How subjective beliefs about HIV infection affect life-cycle fertility: Evidence from rural Malawi

Gil Shapira, University of Pennsylvania


In this project, I study the effect of subjective beliefs about HIV infection on fertility decisions in a context of high HIV prevalence and evaluate the impact of different policy interventions, such as HIV testing programs, informational campaigns, and antiretroviral therapy distribution, on fertility and child mortality. I develop a dynamic discrete-choice life-cycle fertility model in which expectations about the life horizon and child survival depend on a perceived HIV infection hazard process, which is allowed to differ from the actual hazard. In the model, women form and update beliefs about their HIV status and about their own and their children's survival in future periods. Women also update their beliefs when their HIV status is revealed by an HIV test. Model parameters are estimated by maximum likelihood with longitudinal data from the Malawi Diffusion and Ideational Change Project, which contain family rosters, information on HIV testing, and measures of subjective beliefs about own HIV status. I use the model to evaluate the effect of HIV on fertility by simulating behavior in an environment without HIV. The model successfully fits the fertility patterns in the data, as well as the distribution of reported beliefs about own HIV status. Results show that the presence of HIV reduces the average number of births a woman has during her life-cycle by 0.23. Although this effect is due both to shorter life-span of women infected with HIV as well as to a behavioral effect, the behavioral effect is the dominant mechanism that reduces fertility. I find that HIV testing can be effective at reducing fertility of infected women, leading to a reduction of child mortality and orphanhood. I also find that although provision of antiretroviral treatment that prevents mother to child transmission will reduce child mortality, it has negligible effect on the average number of life-cycle births.

Subject Area

Economics|Public health

Recommended Citation

Shapira, Gil, "How subjective beliefs about HIV infection affect life-cycle fertility: Evidence from rural Malawi" (2011). Dissertations available from ProQuest. AAI3462173.