In sorrow to bring forth children: fertility amidst the plague of HIV

Abstract

The HIV epidemic is lowering fertility in sub-Saharan Africa. This decline in fertility appears to reflect a fall in the demand for children, and not any adverse physiological consequences of the disease, as it is matched by changes in the expressed preference for children and the use of contraception, and is not significantly correlated with biological markers of sub-fecundity. A fall in fertility lowers dependency ratios and, for a given savings rate, increases future capital per person. These two effects more than offset the loss of prime working age adults and reduced human capital of orphaned children brought by the epidemic, allowing 27 of the nations of sub-Saharan Africa to cumulatively spend US$ 650 billion, or $5100 per dying adult AIDS victim, on patient care without harming the welfare of future generations. In sum, the behavioral response to the HIV epidemic creates the material resources to fight it.