Fertility Trends in Sub-Saharan Africa: Has HIV contributed to Fertility Stalls?

David Sánchez Páez, Université Catholique de Louvain
Bruno D. Schoumaker, Universite catholique de Louvain (UCL)

Fertility transition in sub-Saharan Africa has been different than elsewhere, showing slow pace in fertility decline and fertility stalls. Likewise, it is the region of the world hardest hit by HIV. HIV is associated with both fertility-enhancing and fertility-reducing behaviors, and the net effect on fertility depends on which effect dominates. Our goal is to better understand the mechanisms through which HIV may have affected fertility changes and whether they are connected to fertility stalls. We first analyze HIV prevalence and fertility trends. Then, we reconstruct fertility rates according to HIV status and analyze changes over time. Finally, we focus on Zimbabwe. Our results suggest that unambiguous cases of fertility stalls are mostly detected in countries of high HIV prevalence. In these countries, there was an unusually rapid decline in fertility during the 1990s and then a slowdown beginning in the mid-2000s. Fertility of HIV-positive women has contributed to fertility stalls, but it is the fertility of HIV-negative women that mainly account for them. In Zimbabwe, during the stall period fertility-enhancing behaviors during the stall period, such as increased sexual activity, low rates of contraceptive use, reduced length of postpartum infecundability, and high demand for children, have counter-balanced fertility-reducing behaviors.

Keywords: Fertility and childbirth, Cross-country comparative analyses, Sexual and Reproductive Health and Rights

See paper.

  Presented in Session 17. Pandemics, Health, and Fertility