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

Fertility Change in Response to HIVIn recent years, several authors have compiled excellent overviews of the mechanisms by whichfertility may respond to HIV. The Population Division of the U.N. (2002) provides a conciseoverview of the different mechanisms and the research supporting these mechanisms. Otheruseful overviews can be found in Gregson, Zaba, and Hunter (2002); Gregson and coauthors(1997); and Nöel-Miller (2003). The pathways through which HIV may affect fertility arenumerous, and they interact at a number of levels. While the reviews mentioned above providemuch-needed elucidation of the mechanisms, they generally do not provide empirical analysis ofhow these mechanisms may interact, or how they may affect large-scale trends. A relativelybrief overview of these mechanisms follows.1. Behavioral mechanismsThe behavioral mechanisms describe how women of child-bearing age intentionally respond toHIV. Behavioral responses are deliberate and in this sense distinguishable from biologicalmechanisms. Research has suggested both directions of fertility change as a behavioral responseto HIV, and effects may differ in relationship to knowledge of own HIV status versus perceivedthreat of HIV. This section outlines two behavioral mechanisms (see Figure 1 below) suggestinghow HIV can lead to various fertility responses.2