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We evaluate the impact of the HIV/AIDS epidemic on the reproductive behaviour for all women in Malawi, HIV-negative and HIV-positive
alike, allowing for heterogeneous response depending on age and prior number of births. HIV/AIDS increases the probability
that a young woman gives birth to her first child, while it decreases the probability to give...
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... When the development of society requires female workers and respects their labor, social fertility rates tend not to be high, which is particularly evident in Western countries such as Europe and the United States after the beginning of industrial societies [22,23]. From the perspective of other external factors: the impact of AIDS on fertility in Africa is complex, diverse and heterogeneous [24,25,26]; the occurrence of natural disasters also has a significant positive effect on fertility intentions in the short term [27,28]; in addition, higher potential home ownership costs significantly reduce fertility intentions and prolong childbearing [29]. In terms of internal influencing factors: first, when couples have good coordination and communication skills and contractual spirit, their family fertility rate is relatively higher, especially when the family division of labor is well handled, the fertility intention of couples will increase [30,31,32,33]. ...
This paper analyzes the current situation of maternity insurance in the context of the three-child policy and finds that although the participation rate and coverage of maternity insurance have increased after the merger with employee medical insurance, there are still problems such as high pressure on the payment of maternity insurance fund, insufficient coverage of maternity insurance, inadequate maternity allowance system, and compensation standards that cannot meet actual needs. Therefore, in the context of China's current maternity situation and policies, this paper makes the following suggestions: to reduce the pressure of payment by expanding the number of potential participants such as the flexibly employed population, and to enrich the investment model of the fund to establish effective supervision of the "open source" method; to expand the time span of maternity insurance coverage, to include the preparation process of pregnancy in the scope of benefits, and to Extend the recovery period for the second trimester and raise the compensation standard; lower the threshold limit for receiving maternity allowance, and provide graded compensation according to the number of births of two and three children, while reformulating the maternity compensation standard according to the actual situation of the region. It is thus hoped that a complete protection system will be established to reduce the worries of maternity families in the process of pregnancy and childbirth and to fulfill the protection and uplifting functions of maternity insurance itself.
... Climate anomalies such as unfavorable temperature and rainfall shocks and adverse economic events that threaten livelihoods are associated with population-level fertility decline (Eissler et al., 2019;Goldstein et al., 2013;Sellers & Gray, 2019;Sobotka et al., 2011). On the other hand, natural disasters such as tsunamis and hurricanes have been observed to result in short-term increases in fertility rates (Behrman & Weitzman, 2016;Davis, 2017), and studies show that the HIV epidemic had heterogeneous effects on fertility by age and parity status (Durevall & Lindskog, 2011;Trinitapoli & Yeatman, 2018). More generally, impacts on fertility vary along age and socioeconomic and institutional lines (Goldstein et al., 2013;Sellers & Gray, 2019;Sobotka et al., 2011). ...
Regions of the world exposed to Zika-linked microcephaly cases have experienced significant declines in fertility. In urban settings, arboviral outbreaks depend on neighborhood environmental factors including residential land use and density of drainage networks, and tend to be highly localized due to the flight dispersal of the vector mosquito. This study investigates whether fertility decline was significantly higher in neighborhoods containing known Zika cases, compared to unexposed neighborhoods in the city state of Singapore. The results show that the average monthly probability of conception leading to a live birth fell during the Zika epidemic in both exposed and unexposed neighborhoods, and that the decline was not significantly greater in neighborhoods with known cases. The study suggests that the fertility response to perceived infection risks was city-wide rather than localized. Public disclosures of outbreak locations did not lead to a disproportionate response in affected neighborhoods.
... Disease prevalence can also affect economic development. One channel is the fertility decision which leads to changes in the demographic structure (e.g.,Durevall and Lindskog 2011;Chin and Wilson 2018). Fogli and Veldkamp (forthcoming) show that because a dense network spreads diseases faster and higher income is positively correlated with more closely connected social network, infectious diseases can reduce long-run economic growth by limiting the size of social networks. ...
This paper models the local and cross-city transmissions of the novel coronavirus in China between January 19 and February 29 in 2020. We examine the role of various socioeconomic mediating factors, including public health measures that encourage social distancing in local communities. Weather characteristics two weeks ago are used as instrumental variables for causal inference. Stringent quarantine, city lockdown, and local public health measures imposed since late January significantly decreased the virus transmission rate. The virus spread was contained by the middle of February. Population outflow from the outbreak source region posed a higher risk to the destination regions than other factors including geographic proximity and similarity in economic conditions. We quantify the effects of different public health measures in reducing the number of infections through counterfactual analyses. Over 1.4 million infections and 56,000 deaths could have been avoided as a result of the national and provincial public health measures imposed in late January in China. JEL Classification: I18, I12, C23
... As changes in the demographic structure (e.g., Durevall andLindskog, 2011, Chin andWilson, 2018). Fogli and Veldkamp (forthcoming) show that because a dense network spreads diseases faster and higher income is positively correlated with more closely connected social network, infectious diseases can reduce long run economic growth by limiting the size of social networks. ...
[forthcoming in: Journal of Population Economics]
This paper models the local and cross-city transmissions of the novel coronavirus in China between January 19 and February 29 in 2020. We examine the role of various socioeconomic mediating factors, including public health measures that encourage social distancing in local communities. Weather characteristics two weeks ago are used as instrumental variables for causal inference. Stringent quarantine, city lockdown, and local public health measures imposed since late January significantly decreased the virus transmission rate. The virus spread was contained by the middle of February. Population outflow from the outbreak source region posed a higher risk to the destination regions than other factors including geographic proximity and similarity in economic conditions. We quantify the effects of different public health measures in reducing the number of infections through counterfactual analyses. Over 1.4 million infections and 56,000 deaths could have been avoided as a result of the national and provincial public health measures imposed in late January in China.
... A major barrier to answering this question is the endogeneity of disease risk to the process determining fertility. Existing economic literature on the fertility response to HIV/AIDS has addressed this issue using geographic-and time-fixed effects (Durevall and Lindskog 2011;Juhn et al. 2012;Kalemli-Ozcan 2012), difference-in-differences approaches exploiting heterogeneity in the rise of the pandemic (Fortson 2009;Fink and Linnemayr 2009;Kalemli-Ozcan 2012), a synthetic control group method for comparative case studies (Karlsson and Pichler 2015), lagged prime age mortality rates (Durevall and Lindskog 2016), and system generalized method of moments (GMM) (Boucekkine et al. 2009) or has not directly addressed this endogeneity problem (Young 2005(Young , 2007. These studies present mixed evidence on the fertility response to HIV/AIDS, with some finding a negative association (Young 2005(Young , 2007Boucekkine et al. 2009), others finding no clear association on average (Fortson 2009;Kalemli-Ozcan and Turan 2011;Juhn et al. 2012;Kalemli-Ozcan 2012;Karlsson and Pichler 2015), and at least four studies finding heterogeneous responses (Fink and Linnemayr 2009;Durevall and Lindskog 2011;Karlsson and Pichler 2015;Durevall and Lindskog 2016). ...
... Existing economic literature on the fertility response to HIV/AIDS has addressed this issue using geographic-and time-fixed effects (Durevall and Lindskog 2011;Juhn et al. 2012;Kalemli-Ozcan 2012), difference-in-differences approaches exploiting heterogeneity in the rise of the pandemic (Fortson 2009;Fink and Linnemayr 2009;Kalemli-Ozcan 2012), a synthetic control group method for comparative case studies (Karlsson and Pichler 2015), lagged prime age mortality rates (Durevall and Lindskog 2016), and system generalized method of moments (GMM) (Boucekkine et al. 2009) or has not directly addressed this endogeneity problem (Young 2005(Young , 2007. These studies present mixed evidence on the fertility response to HIV/AIDS, with some finding a negative association (Young 2005(Young , 2007Boucekkine et al. 2009), others finding no clear association on average (Fortson 2009;Kalemli-Ozcan and Turan 2011;Juhn et al. 2012;Kalemli-Ozcan 2012;Karlsson and Pichler 2015), and at least four studies finding heterogeneous responses (Fink and Linnemayr 2009;Durevall and Lindskog 2011;Karlsson and Pichler 2015;Durevall and Lindskog 2016). ...
... By using an empirical strategy that heretofore has not been applied to this research question, our analysis provides new causal evidence on an unresolved question in the existing economic literature. Although our results do not resolve the mixed findings in the existing literature (Young 2005(Young , 2007Boucekkine et al. 2009;Fink and Linnemayr 2009;Fortson 2009;Durevall and Lindskog 2011;Kalemli-Ozcan and Turan 2011;Juhn et al. 2012;Kalemli-Ozcan 2012;Karlsson and Pichler 2015;Durevall and Lindskog 2016), they do highlight the fact that the evidence, including ours, on the fertility response to the HIV/AIDS pandemic is not definitive. 4 In addition, we expand the very small body of economic literature on the effect of HIV/AIDS on the number of surviving children. ...
A fundamental question about human behavior is whether fertility responds to disease risk. The standard economic theory of household fertility decision-making generates ambiguous predictions, and the response has large implications for human welfare. We examine the fertility response to the HIV/AIDS pandemic using national household survey data from 14 sub-Saharan African countries. Instrumental variable (IV) estimates using distance to the origin of the pandemic suggest that HIV/AIDS has increased the total fertility rate (TFR) and the number of surviving children. These results rekindle the debate about the fertility response to disease risk, particularly the HIV/AIDS pandemic, and highlight the question of whether the HIV/AIDS pandemic has reduced GDP per capita.
... Childbearing in Malawi is an imperative, a moral order, and it is crucial in order to be considered an adult; couples are not considered properly married until they have children (Yeatman and Trinitapoli 2013). This is likely to have a strong effect on young couples' desire to have children and could lead to increased childbearing among young women as a response to HIV (Noël-Miller 2003;Durevall and Lindskog 2011). ...
... There are good reasons to expect a stronger negative response to female than male mortality among older women who already have children, since childbearing is culturally important and all couples are therefore likely to want some children. As a result, the possibility that a woman infects her children, leaves children orphaned, and the (mistaken) perception that pregnancy speeds up the development of AIDS, are all likely to have a stronger effect on older women, while young women with no or few children might aim to give birth earlier when the probability of being HIV positive is lower (Durevall and Lindskog 2011). Furthermore, young women are arguably less influenced by old-age security concerns than older women and older women are likely to have a stronger bargaining position over fertility decisions than young women. ...
... The choice of indicator for HIV/AIDS varies in the literature. Some examples are national HIV-rates obtained from antenatal clinics(Young 2005(Young , 2007Kalemli-Ozcan 2012), district HIV-rates obtained from antenatal clinics(Durevall and Lindskog 2011), AIDS deaths (Kalemli-Ozcan 2012), and regional HIV-rates from DHS(Juhn, Kalemli-Ozcan, and Turan 2013). 10 A serious potential drawback in studies using current HIV prevalence rates, such asJuhn, Kalemli- Ozcan, and Turan (2013) andMagadi and Agwanda (2010) is that women might actually have become infected while getting pregnant. ...
The future course of fertility is a major determinant of economic development in many sub-Saharan countries, so understanding how HIV/AIDS affects childbearing is of great interest. We show that fertility responds negatively to female mortality and positively to male mortality and that the overall fertility response is small. The negative effect of female mortality is in line with earlier studies that only focus on women and their infection and mortality risks, while the finding of a positive effect of adult-male mortality is novel. One interpretation of this finding is that women who perceive a high risk of their husbands' or grown-up sons' deaths are likely to want to have more children to ensure future support.
... In aggregate, our analysis supports that by Juhn et al. (2013). They attribute their results to physiological factors rather than behavioural response to the epidemic, although Durevall and Lindskog (2011) also found behavioural response to HIV among the general female population upon modelling fertility with age and number of prior births. Thus, while behavioural factors cannot be ruled out entirely, it would seem that the physiological response is the more significant vector of explanation; particularly HIV sub-fecundity, increased foetal loss and menstrual disorders. ...
Several studies have shown that HIV is an important distal factor that affects a woman's fertility. This study investigates the effect of HIV on fertility among Malawian women using data from the 2004 and 2010 demographic and health surveys. Specifically, the study assesses fertility differentials between HIV-positive and HIV-negative women and the changes in the relationship between HIV and fertility during the study period. Age-specific fertility rates and logistic regressions are used to investigate these objectives. The results show lower age-specific fertility rates (except for the 15–19-year-old age group) and probabilities of giving birth for HIV-positive relative to HIV-negative women before and after controlling for confounding factors respectively. The odds of giving birth for an HIV-positive woman were 34% lower in the period 12 months before the 2004 survey compared to an HIV-negative woman and 25% lower before the 2010 survey (p < 0.01). We think that the scaling up of antiretroviral treatment has contributed to the increase in the likelihood of giving birth among HIV-positive women between 2004 and 2010, more plausibly entailing a possible reduction in HIV sub-fecundity.
... Studies in Malawi have found that the effect of the HIV epidemic on fertility behavior varies by age, and suggest that the largest impact may be to hasten childbearing rather than to increase the total number of children born. 80 Our study focused on a youth cohort, and thus data do not allow us to make inferences about net fertility, although our analysis of fertility by 2010 showed that levels continued to be elevated among orphans. We also note that our sample of respondents who had lost a parent within the past five years was relatively small, which may have limited our ability to detect statistical significance in some regression models. ...
Although a substantial literature suggests that orphans suffer disadvantage relative to nonorphaned peers, the nature of this disadvantage and the mechanisms driving it are poorly understood. Some evidence suggests that orphans experience elevated fertility, perhaps because structural disadvantage leads them to engage in sexual risk-taking. An alternative explanation is that orphans intentionally become pregnant to achieve a sense of normality, acceptance and love.
Data from the 2006 wave of the Malawi Longitudinal Study of Families and Health on 1,033 young adults aged 15-25 were used to examine the relationship of maternal and paternal orphanhood with sexual risk indicators and desired and actual fertility. Regression analyses were used to adjust for covariates, including social and demographic characteristics and elapsed time since parental death.
Twenty-six percent of respondents had lost their father and 15% their mother. Orphanhood was not associated with sexual risk-taking. However, respondents whose mother had died in the past five years desired more children than did those whose mother was still alive (risk differences, 0.52 among women and 0.97 among men). Actual fertility was elevated among women whose father had died more than five years earlier (0.31) and among men whose mother had died in the past five years (1.06) or more than five years earlier (0.47).
The elevations in desired and actual fertility among orphans are consistent with the hypothesis that orphans intentionally become pregnant. Strategies that address personal desires for parenthood may need to be part of prevention programs aimed at orphaned youth.
... HIV/AIDS is observed to affect fertility especially for older HIV positive women. Fertility is believed to decline mainly for physiological reasons [55]. However, there might also be some general social and behavioral responses to the HIV/AIDS epidemic. ...
... There could be changes in sexual behaviors to avoid infection. It is observed that HIV/AIDS in Malawi increases the probability that a young woman would give birth to her first child, while it decreases fertility for older women and also young women who have already given birth [55]. Fig. (5) shows crude birth rates for five-year periods: 1980-2050. ...
Malawi is one of the countries in the sub-Saharan Africa with high prevalence of HIV/AIDS. This paper ana- lyzes socio-demographic effects using estimates and projections by the United Nations Population Division. It compares estimates and projections for both short term (2005-2020) and also long term (1980-2050), with the reality of HIV/AIDS and without the scenario of it. Detailed comparisons are made on population structure and main demographic processes for Malawi (mortality and fertility). The paper compares stock and period indicators, including life expectancy, crude birth rates, crude death rates, age specific fertility rates and child dependency ratios. Considerable effects of HIV/AIDS on mortality and child dependency ratios are observed with the highest point of impact around 1995. With the HIV/AIDS scenario, there is about 6-13 years of reduction in life expectancy at birth for the period from 1995 to 2050. Most likely, persisting HIV/AIDS demographic impacts will continue perpetuating socio-demographic impacts.
... Second, the youngest women tend to increase fertility due to mortality, while there is no significant response among women over 29 years. Using indicators of the HIV epidemic instead of mortality and different empirical method, Durevall and Lindskog (2011), also find a positive effect on young women's fertility, but a negative and significant effect on older women's fertility. 1 Fink and Linnemayr (2009), analysing micro-data from five African countries, but not Malawi, find that better educated women reduce fertility as a response to the HIV epidemic, while less educated women increase it. ...
... They fail to find that communal HIV affects actual or desired fertility, but indictors of HIV/AIDS awareness seem to reduce overall fertility. Finally, Durevall and Lindskog (2011) construct a panel with recall data on Malawian women's birth histories, collected by MDHS 2004.They find that HIV/AIDS has a small negative effect on fertility. Young (2007) uses DHS data from a large sample of Sub-Saharan countries, collected before HIV testing was widely available, and national HIV rates based on data on women visiting antenatal clinics. ...
... There are a few studies that shed light on heterogeneity in age and schooling among women. Durevall and Lindskog (2011) directly test for age-specific responses in Malawi, and find that young woman give birth to their first child sooner, while older women, who have already started child-bearing, decrease their fertility. Ueyama and Yamauchi (2009), using MDHS 2004 data, find that Malawian women marry earlier if prime-age adult mortality is high. ...
