In sorrow to bring forth children: fertility amidst the plague of HIV

Abstract

The HIV epidemic is lowering fertility in sub-Saharan Africa. This decline in fertility appears to reflect a fall in the demand for children, and not any adverse physiological consequences of the disease, as it is matched by changes in the expressed preference for children and the use of contraception, and is not significantly correlated with biological markers of sub-fecundity. A fall in fertility lowers dependency ratios and, for a given savings rate, increases future capital per person. These two effects more than offset the loss of prime working age adults and reduced human capital of orphaned children brought by the epidemic, allowing 27 of the nations of sub-Saharan Africa to cumulatively spend US$ 650 billion, or $5100 per dying adult AIDS victim, on patient care without harming the welfare of future generations. In sum, the behavioral response to the HIV epidemic creates the material resources to fight it. __________________In memory of Ho Hon and Nechama, terribly missed by us all. I am grateful to Ho Veng-Si, seminar participants at the Rand Corporation and the editors of this journal for many helpful comments.

Can HIV Alter the Quantity-Quality Switch and Delay the Fertility Transition in Sub-Saharan Africa?

“…This scenario, remindful of the "world of opportunities after the Black death", which allowed an epoch of sustained growth in 15th century Europe, would eventually prevail because of the increase in the capital-and output-labour ratios due to the direct and indirect effects of AIDS mortality on labour supply. This conclusion, based on a model à la Becker with children quantity-quality trade-off and fixed saving rate as in Solow (1956), holds both in the medium term, due to the mortality of young individuals, and in the longer term, due to the fertility decline allowed by the increased female labour market participation [Young (2005[Young ( , 2007]. These effects will dominate the main negative one of HIV i.e., disruption of human capital [Young (2005)].…”

Has Democratization Reduced Infant Mortality in Sub-Saharan Africa? Evidence From Micro Data

“…The DHS data is widely used by demographers and public health researchers. Economic research using the DHS data includes Pitt (1997), Dow, Philipson, and Sala-i-Martin (1999), and, most recently, Young (2005). 16 The maximum number of children for each interviewed mother in the dataset is 20.…”

“…of annual HIV-infection rates amongst pregnant women at the country level, used by Young (2005). 43 I fill missing values with zero because the estimates are missing before the outbreak of HIV infection in the late 1970s and the early 1980s.…”

Reproductive Health and Behavior, HIV/AIDS, and Poverty in Africa

“…The challenges to doing so are essentially the same as noted above with respect to risk behavior: first, the simultaneity of the HIV-behavior relationship, since practices such as early marriage and frequency of unprotected sex that increase fertility also increase exposure to HIV, and second, the need to account for the mediating effects of policies. Two recent cross-country econometric exercises that examine this issue, Young (2005) and Kalemli-Ozcan (2006), reach precisely opposite conclusions. Young's estimates, using DHS data from 27 African countries, indicate a negative effect of HIV national prevalence rates on individual probabilities of a recent birth and on total fertility.…”

“…Moreover, in a traditional Solow-type growth framework, reductions in growth are dampened by the fall in the supply of labor relative to capital, since this increases the productivity of labor. A recent similarly optimistic set of projections has been put forth by Allywn Young (2005), who as noted earlier emphasizes a different mechanism, that of reduced fertility in response to the epidemic. The reduction in the dependency ratio increases per capita consumption as well as savings, potentially increasing economic growth as well as providing the resources to care for those with AIDS.…”