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HIV/AIDS and Fertility

This paper studies the response of fertility to the HIV/AIDS epidemic in sub-Saharan Africa. Standard models of fertility have ambiguous predictions in this context. Because childbirth requires unprotected sex (which increases the risk of contracting HIV), we might expect HIV/AIDS to reduce fertility through an infection avoidance motive. Adding to this decline, HIV infection may itself reduce fecundity among infected women. However, because HIV/AIDS affects the expected longevity of children, a quantity-quality model of childbearing would predict an increase in fertility. I use repeated cross-sections of the Demographic and Health Surveys for twelve countries in sub-Saharan Africa to examine this question empirically. Using individual birth histories from these data, I construct estimates of the regional total fertility rate over time. In a difference-in-differences approach, I compare regional HIV prevalence to changes in total fertility rates from the late 1980s to the present. My results suggest that HIV/AIDS had very little impact on fertility, both overall and in a sample of HIV-negative women. * Email: jfortson@uchicago.edu Address: Becker Center on Chicago Price Theory, 5807 S. Woodlawn Avenue, Chicago, IL 60637 Anne Case, Ken Fortson, Jens Ludwig, and seminar participants at the University of Chicago provided helpful suggestions. I am grateful to Daniel Hirschberg and Kristopher Hult for research assistance, and to Bridgette James for help with the DHS data.