The impact of AIDS mortality on individual fertility: evidence from Tanzania
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Date
1998
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Mortality decline and reproductive change
Abstract
During the European demographic transitions, fertility decline was often but not always preceded by an aggregate decline in mortality (Matthiessen and McCann, 1978). In sub-Saharan Africa, high levels of child mortality are thought to be an impediment to fertility decline. Caldwell et al. (1992), for example, suggest that a decline in infant mortality to levels below 70 per 1,000 may be a prerequisite for the onset of fertility decline, based on the experience of Botswana, Kenya, and Zimbabwe.
Child mortality has declined and life expectancy increased in sub-Saharan Africa in recent decades, but the spreading AIDS epidemic threatens this progress. Nearly two-thirds of the 23 million people currently infected with human immunodeficiency virus (HIV) worldwide live in sub-Saharan Africa (UNAIDS data, cited in Ainsworth and Over, 1997). AIDS is fatal and is striking two key groups—sexually active adults who become infected through sexual relations and very young children who are infected from their mothers at birth or while breastfeeding. The impact of AIDS on mortality is difficult to measure, as vital registration systems in sub-Saharan Africa are subject to extensive underreporting (Stover, 1993). However, the U.S. Bureau of the Census predicts that the decline in African infant and child mortality will be stalled and reversed as a result of the AIDS epidemic (Way and Stanecki, 1994). Nicoll et al. (1994) predict that mortality of children under the age of 5 in severely affected urban areas will increase by one-third in eastern and central Africa and by as much as three-quarters in southern Africa, sharply diminishing the existing differentials in child mortality between urban and rural areas. Furthermore, levels of adult mortality in the age group 15-50 can be expected to double, triple, or even quadruple in some locales.
What will be the impact of heightened mortality from AIDS on fertility in sub-Saharan Africa? There is remarkably little empirical evidence on this issue. In fact, demographic modelers of the impact of the AIDS epidemic commonly assume no fertility response to AIDS mortality. For example, The AIDS Epidemic and its Demographic Consequences (UN/WHO, 1991) presents seven mathematical models for the demographic consequences of the spread of HIV, none of which includes an individual fertility response. The World Bank's AIDS-adjusted population projections assume no interaction between HIV prevalence and fertility (Bos and Bulatao, 1992).
In this chapter we review the channels through which we might expect both positive and negative fertility responses to the heightened mortality of the AIDS epidemic, summarize the evidence to date, and present new evidence of the response of individual fertility behavior to heightened mortality based on three data sets from Tanzania. In the next section we provide an overview of levels of HIV infection in sub-Saharan Africa and the relation between HIV infection and mortality. This is followed by a discussion of the channels through which heightened mortality from AIDS might induce changes in fertility. In the fourth section we present results of multivariate analysis of individual fertility using three data sets from Tanzania—two national and one from the severely affected Kagera region. The results suggest that, although there is evidence of a positive effect of heightened child mortality on fertility, adult mortality at the household and community level tends to be associated with lower individual fertility. These results are supported by an analysis of the effect of mortality on other indicators of fertility intentions, such as the desire for additional children and patterns of sexual behavior.
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Keywords
AIDS Mortality, Individual Fertility, Tanzania
Citation
Ainsworth, M., Filmer, D. and Semali, I., 1998. The impact of AIDS mortality on individual fertility: evidence from Tanzania. From death to birth: Mortality decline and reproductive change, pp.138-167.