they drink and smoke, and their behaviour affects their wives Women and children suffer because of men’s drinking and smoking habits, but the men are not willing to change their behaviour

Helse 40 Contact Alister Munthali – Centre for Social Research, University of Malawi Ph: Stine Hellum Braathen – SINTEF Health Research, Norway Ph:

Helse 41 Recommendations Place more emphasis on problems concerning alcohol use, as well as chamba use in Malawi Stronger enforcement of alcohol legislations Consider the possibility of illegalising Kachasu brewing and sales, or placing stricter regulations on the brewing process (where it is done, how, etc) and the sale (where it is sold, price, etc). Make the population aware of the consequences of substance use and abuse Introduce alternative social meeting arenas in communities where substance use has no place (sports/other recreational activities) Further studies are needed to explore the profile of the part of the Malawian population who use substances. What makes people vulnerable to substance use and abuse (age, socio-economic status, area of residence, family background, education, etc.). Further studies to explore the relationship between substance use and poverty and substance use and HIV/AIDS (see pilot project 2 for more information about substance use and abuse and its affect on gender based violence).

Helse 42 Recommendations Empower women through education and jobs, to enable them to be self sufficient and not dependent on their husbands for survival (to increase men’s respect for women and women’s respect for themselves) Increased focus, through research and government priorities, on wives’ being sexually abused by their husbands and how this may contribute to the spread of HIV/ AIDS in Malawi Increased focus on sexual abuse, cheating, prostitution in relation to substance use, and how this relates to the spread of HIV/ AIDS in Malawi Increased focus on women’s rights Increased focus and awareness on alcohol and drug use and how this affects women, children and families in Malawi