Perception of HIV risk and the quantity and quality of children: the case of rural Malawi

Abstract

The empirical literature on the impact of HIV on the quality (Q) and quantity (N) of children provides limited and somewhat mixed evidence. This study introduces individual HIV risk perceptions, as a predictor of mortality, into a Q-N investment model. In this model, higher maternal mortality predicts lower N while higher child mortality predicts lower Q. Thus the two effects together make likely negative associations between HIV and both Q and N. Based on longitudinal micro data on mothers and their children in rural Malawi, our results suggest that higher mothers' reported HIV risk reduces both child quality, as reflected in children's schooling and health, and child quantity, when the perceived risk is already moderate or high. The effects are sizable, and, in the case of Q (schooling and health) are found for children and teenagers, both boys and girls, while in the case of N they are found for young and mature women.

Adult Mortality, AIDS, and Fertility in Rural Malawi

“…There are several possible explanations for the difference in response to female‐ and male‐adult mortality. Our analysis does not directly distinguish between them, but the finding of a negative impact of female‐adult mortality is consistent with studies showing that the more women worry about HIV infection, the fewer children they have (Noël‐Miller ; Shapira ; Castro, Behrman, and Kohler ). The findings could also be due to the widespread belief that pregnancy might wake up a dormant disease and lead to AIDS (Yeatman ) or that women avoid giving birth to HIV‐infected babies or children who might become orphaned (Young ).…”

“…An increase in female mortality from its mean in 1987 to its mean in 1998 is predicted to decrease the average number of births 1999–2004 by 8.1–10.3% (0.076–0.101 children), while a similar increase in male mortality is predicted to increase births by 6.3–13.9% (0.059–0.136 children). These results explain why Noël‐Miller (), Shapira (), and Castro, Behrman, and Kohler (), who analyzed the (perceived) female‐AIDS risk, find that the HIV epidemic reduces fertility in Malawi while Fortson () and Juhn, Kalemli‐Ozcan, and Turan (), who use measure that combines male–female community HIV prevalence, do not find any fertility response.…”

“…We estimate ordered probit models, using data from the 2004 Malawi Demographic and Health Survey (2004 MDHS) and population censuses to analyze the impact of AIDS-induced mortality on fertility. The fertility is measured by the number of children to which women gave birth between 1999 and 2004, so the 1 Apart from the evidence that HIV-infected women in sub-Saharan Africa are 20-40% less fertile than uninfected women (Lewis et al 2004), the findings for the overall population vary greatly: Young (2005Young ( , 2007 and Boucekkine, Desbordes, and Latzer (2009) find a substantial negative effect on fertility; Noël-Miller (2003), Shapira (2013), and Castro, Behrman, and Kohler (2015) find a somewhat negative effect; Lorentzen, McMillan, and Wacziarg (2008) and Kalemli-Ozcan and Turan (2011) find a positive effect; Kalemli-Ozcan (2012) finds both a positive and a negative effect depending on the specification of the model and the data used; Durevall and Lindskog (2011) find a negligible negative effect; Ahuja, Wendell, and Werker (2009) and Fortson (2009) find no effect; while Magadi and Agwanda (2010) and Juhn, Kalemli-Ozcan, and Turan (2013) find a negative effect among HIV-positive women but none among the others.…”

“…Our analysis focuses on women as Noël-Miller (2003), Shapira (2013), Castro, Behrman, and Kohler (2015), and many others did. However, fertility decisions are 2 Very few had access to antiretroviral drugs before public distribution was rolled out, and by early 2004 only three thousand people had initiated treatment, including public and private sectors (Malawi Government 2012).…”

The Impact of AIDS Treatment on Savings and Human Capital Investment in Malawi

“…7 Qualitative interviews as well as quantitative analyses suggests that risk perceptions about HIV/AIDS factor into parental decisions about their children's education (Grant 2008;Castro, Behrman, and Kohler 2015).…”