Perception of HIV risk and the quantity and quality of children: the case of rural Malawi
- 410 Downloads
- 4 Citations
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.
Keywords
HIV Child quantity Child quality Malawi Fertility Schooling Child healthJEL Classification
D13 I12 I20Notes
Acknowledgments
This research was supported by the UK Economic and Social Research Council/Hewlett Foundation Grant (PI Marcos Vera-Hernandez, Institute of Fiscal Studies, University College London; PI on a subcontract to the University of Pennsylvania, Hans-Peter Kohler) on “Effects of Reproductive Health on Poverty in Malawi” and R01-HD-053781-01A1 (PI Hans-Peter Kohler) on “Consequences of High Morbidity and Mortality in a Low-Income Country”. The authors are grateful for insightful comments and suggestions of the three anonymous referees.
References
- Akbulut-Yuksel M, Turan B (2013) Left behind: intergenerational transmission of human capital in the midst of HIV/AIDS. J Popul Econ 26(4):1523–1547CrossRefGoogle Scholar
- Albanesi S, Olivetti C (2010) Maternal health and the baby boom, NBER Working Papers 16146, National Bureau of Economic Research, Inc.Google Scholar
- Anglewicz P, Kohler H-P (2009) Overestimating HIV infection: the construction and accuracy of subjective probabilities of HIV infection in rural Malawi. Demogr Res 20(6):65–96CrossRefGoogle Scholar
- Anglewicz P, Adams J, Obare-Onyango F, Kohler H-P, Watkins S (2009) The Malawi Diffusion and Ideational Change Project 2004–06: data collection, data quality and analyses of attrition. Demogr Res 20(21):503–540CrossRefGoogle Scholar
- Arellano M, Bond S (1991) Some tests of specification for panel data: Monte Carlo evidence and an application to employment equations. Rev Econ Stud 58:277–297CrossRefGoogle Scholar
- Ashenfelter O, Krueger A (1994) Estimates of the economic return to schooling from a new sample of twins. Am Econ Rev 84(5):1157–1174Google Scholar
- Becker G, Lewis H (1973) On the interaction between the quantity and quality of children. J Polit Econ Part 2 New Econ Approach Fertil 81(2):S279–S288Google Scholar
- Behrman JR, Rosenzweig MR, Taubman P (1994) Endowments and the allocation of schooling in the family and in the marriage market: the twins experiment. J Polit Econ 102(6):1131–1174CrossRefGoogle Scholar
- Behrman JR, Calderon CM, Preston S, Hoddinott J, Martorell R, Stein AD (2009) Nutritional supplementation of girls influences the growth of their children: prospective study in Guatemala. Am J Clin Nutr 90:1372–1379CrossRefGoogle Scholar
- Behrman JR, Kohler HP, Jensen VM, Pedersen D, Petersen I, Bingley P, Christensen K (2011) Does more schooling reduce hospitalization and delay mortality? New evidence based on Danish twins. Demography 48(4):1347–1375CrossRefGoogle Scholar
- Bennell P (2005) The impact of the AIDS epidemic on teachers in sub-Saharan Africa. J Dev Stud 41(3):440–466CrossRefGoogle Scholar
- Bíró A (2013) Subjective mortality hazard shocks and the adjustment of consumption expenditures. J Popul Econ 26(4):1379–1408CrossRefGoogle Scholar
- Case A, Ardington C (2006) The impact of parental death on school enrollment and achievement: longitudinal evidence from South Africa. Demography 43(3):401–420CrossRefGoogle Scholar
- Case A, Paxson C (2009) The impact of the AIDS pandemic on health services in Africa: evidence from demographic health surveys research program in development studies and center for health and wellbeing. Princeton University, PrincetonCrossRefGoogle Scholar
- Chen L, Evans T, Anand S, et al (2004) Human resources for health: overcoming the crisis. Lancet 364:1984–1990CrossRefGoogle Scholar
- Cigno A (1998) Fertility decisions when infant survival is endogenous. J Popul Econ 11(1):21–28CrossRefGoogle Scholar
- Cleland J (2001) The effects of improved survival on fertility: a reassessment. Popul Dev Rev 27:60–92Google Scholar
- Datar A, Ghosh A, Sood N (2007) Mortality risks, health endowments, and parental investments in infancy: evidence from rural India. NBER Working paper no. 13649Google Scholar
- De Lannoy A (2005) There is no other way out: educational decision-making in an era of AIDS: how do HIV-positive mothers value education? Centre for social science research working paper no. 137. University of Cape TownGoogle Scholar
- Delavande A, Kohler HP (2012) The impact of HIV testing on subjective expectations and risky behavior in Malawi. Demography 49(3):1011–1036CrossRefGoogle Scholar
- De Paula A, Shapira G, Todd P (2010) How beliefs about hiv status affect risky behaviors: evidence from Malawi. PIER working paper no. 11-005Google Scholar
- Durevall D, Lindskog A (2008) Adult mortality and fertility: evidence from Malawi. Country Econ Report 2008:1Google Scholar
- Evans D, Miguel E (2007) Orphans and schooling in Africa: a longitudinal analysis. Demography 44(1):35–57CrossRefGoogle Scholar
- Fink G, Linnemayr S (2008) HIV, education and fertility: long term evidence from sub-Saharan Africa. Working paper, Harvard School of Public HealthGoogle Scholar
- Fortson J (2008) Mortality risk and human capital investment: the impact of HIV/AIDS in sub-Saharan Africa. Rev Econ Stat 93(1):1–15CrossRefGoogle Scholar
- Fortson J (2009) HIV/AIDS and fertility. Am Econ J Appl Econ 1(3):170–194CrossRefGoogle Scholar
- Grassly N, Desai K, Pegurri E, Sikazwe A, Malambo I, Siamatowe C, Bundy D (2003) The economic impact of HIV/AIDS on the education sector in Zambia. AIDS 17(7):1039–1044CrossRefGoogle Scholar
- Hoddinott J, Maluccio JA, Behrman JR, Flores R, Martorell R (2008) The impact of nutrition during early childhood on income, hours worked, and wages of Guatemalan adults. Lancet 371:411–416CrossRefGoogle Scholar
- Idler E, Benyamini Y (1997) Self-rated health and mortality: a review of twenty seven community studies. J Health Soc Behav 38(1):21–37CrossRefGoogle Scholar
- Jayachandran S, Lleras-Muney A (2009) Life expectancy and human capital investments: evidence from maternal mortality declines. Q J Econ 124(1):349–397CrossRefGoogle Scholar
- Juhn C, Kalemli-Ozcan S, Turan B (2008) HIV and fertility in Africa: first evidence from population-based surveys. J Popul Econ 1–19Google Scholar
- Kalemli-Ozcan S (2012) AIDS, reversal of the demographic transition and economic development: evidence from Africa. J Popul Econ 25(3):871–897CrossRefGoogle Scholar
- Kalemli-Ozcan S, Turan B (2011) HIV and fertility revisited. J Dev Econ 96(1):61–65CrossRefGoogle Scholar
- Kelly M (2000) Planning for education in the context of HIV/AIDS IIEP fundamental of educational planning, No. 66. UNESCO, ParisGoogle Scholar
- Maluccio JA, Hoddinott J, Behrman JR, Quisumbing A, Martorell R, Stein AD (2009) The impact of nutrition during early childhood on education among Guatemalan adults. Econ J 119:734–763CrossRefGoogle Scholar
- Matovu J, Gray R, Makumbi F, Wawer M, Serwadda D, Kigozi G, Sewankambo N, Nalugoda F (2005) Voluntary HIV counseling and testing acceptance, sexual risk behavior and HIV incidence in Rakai, Uganda. AIDS 19(5):503–511CrossRefGoogle Scholar
- Mishra V, et al (2007) Education and nutritional status of orphans and children of HIV-infected parents in Kenya. AIDS Educ Prev 19(5):383–395CrossRefGoogle Scholar
- Montgomery M (2000) Perceiving mortality decline. Popul Dev Rev 26(4):795–819CrossRefGoogle Scholar
- Noël-Miller CM (2003) Concern regarding the HIV/AIDS epidemic and individual childbearing, evidence from rural Malawi. Demogr Res 1(10):318–349Google Scholar
- Nyblade L, Menken J, Wawer M, Sewankambo N, Serwadda D, Makumbi F, Lutalo T, Gray R (2001) Population-based HIV testing and counseling in rural Uganda: participation and risk characteristics. J Acquir Immune Defic Syndr 28(5):463–470CrossRefGoogle Scholar
- Oster E (2012) HIV and sexual behavior change: why not Africa? J Health Econ 31(1):35–49CrossRefGoogle Scholar
- Papageorgiou C, Stoytcheva P (2008) What is the impact of AIDS on cross-country income mimeo. International Monetary Fund, WashingtonGoogle Scholar
- Preston SH (1978) The effects of infant and child mortality on fertility. Academic, New YorkGoogle Scholar
- Shapira G (2011) The effect of beliefs about own HIV status on fertility Philadelphia, University of Pennsylvania, unpublished Ph.D. DissertationGoogle Scholar
- Singh-Manoux A, Guéguen A, Martikainen P, Ferrie J, Marmot M, Shipley M (2007) Self-rated health and mortality: short-and long-term associations in the Whitehall II study. Psychosom Med 69(2):138–143CrossRefGoogle Scholar
- Strulik H (2003) Mortality, the trade-o? between child quality and quantity, and demoeconomic development. Metroeconomica 54(4):499–520CrossRefGoogle Scholar
- Ueyama M, Yamauchi F (2009) Marriage behavior response to prime-age adult mortality: evidence from Malawi. Demography 46(1):43–63CrossRefGoogle Scholar
- UNAIDS (2010) Global report. http://www.unaids.org/globalreport/
- Waters E, Doyle J, Wolfe R, Wright M, Wake M, Salmon L (2000) Influence of parental gender and self-reported health and illness on parent-reported child health. Pediatrics 106(6):1422–1428CrossRefGoogle Scholar
- Watkins S, Behrman JR, Kohler HP, Zulu EM (2003) Introduction to research on demographic aspects of HIV/AIDS in rural Africa. Demogr Res S1(1):1–30CrossRefGoogle Scholar
- Weinhardt L, Carey M, Johnson B, Bickham N (1999) Effects of HIV counseling and testing on sexual risk behavior: a meta-analytic review of published research, 1985–1997. Am J Public Health 89(9):1397–1405CrossRefGoogle Scholar
- Whiteside A (2002) Poverty and HIV/AIDS in Africa. Third World Q 23:313–332CrossRefGoogle Scholar
- Willis R (1973) A new approach to the economic theory of fertility. J Polit Econ Part 2 New Econ Approach Fertil 81(2):S14–S64Google Scholar
- Yamano T, Shimamura Y, Sserunkuuma D (2006) Living arrangements and schooling of orphaned children and adolescents in Uganda. Econ Dev Cult Chang 54(4):833–856CrossRefGoogle Scholar
- Young A (2005) The gift of the dying: the tragedy of AIDS and the welfare of future African generations. Q J Econ 120(2):423–466Google Scholar