Fertility Trends in Sub-Saharan Africa: Has HIV Contributed to Fertility Stalls?
(2021) International Population Conference (IPC) — Location: Virtual (6.December.2021)
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- Abstract
- Fertility transition in sub-Saharan Africa has been different than elsewhere, showing slow pace, halts and reversals in fertility decline since the early 2000s. Likewise, it is the region of the world hardest hit by HIV. HIV is associated with both fertility-enhancing and fertility-reducing behaviors, and the net effect on fertility depends on which effect dominates. Our goal is to better understand the mechanisms through which HIV may have affected fertility changes over the last decades and whether they are connected to fertility stalls. Our analyses are conducted at three levels, regional, cross-country, and country level, focusing on countries with strong and moderate evidence of fertility stalls. We use information from the World Bank data repository, UNAIDS, and the Demographic and Health Surveys. We reconstruct fertility rates according to HIV status and analyze changes over time. Our results suggest that unambiguous cases of fertility stalls are mostly detected in countries of high HIV prevalence. In these countries, there was an unusually rapid decline in fertility during the 1990s and then a slowdown beginning in the mid-2000s. Fertility of HIV-positive women has contributed to fertility stalls, but it is the fertility of HIV-negative women that explains them to a greater extent. In Zimbabwe, fertility-enhancing behaviors during the stall period, such as increased sexual activity, low rates of contraceptive use, reduced length of postpartum infecundability, and high demand for children, together with high rates of antiretroviral treatment among pregnant women, have counter-balanced fertility-reducing behaviors.
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Sanchez Paez, D., & Schoumaker, B. (2021). Fertility Trends in Sub-Saharan Africa: Has HIV Contributed to Fertility Stalls? International Population Conference (IPC), Virtual. https://hdl.handle.net/2078.5/234584