From Death to Birth Mortality Decline and Reproductive Change (1998) / Chapter Skim
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5 The Impact of AIDS Mortality on Individual Fertility: Evidence from Tanzania
5 The Impact of AIDS Mortality on Individual Fertility: Evidence from Tanzania
Pages 138-181
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From page 138... ...
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)
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From page 139... ...
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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From page 140... ...
Heterosexual transmission accounts for approximately 80-90 percent of all adult HIV infections in sub-Saharan Africa (Mann et al., 1992; National Research Council, 1996~. In many hard-hit countries, women are equally if not more likely to be infected than men.
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From page 141... ...
The baseline mortality in their comparison population without HIV is clearly not from sub-Saharan Afnca, where infant mortality ranges from 70-150 per 1,000 and where prevailing mortality among pnme-aged adults, which ranges between 5 and 8 per 1,000, is roughly eight times higher than in a developed country. Furthermore, their estimates of AIDS-related child mortality likely do not include the deaths of HIV-negative children who are put at greater risk because of the loss of their parents due to AIDS.
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From page 142... ...
Thus, when we consider the effects of AIDS-related child mortality on fertility, we must at the same time consider the effects of AIDS-related mortality among adults in their prime years. HOW AIDS-RELATED MORTALITY AFFECTS FERTILITY Increased mortality due to the AIDS epidemic can induce changes in individual fertility through many different channels, some biological and some behavioral.
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From page 143... ...
These studies collectively suggest a positive, if sometimes weak, relation between child deaths and fertility in sub-Saharan Africa. Adult Mortality and Fertility Heightened adult mortality due to AIDS may reduce desired family size and the observed demand for children of individual women through the following channels: · AIDS mortality often occurs in young adulthood before the long-run benefits of earlier child investments can be realized by the parents of those infected.
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From page 144... ...
These orphaned children make additional claims on existing income and the time of adults and may reduce the demand for additional children of their own. Other Channels Through Which AIDS Morbidity and Mortality May Affect Fertility Any change in the demand for children or in biological factors affecting the supply of children because of the AIDS epidemic will be reflected in corresponding changes in the proximate determinants of fertility, such as contraceptive use, breastfeeding, marriage, abortion, infecundity, and sterility (Bongaarts, 1978~.
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From page 145... ...
Finally, in the aggregate, AIDS mortality affects fertility through its impact on the age structure of women of reproductive age. But there are other aspects of the selective mortality of women of reproductive age that could affect aggregate fertility.
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From page 146... ...
INDIVIDUAL FERTILITY RESPONSE IN TANZANIA Tanzania, on the eastern coast of Africa, stretches to Lake Victoria in the northwest, Lake Tanganyika in the west, and Lake Nyassa in the southwest. Per capita gross national product (GNP)
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From page 147... ...
Although the levels may be underestimates, the differentials in mortality across regions point to the areas with relatively higher mortality. The highest adult mortality was recorded in Kagera region; Mbeya and Dar es Salaam, where HIV infection is also widespread, had relatively high adult death rates as well (6.3 and 6.5 per 1,000, respectively)
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From page 148... ...
These regional differentials in mortality reflect not only the effect of the AIDS epidemic but the distribution of other underlying determinants of mortality and nutritional status, such as household incomes, food prices, disease vectors (such as mosquitos) , and the availability of medical care.
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From page 149... ...
Even though high levels of child mortality are likely to raise fertility among parents who wish to be assured of a target number of surviving births, community levels of adult mortality are likely to reduce the demand for children by lowering their long-run expected benefits. Deaths of adults in a given household may lower fertility through decreased income and household production.
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From page 150... ...
and random-effects probit (for the longitudinal survey) 4we do not examine the impact of women s own child mortality on their subsequent fertility because: (1)
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From page 151... ...
The impacts in Tanzania are likely to be similar to those in other East African countries hard hit by the AIDS epidemic at equivalent points in the demographic transition and with similar levels of economic development. The dependent variables, measures of mortality, and other regressors in the three data sets are compared in Table 5-1.
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From page 152... ...
152 Cq a' · _4 o Cq VO ~ ~ V, .~ Em o 3 a' .t a' o ¢ En ;^ o ca ca .
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From page 153... ...
153 ~ o ~ o o ~4= ~ o ~ an, , an, , 4= ~ 4= + ~my, ~ma, ~ ~o ¢ I= 4= ~ ', ~ ,~ e , a ~ , ~ ~ , , ~ ~ D a ~ to ca · ~ ca ;^ ca o o is t004 ca hi hi t004 hi .~ ~ O .~ ~ t-1 ca ·= · ^ O ~ O ·0 ~ A C)
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From page 154... ...
This ranges from about 1 percent in the Dodoma 5The under-5 child mortality rate is from Bureau of statistics (no date) and the adult mortality rate is from Ainsworth and Rwegarulira (1992)
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From page 155... ...
. This information was divided by the total population of 6The means of the dependent variables are quite different across the three data sets, part of which can be accounted for by the stratification of the samples.
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From page 156... ...
The inclusion of controls for household expenditure per adult do not much alter the results. The Impact of Adult Death Rates on Recent Fertility Higher levels of adult mortality at the community level are associated with lower recent fertility in all three data sets (Table 5-3~.
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From page 157... ...
reduce the percentage of women giving birth from 10.4 to 6.2 percent. Such an increase would represent a doubling of adult mortality, which is not unexpected in areas hard hit by the AIDS epidemic.
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From page 158... ...
Women in households where another female adult died 0-12 months ago have a three 7The relative rarity of the deaths of prime-aged adults in the THRDS (with 5,000 households) underscores the difficulty of studying the impact of adult deaths from AIDS, even in a country with an AIDS epidemic.
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From page 159... ...
The death of close relatives of both genders (siblings, husband, parents) in the past 30 months is associated with lower fertility.
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From page 160... ...
160 a' _' lo a' be ¢ a' a' a' o o hi a' o Cq o A= to Co C)
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From page 161... ...
In this section we consider the impact of deaths on several "proximate" indicators of fertility intentions or outcomes that are likely to respond to mortality with a shorter lag: · the desire for an additional child; and · measures of recent sexual activity. If mortality affects fertility outcomes through behavioral channels, then to be consistent with the results on fertility in the previous section, heightened adult mortality from AIDS or other causes would be associated with a reduction in desire for additional children and a reduction in sexual activity.
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From page 162... ...
162 ca ;^ ~ ~ X C)
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From page 164... ...
Among those aged 15-19, 53 percent of women and 64 percent of men had ever had sexual intercourse. These dependent variables are regressed on the same set of explanatory variables as in the fertility regressions and include three measures of adult mortality: the proportion of households in the sample cluster who know someone who has AIDS or who has died of AIDS, the district-level under-5 mortality rate, and the region-level adult (aged 15-49)
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From page 165... ...
All of these outcomes would be associated with lower fertility. CONCLUSIONS This chapter has examined the impact of increased mortality that is due to the AIDS epidemic on individual fertility behavior.
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From page 166... ...
Analysis of the impact of mortality on other indicators of fertility intentions tends to reinforce the hypothesis that higher adult mortality will lead to a decrease in fertility. Higher personal awareness of AIDS and AIDS mortality are associated with a reduced desire for additional children among both men and women and a decrease in sexual activity among men.
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From page 167... ...
MARTHA AINSWORTH, DEON FILMER, AND INNOCENT SEMALI 167 mortality will be negative. Although we have identified evidence of behavioral response, the total effect of heightened mortality due to AIDS on fertility will include both behavioral and biological components, the latter reflecting the impact of HIV infection on fecundity.
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From page 168... ...
168 THE IMPACT OF AIDS MORTALITY: EVIDENCE FROM TANZANIA APPENDIX 5-A: SUMMARY STATISTICS FOR THE THREE SAMPLES (a) Kagera Sample of Women Aged 15-50 in Waves 2, 3, and 4 (n = 2,896)
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From page 169... ...
MARTHA AINSWORTH, DEON FILMER, AND INNOCENT SEMALI (a) Kagera Sample of Women Aged 15-50 in Waves 2, 3, and 4 (n = 2,896)
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From page 170... ...
0.100 0.300 Lake zoneb (0/1) 0.251 0.434 Under-5 mortality rate 177.15 40.54 Adult mortality rate 5.632 1.341 Household expenditure variables Log of annual household expenditure per adult (/1000000)
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From page 171... ...
MARTHA AINSWORTH, DEON FILMER, AND INNOCENT SEMALI (c) TKAP Sample of Women Aged 15-49 and Sample of Men Aged 15-59 171 Women Aged 15-49 (n = 3,950)
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From page 172... ...
Women Aged 15-49 (n = 3,950)
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From page 173... ...
A non-normal distribution of vi or omitted variables can cause the parameter estimates to be biased. In this chapter we check the robustness of our results to certain types of violations of the underlying assumptions (see below)
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174 THE IMPACT OF AIDS MORTALITY: EVIDENCE FROM TANZANIA (1988) propose an erogeneity test for a model with a dichotomous dependent variable and a potentially endogenous continuous explanatory variable.
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From page 175... ...
The first-stage regressions perform well in the sense that they explain a good part of the variance of the dependent variable. The adjusted it-squared in the KHDS sample is 0.32 and in the THRDS is 0.39.
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From page 176... ...
Transforming the Results from A Probit or Tobit Regression In Tables 5-1 through 5-6, the probit parameter estimates have all been transformed to correspond to the marginal effect of a change in one of the independent variables on the expected value of the dependent variable (i.e., the probability that it equals one)
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From page 177... ...
, where pi is the Tobit parameter estimate on X, F() is the standard normal cumulative distnbution function, and z is equal to Xp/c,, where c, is the standard deviation of £.
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From page 178... ...
Background paper prepared for the Tanzania AIDS Assessment and Planning Study. The World Bank, Washington, D.C.
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From page 179... ...
Hanson, and W.T. Shearer 1995 Excess intrauterine fetal demise associated with maternal human immunodeficiency virus infection.
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From page 180... ...
Over, M., and M Ainsworth 1989 The Economic Impact of Fatal Adult Illness due to AIDS and other Causes in SubSaharan Africa: A Research Proposal.
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From page 181... ...
World Bank 1992 Tanzania: AIDS Assessment and Planning Study. Washington, D.C.: The World Bank.
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