Abstract
BackgroundLiterature is limited on the effects of high prevalence HIV on fertility in the absence of treatment, and the effects of the introduction of sustained access to antiretroviral therapy (ART) on fertility. We summarize fertility patterns in rural northeast South Africa over 21 years during dynamic social and epidemiological change.MethodsWe use data for females aged 15–49 from the Agincourt health and socio-demographic surveillance system (1993–2013). We use discrete time event history analysis to summarize patterns in the probability of any birth.ResultsOverall fertility declined in 2001–2003, increased in 2004–2011, and then declined in 2012–2013. South Africans showed a similar pattern. Mozambicans showed a different pattern, with strong declines prior to 2003 before stalling during 2004–2007, and then continued fertility decline afterwards. There was an inverse gradient between fertility levels and household socioeconomic status. The gradient did not vary by time or nationality.ConclusionsThe fertility transition in rural South Africa shows a pattern of decline until the height of the HIV/AIDS pandemic, with a resulting stall until further decline in the context of ART rollout. Fertility patterns are not homogenous among groups.
Highlights
Literature is limited on the effects of high prevalence HIV on fertility in the absence of treatment, and the effects of the introduction of sustained access to antiretroviral therapy (ART) on fertility
Socioeconomic development and household socioeconomic status has long been hypothesized to contribute to fertility decline though evidence in sub-Saharan Africa (SSA) has been inconsistent, and it has been difficult to identify levels of socioeconomic development or affluence that are associated with initiation of decline or that trigger stalls in fertility decline [6,7,8]
Our findings demonstrate the differentials across socioeconomic status (SES) seen in a poor, rural South African community for over a decade, which we are able to demonstrate with models that follow wealth trajectories for households rather than crosssectional assessments at wide intervals
Summary
Literature is limited on the effects of high prevalence HIV on fertility in the absence of treatment, and the effects of the introduction of sustained access to antiretroviral therapy (ART) on fertility. At the national level in South Africa, fertility continued to decline to an estimated total fertility rate (TFR) of 2.57 in 2014 [2], while in neighboring Mozambique fertility has remained much higher, with a TFR of 5.5 in 2003, increasing to 5.9 as measured in 2011 [3]. Higher socioeconomic status (SES) has been found to be generally associated with lower desired family size, Houle et al Population Health Metrics (2016) 14:10 lower completed fertility, and greater use of contraception in many African contexts [9,10,11]. In Agincourt, Williams et al [13] found an increasing convergence in education and wealth indicators between Mozambican and South African women, and suggested that increased access to education contributed to fertility declines among Mozambicans
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