A Closer Examination of the HIV/Fertility Linkage ... - Measure DHS

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particularly in the presence of shifting samples. Discerning conflicting trends at the individualand aggregate levels would therefore require understanding of both sample changes andindividual effects.Examination of changes in the TFR and ASFRs will not provide an indication of whetherthe change is due to a change in the sample or to a behavioral change in those still living.Without knowledge of the medical characteristics of HIV-positive women, it would be difficultto understand what aspect of any change in fertility is due to behavioral versus biological factors.The only method of estimating the biological factors would be in a scenario in which behavior isconstant. It would therefore be necessary first to identify whether behavioral changes areoccurring. If no behavior change is evident, then any change in fertility (net of trendsattributable to other proximate determinants of fertility) could be attributed to biologicalmechanisms.Discerning changes in behavior would require examining variables related to fertilitydesires and actions at different stages of the AIDS epidemic in a country. The Demographic andHealth Surveys (DHS) provide large, high-quality repeated cross-sections of the population thatare comparable across countries and time. Perception of a heightened threat of mortality, or ofany threat from HIV, could be documented using the DHS survey questions that ask aboutknowledge of HIV or about deaths from HIV. Changes in desires for children could beestimated via the DHS questions about reproductive intentions.Availability of methods to alter fertility could come from DHS data as well. The use ofcontraception provides a measure of availability, but low use may occur in an environment ofready availability. It would therefore be necessary to examine not only use but knowledge ofcontraceptive methods, as well as unmet need for family planning.12
Actions to put fertility desires into effect could be estimated using a number of measures,including changing patterns of use and type of contraception. The outcomes of fertility controlmeasures could also be witnessed via birth spacing. In addition, age at first marriage, prevalenceand date of sterilization, and rates of remarriage and divorce could also serve to indicate changesin fertility behaviors (particularly in conjunction with other measures).If no behavioral responses are evident (net of other trends and confounding factors), thenthe next step would be to examine fertility-selected deaths from AIDS. In order to discernwhether women with high versus low fertility are more likely to die from AIDS, it would benecessary to examine death records by fertility and age. If women who die from AIDS hadfertility histories suggesting either higher or lower than average total lifetime fertility (net ofother effects on fertility), this would imply that HIV has an impact on the sample. This samplingwould therefore affect overall fertility rates, specifically ASFRs and the TFR. One could thencreate pseudo-fertility patterns for the women who died as if they had lived. Comparison ofwhat fertility would have been had these women not died with observed fertility would thenprovide a measure of how much fertility-selected deaths affected overall fertility rates.In the absence of death records with fertility histories, the next best alternative would beexamination of death records by age. Without fertility histories, it would be necessary to ascriberates by age alone. Thus, women age 20-24 who died from AIDS-related illnesses would beassigned the same fertility schedule as women age 20-24 who lived. Fertility trends by age aremuch more readily available. By construction, this would not have impacts on ASFRs or theTFR but would have impacts on measures of fertility that account for the age structure of thepopulation (like the net and gross reproduction rates). This would be useful in understandinghow population growth is affected by HIV/AIDS.13
Page 2 and 3: The DHS Working Papers series is an
Page 4 and 5: ACKNOWLEDGEMENTSWe have benefited f
Page 7 and 8: INTRODUCTIONRecent research has sug
Page 9 and 10: Figure 1: Fertility behavior respon
Page 11 and 12: worry about passing the virus to an
Page 13 and 14: Changes in fertility outcomes: Whet
Page 15 and 16: of the increased likelihood of pass
Page 17: 12 percent. Reductions in fertility
Page 21 and 22: Zimbabwe1. Trends in HIV prevalence
Page 23 and 24: Figure 3: Trend in ideal number of
Page 25 and 26: Figure 5: Trends in sexual activity
Page 27 and 28: Finally, to understand whether wome
Page 29 and 30: Uganda1. Trends in HIV prevalence a
Page 31 and 32: 3. Trends in fertility action: mari
Page 33 and 34: Modern contraceptive use is growing
Page 35 and 36: Figure 15: Trends in number of mont
Page 37 and 38: 2. Trends in fertility desiresWomen
Page 39 and 40: Figure 19: Trends in sexual activit
Page 41 and 42: 4. Summary for Burkina FasoIn many
Page 43 and 44: CONCLUSIONSThis paper has investiga
Page 45 and 46: REFERENCESCasterline EL. 2003. Fert

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