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Disease risk and fertility: evidence from the HIV/AIDS pandemic

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Yoo-Mi Chin at Baylor University
Yoo-Mi Chin
Nicholas Wilson
Nicholas Wilson
Nicholas Wilson
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Abstract and Figures

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.
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ORIGINAL PAPER
Disease risk and fertility: evidence from the HIV/
AIDS pandemic
Yoo-Mi Chin
1
&Nicholas Wilson
2
Received: 30 December 2016 / Accepted: 24 August 2017 /Published online: 4 October 2017
#US Government (outside the USA) 2017
Abstract 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.
Keywords Disease .Fertility .HIV/AIDS .Instrumental variable regression
JEL classification I15 .J13 .O12
1 Introduction
A fundamental question about human behavior is whether fertility responds to disease
risk. The standard economic theory of household fertility decision-making (Becker and
Gregg Lewis, 1973) suggests that disease risk may affect demand for children through
changes in household resources and the shadow prices of child quantity and quality, yet
this theory does not yield clear predictions about the net effect of disease risk. Not only
J Popul Econ (2018) 31:429–451
DOI 10.1007/s00148-017-0669-5
Responsible editor: Erdal Tekin
*Nicholas Wilson
nwilson@reed.edu
1
Department of Economics, Baylor University, Waco, TX, USA
2
White House Social and Behavioral Sciences Team and Department of Economics, Reed College,
Portland, OR, USA
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... Nitsche and Lee (2022) discuss the terror management theory in the context of the COVID-19 pandemic and argue that negative emotions, such as anxiety, anger, and loneliness, and other concerns at the beginning of the pandemic should have a positive effect on fertility desires. Chin and Wilson (2018) discusses an economic theory of household fertility decision-making, previously labelled demand theory, in the context of the human immunodeficiency viruses (HIV) and acquired immunodeficiency syndrome (AIDS). The authors argue that the risk of disease will affect the demand for children through mainly two channels, the adult health risk and the child health risk. ...
... There are mixed results on the impact of the HIV/AIDS pandemic on fertility and marriage decisions in Africa. On the one hand, Chin and Wilson (2018) show a positive association between the HIV/AIDS pandemic and fertility rates for 14 Sub-Saharan African countries. Family composition and fertility decisions can also be impacted by foster children that come into new families (Deininger, Crommelynck, and Kempaka 2005). ...
... On the one hand, marriages at least need to be postponed due to an infection, and on the other hand, a life-threatening experience, especially when being hospitalized, can create fear for a newborn's health. The health risk for the child is also discussed in the community influence theory (Rodgers, St John, and Colemann 2005) and economic theory (Chin and Wilson 2018). This fear or risk can be stronger if the healthcare system was not able to cope with the burden of the pandemic, as seen in several countries (Ameyaw et al. 2021;Chu et al. 2022). ...
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... Such studies reveal a decline in fertility in SSA countries. However, they are contradicted by a recent study by Chin and Wilson (2018). These researchers examined how and whether fertility responds to the HIV/AIDS pandemic in 14 SSA countries: Burkina Faso, Cameroon, Ethiopia, Ghana, Guinea, Kenya, Lesotho, Malawi, Mali, Senegal, Sierra Leone, Swaziland, Zambia, and Zimbabwe. ...
... HIV/AIDS pandemic and fertilityrelated studies conducted in SSA and published at the beginning of the 21st century reveal that fertility declined in response to the pandemic (Hunter et al., 2003;Daniel, 2000;Terceira et al., 2003). However, as we have seen, one recent investigation in 14 SSA countries found that TFR and the number of surviving children both grew despite increasing HIV prevalence (Chin & Wilson, 2018). ...
The Disaster-Fertility Nexus in Sub-Saharan African Countries
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Natural disasters, especially those resulting from climate change (climate extremes and variations), are likely to increase in frequency and intensity. There is a pressing need for research on how natural and human-made disasters affect human fertility's behavioural aspects. This chapter addresses those effects in Sub-Saharan Africa (SSA), with its total of 48 countries. Since the mid-20th century, the world has seen a remarkable decline in the global total fertility rate (TFR), from 5.5 children per woman in 1950 to 2.49 in 2015. Eighty per cent of the world's population in 2015 lived in countries with TFRs below three children per woman; but many SSA countries were reported as exceeding 5: for example, Niger (7.29), Democratic Republic of Congo (6.2), Mali (6.15), and Chad (6.05). The decline in TFRs in SSA countries remains much slower than elsewhere, focusing the attention of those researching fertility in the context of climate change or disasters more broadly. This chapter reviews the literature on connections between disasters (natural or anthropogenic) and fertility across SSA countries. Using the International Disaster Database (EM-DAT) administered by the Centre for Research on Epidemiology of Disasters (CRED) and data on TFRs sourced from the World Bank, we examine trends in TFRs and natural disasters across these countries since 1960. We touch on implications of the SSA experience with HIV/AIDS for a future altered by COVID 19. These and other findings may inform research and policy directions concerned with family-planning initiatives and disaster management programs in the region.
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... Pre-COVID-19 literature (e.g. Chin & Wilson 2018;Lau et al. 2005;Sardinha et al. 2018;Scheper-Hughes & Bourgois 2004) on GBV catered to women and children generally and any migration centred literature with a bias to GBV looked at refugees and other legal migrants. There is also extensive GBV-centred research (Piret & Boivin 2021;Rees et al. 2011;Schjonberg 2017) conducted over the past 30 years and has been carried out on many pandemics (Ebola, AIDS, H1N1 Flu, etc.), wars and natural disasters, and their influence on women and children has been studied. ...
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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]. ...
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