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Brazil’s Missing Infants: Zika Risk Changes Reproductive Behavior

  • Published:
Demography

Abstract

Zika virus epidemics have potential large-scale population effects. Controlled studies of mice and nonhuman primates indicate that Zika affects fecundity, raising concerns about miscarriage in human populations. In regions of Brazil, Zika risk peaked months before residents learned about the epidemic and its relation to congenital anomalies. This spatiotemporal variation supports analysis of both biological effects of Zika infection on fertility and the effects of learning about Zika risk on reproductive behavior. Causal inference techniques used with vital statistics indicate that the epidemic caused reductions in birth cohort size of approximately one-quarter 18 months after Zika infection risk peaked but 10 months after public health messages advocated childbearing delay. The evidence is consistent with small but not statistically detectable biological reductions in fecundity, as well as large strategic changes in reproductive behavior to temporally align childbearing with reduced risk to infant health. The behavioral effects are larger for more-educated and older women, which may reflect facilitated access to information and to family planning services within high-risk, mosquito-infested urban locations as well as perceptions about the opportunity costs of risks to pregnancy and infant survival.

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Data Availability

All data sets used in the article are public and can be retrieved from the sources listed. STATA-SE programs utilized on compiling analysis samples can be obtained from the corresponding author.

Notes

  1. Reports of a new disease appeared as early as the third trimester of 2014. Laboratory tests later confirmed cases in Pernambuco in December 2014; and in Maranhao, Rio Grande do Norte, and Bahia, in February and March 2015.

  2. Zika was then added to the list of microcephaly-correlated factors, such as severe malnutrition, substance abuse, infections with rubella or toxoplasmosis, and some conditions that interrupt blood supply to the fetus.

  3. See the Pan American Health Organization website (https://www.paho.org/hq/index.php?option=com_topics&view=rdmore&cid=8095&item=zika-virus-infection&type=statistics&lang=en).

  4. See the online appendix, Figs. A1 and A2, for a map of the Northeast region and of its microregional subdivisions.

  5. Aaronson et al. (2014), used similar reasoning and argued that these “cheaper-quality” substitution effects operate among those who already have children, whereas fertility is stimulated among the childless.

  6. Social media is an increasingly important conduit for health risk information (Fung et al. 2014; Panagiotopoulos et al. 2016). Media representations often inflate infectious illness threats relative to their contribution to population morbidity and mortality (Frost et al. 1997; McComas 2006).

  7. In a recent review in the Annual Review of Virology, Dudley et al. (2018) argued that macaque studies could provide an important source of information on Zika-associated fetal death given how difficult it has been to study in humans.

  8. See http://g1.globo.com/economia/noticia/2014/12/o-que-esperar-da-economia-em-2015.html and http://g1.globo.com/economia/noticia/2015/12/o-que-esperar-para-economia-em-2016.html.

  9. A large literature spanning the social sciences suggests that fertility co-moves with the economic business cycles, with improvements in the latter generating increased fertility (see Adsera 2004, 2011), for example. A recent contribution by Buckles et al. (2018) has even uncovered evidence that fertility decisions are a leading economic indicator, with conceptions moving in anticipation of bad and good future economic tides.

  10. Because we employ numerous data sets, to help readers, we include in Table A1 (online appendix) a list of all information and the respective sources.

  11. See Sistema de Informacao de Nascidos Vivos (SINASC-DATASUS) for live births; see Sistema de Informacao de Mortalidade (SIM-DATASUS) for a registry of fetal deaths (http://www2.datasus.gov.br/DATASUS/index.php?area=0901&item=1).

  12. We last updated our analysis files with data uploaded on May 23, 2019, by Brazilian authorities.

  13. Retrieved from https://www.br.undp.org/.

  14. See http://www.ipeadata.gov.br/Default.aspx.

  15. Despite the high coverage, we expect more-educated, high-income, and privately insured individuals to be underrepresented within the SUS’s hospitalization records.

  16. Collected under the Sistema de Informacoes Hospitalares (SIH-DATASUS) and the Sistema de Informacoes Ambulatoriais (SIA-DATASUS). Data can be found online at http://www2.datasus.gov.br/DATASUS/index.php?area=0901&item=1.

  17. See http://www2.datasus.gov.br/DATASUS/.

  18. This includes codes for vaginal and C-section deliveries (O80-O82) and deliveries with complications (O60–O69).

  19. In practice, there is only one treated unit, which does not provide cross-sectional variation needed for parameter identification. This method heavily relies on longer time series variation, which we accommodate by including data from as early as 2011.

  20. We use CBR values versus TFR and explicitly adjust for variation in the population age composition.

  21. There is some discretion on the implementation of the method, including which attributes to use in the prediction and which period to use in order to fit the time series of interest. We make our choices clear in this section and examine robustness of findings with respect to those choices when discussing results.

  22. We use as a cutoff for urbanization rates, measured from the 2010 census data, the rate for the least urbanized of the state capitals: approximately 77%.

  23. We match the municipality-level reports to the microregions in our data by taking the maximum value of the index across municipalities within a given microregion. The latter is red-flagged if at least one of the municipalities within it is red-flagged.

  24. Effect estimates are presented for the entire period of study in panel b of Fig. A4 and in Table A3 of the online appendix.

  25. They are also robust to the analysis, which includes recorded miscarriages to the counts of births (online appendix, Table A6, columns 3 and 4), suggesting that fetal mortality accounted for in official records cannot explain variation in fertility we observe, particularly for the 2016 effects.

  26. This reasoning is consistent with our finding that higher-parity births are also less frequent in Pernambuco as a result of the epidemics. See Fig. A5 in the online appendix.

  27. Our full investigation of additional health records reveals interesting patterns of increase (although not statistically significantly different from 0) in use of intrauterine device and diaphragm insertion in health posts. We also see a significant reduction in abortion-related procedures (curettage), which we interpret as representing reductions in conception rates among portions of the population that were more prone to interrupting pregnancies. Finally, we see no change in counts of tubal ligation and vasectomies. See Table A11 in the online appendix for summary of these findings. See also Lautharte and Rasul (2020) for an interesting and complementary analysis.

  28. For an interesting empirical exercise on long-term effects of aggregate fertility changes, see Pop-Eleches (2006).

References

  • Aaronson, D., Lange, F., & Mazumder, B. (2014). Fertility transitions along the extensive and intensive margins. American Economic Review, 104, 3701–3724.

    Google Scholar 

  • Abadie, A., Diamond, A., & Hainmueller, J. (2010). Synthetic control methods for comparative case studies: Estimating the effect of California’s tobacco control program. Journal of the American Statistical Association, 105, 493–505.

    Google Scholar 

  • Abadie, A., Diamond, A., & Hainmueller, J. (2015). Comparative politics and the synthetic control method. American Journal of Political Science, 59, 495–510.

    Google Scholar 

  • Adsera, A. (2004). Changing fertility rates in developed countries. The impact of labor market institutions. Journal of Population Economics, 19, 17–43.

    Google Scholar 

  • Adsera, A. (2011). Where are the babies? Labor market conditions and fertility in Europe. European Journal of Population/Revue européene de Démographie, 27, 1–32.

    Google Scholar 

  • Agadjanian, V., & Prata, N. (2002). War, peace, and fertility in Angola. Demography, 39, 215–231.

    Google Scholar 

  • Ager, P., Hansen, C. W., & Jensen, P. S. (2018). Fertility and early-life mortality: Evidence from smallpox vaccination in Sweden. Journal of the European Economic Association, 16, 487–521.

    Google Scholar 

  • Akwwara, P. A., Madise, N. J., & Hinde, A. (2003). Perception of risk of HIV/AIDS and sexual behaviour in Kenya. Journal of Biosocial Science, 35, 385–411.

    Google Scholar 

  • Alam, S. A., & Portner, C. C. (2018). Income shocks, contraceptive use, and timing of fertility. Journal of Development Economics, 131, 96–103.

    Google Scholar 

  • Araujo, T. V. B., Rodrigues, L. C., de Alencar Ximenes, R. A., de Barros Miranda-Filho, D., Montarroyos, U. R., Lopes de Melo, A. P., . . . Figueira, F. (2016). Association between Zika virus infection and microcephaly in Brazil, January to May, 2016: Preliminary report of a case-control study. Lancet Infectious Diseases, 16, 1356–1363.

  • Arck, P. C., Rucke, M., Rose, M., Szekeres-Bartho, J., Douglas, A. J., Pritsch, M., . . . Klapp, B. F. (2008). Early risk factors for miscarriage: A prospective cohort study in pregnant women. Reproductive BioMedicine Online, 17, 101–113. https://doi.org/10.1016/S1472-6483(10)60300-8

  • Arkhangelsky, D., Athey, S., Hirshberg, D. A., Imbens, G. W., & Wager, S. (2019). Synthetic differences in differences (NBER Working Paper No. 25532). Cambridge, MA: National Bureau of Economic Research.

  • Bahamondes, L., Ali, M., Monteiro, I., & Fernandes, A. (2017a). Contraceptive sales in the setting of the Zika virus epidemic. Human Reproduction, 32(1), 88–93.

    Google Scholar 

  • Bahamondes, L., Ali, M., Monteiro, I., & Fernandes, A. (2017b). Stagnant contraceptive sales after the Zika epidemic in Brazil. European Journal of Contraception & Reproductive Health Care, 22, 381–383.

    Google Scholar 

  • Barreca, A., Deschenes, O., & Guldi, M. (2018). Maybe next month? Temperature shocks, climate change, and dynamic adjustments in birth rates. Demography, 55, 1269–1293.

    Google Scholar 

  • Becker, G. S., & Lewis, H. G. (1973). On the interaction between the quantity and quality of children. Journal of Political Economy 81(2, Part 2), S279–S288.

  • Bleakley, H., & Lange, F. (2009). Chronic disease burden and the interaction of education, fertility, and growth. Review of Economics and Statistics, 29, 52–65.

    Google Scholar 

  • Borges, A. L. V., Moreau, C., Burke, A., dos Santos, O. A., & Chofakian, C. B. (2018). Women’s reproductive health knowledge, attitudes and practices in relation to the Zika virus outbreak in Northeast Brazil. PLoS One, 13(1), e0190024. https://doi.org/10.1371/journal.pone.0190024

  • Boucekkine, R., Desbordes, R., & Latzer, H. (2009). How do epidemics induce behavioral changes? Journal of Economic Growth, 14, 233–264.

    Google Scholar 

  • Brazilian Center for Analysis and Planning (CEBRAP), Brazilian Institute of Public Opinion and Statistics (IBOPE), Ministry of Health (Brazil). (2006). Brazil National Demographic and Health Survey of Children and Women 2006–2007. Rio de Janeiro, Brazil: Ministry of Health.

  • Buckles, K., Hungerman, D., & Lugauer, S. (2018). Is fertility a leading economic indicator? (NBER Working Paper No. 24355). Cambridge, MA: National Bureau of Economic Research.

  • Castro, M. C. (2016). Zika virus and health systems in Brazil: From unknown to a menace. Health Systems & Reform, 2, 119–122.

    Google Scholar 

  • Castro, M. C., Han, Q. C., Carvalho, L. R., Victora, C. G., & Frana, G. V. A. (2018). Implications of Zika virus and congenital Zika syndrome for the number of live births in Brazil. Proceedings of the National Academy of Sciences, 115, 6177–6182.

  • Cauchemez, S., Besnard, M., Bompard, P., Dub, T., Guillemette-Artur, P., Eyrolle-Guignot, D., . . . Mallet, H.-P. (2016). Association between Zika virus and microcephaly in French Polynesia, 2013–15: A retrospective study. Lancet, 387, 2125–2132.

  • Chin, Y.-M., & Wilson, N. (2018). Disease risk and fertility: Evidence from the HIV/AIDS pandemic. Journal of Population Economics, 31, 429–451.

    Google Scholar 

  • Coelho, F. C., Armstrong, M., Saraceni, V., & Lemos, C. (2015). Can Zika account for the missing babies? Frontiers in Public Health, 5, 317. https://doi.org/10.3389/fpubh.2017.00317

    Article  Google Scholar 

  • de La Vega, M. A., Piret, J., Griffin, B. D., Rhéaume, C., Venable, M. C., Carbonneau, J., . . . Park, Y. K. (2019). Zika-induced male infertility in mice is potentially reversible and preventable by deoxyribonucleic acid immunization. Journal of Infectious Diseases, 219, 365–374.

  • Dias, T. Z., Passini, R., Jr., Duarte, G. A., Sousa, M. H., & Faúndes, A. (2015). Association between educational level and access to safe abortion in a Brazilian population. International Journal of Gynecology & Obstetrics, 128, 224–227.

    Google Scholar 

  • Doudchenko, N., & Imbens, G. W. (2016). Balancing, regression, difference-in-differences and synthetic control methods: A synthesis (NBER Working Paper No. 22791). Cambridge, MA: National Bureau of Economic Research.

  • Dudley, D. M., Aliota, M. T., Mohr, E. L., Newman, C. M., Golos, T. G., Friedrich, T. C., & O'Connor, D. H. (2019). Using macaques to address critical questions in Zika virus research. Annual Review of Virology, 6, 481–500.

    Google Scholar 

  • Dudley, D. M., Van Rompay, K. K., Coffey, L. L., Ardeshir, A., Keesler, R. I., Bliss-Moreau, E., . . . O’Connor, D. H. (2018). Miscarriage and stillbirth following maternal Zika virus infection in nonhuman primates. Nature Medicine, 24, 1104–1107.

  • Duffy, M. R., Chen, T.-H., Hancock, W. T., Powers, A. M., Kool, J. L., Lanciotti, R. S., . . . Hayes, E. B. (2009). Zika virus outbreak on Yap Island, Federated States of Micronesia. New England Journal of Medicine, 360, 2536–2543.

  • Epelboin, Y., Talaga, S., Epelboin, L., & Dusfour, I. (2017). Zika virus: An updated review of competent or naturally infected mosquitoes. PLoS Neglected Tropical Diseases, 11, e0005933. https://doi.org/10.1371/journal.pntd.0005933

    Article  Google Scholar 

  • Esposito, D. L., Ferreira, A. A., Moraes, F. M., Persona, M. R., dos Ribeiro, B., Fabio, S. V., . . . Fonseca, B. A. (2017, November). Abortion rate is much higher than microcephaly rate in Zika virus infections occurring in the first trimester of pregnancy. Paper presented at the annual meeting of the American Society of Tropical Medicine & Hygiene, Baltimore, MD.

  • Frost, K., Frank, E., & Maibach, E. (1997). Relative risk in the news media: A quantification of misrepresentation. American Journal of Public Health, 87, 842–845.

    Google Scholar 

  • Fung, I. C.-H., Tse, Z. T. H., Cheung, C.-N., Miu, A. S., & Fu, K.-W. (2014). Ebola and the social media. Lancet, 384, 2207.

    Google Scholar 

  • Goncé, A., Martínez, M., Marbná-Castro, E., Saco, A., Soler, A., Alvarez-Mora, M., . . . Bardají, A. (2018). Spontaneous abortion associated with Zika virus infection and persistent viremia. Emerging Infectious Diseases, 24, 933–935. https://doi.org/10.3201/eid2405.171479

  • Goodkind, D. M. (1993). New zodiacal influences on Chinese family formation: Taiwan, 1976. Demography, 30, 127–142.

    Google Scholar 

  • Govero, J., Esakky, P., Scheaffer, S. M., Fernandez, E., Drury, A., Platt, D. J., . . . Diamond, M. S. (2016). Zika virus infection damages the testes in mice. Nature, 540, 438–442.

  • Hayford, S. R. (2009). The evolution of fertility expectations over the life course. Demography, 46, 765–783.

    Google Scholar 

  • Hayford, S. R., Agadjanian, V., & Luz, L. (2012). Now or never: Perceived HIV status and fertility intentions in rural Mozambique. Studies in Family Planning, 43, 191–199.

    Google Scholar 

  • Heuveline, P., & Poch, B. (2007). The phoenix population: Demographic crisis and rebound in Cambodia. Demography, 44, 405–426.

    Google Scholar 

  • Hoen, B., Schaub, B., Funk, A. L., Ardillon, V., Boullard, M., Cabi, A., . . . Fontanet, A. (2018). Pregnancy outcomes after ZIKV infection in French territories in the Americas. New England Journal of Medicine, 378, 985–994.

  • Honein, M. A., & Jamieson, D. J. (2019). Revealing the effects of Zika—Detection of brain abnormalities and other disabilities associated with congenital infection. JAMA Pediatrics, 173, 16–18.

    Google Scholar 

  • Hotz, V. J., Klerman, J. A., & Willis, R. J. (1997). The economics of fertility in developed countries. In M. R. Rosenzweig & O. Stark (Eds.), Handbook of population and family economics (Vol. 1, Part A, pp. 275–347). Amsterdam, the Netherlands: North Holland.

  • Jacobs, A. (2016, February 14). Brazil pushes public to do its part in fighting Zika spread. The New York Times. Retrieved from https://www.nytimes.com/2016/02/15/world/americas/brazil-pushes-public-to-do-its-part-in-fighting-zika-spread.html

  • Jaenisch, T., Rosenberger, K. D., Brito, C., Brady, O., Brasil, P., & Marques, E. T. A. (2017). Risk of microcephaly after Zika virus infection in Brazil, 2015 to 2016. Bulletin of the World Health Organization, 95, 191–198. https://doi.org/10.2471/BLT.16.178608

    Article  Google Scholar 

  • Johansson, M. A., Mier-y-Teran-Romero, L., Reefhuis, J., Gilboa, S. M., & Hills, S. L. (2016). Zika and the risk of microcephaly. New England Journal of Medicine, 375, 1–4.

    Google Scholar 

  • Johnson-Hanks, J. A., Bachrach, C. A., Morgan, S. P., & Kohler, H.-P. (2011). Understanding family change and variation: Toward a theory of conjunctural action. Dordrecht, the Netherlands: Springer Science Business Media.

  • Jones, K. M. (2014). Growing up together: Cohort composition and child investment. Demography, 51, 229–255.

    Google Scholar 

  • Jones, R. K., Tapales, A., Lindberg, L. D., & Frost, J. J. (2015). Using longitudinal data to understand changes in consistent contraceptive use. Perspectives on Sexual and Reproductive Health, 47, 131–139. https://doi.org/10.1363/47e4615

  • Kalemli-Ozcan, S. (2012). AIDS, “reversal” of the demographic transition and economic development: Evidence from Africa. Journal of Population Economics, 25, 871–897.

  • Keegan, L. T., Lessler, J., & Johansson, M. A. (2017). Quantifying Zika: Advancing the epidemiology of Zika with quantitative models. Journal of Infectious Diseases, 216, S884–S890.

    Google Scholar 

  • Kim, J., & Prskawetz, A. (2010). External shocks, household consumption and fertility in Indonesia. Population Research and Policy Review, 29, 503–526.

    Google Scholar 

  • Kohler, H.-P., Behrman, J. R., & Watkins, S. C. (2007). Social networks and HIV/AIDS risk perceptions. Demography, 44, 1–33.

    Google Scholar 

  • Larsen, E. C., Christiansen, O. B., Kolte, A. M., & Macklon, N. (2013). New insights into mechanisms behind miscarriage. BMC Medicine, 11. https://doi.org/10.1186/1741-7015-11-154

  • Lautharte, I. J., Jr., & Rasul, I. (2020). The anatomy of a public health crisis: Household responses over the course of the Zika epidemic in Brazil. VoxDev. Retrieved from https://voxdev.org/topic/health-education/anatomy-public-health-crisis-household-responses-during-zika-epidemic-brazil

  • Lindstrom, D. P., & Berhanu, B. (1999). The impact of war, famine, and economic decline of marital fertility in Ethiopia. Demography, 36, 247–261.

    Google Scholar 

  • Lucas, A. M. (2013). The impact of malaria eradication on fertility. Economic Development and Cultural Change, 61, 607–631.

    Google Scholar 

  • Marteleto, L. J., Guedes, G., Coutinho, R. Z., & Weitzman, A. (2020). Live births and fertility amid the Zika epidemic in Brazil. Demography, 57, 843–872.

  • Marteleto, L. J., Weitzman, A., Coutinho, R. Z., & Valongueiro Alves, S. (2017). Women’s reproductive intentions and behaviors during the Zika epidemic in Brazil. Population and Development Review, 43, 199–227.

    Google Scholar 

  • McComas, K. A. (2006). Defining moments in risk communication research. Journal of Health Communication, 11, 75–91.

    Google Scholar 

  • McCord, G. C., Conley, D., & Sachs, J. D. (2017). Malaria ecology, child mortality & fertility. Economics and Human Biology, 24, 1–17.

    Google Scholar 

  • McNeil, D. G., Jr. (2016). Zika: The emerging epidemic (1st ed.). New York, NY: Norton.

  • Mello-Jorge, M. H. P., Laurenti, R., & Davidson Gotlieb, S. L. (2007). Análise da qualidade das estatstícas vitais brasileiras: A experiéncia de implantação do SIM e do SINASC [Quality analysis of Brazilian vital statistics: The experience of implementing the SIM and SINASC systems]. Ciêcia & Saúde Coletiva, 12, 643–654.

    Google Scholar 

  • Messina, J. P., Kraemer, M. U. G., Brady, O. J., Pigott, D. M., Shearer, F. M., Weiss, D. J., . . . Hay, S. I. (2016). Mapping global environmental suitability for Zika virus. eLife, 5, e15272. https://doi.org/10.7554/eLife.15272

  • Minowa, E., Julian, G. S., Pomerantz, D., Sternbach, N., Feijo, L. F. A., & Annunziata, K. (2015, September). Contraception patterns in Brazil: 2012 National Survey Data. Paper presented at the ISPOR 5th Latin America Conference, Santiago, Chile.

  • Mlakar, J., Korva, M., Tul, N., Popović, M., Poljšak-Prijatelj, M., Mraz, J., . . . Avšič Županc, T. A. (2016). Zika virus associated with microcephaly. New England Journal of Medicine, 374, 951–958.

  • Molnar, Z., & Kennedy, S. (2016). Risks of Zika virus during the first trimester of pregnancy. Nature Reviews Neurology, 12, 315–316.

    Google Scholar 

  • Montgomery, M. R. (2000). Perceiving mortality decline. Population and Development Review, 26, 795–819.

    Google Scholar 

  • Mulkey, S. B., Bulas, D. I., Vezina, G., Fourzali, Y., Morales, A., Arroyave-Wessel, M., . . . du Plessis, A. J. (2019). Sequential neuroimaging of the fetus and newborn with in utero Zika virus. JAMA Pediatrics, 173, 52–59.

  • Nattabi, B., Li, J., Thompson, S. C., Orach, C. G., & Earnest, J. (2009). A systematic review of factors influencing fertility desires and intentions among people living with HIV/AIDS. AIDS and Behavior, 13, 949–968.

    Google Scholar 

  • National Research Council. (2004). War, humanitarian crises, population displacement, and fertility: A review of evidence. Washington, DC: National Academies Press.

  • Netto, E. M., Moreira-Soto, A., Pedroso, C., Höser, C., Funk, S., Kucharski, A. J., . . . Drexler, J. F. (2017). High Zika virus seroprevalence in Salvador, northeastern Brazil limits the potential for further outbreaks. MBio, 8, e01390–e01317. https://doi.org/10.1128/mBio.01390-17

  • Ní Bhrolcháin, M. (2011). Tempo and the TFR. Demography, 48, 841–861.

    Google Scholar 

  • Oliveira, W. K., Henriques, C. M., Coelho, G., Vazquez, E., Cortez-Escalante, J., Molina, J., . . . Dye, C. (2017). Zika virus infection and associated neurologic disorders in Brazil. New England Journal of Medicine, 376, 1591–1593.

  • Oliveira Melo, A. S., Malinger, G., Ximenes, R., Szejnfeld, P. O., Alves Sampaio, S., & Bispo de Filippis, A. M. (2016). Zika virus intrauterine infection causes fetal brain abnormality and microcephaly: Tip of the iceberg? Ultrasound in Obstetrics & Gynecology, 47, 6–7.

    Google Scholar 

  • Ophir, Y., & Jamieson, K. H. (2018). Intentions to use a novel Zika vaccine: The effects of mis-beliefs about the MMR vaccine and perceptions about Zika. Journal of Public Health, 40, e531–e537. https://doi.org/10.1093/pubmed/fdy042

    Article  Google Scholar 

  • Panagiotopoulos, P., Barnett, J., Bigdeli, A. Z., & Sams, S. (2016). Social media in emergency management: Twitter as a tool for communicating risks to the public. Technological Forecasting and Social Change, 111, 36–96.

    Google Scholar 

  • Ponce de Leon, R. G., Ewerling, F., Serruya, S. J., Silveira, M. F., Sanhueza, A., Moazzam, A., . . . Barros, A. J. (2019). Contraceptive use in Latin America and the Caribbean with a focus on long-acting reversible contraceptives: Prevalence and inequalities in 23 countries. Lancet Global Health, 7(2), e227–e235. https://doi.org/10.1016/S2214-109X(18)30481-9

  • Pop-Eleches, C. (2006). The impact of an abortion ban on socioeconomic outcomes of children: Evidence from Romania. Journal of Political Economy, 114, 744–773.

    Google Scholar 

  • Preston, S. H. (Ed.). (1978). The effects of infant and child mortality on fertility. New York, NY: Academic Press.

  • Rasanathan, J. J. K., MacCarthy, S., Diniz, D., Torreele, E., & Gruskin, S. (2017). Engaging human rights in the response to the evolving Zika virus epidemic. American Journal of Public Health, 107, 525–531.

    Google Scholar 

  • Ribeiro, B., Hartley, S., Nerlich, B., & Jaspal, R. (2018). Media coverage of the Zika crisis in Brazil: The construction of a “war” frame that masked social and gender inequalities. Social Science & Medicine, 200, 137–144.

    Google Scholar 

  • Ribeiro, L. S., Marques, R. E., Ribeiro de Jesus, A. M., de Almeida, R. P., & Teixeira, M. M. (2016). Zika crisis in Brazil: Challenges in research and development. Current Opinion in Virology, 18, 76–81.

    Google Scholar 

  • Rice, M. E., Galang, R. R., Roth, N. M., Ellington, S. R., Moore, C. A., Valencia-Prado, M., . . . Honein, M. A. (2018). Vital signs: Zika-associated birth defects and neurodevelopmental abnormalities possibly associated with congenital Zika virus infection - U.S. territories and freely associated states. Morbidity and Mortality Weekly Report, 67(31), 858–867. https://doi.org/10.15585/mmwr.mm6731e1

  • Schneider, D. (2017). Non-marital and teen fertility and contraception during the Great Recession. Russell Sage Foundation Journal of the Social Sciences, 3(3), 126–144. https://doi.org/10.7758/rsf.2017.3.3.06

  • Schultz, T. P. (1997). The demand for children in low income countries. In M. R. Rosenzweig & O. Stark (Eds.), Handbook of population and family economics (Vol. 1, Part A., pp. 349–430). Amsterdam, the Netherlands: Elsevier.

  • Schultz, T. P. (2001). The fertility transition: Economic explanations (Working Paper No. 833). New Haven, CT: Economic Growth Center, Yale University.

  • Simmons, A. M., & Rigby, C. (2016, March 27). Brazil seizes abortion drugs sent to women living in fear of Zika. Los Angeles Times. Retrieved from https://www.latimes.com/world/mexico-americas/la-fg-global-abortion-drugs-20160327-story.html

  • Sobotka, T., Skirbekk, V., & Philipov, D. (2011). Economic recession and fertility in the developed world. Population and Development Review, 37, 267–306.

    Google Scholar 

  • Terceira, N., Gregson, S., Zaba, B., & Mason, P. R. (2003). The contribution of HIV to fertility decline in rural Zimbabwe, 1985–2000. Population Studies, 57, 149–164.

    Google Scholar 

  • Trinitapoli, J., & Yeatman, S. (2011). Uncertainty and fertility in a generalized AIDS Epidemic. American Sociological Review, 76, 935–954.

    Google Scholar 

  • Trinitapoli, J., & Yeatman, S. (2018). The flexibility of fertility preferences in a context of uncertainty. Population and Development Review, 44, 87–116.

    Google Scholar 

  • van der Eijk, A. A., van Genderen, P. J., Verdijk, R. M., Reusken, C. B., Mögling, R., van Kampen, J. J., . . . Raj, V. S. (2016). Miscarriage associated with Zika virus infection. New England Journal of Medicine, 375, 1002–1004.

  • Walker, C. L., Little, M. T. E., Roby, J. A., Armistead, B., Gale, M., Jr., Rajagopal, L., . . . Curry, C. L. (2019). Zika virus and the non-microcephalic fetus: Why we should still worry. American Journal of Obstetrics and Gynecology, 220, 45–56.

  • Walker, C. L., Merriam, A. A., Ohuma, E. O., Dighe, M. K., Gale, M., Jr., Rajagopal, L., . . . Waldorf, K. M. (2018). Femur-sparing pattern of abnormal fetal growth in pregnant women from New York City after maternal Zika virus infection. American Journal of Obstetrics and Gynecology, 219, 187.e1–20. https://doi.org/10.1016/j.ajog.2018.04.047

  • Wang, X., Chen, C., Wang, L., Chen, D., Guang, W., French, J., & Reproductive Health Study Group. (2003). Conception, early pregnancy loss, and time to clinical pregnancy: A population-based prospective study. Fertility and Sterility, 79, 577–584.

    Google Scholar 

  • Wilcox, A. J. (2010). Fertility and pregnancy: An epidemiologic perspective. Oxford, UK: Oxford University Press.

  • World Health Organization (WHO). (2016). Zika situation report. Retrieved from https://www.who.int/emergencies/zika-virus/situation-report/15-september-2016/en/

  • Yeatman, S. (2009). HIV infection and fertility preferences in rural Malawi. Studies in Family Planning, 40, 261–276.

    Google Scholar 

  • Zhang, Q., Sun, K., Chinazzi, M., Pastorey Piontti, A., Dean, N. E., Rojas, D. P., . . . Vespignani, A. (2017). Spread of Zika virus in the Americas. Proceedings of the National Academy of Sciences, 114, E4334–E4343. https://doi.org/10.1073/pnas.1620161114

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Acknowledgments

The authors thank Elizabeth Frankenberg, Sarah Hayford, Malia Jones, Giovanna Merli, Seth Sanders, Duncan Thomas, Romina Tome, Jenny Trinitapoli, Abby Weitzman, PAA 2017 Meeting participants, and three anonymous referees for comments and suggestions. Funding support was provided by NICHD (1R03HD092818-01), the University of Wisconsin–Madison Graduate School, the Center for Demography and Ecology at Wisconsin (NICHD P2C HD047873), and the Sanford School of Public Policy Pilot Project Fund. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Sanford School of Public Policy, Duke University, 302 Towerview Road, Rubenstein Hall, Office 262, Durham, NC, 27708, USA

    Marcos A. Rangel

  2. Bureau for Research and Economic Analysis of Development (BREAD), London, UK

    Marcos A. Rangel

  3. Department of Sociology, University of Wisconsin–Madison, Madison, WI, USA

    Jenna Nobles

  4. Center for Demography and Ecology, University of Wisconsin–Madison, Madison, WI, USA

    Amar Hamoudi

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  1. Marcos A. Rangel
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  2. Jenna Nobles
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  3. Amar Hamoudi
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All authors contributed to the study conception and design. Material preparation, data collection and analysis, and data visualization were all performed and created by Marcos A. Rangel. The first draft of the manuscript was written by Jenna Nobles and Marcos A. Rangel. All authors edited and contributed sections to previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Marcos A. Rangel.

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Rangel, M.A., Nobles, J. & Hamoudi, A. Brazil’s Missing Infants: Zika Risk Changes Reproductive Behavior. Demography 57, 1647–1680 (2020). https://doi.org/10.1007/s13524-020-00900-9

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