A Closer Examination of the HIV/Fertility Linkage ... - Measure DHS
A Closer Examination of the HIV/Fertility Linkage ... - Measure DHS
A Closer Examination of the HIV/Fertility Linkage ... - Measure DHS
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particularly in <strong>the</strong> presence <strong>of</strong> shifting samples. Discerning conflicting trends at <strong>the</strong> individualand aggregate levels would <strong>the</strong>refore require understanding <strong>of</strong> both sample changes andindividual effects.<strong>Examination</strong> <strong>of</strong> changes in <strong>the</strong> TFR and ASFRs will not provide an indication <strong>of</strong> whe<strong>the</strong>r<strong>the</strong> change is due to a change in <strong>the</strong> sample or to a behavioral change in those still living.Without knowledge <strong>of</strong> <strong>the</strong> medical characteristics <strong>of</strong> <strong>HIV</strong>-positive women, it would be difficultto understand what aspect <strong>of</strong> any change in fertility is due to behavioral versus biological factors.The only method <strong>of</strong> estimating <strong>the</strong> biological factors would be in a scenario in which behavior isconstant. It would <strong>the</strong>refore be necessary first to identify whe<strong>the</strong>r behavioral changes areoccurring. If no behavior change is evident, <strong>the</strong>n any change in fertility (net <strong>of</strong> trendsattributable to o<strong>the</strong>r proximate determinants <strong>of</strong> fertility) could be attributed to biologicalmechanisms.Discerning changes in behavior would require examining variables related to fertilitydesires and actions at different stages <strong>of</strong> <strong>the</strong> AIDS epidemic in a country. The Demographic andHealth Surveys (<strong>DHS</strong>) provide large, high-quality repeated cross-sections <strong>of</strong> <strong>the</strong> population thatare comparable across countries and time. Perception <strong>of</strong> a heightened threat <strong>of</strong> mortality, or <strong>of</strong>any threat from <strong>HIV</strong>, could be documented using <strong>the</strong> <strong>DHS</strong> survey questions that ask aboutknowledge <strong>of</strong> <strong>HIV</strong> or about deaths from <strong>HIV</strong>. Changes in desires for children could beestimated via <strong>the</strong> <strong>DHS</strong> questions about reproductive intentions.Availability <strong>of</strong> methods to alter fertility could come from <strong>DHS</strong> data as well. The use <strong>of</strong>contraception provides a measure <strong>of</strong> availability, but low use may occur in an environment <strong>of</strong>ready availability. It would <strong>the</strong>refore be necessary to examine not only use but knowledge <strong>of</strong>contraceptive methods, as well as unmet need for family planning.12