Journal of Population Economics

, Volume 31, Issue 2, pp 429–451 | Cite as

Disease risk and fertility: evidence from the HIV/AIDS pandemic

  • Yoo-Mi Chin
  • Nicholas WilsonEmail author
Original Paper


A fundamental question about human behavior is whether fertility responds to disease risk. The standard economic theory of household fertility decision-making generates ambiguous predictions, and the response has large implications for human welfare. We examine the fertility response to the HIV/AIDS pandemic using national household survey data from 14 sub-Saharan African countries. Instrumental variable (IV) estimates using distance to the origin of the pandemic suggest that HIV/AIDS has increased the total fertility rate (TFR) and the number of surviving children. These results rekindle the debate about the fertility response to disease risk, particularly the HIV/AIDS pandemic, and highlight the question of whether the HIV/AIDS pandemic has reduced GDP per capita.


Disease Fertility HIV/AIDS Instrumental variable regression 

JEL classification

I15 J13 O12 



We thank Erdal Tekin and three anonymous reviewers for excellent comments. Ran Duan and Mark Jarrett provided timely research assistance. The findings, interpretations, and conclusions expressed in this paper are those of the authors and do not necessarily represent the views of the aforementioned individuals or agencies. All errors are our own.

Funding information

This study was not funded by a research grant or other funding source.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. Acemoglu D, Johnson S (2007) Disease and development: the effect of life expectancy on economic growth. J Polit Econ 115(6):925–985CrossRefGoogle Scholar
  2. Ainsworth M, Beegle K, Nyamete A (1996) The impact of women's schooling on fertility and contraceptive use: a study of fourteen sub-Saharan African countries. World Bank Econ Rev 10(1):85–122CrossRefGoogle Scholar
  3. Aksan A-M, Chakraborty S (2013) Childhood disease and the precautionary demand for children. J Popul Econ 26:855–885CrossRefGoogle Scholar
  4. Angeles L (2010) Demographic transitions: analyzing the effects of mortality on fertility. J Popul Econ 23:99–120CrossRefGoogle Scholar
  5. Becker G, Gregg Lewis H (1973) On the interaction between the quantity and quality of children. J Polit Econ 81(2, Part 2):S279–S288CrossRefGoogle Scholar
  6. Behrman JA (2015) Does schooling affect women’s desired fertility? Evidence from Malawi, Uganda, and Ethiopia. Demography 52(3):787–809CrossRefGoogle Scholar
  7. Bleakley H, Lange F (2009) Chronic disease burden and the interaction of education, fertility, and growth. Rev Econ Stat 91(1):52–65CrossRefGoogle Scholar
  8. Bhalotra S, Van Soest A (2008) Birth-spacing, fertility and neonatal mortality in India: dynamics, frailty, and fecundity. J Econ 143(2):274–290CrossRefGoogle Scholar
  9. Boucekkine R, Desbordes R, Latzer H (2009) How do epidemics induce behavioral changes? J Econ Growth 14:233–264CrossRefGoogle Scholar
  10. Caldwell JC, Orubuloye IO, Caldwell P (1992) Fertility decline in Africa: a new type of transition? Popul Dev Rev 18(2):211–242CrossRefGoogle Scholar
  11. Chin Y-M (2013) Does HIV increase the risk of spousal violence in sub-Saharan Africa? J Health Econ 32:997–1006CrossRefGoogle Scholar
  12. Durevall D, Lindskog A (2011) Uncovering the impact of the HIV epidemic on fertility in sub-Saharan Africa: the case of Malawi. J Popul Econ 24:629–655CrossRefGoogle Scholar
  13. Durevall D, Lindskog A (2016) Adult mortality, AIDS, and fertility in rural Malawi. Dev Econ 54(3):215–242CrossRefGoogle Scholar
  14. Faria NR, Rambaut A, Suchard MA, Baele G, Bedford T, Ward MJ, Tatem AJ, Sousa JD, Arinaminpathy N, Pépin J, Posada D (2014) The early spread and epidemic ignition of HIV-1 in human populations. Science 346(6205):56–61CrossRefGoogle Scholar
  15. Fink, Gunther and Sebastian Linnemayr. 2009. HIV does matter for fertility: human capital, mortality and family size. Harvard University working paperGoogle Scholar
  16. Fortson J (2008) The gradient in sub-Saharan Africa: socioeconomic status and HIV/AIDS. Demography 45(2):303–322CrossRefGoogle Scholar
  17. Fortson J (2009) HIV/AIDS and fertility. Am Econ J: Appl Econ 1(3):170–194Google Scholar
  18. Gray RH, Wawer MJ, Serwadda D (1998) Population-based study of fertility of women with HIV-1 infection in Uganda. Lancet 351(9096):98–103CrossRefGoogle Scholar
  19. Juhn C, Kalemli-Ozcan S, Turan B (2012) HIV and fertility in Africa: first evidence from population-based surveys. J Popul Econ 26(3):835–853CrossRefGoogle Scholar
  20. Kalemli-Ozcan S (2012) AIDS, “reversal” of the demographic transition and economic development: evidence from Africa. J Popul Econ 25(3):871–897CrossRefGoogle Scholar
  21. Kalemli-Ozcan S, Turan B (2011) HIV and fertility revisited. J Dev Econ 96(1):61–65CrossRefGoogle Scholar
  22. Karlsson M, Pichler S (2015) Demographic consequences of HIV. J Popul Econ 28(4):1097–1135CrossRefGoogle Scholar
  23. Lam D (2011) How the world survived the population bomb: lessons from 50 years of extraordinary demographic history. Demography 48(4):1231–1262CrossRefGoogle Scholar
  24. Lloyd CB, Kaufman CE, Hewett P (2000) Implications for fertility change of the spread of primary schooling in sub-Saharan Africa. Popul Dev Rev 26(3):483–515CrossRefGoogle Scholar
  25. Lucas A (2013) The impact of malaria eradication on fertility. Econ Dev Cult Chang 61(3):607–631CrossRefGoogle Scholar
  26. Malthus T (1798) An essay on the principle of population. J. Johnson, St. Paul's Churchyard, EnglandGoogle Scholar
  27. McCord G, Conley D, Sachs JD (2017) Malaria ecology, child mortality & fertility. Econ Hum Biol 24:1–17CrossRefGoogle Scholar
  28. Ministry of Defence (Navy) (1987) Admiralty of manual of navigation, volume 1: general navigation, coastal navigation and pilotage. In: Volume 45 of BR series. The Stationary Office, EnglandGoogle Scholar
  29. Osili UO, Long BT (2008) Does female schooling reduce fertility? Evidence from Nigeria. J Dev Econ 87(1):57–75CrossRefGoogle Scholar
  30. Oster E (2012a) HIV and sexual behavior change: why not Africa? J Health Econ 31:35–49CrossRefGoogle Scholar
  31. Oster E (2012b) Routes of infection: exports and HIV incidence in sub-Saharan Africa. J Eur Econ Assoc 10(5):1025–1058CrossRefGoogle Scholar
  32. United Nations. 2017. World population prospects: the 2017 revision. Department of Economic and Social Affairs, Population Division https://esaunorg/unpd/wpp/DataQuery/ Accessed June 26, 2017
  33. WHO (2011) Causes of death summary tables. Health statistics and informatics department. World Health Organization, SwitzerlandGoogle Scholar
  34. 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
  35. Young A (2007) In sorrow to bring forth children. J Econ Growth 12:283–327CrossRefGoogle Scholar

Copyright information

© US Government (outside the USA) 2017

Authors and Affiliations

  1. 1.Department of EconomicsBaylor UniversityWacoUSA
  2. 2.White House Social and Behavioral Sciences Team and Department of EconomicsReed CollegePortlandUSA

Personalised recommendations