How Subjective Beliefs about HIV Infection Affect Life-Cycle Fertility : Evidence from Rural Malawi
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World Bank, Washington, DC
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This paper studies the effect of
subjective beliefs about HIV infection on fertility
decisions in a context of high HIV prevalence and simulates
the impact of different policy interventions, such as HIV
testing programs and prevention of mother-to-child
transmission, on fertility and child mortality. It develops
a model of women's life-cycle, in which women make
sequential fertility decisions. Expectations about the life
horizon and child survival depend on women's perceived
exposure to HIV infection, which is allowed to differ from
the actual exposure. In the model, women form beliefs about
their HIV status and about their own and their
children's survival in future periods. Women update
their beliefs with survival to each additional period as
well as when their HIV status is revealed by an HIV test.
Model parameters are estimated by maximum likelihood with
longitudinal data from the Malawi Diffusion and Ideational
Change Project, which contain family rosters, information on
HIV testing, and measures of subjective beliefs about own
HIV status. The model successfully fits the fertility
patterns in the data, as well as the distribution of
reported beliefs about own HIV status. The analysis uses the
model to assess the effect of HIV on fertility by simulating
behavior in an environment without HIV. The results show
that the presence of HIV reduces the average number of
births a woman has during her life-cycle by 0.15. The paper
also finds that HIV testing can reduce the fertility of
infected women, leading to a reduction of child mortality
and orphan-hood.
Palabras clave
AGE GROUPS, AGE OF MARRIAGE, AGED, ANTENATAL CLINICS, ANTIVIRAL DRUGS, AVERAGE AGE, BIRTH OUTCOMES, BIRTH SPACING, BLOOD TESTS, CHILD MORTALITY, CHILD MORTALITY RATES, CHILD SURVIVAL, CHILDBEARING, CHILDHOOD, CLINICS, CONSECUTIVE PREGNANCIES, CONTRACEPTION, CONTRACEPTIVES, DEMOGRAPHIC TRANSITION, DEVELOPING COUNTRIES, DEVELOPMENT POLICY, DISEASE, DISSEMINATION, DRUGS, DYING, ECONOMIC GROWTH, EDUCATED WOMEN, EDUCATIONAL ATTAINMENT, EPIDEMIC, EPIDEMICS, EU, FACT SHEETS, FAMILY SIZE, FERTILITY, FERTILITY BEHAVIOR, FERTILITY LEVELS, FERTILITY PATTERNS, FERTILITY RATE, FERTILITY RATES, FEWER BIRTHS, FEWER PREGNANCIES, FEWER WOMEN, FREQUENCY OF INTERCOURSE, HAZARD, HAZARDS, HEALTH SURVEYS, HIV, HIV INFECTION, HIV POSITIVE, HIV TESTING, HIV/AIDS, HOMES, HOUSEHOLD INCOME, HOUSEHOLD LEVEL, HOUSEHOLD SIZE, HUMAN CAPITAL, HUMAN DEVELOPMENT, HUSBAND, HUSBANDS, IMPACT OF POLICIES, INFANT, INFANT MORTALITY, INFECTION RATES, INFECTIOUS DISEASES, INFORMATION CAMPAIGNS, INTERCOURSE, INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE, LEVELS OF EDUCATION, LIFE EXPECTANCY, LITERACY, LIVING STANDARDS, LOWER FERTILITY, MARITAL STATUS, MARRIAGE AGE, MARRIAGES, MARRIED WOMEN, MEDICINE, MIGRATION, MORTALITY RISK, MOTHER, MOTHER TO CHILD, MOTHER TO CHILD TRANSMISSION, MOTHER-TO-CHILD, MOTHER-TO-CHILD HIV TRANSMISSION, MOTHER-TO-CHILD TRANSMISSION, MOTHERS, NUMBER OF BIRTHS, NUMBER OF CHILDREN, NUMBER OF WOMEN, NUTRITION, OLDER WOMEN, OPPORTUNITIES FOR WOMEN, ORPHANS, PLAGUE, POLICY DISCUSSIONS, POLICY RESEARCH, POLICY RESEARCH WORKING PAPER, POLYGAMY, PREGNANCIES, PREGNANCY, PREGNANCY OUTCOMES, PREGNANCY STATUS, PREVALENCE, PREVENTION OF MOTHER, PREVENTION OF MOTHER-TO-CHILD TRANSMISSION, PRIOR TO MARRIAGE, PROBABILITY OF CONCEPTION, PROGRESS, PUBLIC SERVICES, RELIGIOUS GROUPS, REPRODUCTION, REPRODUCTIVE CHOICES, REPRODUCTIVE DECISIONS, RESIDENCE, RESPECT, RISK OF INFECTION, RURAL AREAS, SECONDARY EDUCATION, SECONDARY SCHOOL, SEX, SEXUAL ACTIVITY, SEXUAL BEHAVIOR, SEXUALLY TRANSMITTED INFECTIONS, STDS, SURVIVAL OF CHILDREN, SYMPTOMS, TB, THERAPY, TREATMENT, UNEDUCATED WOMEN, UNPROTECTED INTERCOURSE, UNPROTECTED SEXUAL ACTIVITY, URBAN AREAS, VOLUNTARY COUNSELLING, WIFE, WILL, WOMAN, YOUNG CHILDREN